PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1)
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old woman presents for initial psychotherapy
following referral from her PCP for chronic anxiety and poor
sleep. During intake she repeatedly asks whether therapy will
"fix" her quickly and seems ambivalent about long-term work.
As a nurse psychotherapist beginning the therapeutic
,relationship, which immediate therapist action best reflects
professional role clarity and sets an ethical framework for care?
A. Offer an optimistic time estimate and promise measurable
symptom reduction within a few sessions to build hope.
B. Provide a clear explanation of the nurse psychotherapist’s
scope, treatment approach, expected time frame, and limits of
confidentiality.
C. Begin cognitive restructuring techniques immediately to
demonstrate active treatment and competence.
D. Recommend medication management with the PCP and
discharge from psychotherapy referral since the patient wants
quick change.
Correct answer
B
Rationale — Correct
Providing a clear explanation of scope, approach, time frame,
and confidentiality establishes role clarity, informed consent,
and collaborative expectations—core ethical responsibilities for
the nurse psychotherapist and foundational to alliance
formation. This aligns with Wheeler’s emphasis on outlining the
therapeutic framework at intake to support shared decision-
making and safety.
Rationale — A (incorrect)
Promising rapid change is ethically problematic and may create
unrealistic expectations that undermine alliance and informed
consent.
,Rationale — C (incorrect)
Jumping to interventions before shared formulation and
consent risks misalignment with patient goals and may bypass
assessment of readiness and safety.
Rationale — D (incorrect)
Referring out immediately because of patient preference for
quick results dismisses the therapeutic role and fails to offer
collaborative planning; medication and psychotherapy are not
mutually exclusive.
Teaching point
Clarify role, approach, time frame, and confidentiality at intake
to support informed consent.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2)
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A patient with complex trauma describes mistrust toward
providers and frequently tests boundaries (e.g., arriving late,
calling between sessions). Which therapist stance best balances
therapeutic containment with trauma-informed care?
, A. Strictly enforce rules without discussion to demonstrate
reliability and authority.
B. Negotiate clear limits collaboratively while exploring how
safety and predictability relate to trauma history.
C. Avoid setting limits to prevent re-traumatization and preserve
the alliance.
D. Refer immediately to a trauma specialist because boundary
testing makes therapy unsafe.
Correct answer
B
Rationale — Correct
Negotiating limits collaboratively both maintains necessary
therapeutic boundaries and respects trauma-informed
principles (safety, choice, collaboration), facilitating
containment while exploring relational meanings—consistent
with Wheeler’s framework integrating nursing ethics and
trauma sensitivity.
Rationale — A (incorrect)
Rigid enforcement without collaboration may replicate coercive
dynamics and damage trust with a trauma survivor.
Rationale — C (incorrect)
Avoiding limits compromises safety and the therapeutic frame;
boundaries are therapeutic when set empathically.
Rationale — D (incorrect)
Boundary testing alone does not mandate referral; specialist
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1)
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old woman presents for initial psychotherapy
following referral from her PCP for chronic anxiety and poor
sleep. During intake she repeatedly asks whether therapy will
"fix" her quickly and seems ambivalent about long-term work.
As a nurse psychotherapist beginning the therapeutic
,relationship, which immediate therapist action best reflects
professional role clarity and sets an ethical framework for care?
A. Offer an optimistic time estimate and promise measurable
symptom reduction within a few sessions to build hope.
B. Provide a clear explanation of the nurse psychotherapist’s
scope, treatment approach, expected time frame, and limits of
confidentiality.
C. Begin cognitive restructuring techniques immediately to
demonstrate active treatment and competence.
D. Recommend medication management with the PCP and
discharge from psychotherapy referral since the patient wants
quick change.
Correct answer
B
Rationale — Correct
Providing a clear explanation of scope, approach, time frame,
and confidentiality establishes role clarity, informed consent,
and collaborative expectations—core ethical responsibilities for
the nurse psychotherapist and foundational to alliance
formation. This aligns with Wheeler’s emphasis on outlining the
therapeutic framework at intake to support shared decision-
making and safety.
Rationale — A (incorrect)
Promising rapid change is ethically problematic and may create
unrealistic expectations that undermine alliance and informed
consent.
,Rationale — C (incorrect)
Jumping to interventions before shared formulation and
consent risks misalignment with patient goals and may bypass
assessment of readiness and safety.
Rationale — D (incorrect)
Referring out immediately because of patient preference for
quick results dismisses the therapeutic role and fails to offer
collaborative planning; medication and psychotherapy are not
mutually exclusive.
Teaching point
Clarify role, approach, time frame, and confidentiality at intake
to support informed consent.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2)
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A patient with complex trauma describes mistrust toward
providers and frequently tests boundaries (e.g., arriving late,
calling between sessions). Which therapist stance best balances
therapeutic containment with trauma-informed care?
, A. Strictly enforce rules without discussion to demonstrate
reliability and authority.
B. Negotiate clear limits collaboratively while exploring how
safety and predictability relate to trauma history.
C. Avoid setting limits to prevent re-traumatization and preserve
the alliance.
D. Refer immediately to a trauma specialist because boundary
testing makes therapy unsafe.
Correct answer
B
Rationale — Correct
Negotiating limits collaboratively both maintains necessary
therapeutic boundaries and respects trauma-informed
principles (safety, choice, collaboration), facilitating
containment while exploring relational meanings—consistent
with Wheeler’s framework integrating nursing ethics and
trauma sensitivity.
Rationale — A (incorrect)
Rigid enforcement without collaboration may replicate coercive
dynamics and damage trust with a trauma survivor.
Rationale — C (incorrect)
Avoiding limits compromises safety and the therapeutic frame;
boundaries are therapeutic when set empathically.
Rationale — D (incorrect)
Boundary testing alone does not mandate referral; specialist
