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NRNP 6640 Final EXAM
Question 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 ____________.
Answer: B. self-regulation
Question 2
The PMHNP is caring for a patient who experiences depression caused by the traumatic
experience of her dog passing away. She reports not being able to eat or sleep, and sometimes
doesn’t want to leave the house at all. Which statement is most appropriate for the PMHNP to
maximize the patient’s adaptive coping mechanisms?
Answer: C. “It’s important to be mindful of how you feel and then to determine what causes
those feelings.”
Question 3
A PMHNP is using Gestalt therapy to communicate with a 50-year-old patient who is going
through a divorce. As he is calmly sharing the details of his divorce, the PMHNP notices that
Dave is tapping his fingers on his legs. What is an appropriate response by the PMHNP using the
technique of focusing?
Answer: A. “I noticed that your fingers were tapping. Can you give a voice to your fingers?”
Question 4
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?

Answer: B. “The type of treatment depends on the stage of dementia and safety considerations.”
Question 5
A PMHNP is treating a 10-year-old boy who is exhibiting signs of aggression and attention
problems. What type of intervention will the PMHNP consider using a common elements
approach?
A. Parent training to improve behavior management
B. Cognitive-behavioral strategies to address attention issues
C. Social skills training to enhance peer interactions
D. All of the above
Answer: D. All of the above
Question 6
A 35-year-old male patient is being treated for alcohol addiction. He asks for the PMHNP’s cell
phone number to use in case of an emergency. When the PMHNP responds that giving her
number would be against therapeutic rules, the patient threatens an act of violence to the
therapist. What would be the most appropriate response by the PMHNP?
Answer: A. Immediately report the threat to the local police department
Question 7
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 selfesteem?
Answer: A. Correcting cognitive distortions
Question 8

The PMHNP uses therapeutic communication skills while ensuring that the patient understands
that he has choices. The PMHNP comprehends and practices motivational interviewing. This is
best understood as which of the following?
Answer: B. A statement that both challenges the patient’s resistance and offers an opportunity to
discuss the issues allows the patient to argue with him/herself to help produce a desired change.
Question 9
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?
Answer: B. Discusses all issues that have been addressed
Question 10
The PMHNP is assessing an older adult male patient with depression and comorbidities.
According to the medical chart, the patient takes medication to manage joint and bone pain. The
patient reports feeling “forgetful” and complains that he has a hard time remembering where he
puts things. What is the primary action by the PMHNP?
Answer: C. Determining if the patient’s medications can be causing memory problems
Question 11
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. Continue attending social events but limit alcohol consumption
B. Attend a support group for students struggling with alcohol use
C. Explore healthier coping strategies for stress and anxiety
D. None of the above
Answer: D. None of the above
Question 12

The PMHNP is assessing a new geriatric patient who reports symptoms of depression. The
PMHNP wants to identify the patient’s symptom severity over time. Which assessment tool will
the PMHNP use to collect this data on the patient?
Answer: C. AB Clinician Depression Screen
Question 13
How does the PMHNP approach termination with the patient who has been receiving
intermittent therapy?
A. Review the progress made during therapy
B. Discuss the patient's feelings about ending therapy
C. Provide resources for ongoing support
D. A and C
Answer: D. A and C
Question 14
A 55-year-old patient recovering from substance abuse tells the PMHNP, “It’s impossible to
meet new people. I really hate being single.” Using existential psychotherapy, what might the
PMHNP say next?
Answer: B. “So you feel frustrated and unhappy being single. Is that right?”
Question 15
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?
Answer: A. “Although it’s your first session, we will discuss how termination of your treatment
will go.”
Question 16
The PMHNP is caring for a patient who is histrionic. Using the supportive psychodynamic
therapy model, what is the best statement made by the PMHNP?
Answer: B. “Let’s not think too much about emotion right now. Let’s focus on what got you
upset in the first place.”

