Walden University NRNP 6645 Midterm Exam –
Psychotherapy With Individuals – 200 Practice
Questions with Answers
A client with major depressive disorder (MDD) expresses feelings of hopelessness during a
cognitive-behavioral therapy (CBT) session. Which intervention should the psychiatric nurse
practitioner (PNP) prioritize?
A. Challenge the client’s negative thoughts
B. Administer an antidepressant immediately
C. Refer the client to a psychiatrist
D. Encourage the client to join a support group
Correct Answer: A. Challenge the client’s negative thoughts
Rationale : CBT focuses on identifying and challenging negative thought patterns to improve
mood. Administering medication is outside the session’s scope, referral is premature without
further assessment, and support groups are secondary to active therapeutic intervention.
Question 2
A client with generalized anxiety disorder (GAD) reports excessive worry about daily activities.
Which therapeutic approach is most effective for this client?
A. Psychoanalysis
B. Cognitive-behavioral therapy
C. Gestalt therapy
D. Existential therapy
Correct Answer: B. Cognitive-behavioral therapy
Rationale : CBT is evidence-based for GAD, addressing maladaptive thoughts and behaviors to
reduce anxiety. Psychoanalysis is less structured, Gestalt focuses on present awareness, and
existential therapy addresses life meaning, which are less specific to GAD.
Question 3
The PNP is using motivational interviewing with a client who abuses alcohol. Which statement
reflects this approach?
,A. “You need to stop drinking immediately.”
B. “What are your reasons for wanting to reduce your drinking?”
C. “Alcohol is causing all your problems.”
D. “You should attend AA meetings daily.”
Correct Answer: B. “What are your reasons for wanting to reduce your drinking?”
Rationale : Motivational interviewing encourages clients to explore their own reasons for change,
promoting autonomy. Directive statements, blaming, or mandating specific actions undermine
this client-centered approach.
Question 4
A client with schizophrenia reports auditory hallucinations. Which response by the PNP is most
therapeutic?
A. “Those voices aren’t real.”
B. “What are the voices saying to you?”
C. “Ignore the voices and focus on me.”
D. “I’ll increase your medication dose.”
Correct Answer: B. “What are the voices saying to you?”
Rationale : Exploring the content of hallucinations assesses their nature (e.g., command
hallucinations) and builds trust. Denying the voices, directing the client to ignore them, or
adjusting medication without assessment is non-therapeutic.
Question 5
Which ethical principle is most relevant when a client with suicidal ideation refuses
hospitalization?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Correct Answer: A. Autonomy
Rationale : Autonomy respects the client’s right to make decisions, even if refusing
hospitalization. Beneficence focuses on doing good, justice on fairness, and fidelity on keeping
promises, but autonomy is central to respecting the client’s choice while ensuring safety.
,Question 6
A client with borderline personality disorder (BPD) exhibits splitting during therapy. Which
intervention is most appropriate?
A. Confront the client about their behavior
B. Set clear boundaries and maintain consistency
C. Ignore the behavior to avoid escalation
D. Refer the client to another therapist
Correct Answer: B. Set clear boundaries and maintain consistency
Rationale : Splitting in BPD requires clear, consistent boundaries to provide structure and
reduce manipulation. Confrontation may escalate, ignoring the behavior is ineffective, and
referral avoids addressing the issue.
Question 7
The PNP is prescribing sertraline for a client with depression. Which side effect should the PNP
monitor for?
A. Bradycardia
B. Insomnia
C. Weight loss
D. Hypotension
Correct Answer: B. Insomnia
Rationale : Sertraline, an SSRI, commonly causes insomnia as a side effect. Bradycardia,
weight loss, and hypotension are less commonly associated with SSRIs.
Question 8
A client with post-traumatic stress disorder (PTSD) avoids discussing a traumatic event. Which
therapeutic approach is most effective?
A. Exposure therapy
B. Psychoanalysis
C. Humanistic therapy
D. Solution-focused therapy
Correct Answer: A. Exposure therapy
Rationale : Exposure therapy helps clients process trauma by gradually confronting avoided
, memories, reducing PTSD symptoms. Psychoanalysis is less targeted, humanistic therapy
focuses on self-actualization, and solution-focused therapy is less trauma-specific.
Question 9
The PNP is conducting a family therapy session. Which model emphasizes communication
patterns and family roles?
A. Bowenian family therapy
B. Structural family therapy
C. Strategic family therapy
D. Narrative family therapy
Correct Answer: B. Structural family therapy
Rationale : Structural family therapy focuses on reorganizing family roles and communication
patterns to improve functioning. Bowenian therapy emphasizes differentiation, strategic therapy
focuses on problem-solving, and narrative therapy reframes family stories.
Question 10
A client with bipolar disorder is prescribed lithium. Which laboratory test should the PNP
monitor?
A. Liver function tests
B. Thyroid function tests
C. Complete blood count
D. Blood glucose levels
Correct Answer: B. Thyroid function tests
Rationale : Lithium can cause hypothyroidism, requiring regular thyroid function monitoring. Liver
function, blood count, and glucose levels are not primarily affected by lithium.
Question 11
A client with obsessive-compulsive disorder (OCD) reports intrusive thoughts. Which
intervention is most appropriate?
