While assessing a patient using a humanistic-existential approach

Quiz: Final Exam

This exam will cover the following topics from the Wheeler textbook, which relate to psychotherapy of individuals:

 

· Supportive and Psychodynamic Psychotherapy

· Interpersonal Psychotherapy

· Humanistic-Existential and Solution-Focused Approaches to Psychotherapy

· Psychotherapy With Children

· Psychotherapy With Older Adults

· Termination and Outcome Evaluation

 

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

 

Question 1

1. The PMHNP is caring for a young adult patient with whom the PMHNP decides to use a dynamic supportive therapy approach in addition to pharmacological intervention. Which therapeutic action will the PMHNP take to employ the strategy of holding and containing the patient?

A. Encouraging and nurturing the patient
B. Asking the patient how the patient feels
C. Discussing why the patient is not taking the medication as directed
D. Teaching the patient about medication side effects

1 points

Question 2

1. A PMHNP is using motivational interviewing (MI) with a 50-year-old patient named Dave to commit to a healthy drug-free lifestyle. By using “change talk,” the PMHNP hopes to help the patient build self-esteem and hope. True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful.

True

False

1 points

Question 3

1. The PMHNP is meeting with an older, female adult patient and her daughter. The patient has early onset dementia. The daughter expresses concern, saying, “I don’t want you to just stick my mother in a home and give her medicine. I’m worried that’s what people are going to want to do.” What is the best response by the PMHNP to the daughter?

A. “Most of the time, institutionalization cannot be prevented.”
B. “The type of treatment depends on the stage of dementia and safety considerations.”
C. “Don’t worry; I do not believe in hospitalizing my patients.”
D. “The treatment decision will be up to your mother and what she wants.”

1 points

Question 4

1. Mia is a 75-year-old patient who has completed initial treatment for depression. What might a PMHNP ask Mia when using a solution-focused therapy approach?

A. “What specific improvements have you noticed in your mood since you made the call to see me?”
B. “On a scale of 1–10 (with 1 being little to no improvement to 10 being a great deal of improvement) how much has your mood changed since we started working together?”
C. “What needs to happen today in order for you to feel that is was a productive session?”
D. All of the above.

1 points

Question 5

1. A PMHNP has been treating a 14-year-old patient using interpersonal psychotherapy. The patient has been depressed since the death of his grandmother. To help the patient recover, the PMHNP has told the parents:

A. “Keep your expectations high to show that you believe in his abilities.”
B. “Modify your expectations at home and school until the depression lifts.”
C. “Don’t put expectations on him while he is showing signs of depression.”
D. “Allow him to be an active participant by setting his own expectations.”

1 points

Question 6

1. A 21-year-old patient is worried about starting a new job. She talks about her fears of failure and not making friends at the office. Using a person-centered approach, an appropriate response by the PMHNP is to ______________.

A. give the patient advice based on the therapist’s experiences
B. persuade the patient to release her unfounded fears and worries
C. ask the patient to reflect on and explore what she is experiencing
D. all of the above

1 points

Question 7

1. A 21-year-old patient has been having trouble adjusting to college life. She tells the PMHNP that she had five alcoholic drinks at a party this past weekend. She also acknowledges that she drank the same amount of alcohol at a party the previous month. Based on this information, what would the PMHNP most likely recommend?

A. Group therapy
B. Peer support
C. Hospitalization
D. None of the above

1 points

Question 8

1. The PMHNP is treating an older adult patient who reports experiencing nightmares associated with an automobile accident he was in 20 years ago. As the PMHNP formulates the case using the dynamic supportive therapy model, what questions will the PMHNP use during the session?

A. “What can you tell me about this room?”
B. “You might benefit from a sleep aid.”
C. “Let’s talk about what kinds of things are triggering you now.”
D. “Do I have your permission to advocate for you with your primary care physician?”

1 points

Question 9

1. The PMHNP has been providing interpersonal psychotherapy (IPT) for a patient who the PMHNP observes implementing new ways of being, such as interacting more with peers and being less isolated in social scenarios. The PMHNP understands that the patient is approaching termination. How does the PMHNP address termination with this patient?