Question 17
The PMHNP uses the cognitive behavioral therapy model with Gerald, an older adult patient
who is being treated for depression and mood disorder. What will the PMHNP do with the
patient during the first three sessions?
Answer: A. Build a therapeutic alliance
Question 18
A PMHNP is using emotion-focused therapy to help a 38-year-old patient who says, “I’ve been
feeling angry lately, but I’m not sure why.” The first attempt by the PMHNP is to say:
Answer: A. “Focus on your anger, take a deep breath, and allow an image to emerge.”
Question 19
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?
Answer: B. “Have you thought of how you will continue your treatment plans?”
Question 20
The PMHNP is communicating with a middle-aged male patient who has a history of addiction
to Percocet (acetaminophen/oxycodone). The patient suddenly yells, “I do not have a problem
with pain pills! I’ve never had an overdose and no one even knows that I take them unless I tell
them.” The PMHNP understands that there are phases of change and can best demonstrate
“focusing” by responding with:
Answer: D. “I am wondering if your use of pain medication has ever prompted you to seek
medical attention.”
Question 21

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?
Answer: D. Encourage the patient to clarify by asking, “You constantly feel anxious?”
Question 22
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?
Answer: A. Identify the primary defenses the patient uses to ward off anxiety
Question 23
A 38-year-old patient tells the PMHNP that her father went to jail for selling drugs when she was
a child. The patient is visibly upset when discussing what happened. Using a humanisticexistential approach to psychotherapy, which of the following is the most appropriate response
by the PMHNP?
Answer: B. “What are you experiencing now as you share this story?”
Question 24
A PMHNP has been working with a 50-year-old patient who has a stressful job and goes to the
casino on weekends to play poker with his friends, which he says relieves his stress. Tim admits
that he sometimes misses work on Monday when he stays out too late at the casino on Sunday
nights. In addition, he once was an avid runner, and has given up running to spend more time
gambling.
True or false: According to the PMHNP, the desired goal after treatment is not complete
abstinence from gambling, but reaching a healthy level of the behavior.
Answer: False
Question 25

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:
Answer: B. The patient already has everything needed and the PMHNP would like to help him
facilitate his own inner coping.
Question 26
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?
Answer: C. The patient can be weaned off from therapy, but cannot receive treatment
indefinitely.
Question 27
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?
Answer: A. Give the patient an option about terminating the therapy
Question 28
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?
Answer: C. Guide the patient to examine her feelings and explore the underlying meaning
Question 29

A 38-year-old patient has been having trouble communicating with his teenage daughter. Using a
solution-focused therapy approach, the PMHNP responds by saying, “When was a time that a
communication problem could have occurred, but did not?” In this case, what type of question is
the PMHNP asking?
Answer: C. Exception question
Question 30
The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What
type of treatment(s) will the PMHNP consider?
Answer: A. Employ cognitive behavioral therapy
Question 31
A cocaine-addicted female patient is entering residential treatment for substance abuse. Using
the 10 guiding principles of recovery, an appropriate step by the PMHNP is to ______________.
Answer: B. integrate services that encompass mind, body, spirit, and community
Question 32
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 selfesteem and hope.
True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order
for MI to be successful.
Answer: True
Question 33
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 ______________.
Answer: C. ask the patient to reflect on and explore what she is experiencing
Question 34

The PMHNP is initiating a plan of care for a patient who requires comprehensive psychotherapy
to manage his depression and mood disorder. Throughout the initial sessions, the patient reports
feeling as though he cannot be helped. The PMHNP is concerned about premature termination
initiated by the patient. What strategy can the PMHNP employ to prevent or reduce premature
termination?
A. Build a strong therapeutic alliance
B. Normalize the patient’s feelings and concerns
C. Set achievable goals to demonstrate progress
D. All of the above
Answer: D. All of the above
Question 35
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:
Answer: B. “Modify your expectations at home and school until the depression lifts.”
Question 36
The PMHNP is caring for an older adult patient who presents with mixed dysphoric states and
whose daughter reports “is becoming more irritable more easily.” When talking with the patient,
the PMHNP also recognizes displays of cognitive dysfunction. Which treatment options will the
PMHNP most likely suggest?
Answer: D. Combination of CBT and medication
Question 37
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?
Answer: C. Cognitive behavioral therapy

