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 client with recurrent major depressive episodes
requests psychotherapy in an outpatient clinic where you also
manage medications. At intake the client expresses hope for
talk therapy but says they prefer to wait on medication changes.
You must decide how to proceed to best support the client's
,treatment choice while ensuring safety and integrated care.
What is the most appropriate immediate action?
Options
A. Begin an evidence-based psychotherapy modality
immediately and defer medication discussions until subsequent
sessions.
B. Accept the client's preference, begin psychotherapy, and
document a plan to reassess medication if depressive severity
worsens.
C. Refuse to start psychotherapy until a medication plan is
established with the prescribing clinician.
D. Encourage immediate medication initiation and schedule
psychotherapy only after mood stabilizes on medication.
Correct answer
B
Rationales
Correct (B): Aligns with a nurse psychotherapist’s framework
that integrates client autonomy, stepped care, and safety
monitoring. Beginning psychotherapy while documenting
reassessment criteria preserves the therapeutic alliance and
allows for timely intervention if risk or symptom severity
increases. Wheeler emphasizes collaborative, client-centered
planning within scope of nursing practice.
Incorrect (A): Prematurely deferring medication discussion
ignores integrated care responsibilities and safety planning; an
explicit reassessment plan is necessary.
,Incorrect (C): Inappropriately restrictive; withholding
psychotherapy undermines access and the nurse
psychotherapist’s role in coordinating care.
Incorrect (D): Coercive and misaligned with client preference;
may damage alliance and violate collaborative decision-making
principles.
Teaching point
Start therapy with documented safety and medication
reassessment plan.
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
During the second session a client asks whether you can act as
both their psychotherapist and their prescriber. They are
concerned about coordinating care across multiple clinicians.
Which response best reflects the nurse psychotherapist
framework and ethical practice?
Options
A. Agree to perform both roles without limitation — integrated
, care is more efficient for the client.
B. Explain potential benefits and risks of dual-role care, assess
for conflicts, and document informed consent if both roles are
taken.
C. Refuse to prescribe and insist the client see a separate
prescriber to avoid any boundary confusion.
D. Prescribe needed medications but refer psychotherapy to a
colleague to avoid role overlap.
Correct answer
B
Rationales
Correct (B): Wheeler’s framework endorses transparent
discussion of dual roles, assessing for conflicts of interest and
impact on therapeutic boundaries; informed consent and
documentation are required when assuming both roles. This
balances integrated care benefits with ethical safeguards.
Incorrect (A): Fails to consider boundary risks, conflicts of
interest, and informed consent obligations.
Incorrect (C): Unnecessarily rigid; refusal removes integrated
care advantages without assessing client preference or risk.
Incorrect (D): May be appropriate in some cases but
prematurely delegates without exploring client preference and
risks/benefits of dual roles.
Teaching point
Discuss dual roles openly; obtain informed consent and
document boundary safeguards.
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 client with recurrent major depressive episodes
requests psychotherapy in an outpatient clinic where you also
manage medications. At intake the client expresses hope for
talk therapy but says they prefer to wait on medication changes.
You must decide how to proceed to best support the client's
,treatment choice while ensuring safety and integrated care.
What is the most appropriate immediate action?
Options
A. Begin an evidence-based psychotherapy modality
immediately and defer medication discussions until subsequent
sessions.
B. Accept the client's preference, begin psychotherapy, and
document a plan to reassess medication if depressive severity
worsens.
C. Refuse to start psychotherapy until a medication plan is
established with the prescribing clinician.
D. Encourage immediate medication initiation and schedule
psychotherapy only after mood stabilizes on medication.
Correct answer
B
Rationales
Correct (B): Aligns with a nurse psychotherapist’s framework
that integrates client autonomy, stepped care, and safety
monitoring. Beginning psychotherapy while documenting
reassessment criteria preserves the therapeutic alliance and
allows for timely intervention if risk or symptom severity
increases. Wheeler emphasizes collaborative, client-centered
planning within scope of nursing practice.
Incorrect (A): Prematurely deferring medication discussion
ignores integrated care responsibilities and safety planning; an
explicit reassessment plan is necessary.
,Incorrect (C): Inappropriately restrictive; withholding
psychotherapy undermines access and the nurse
psychotherapist’s role in coordinating care.
Incorrect (D): Coercive and misaligned with client preference;
may damage alliance and violate collaborative decision-making
principles.
Teaching point
Start therapy with documented safety and medication
reassessment plan.
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
During the second session a client asks whether you can act as
both their psychotherapist and their prescriber. They are
concerned about coordinating care across multiple clinicians.
Which response best reflects the nurse psychotherapist
framework and ethical practice?
Options
A. Agree to perform both roles without limitation — integrated
, care is more efficient for the client.
B. Explain potential benefits and risks of dual-role care, assess
for conflicts, and document informed consent if both roles are
taken.
C. Refuse to prescribe and insist the client see a separate
prescriber to avoid any boundary confusion.
D. Prescribe needed medications but refer psychotherapy to a
colleague to avoid role overlap.
Correct answer
B
Rationales
Correct (B): Wheeler’s framework endorses transparent
discussion of dual roles, assessing for conflicts of interest and
impact on therapeutic boundaries; informed consent and
documentation are required when assuming both roles. This
balances integrated care benefits with ethical safeguards.
Incorrect (A): Fails to consider boundary risks, conflicts of
interest, and informed consent obligations.
Incorrect (C): Unnecessarily rigid; refusal removes integrated
care advantages without assessing client preference or risk.
Incorrect (D): May be appropriate in some cases but
prematurely delegates without exploring client preference and
risks/benefits of dual roles.
Teaching point
Discuss dual roles openly; obtain informed consent and
document boundary safeguards.