A. Encourage thought suppression
B. Use exposure and response prevention
Psychotherapy With Individuals – 200 Practice
Questions with Answers
A client with major depressive disorder (MDD) expresses feelings of hopelessness during a
cognitive-behavioral therapy (CBT) session. Which intervention should the psychiatric nurse
practitioner (PNP) prioritize?
A. Challenge the client’s negative thoughts
B. Administer an antidepressant immediately
C. Refer the client to a psychiatrist
D. Encourage the client to join a support group
Correct Answer: A. Challenge the client’s negative thoughts
Rationale : CBT focuses on identifying and challenging negative thought patterns to improve
mood. Administering medication is outside the session’s scope, referral is premature without
further assessment, and support groups are secondary to active therapeutic intervention.
Question 2
A client with generalized anxiety disorder (GAD) reports excessive worry about daily activities.
Which therapeutic approach is most effective for this client?
A. Psychoanalysis
B. Cognitive-behavioral therapy
C. Gestalt therapy
D. Existential therapy
Correct Answer: B. Cognitive-behavioral therapy
Rationale : CBT is evidence-based for GAD, addressing maladaptive thoughts and behaviors to
reduce anxiety. Psychoanalysis is less structured, Gestalt focuses on present awareness, and
existential therapy addresses life meaning, which are less specific to GAD.
Question 3
The PNP is using motivational interviewing with a client who abuses alcohol. Which statement
reflects this approach?
,A. “You need to stop drinking immediately.”
B. “What are your reasons for wanting to reduce your drinking?”
C. “Alcohol is causing all your problems.”
D. “You should attend AA meetings daily.”
Correct Answer: B. “What are your reasons for wanting to reduce your drinking?”
Rationale : Motivational interviewing encourages clients to explore their own reasons for change,
promoting autonomy. Directive statements, blaming, or mandating specific actions undermine
this client-centered approach.
Question 4
A client with schizophrenia reports auditory hallucinations. Which response by the PNP is most
therapeutic?
A. “Those voices aren’t real.”
B. “What are the voices saying to you?”
C. “Ignore the voices and focus on me.”
D. “I’ll increase your medication dose.”
Correct Answer: B. “What are the voices saying to you?”
Rationale : Exploring the content of hallucinations assesses their nature (e.g., command
hallucinations) and builds trust. Denying the voices, directing the client to ignore them, or
adjusting medication without assessment is non-therapeutic.
Question 5
Which ethical principle is most relevant when a client with suicidal ideation refuses
hospitalization?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Correct Answer: A. Autonomy
Rationale : Autonomy respects the client’s right to make decisions, even if refusing
hospitalization. Beneficence focuses on doing good, justice on fairness, and fidelity on keeping
promises, but autonomy is central to respecting the client’s choice while ensuring safety.
,Question 6
A client with borderline personality disorder (BPD) exhibits splitting during therapy. Which
intervention is most appropriate?
A. Confront the client about their behavior
B. Set clear boundaries and maintain consistency
C. Ignore the behavior to avoid escalation
D. Refer the client to another therapist
Correct Answer: B. Set clear boundaries and maintain consistency
Rationale : Splitting in BPD requires clear, consistent boundaries to provide structure and
reduce manipulation. Confrontation may escalate, ignoring the behavior is ineffective, and
referral avoids addressing the issue.
Question 7
The PNP is prescribing sertraline for a client with depression. Which side effect should the PNP
monitor for?
A. Bradycardia
B. Insomnia
C. Weight loss
D. Hypotension
Correct Answer: B. Insomnia
Rationale : Sertraline, an SSRI, commonly causes insomnia as a side effect. Bradycardia,
weight loss, and hypotension are less commonly associated with SSRIs.
Question 8
A client with post-traumatic stress disorder (PTSD) avoids discussing a traumatic event. Which
therapeutic approach is most effective?
A. Exposure therapy
B. Psychoanalysis
C. Humanistic therapy
D. Solution-focused therapy
Correct Answer: A. Exposure therapy
Rationale : Exposure therapy helps clients process trauma by gradually confronting avoided
, memories, reducing PTSD symptoms. Psychoanalysis is less targeted, humanistic therapy
focuses on self-actualization, and solution-focused therapy is less trauma-specific.
Question 9
The PNP is conducting a family therapy session. Which model emphasizes communication
patterns and family roles?
A. Bowenian family therapy
B. Structural family therapy
C. Strategic family therapy
D. Narrative family therapy
Correct Answer: B. Structural family therapy
Rationale : Structural family therapy focuses on reorganizing family roles and communication
patterns to improve functioning. Bowenian therapy emphasizes differentiation, strategic therapy
focuses on problem-solving, and narrative therapy reframes family stories.
Question 10
A client with bipolar disorder is prescribed lithium. Which laboratory test should the PNP
monitor?
A. Liver function tests
B. Thyroid function tests
C. Complete blood count
D. Blood glucose levels
Correct Answer: B. Thyroid function tests
Rationale : Lithium can cause hypothyroidism, requiring regular thyroid function monitoring. Liver
function, blood count, and glucose levels are not primarily affected by lithium.
Question 11
A client with obsessive-compulsive disorder (OCD) reports intrusive thoughts. Which
intervention is most appropriate?
A. Encourage thought suppression
B. Use exposure and response prevention