A. Give the patient an option about terminating the therapy
B. Allow the patient to bring up termination on his/her own
C. Embed the termination into the work of the therapeutic phase
D. None of the above

1 points

Question 10

1. The PMHNP continues to meet with Gerald, who is the patient with depression and mood disorder. The PMHNP uses the CBT approach. Gerald is now meeting with the PMHNP for his fifth session and feels comfortable with how the therapy works. What does the PMHNP plan to do with Gerald over the course of the next several sessions?

A. Set treatment goals with Gerald
B. Identify barriers to treatment
C. Develop cognitive skills to challenge Gerald’s negative thinking
D. None of the above

1 points

Question 11

1. The PMHNP is caring for a geriatric patient who expresses symptoms of gastrointestinal problems, aches and pains, and loss of appetite. The patient reports feeling lonely, as more of his friends have been passing away over the recent months and years. The PMHNP focuses on which therapeutic approach for this patient?

A. Supportive therapy
B. Problem-solving therapy
C. Cognitive behavioral therapy
D. All of the above

1 points

Question 12

1. The PMHNP is interviewing a patient with a history of substance abuse. He has attempted to stop abusing drugs three times before. He states to the PMHNP, “I just cannot change. How can you help me?!” As it applies to change, the PMHNP understands the principle of evocation to mean:

A. The patient can choose to leave the program whenever he wants because changing is his choice.
B. The patient already has everything needed and the PMHNP would like to help him facilitate his own inner coping.
C. If the patient tries, he will one day become successful; he must not give up.
D. The patient must evolve and change with the times to successfully change his way of thinking.

1 points

Question 13

1. A patient’s depression is affecting her relationship with her spouse. What might the PMHNP ask during the initial sessions of interpersonal psychotherapy treatment?

A. “What expectations do you have of your spouse?”
B. “How is your depression affecting the relationship with your spouse?”
C. “What changes would you and your spouse like to see in the relationship?”
D. All of the above.

1 points

Question 14

1. The PMHNP is terminating treatment for a patient who has been receiving eye movement desensitization and reprocessing (EMDR) therapy. What action does the PMHNP take at the final session to terminate treatment?

A. Helps the patient create a future template
B. Discusses all issues that have been addressed
C. Asks the patient to take a new assessment
D. All of the above

1 points

Question 15

1. The PMHNP is interviewing a patient who is in the process of successfully completing a substance abuse program. During the interview, the patient states, “I wish I was strong enough to keep the same friends I had before I came here for treatment. I’m really afraid of being discharged because I’ll probably run into my old friends again.” The PMHNP offers a complex reflection when she states the following:

A. “You feel as though you are weak and you wish that you were strong.”
B. “The thought of being discharged scares you because you don’t feel strong enough.”
C. “You’d like to keep your old friends but know being around them may lead you to abuse substances again.”
D. “You believe that you’ll run into your old friends if you’re discharged.”

1points

Question 16

1. The PMHNP is assessing a patient who requires cognitive behavioral therapy (CBT). Which of the following statements made by the PMHNP approach the termination phase for this patient?

A. “Although it’s your first session, we will discuss how termination of your treatment will go.”
B. “Now that you are feeling more stable, let’s talk about terminating these sessions.”
C. “We will wait to discuss terminating the treatment until you’ve attended at least five sessions.”
D. None of the above.

1 points

Question 17

1. The PMHNP is actively listening to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently discussing with the PMHNP the reasons why she feels guilty about her drinking. Ms. Thomas tearfully states, “I have driven my family and friends away with this terrible habit. I have no one left. I had more than enough chances and now my children won’t even talk to me.” Which of the following statements demonstrate a simple reflection?

A. “You feel that your children have given you many chances.”
B. “You believe that you have no one to support you through this.”
C. “You feel that your use of alcohol is a terrible habit.”
D. All the above.

