Latest NRNP 6645 FINAL EXAM 2026/2027 Psychotherapy With
Multiple Modalities | Original PMHNP Practice Questions &
Rationales
Section I — Standalone Practice Questions (1–100)
1. [CBT] A client says, “One mistake means I am incompetent.” Which
distortion is most evident?
A. Personalization
B. Emotional reasoning
C. Overgeneralization
D. Mind reading
Answer: C. Overgeneralization
Rationale: A single event is being generalized into a broad negative
conclusion about the self.
2. [CBT] What best describes a collaborative CBT agenda?
A. Therapist and client jointly prioritize the session
B. Client receives only unstructured reassurance
C. Therapist interprets dreams without agenda
D. Therapist selects all topics without input
Answer: A. Therapist and client jointly prioritize the session
Rationale: CBT uses transparent, collaborative, goal-oriented sessions and
feedback.
3. [CBT] A patient assumes coworkers dislike them without evidence.
Which distortion is likely?
A. Labeling
B. Mind reading
C. Discounting the positive
D. Catastrophizing
Answer: B. Mind reading
NRNP 6645 Original Practice Guide • Educational Use
,Rationale: Mind reading infers others’ thoughts without adequate evidence.
4. [CBT] What is the main purpose of a thought record?
A. Examine links between events, appraisals, feelings, and responses
B. Document medication doses only
C. Replace collaborative assessment with advice
D. Suppress emotions through distraction
Answer: A. Examine links between events, appraisals, feelings, and
responses
Rationale: Thought records help identify and evaluate interpretations and
associated emotion and behavior.
5. [CBT] Which question best demonstrates Socratic questioning?
A. “Why can't you think positively?”
B. “You know that belief is irrational, right?”
C. “What evidence supports and challenges that belief?”
D. “Can we ignore this thought?”
Answer: C. “What evidence supports and challenges that belief?”
Rationale: Guided discovery explores evidence and alternatives without
arguing with the patient.
6. [CBT] A depressed client has stopped pleasurable activities. Which
intervention is a CBT priority?
A. Recommend avoiding all social contact
B. Wait until motivation returns
C. Begin intensive trauma exposure immediately
D. Schedule small, feasible, meaningful activities
Answer: D. Schedule small, feasible, meaningful activities
Rationale: Behavioral activation counters withdrawal and increases access
to reinforcement.
NRNP 6645 Original Practice Guide • Educational Use
,7. [CBT] Which experiment most directly tests “If I speak once,
everyone will laugh”?
A. Make one brief comment and record actual reactions
B. Ask therapist to guarantee no one laughs
C. Avoid the meeting for two weeks
D. Repeat a positive affirmation without testing
Answer: A. Make one brief comment and record actual reactions
Rationale: A behavioral experiment compares a prediction against
observable results.
8. [CBT] When planning exposure for a specific phobia, what is
essential?
A. Avoid discussing the rationale
B. Force immediate maximal exposure
C. Use reassurance as a substitute for exposure
D. Agree on a graded approach with consent and safety review
Answer: D. Agree on a graded approach with consent and safety review
Rationale: Exposure is collaborative, graded or otherwise evidence-based,
and tailored to readiness and safety.
9. [CBT] What is response prevention in OCD treatment?
A. Suppressing all intrusive thoughts
B. Refraining from rituals while practicing exposure
C. Avoiding all triggers permanently
D. Replacing rituals with clinician reassurance
Answer: B. Refraining from rituals while practicing exposure
Rationale: Exposure and response prevention disrupts the ritual-driven
maintenance cycle.
NRNP 6645 Original Practice Guide • Educational Use
, 10. [CBT] Which response best addresses a client’s cognitive fusion
with “I will fail”?
A. “You should stop having that thought.”
B. “It proves you are unmotivated.”
C. “That can never happen.”
D. “Let's examine how certain that prediction is.”
Answer: D. “Let's examine how certain that prediction is.”
Rationale: Evaluating certainty makes room for a more balanced appraisal
rather than guaranteeing outcomes.
11. [CBT] Which measure best evaluates progress in CBT for panic
symptoms?
A. Only demographic characteristics
B. Only therapist intuition
C. Only the number of visits attended
D. Repeated symptom and functional measures tied to treatment goals
Answer: D. Repeated symptom and functional measures tied to treatment
goals
Rationale: Measurement-based care follows symptom burden, functioning,
and agreed goals over time.
12. [CBT] What is a safety behavior in social anxiety?
A. Allowing uncertainty during practice
B. Approaching a feared conversation
C. Recording the actual outcome
D. Rehearsing every sentence to prevent feared judgment
Answer: D. Rehearsing every sentence to prevent feared judgment
Rationale: Safety behaviors can reduce immediate fear while limiting
disconfirmation of feared outcomes.