Question 38
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. Gather information from parents about the child's behavior
B. Conduct observations in the school environment
C. Assess the child's social skills and emotional well-being
D. All of the above
Answer: D. All of the above
Question 39
A PMHNP is using interpersonal psychotherapy with a 40-year-old patient having relationship
problems with his extended family. The patient shares that he has been using the strategies they
identified to reduce his distress, but they have not been helping. He is frustrated and is
considering stopping treatment. What would be an appropriate step by the PMHNP?
Answer: A. Encourage the patient to continue treatment by using alternative strategies
Question 40
The PMHNP is assessing a patient who has been receiving months of outpatient psychotherapy.
According to the PMHNP’s assessment, the patient is nearing the termination phase of their
therapeutic relationship because the patient’s symptoms have improved, and the patient shows
progress managing behaviors and decision-making abilities according to the diagnosis. How
does the PMHNP approach termination with this patient?
Answer: B. Manage termination issues as part of the treatment
Question 41
When recalling the phases of change, the PMHNP demonstrates “open questioning” in the
“engagement” phase by making which statement?
Answer: B. “What occurred to cause you to seek treatment?”
Question 42

A 12-year-old girl was referred for treatment after witnessing the physical abuse of her sibling by
their mother. The patient has been anxious and irritable since the experience. What evidencebased treatment would be most appropriate for the PMHNP to use?
Answer: A. Trauma-focused CBT
Question 43
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?
Answer: A. Help Linda develop an awareness of triggers in order to have greater control over
physical and emotional responses
Question 44
The PMHNP assesses a 27-year-old patient named Jeff, who was a victim of child abuse and
neglect. Jeff says that he remembers a traumatic situation that he wants to share, but is having
trouble talking about it. Which statement made by the PMHNP demonstrates the use of emotionfocused therapy?
Answer: A. “Let’s see if we can come up with some ideas for you to feel safe telling your story.”
Question 45
The PMHNP is caring for an older patient with major depressive disorder, seasonal pattern. The
patient has been resolute about not taking medication to manage the depression brought on by
his illness, stating that it is against his yogic lifestyle. In addition to psychotherapy, what can the
PMHNP suggest to this patient?
Answer: A. “You may want to look into therapeutic oils and aromatherapy as an alternative to
medication.”
Question 46
The PMHNP initiates feeling-state therapy to help a 25-year-old patient named Monique who
has a compulsive urge to exercise. Using the Feeling-State Addiction Protocol, what is an

appropriate next step the PMHNP should take after identifying the specific positive feeling
linked with the addictive behavior and its Positive Feeling Score level?
Answer: C. Locate and identify any physical sensations created by the positive feelings
Question 47
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. How does your depression impact your daily interactions with your spouse?
B. Can you describe any recent conflicts or challenges in your relationship?
C. What support do you feel you need from your spouse during this time?
D. All of the above
Answer: D. All of the above.
Question 48
A PMHNP is assessing a 60-year-old patient named Carlos. He has severe PTSD and mild
substance abuse issues. The most appropriate setting to treat Carlos would be a _________.
Answer: D. mental health system of care
Question 49
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?
Answer: C. Develop cognitive skills to challenge Gerald’s negative thinking
Question 50
A PMHNP is treating a 25-year-old patient who has a compulsive urge to exercise to excess.
When asked to describe why she does so much exercise, she says, “I like the compliments I
receive from others on my new level of fitness, and the excitement of getting more attention.”
The PMHNP can use feeling-state therapy to help Monique ___________.
A. Identify the underlying emotions driving her compulsive behavior

B. Develop healthier coping strategies for seeking validation
C. Explore the impact of external validation on her self-esteem
D. All of the above
Answer: D. all of the above
Question 51
A 43-year-old single mother is seeing the PMHNP at the request of her sister. “My sister thinks I
need to come here to talk about my feelings,” the patient reports. The PMHNP learns that the
patient has three children from three different men, but is unable to collect appropriate child
support payments from any of the biological fathers. Additionally, the woman is barely able to
afford her apartment or utilities payments. What is the appropriate response from the PMHNP
when using the psychodynamic psychotherapy technique?
Answer: C. Suggesting that the patient seek professional legal help
Question 52
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?
Answer: D. “That must be a very tiring work schedule. How do you feel about working so
much?”
Question 53
A 13-year-old patient and his parents are meeting with a PMHNP. When the PMHNP says hello,
the boy just nods. His parents tell the PMHNP that he didn’t want to come to the session, but
they insisted. They explain that their son has been moody and depressed at home, but is still
getting good grades at school. Which of the following would be the best response by the
PMHNP?
Answer: C. Compliment the patient on his academic achievement

