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NRNP 6645 Psychotherapy Midterm & Final Study Guide
2026 | Complete Review | Graded A+
1. A psychiatric mental health nurse practitioner (PMHNP) is
seeing a patient for the first time. The patient states, “I don’t
know if talking will help.” Which response best
demonstrates a therapeutic frame?
• A) “Talking always helps, trust me.”
• B) “Medication might be a better option for you.”
• C) “Some people feel that way. What concerns you
about talking?”
• D) “Let’s just try it for 15 minutes.”
Correct Answer: C
Rationale: Validating the patient’s concern while inviting
exploration respects autonomy and builds alliance. Option A is
dismissive, B changes the subject prematurely, D imposes
without addressing resistance.
2. A PMHNP notices a patient consistently arrives 10
minutes late to sessions. Which psychodynamic concept
best explains this behavior?
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• A) Transference
• B) Resistance
• C) Countertransference
•D) Free association
Correct Answer: B
Rationale: Resistance refers to unconscious avoidance of painful
material. Lateness may protect against anxiety. Transference
involves projecting past feelings onto therapist;
countertransference is therapist’s response.
Domain 2: Psychodynamic Psychotherapy
3. A 32-year-old patient with childhood emotional neglect
becomes tearful when the PMHNP takes a 1-week vacation.
The patient says, “You’re abandoning me like everyone
else.” This is an example of:
• A) Projective identification
• B) Positive transference
• C) Negative transference
• D) Reality testing
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Correct Answer: C
Rationale: Negative transference involves hostile or dependent
feelings displaced from past figures. Positive transference
involves idealization. Projective identification involves inducing
feelings in the therapist.
4. During a session, a patient says, “I feel nothing about
my father’s death.” The PMHNP responds, “And yet your
fists are clenched.” Which technique is being used?
• A) Confrontation
• B) Interpretation
• C) Clarification
• D) Containment
Correct Answer: A
Rationale: Confrontation gently points out a discrepancy
between affect and verbal content. Interpretation explains
unconscious meaning; clarification seeks more detail.
Domain 3: Cognitive-Behavioral Therapy (CBT)
5. A patient with social anxiety reports, “If I stutter during
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my presentation, everyone will think I’m incompetent.” The
PMHNP asks the patient to examine the evidence for and
against this thought. This is an example of:
• A) Behavioral activation
• B) Cognitive restructuring
• C) Exposure therapy
• D) Relaxation training
Correct Answer: B
Rationale: Cognitive restructuring involves identifying and
challenging distorted thoughts. Behavioral activation targets
depression; exposure reduces avoidance.
6. A PMHNP is treating a patient with panic disorder. Which
intervention is most consistent with CBT for panic?
• A) Exploring early childhood attachment patterns
• B) Interpreting dreams about losing control
• C) Interoceptive exposure (e.g., spinning in a chair)
• D) Prescribing propranolol as needed
Correct Answer: C
NRNP 6645 Psychotherapy Midterm & Final Study Guide
2026 | Complete Review | Graded A+
1. A psychiatric mental health nurse practitioner (PMHNP) is
seeing a patient for the first time. The patient states, “I don’t
know if talking will help.” Which response best
demonstrates a therapeutic frame?
• A) “Talking always helps, trust me.”
• B) “Medication might be a better option for you.”
• C) “Some people feel that way. What concerns you
about talking?”
• D) “Let’s just try it for 15 minutes.”
Correct Answer: C
Rationale: Validating the patient’s concern while inviting
exploration respects autonomy and builds alliance. Option A is
dismissive, B changes the subject prematurely, D imposes
without addressing resistance.
2. A PMHNP notices a patient consistently arrives 10
minutes late to sessions. Which psychodynamic concept
best explains this behavior?
,Page 2 of 186
• A) Transference
• B) Resistance
• C) Countertransference
•D) Free association
Correct Answer: B
Rationale: Resistance refers to unconscious avoidance of painful
material. Lateness may protect against anxiety. Transference
involves projecting past feelings onto therapist;
countertransference is therapist’s response.
Domain 2: Psychodynamic Psychotherapy
3. A 32-year-old patient with childhood emotional neglect
becomes tearful when the PMHNP takes a 1-week vacation.
The patient says, “You’re abandoning me like everyone
else.” This is an example of:
• A) Projective identification
• B) Positive transference
• C) Negative transference
• D) Reality testing
,Page 3 of 186
Correct Answer: C
Rationale: Negative transference involves hostile or dependent
feelings displaced from past figures. Positive transference
involves idealization. Projective identification involves inducing
feelings in the therapist.
4. During a session, a patient says, “I feel nothing about
my father’s death.” The PMHNP responds, “And yet your
fists are clenched.” Which technique is being used?
• A) Confrontation
• B) Interpretation
• C) Clarification
• D) Containment
Correct Answer: A
Rationale: Confrontation gently points out a discrepancy
between affect and verbal content. Interpretation explains
unconscious meaning; clarification seeks more detail.
Domain 3: Cognitive-Behavioral Therapy (CBT)
5. A patient with social anxiety reports, “If I stutter during
, Page 4 of 186
my presentation, everyone will think I’m incompetent.” The
PMHNP asks the patient to examine the evidence for and
against this thought. This is an example of:
• A) Behavioral activation
• B) Cognitive restructuring
• C) Exposure therapy
• D) Relaxation training
Correct Answer: B
Rationale: Cognitive restructuring involves identifying and
challenging distorted thoughts. Behavioral activation targets
depression; exposure reduces avoidance.
6. A PMHNP is treating a patient with panic disorder. Which
intervention is most consistent with CBT for panic?
• A) Exploring early childhood attachment patterns
• B) Interpreting dreams about losing control
• C) Interoceptive exposure (e.g., spinning in a chair)
• D) Prescribing propranolol as needed
Correct Answer: C