1 points

Question 18

1. How does the PMHNP approach termination with the patient who has been receiving intermittent therapy?

A. Uses the word “interrupt” instead of “terminate” with the patient
B. Requires the therapy be resumed in several months
C. Encourages the patient to check in with the PMHNP about his/her progress
D. A and C

1 points

Question 19

1. A PMHNP is treating a 12-year-old girl who witnessed the physical abuse of her sibling. She has been anxious and irritable since the experience. After speaking with the PMHNP, the patient says she keeps having anxiety-causing thoughts about the experience. Using the PRACTICE technique, which skill will best help the patient interrupt these negative thoughts?

A. Relaxation
B. Affect modulation
C. Enhancing safety
D. Trauma narrative

1 points

Question 20

1. The PMHNP is in the process of terminating treatment with a patient who witnessed the death of her parent who used to sexually abuse her. What does the PMHNP understand about terminating this patient?

A. The patient should be made aware that he/she may have trouble managing the trauma.
B. The patient will have to resume treatment with a different provider for further treatment.
C. The patient can be weaned off from therapy, but cannot receive treatment indefinitely.
D. The patient may need to have follow-up sessions every few months.

1 points

Question 21

1. A 19-year-old female patient named Anna, who was the victim of child abuse and neglect, is also in treatment for substance abuse. At her most recent appointment, Anna confesses to the PMHNP that she is having romantic fantasies about him, and explains the he is one of the few people she trusts. She believes that he is interested in her as well. What is the most appropriate response by the PMHNP in this situation?

A. Encourage her to focus on therapy and keep the conversation professional
B. Explain that he must terminate counseling because of the therapeutic frame
C. Guide the patient to examine her feelings and explore the underlying meaning
D. None of the above

1 points

Question 22

1. Linda is a 65-year-old patient who has completed initial treatment for alcohol addiction and anxiety problems. She is motivated to continue her treatment gains and have a healthy lifestyle. How would the PMHNP apply a mindfulness approach to this case?

A. Help Linda develop an awareness of triggers in order to have greater control over physical and emotional responses
B. Encourage Linda to have her husband and children participate in family therapy to facilitate her integration into the community
C. Ask Linda to do homework to elicit any other feelings related to her addictive behavior and evaluate her progress
D. All of the above

1 points

Question 23

1. As part of the PMHNP’s role in the clinic, the PMHNP oversees students that gain clinical experience at the agency. The student is instructed to use the supportive psychodynamic therapy approach with the patient. Which action made by the student causes the PMHNP to intervene, after observing the student interacting with the patient?

A. Focusing too heavily on defenses
B. Talking to the patient about the use of problem-solving strategies
C. Inviting the patient to emote about thoughts and fantasies
D. Asking the patient about the patient’s work stress

1 points

Question 24

1. A PMHNP has been treating a 9-year-old patient who was referred by her school. Students are asked to raise their hands before speaking during group discussion, but the patient seems to blurt out what she wants to say without being called on. She also interrupts other children while they are talking instead of waiting her turn. When the patient gets frustrated, she has trouble controlling her emotions and cries often. Based on the initial information provided, the first focus by PMHNP is the child’s ____________.

A. memory
B. self-regulation
C. language skills
D. social system

1 points

Question 25

1. The PMHNP is caring for an adult male patient whose wife left him several months ago. He recently learned that his ex-wife is dating someone much younger. The man feels belittled, sad, and lonely. He talks about trying to meet other women, but says, “I can’t compete with the younger guys these days, with the cool clothes and the vegan diets. I’m bald and overweight, and what woman is going to want to be with me?” How does the PMHNP help raise the man’s self-esteem?

A. Correcting cognitive distortions
B. Using role-playing techniques
C. Unraveling unconscious guilt
D. All of the above

1 points

Question 26

1. The PMHNP meets with a 31-year-old woman who reports feeling as though she is “at her breaking point” with work. The PMHNP learns that the woman works 12-hour days, including one day on the weekend, because she is nervous about company layoffs. “I feel like I need to work myself to death in order to prove that I am valuable to the organization,” the woman says. Using the supportive psychodynamic therapy approach, how does the PMHNP respond?

A. “You need to find a new place to work.”
B. “Who cares about getting laid off? Then you can collect unemployment benefits.”
C. “I’m sure you have parents or a husband to take care of you if you lose your job.”
D. “That must be a very tiring work schedule. How do you feel about working so much?”