Question 54
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?
Answer: C. “Let’s talk about what kinds of things are triggering you now.”
Question 55
The PMHNP is caring for an older adult patient who is in the acute phase of schizophrenia.
Which therapeutic model will the PMHNP employ with this patient?
A. Cognitive Behavioral Therapy (CBT)
B. Psychodynamic Therapy
C. Interpersonal Therapy
D. None of the above
Answer: D. None of the above
Question 56
The PMHNP has been providing supportive psychodynamic psychotherapy to a patient and is
nearing the termination stage. The PMHNP will use which criteria for determining that the
patient is ready for termination?
Answer: B. Symptoms have improved.
Question 57
When completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Answer: Yes
Question 58
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?
Answer: D. “You seem upset. Tell me what seems to be bothering you.”

Question 59
The PMHNP has been treating a patient who is now being transferred to another provider. What
is the appropriate action made by the PMHNP?
Answer: A. Introducing the patient to the new provider
Question 60
The PMHNP who practices motivational interviewing understands its relationship to patient
behaviors and/or outcomes to mean which of the following?
Answer: D. There is a lower incidence of inconsistent behaviors with motivational interviewing.
This is related to client engagement and better outcomes.
Question 61
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?
Answer: B. Affect modulation
Question 62
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?
Answer: A. Encouraging and nurturing the patient
Question 63
The PMHNP is meeting with a patient who has been diagnosed with depression. The patient is
having trouble adjusting to her new job and hasn’t made any new friends there. What would an
appropriate response be by the PMHNP using the interpersonal psychotherapy approach?
Answer: C. “Tell me more about why you’re having trouble making new friends at work.”

Question 64
The PMHNP is initiating a plan of care for Holly, a 73-year-old female patient who has late-life
bipolar disorder and reports consuming alcoholic beverages four times per week. What is the
focus of Holly’s therapy going to be?
A. Managing symptoms of bipolar disorder
B. Addressing alcohol use and its impact on her mental health
C. Improving coping strategies and social support
D. None of the above
Answer: D. All of the above
Question 65
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:
Answer: C. “You’d like to keep your old friends but know being around them may lead you to
abuse substances again.”
Question 66
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:
Answer: C. “This is a great technique, though it may not work if there is an ATM in the casino
you go to.”
Question 67

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?
Answer: C. Substance abuse treatment system
Question 68
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?
Answer: A. “What specific improvements have you noticed in your mood since you made the
call to see me?”
Question 69
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?
Answer: B. Empty-chair dialogue
Question 70
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?
Answer: C. Inviting the patient to emote about thoughts and fantasies
Question 71
The PMHNP is assessing a 30-year-old client who reports feeling stressed out due to his current
employment situation. When asked about how he manages this work-related stress, the patient
says that exercise helps him feel less anxious, so he often spends 2 or more hours at the gym
each night. After completing the patient assessment, the PMHNP has determined that an
existential psychotherapy approach may best benefit this client. What is the PMHNP’s goal in
employing this treatment approach?

Answer: B. Help the patient be aware of his anxiety and embrace it
Question 72
When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the
patient’s progress made during treatment?
Answer: B. Reviews the patient’s file to identify issues and important themes that were
highlighted throughout treatment
Question 73
The PMHNP uses the Adult Attachment Interview (AAI) with a male patient who reports having
had a difficult time being separated from his parents during his childhood. He explains that
going to school or visiting his relatives without his parents was troublesome. The PMHNP
characterizes the patient as unresolved/disorganized, according to his outcomes on the AAI.
What does the PMHNP anticipate from the patient?
Answer: A. He will have lapses in his memory of his childhood.
Question 74
The PMHNP is terminating treatment with a patient who is aggressive and has a history of anger.
What does the PMHNP do when terminating treatment with this patient?
Answer: A. Makes a list of all the positive things the patient gained from treatment
Question 75
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?
Answer: C. “You feel that your use of alcohol is a terrible habit.”
Question 76

A 25-year-old female states, “I really need to lose weight. I know I’m the cause of our problems,
if I could just lose weight he might be more attracted to me. Then we could start a family and we
would be happy. I’m sure of it, right, we would definitely be happy!” Which statement shows the
PMHNP’s ability to apply “summarizing”?
Answer: A. “You believe that your weight is a cause of your marital problems.”

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