NRNP 6645 Original Practice Guide • Educational Use
Multiple Modalities | Original PMHNP Practice Questions &
Rationales
Section I — Standalone Practice Questions (1–100)
1. [CBT] A client says, “One mistake means I am incompetent.” Which
distortion is most evident?
A. Personalization
B. Emotional reasoning
C. Overgeneralization
D. Mind reading
Answer: C. Overgeneralization
Rationale: A single event is being generalized into a broad negative
conclusion about the self.
2. [CBT] What best describes a collaborative CBT agenda?
A. Therapist and client jointly prioritize the session
B. Client receives only unstructured reassurance
C. Therapist interprets dreams without agenda
D. Therapist selects all topics without input
Answer: A. Therapist and client jointly prioritize the session
Rationale: CBT uses transparent, collaborative, goal-oriented sessions and
feedback.
3. [CBT] A patient assumes coworkers dislike them without evidence.
Which distortion is likely?
A. Labeling
B. Mind reading
C. Discounting the positive
D. Catastrophizing
Answer: B. Mind reading
NRNP 6645 Original Practice Guide • Educational Use
,Rationale: Mind reading infers others’ thoughts without adequate evidence.
4. [CBT] What is the main purpose of a thought record?
A. Examine links between events, appraisals, feelings, and responses
B. Document medication doses only
C. Replace collaborative assessment with advice
D. Suppress emotions through distraction
Answer: A. Examine links between events, appraisals, feelings, and
responses
Rationale: Thought records help identify and evaluate interpretations and
associated emotion and behavior.
5. [CBT] Which question best demonstrates Socratic questioning?
A. “Why can't you think positively?”
B. “You know that belief is irrational, right?”
C. “What evidence supports and challenges that belief?”
D. “Can we ignore this thought?”
Answer: C. “What evidence supports and challenges that belief?”
Rationale: Guided discovery explores evidence and alternatives without
arguing with the patient.
6. [CBT] A depressed client has stopped pleasurable activities. Which
intervention is a CBT priority?
A. Recommend avoiding all social contact
B. Wait until motivation returns
C. Begin intensive trauma exposure immediately
D. Schedule small, feasible, meaningful activities
Answer: D. Schedule small, feasible, meaningful activities
Rationale: Behavioral activation counters withdrawal and increases access
to reinforcement.
NRNP 6645 Original Practice Guide • Educational Use
,7. [CBT] Which experiment most directly tests “If I speak once,
everyone will laugh”?
A. Make one brief comment and record actual reactions
B. Ask therapist to guarantee no one laughs
C. Avoid the meeting for two weeks
D. Repeat a positive affirmation without testing
Answer: A. Make one brief comment and record actual reactions
Rationale: A behavioral experiment compares a prediction against
observable results.
8. [CBT] When planning exposure for a specific phobia, what is
essential?
A. Avoid discussing the rationale
B. Force immediate maximal exposure
C. Use reassurance as a substitute for exposure
D. Agree on a graded approach with consent and safety review
Answer: D. Agree on a graded approach with consent and safety review
Rationale: Exposure is collaborative, graded or otherwise evidence-based,
and tailored to readiness and safety.
9. [CBT] What is response prevention in OCD treatment?
A. Suppressing all intrusive thoughts
B. Refraining from rituals while practicing exposure
C. Avoiding all triggers permanently
D. Replacing rituals with clinician reassurance
Answer: B. Refraining from rituals while practicing exposure
Rationale: Exposure and response prevention disrupts the ritual-driven
maintenance cycle.
NRNP 6645 Original Practice Guide • Educational Use
, 10. [CBT] Which response best addresses a client’s cognitive fusion
with “I will fail”?
A. “You should stop having that thought.”
B. “It proves you are unmotivated.”
C. “That can never happen.”
D. “Let's examine how certain that prediction is.”
Answer: D. “Let's examine how certain that prediction is.”
Rationale: Evaluating certainty makes room for a more balanced appraisal
rather than guaranteeing outcomes.
11. [CBT] Which measure best evaluates progress in CBT for panic
symptoms?
A. Only demographic characteristics
B. Only therapist intuition
C. Only the number of visits attended
D. Repeated symptom and functional measures tied to treatment goals
Answer: D. Repeated symptom and functional measures tied to treatment
goals
Rationale: Measurement-based care follows symptom burden, functioning,
and agreed goals over time.
12. [CBT] What is a safety behavior in social anxiety?
A. Allowing uncertainty during practice
B. Approaching a feared conversation
C. Recording the actual outcome
D. Rehearsing every sentence to prevent feared judgment
Answer: D. Rehearsing every sentence to prevent feared judgment
Rationale: Safety behaviors can reduce immediate fear while limiting
disconfirmation of feared outcomes.
NRNP 6645 Original Practice Guide • Educational Use