1 points

Question 27

1. The PMHNP has been treating a patient who is now being transferred to another provider. What is the appropriate action made by the PMHNP?

A. Introducing the patient to the new provider
B. Leaving the door open for the patient to return at any time
C. Having the new provider come to a few sessions
D. A and C

1 points

Question 28

1. A patient is finishing the active treatment phase of interpersonal psychotherapy (IPT). After the PMHNP reminds the patient that she has three sessions left, the patient says nothing, but looks distressed. What would be the best reply by the PMHNP following IPT protocol?

A. “Maybe we should extend your active treatment phase.”
B. “Remember that the end of treatment is not a time to grieve.”
C. “Don’t worry. Finishing therapy means you’ve met your goals.”
D. “You seem upset. Tell me what seems to be bothering you.”

1 points

Question 29

1. In the planning phase of change, a 42-year-old male client who struggles with gambling discusses how he plans to abstain from gambling. He tells the PMHNP, “I am no longer going to carry cash to the casino because you can’t spend what you don’t have.” The PMHNP uses an affirming communication skill when she states:

A. “Not gambling is a tough habit to break; not carrying cash is a big step in the right direction.”
B. “Are you saying that you will still go to a casino: however, you will only have a debit card in terms of funds?”
C. “This is a great technique, though it may not work if there is an ATM in the casino you go to.”
D. “Why don’t we try to deal with your addiction to gambling before you go into a casino to decrease your temptation?”

1 points

Question 30

1. A PMHNP is using Gestalt therapy to communicate with a 42-year-old patient who is upset with her mother. She says, “I want to tell her how hurt I feel when she doesn’t call me, but I don’t want to upset her.” What technique can the PMHNP use to help Sasha express herself?

A. Language of responsibility
B. Empty-chair dialogue
C. Dreamwork
D. Focusing

1 points

Question 31

1. A PMHNP is assessing a 40-year-old patient named Sarah who has a severe cocaine addiction and mild depression. Using the four-quadrant model, what would be the most appropriate setting to help the patient?

A. Primary health care settings with some specialized care
B. State psychiatric hospitals and emergency rooms
C. Substance abuse treatment system
D. The mental health system of care

1 points

Question 32

1. An 8-year-old has been having trouble making friends at school. His parents initiated treatment when he also started acting out at home. Which is the most appropriate step that the PMHNP takes during the assessment process when using an integrated approach?

A. Collect information from the patient, his parents, and school
B. Rule out medical issues that may affect behavior
C. Get a measure of the patient’s developmental level
D. All of the above

1 points

Question 33

1. Following an attempted suicide, Mr. Durham was admitted to an acute psychiatric facility. After 4 weeks in treatment, he is preparing for discharge. He is beginning to miss individual and group therapy sessions and has refused medications twice in the past 2 days. The PMHNP demonstrates understanding in this phase by saying which of the following statements?

A. “It is your choice whether to continue to take your medications.”
B. “Have you thought of how you will continue your treatment plans?”
C. “Are you upset with someone here? Tell me more about this.”
D. “Are you sure you no longer want to go to therapy?”

1 points

Question 34

1. The PMHNP is working with a patient who describes having a painful and traumatic childhood experience, which causes her to have anxiety as an adult. When asked how she manages her anxiety, the patient dismisses it and denies that it is a problem. Using the supportive psychotherapy approach, the PMHNP will do which of the following when assessing the patient’s ego strength?

A. Identify the primary defenses the patient uses to ward off anxiety
B. Focus on the patient’s attachment to the anxiety and memories of her childhood
C. Identify whether the patient has an unresolved or disorganized attachment style
D. All of the above

1 points

Question 35

1. While assessing a patient using a humanistic-existential approach, a patient tells the PMHNP, “For the past few weeks, I’ve felt anxious almost every single day.” What would be an appropriate next step by the PMHNP?

A. Try to provide a diagnosis based on the patient’s description of daily anxiety
B. Give the patient some possible solutions they might use for feeling less anxious
C. Use traditional assessment procedures, such as giving a psychometric test
D. Encourage the patient to clarify by asking, “You constantly feel anxious?”
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