NRNP 6645 Psychotherapy Midterm Exam (2025) – Practice Test (100 Questions
– Latest Release | Walden University | Professor Verified | Already Graded A+)
Domain I: Foundational Concepts in Psychotherapy
1. A PMHNP is treating a patient who confesses to having detailed, violent fantasies
about a specific co-worker. The patient has not made any threats or purchased
weapons. Which ethical duty guides the PMHNP’s decision regarding confidentiality?
A. Duty to protect
B. Duty to warn
C. Duty to maintain confidentiality unless an imminent threat exists
D. Duty to report workplace harassment
C. Duty to maintain confidentiality unless an imminent threat exists
Confidentiality is fundamental to psychotherapy. While the Tarasoff ruling established
the "duty to warn" (and later the "duty to protect") potential victims, these duties
generally apply when there is a specific, imminent threat of bodily harm to an
identifiable person. Mere fantasies without a specific plan, capability, or immediate
intent typically do not meet the threshold for breaching confidentiality.
2. During an initial session, a PMHNP explains the risks, benefits, and alternatives to
treatment, including the possibility that symptoms might worsen before improving.
Which legal and ethical concept is being demonstrated?
A. Informed consent
B. Privileged communication
C. Malpractice liability
D. Beneficence
A. Informed consent
Informed consent is a legal and ethical requirement that ensures the patient
understands the nature of the treatment, including potential risks, benefits,
,alternatives, and the limits of confidentiality. It respects the patient's autonomy and
right to make informed decisions about their care.
3. A therapist accepts an invitation to attend a former patient's wedding 6 months
after termination. What is the most clinically appropriate consideration regarding this
boundary crossing?
A. It is always ethical because the treatment has ended.
B. It is a dual relationship that could be exploitative or harmful.
C. It is acceptable if the therapist pays for their own meal.
D. It is recommended to strengthen the therapeutic alliance.
B. It is a dual relationship that could be exploitative or harmful.
Even after termination, social relationships with former clients can be problematic.
They constitute dual relationships that can impair professional judgment, exploit the
patient's vulnerability, or obscure the boundaries of the therapeutic relationship.
Generally, such interactions are discouraged.
4. A PMHNP is conducting telepsychiatry with a patient located in a different state.
Which regulatory mechanism allows the PMHNP to practice across state lines
without obtaining a full license in that state?
A. HIPAA
B. PSYPACT
C. The Ryan Haight Act
D. Medicare Part B
B. PSYPACT
The Psychology Interjurisdictional Compact (PSYPACT) is an agreement between
states that allows psychologists and, increasingly, other licensed mental health
practitioners (depending on state legislation) to practice telepsychology and conduct
in-person face-to-face practice across state lines, provided specific requirements are
met.
5. According to Carl Rogers, which condition is NOT considered one of the three
"core conditions" necessary for therapeutic change?
A. Congruence (Genuineness)
,B. Unconditional positive regard
C. Empathic understanding
D. Directive guidance
D. Directive guidance
Rogers' person-centered therapy posits that three conditions are necessary and
sufficient for therapeutic change: congruence (genuineness), unconditional positive
regard, and empathic understanding. Directive guidance is contrary to the
nondirective nature of person-centered therapy.
6. A patient cancels their session and arrives early the following week with an
expensive gift for the therapist. The PMHNP’s best course of action is to:
A. Accept the gift to avoid hurting the patient’s feelings.
B. Refuse the gift and explore the meaning behind it in the next session.
C. Accept the gift but report it to the state board.
D. Sell the gift and donate the money to charity without telling the patient.
B. Refuse the gift and explore the meaning behind it in the next session.
Accepting significant gifts can create dual relationships and boundary violations. The
standard of care is to refuse the gift gently but firmly, while using the opportunity to
explore the patient's motivations, feelings, and the therapeutic dynamic in session.
7. A patient states, "I think you are the only one who understands me, unlike my
spouse who is incompetent." This statement exemplifies:
A. Countertransference
B. Transference
C. Resistance
D. Projection
B. Transference
Transference occurs when the patient unconsciously redirects feelings, desires, and
expectations from significant figures in their past (like parents) onto the therapist.
Viewing the therapist as "the only one who understands" while devaluing the spouse
is a classic displacement of past relational patterns.
, 8. The PMHNP finds themselves feeling unusually angry and critical toward a patient
who is late and disrespectful. The therapist recognizes these feelings as:
A. Transference
B. Countertransference
C. Projective identification
D. Boundary violation
B. Countertransference
Countertransference refers to the therapist's unconscious emotional reactions to the
patient, often influenced by the therapist's own past or unresolved issues.
Recognizing these feelings is crucial for managing them and preventing them from
interfering with treatment.
9. Which documentation requirement specifically separates notes kept by the
psychotherapist regarding the contents of therapy sessions from the general medical
record?
A. HIPAA Privacy Rule
B. Tarasoff duty
C. Psychotherapy notes protection
D. Informed consent
C. Psychotherapy notes protection
HIPAA defines "psychotherapy notes" (or process notes) separately from the rest of
the medical record. These notes are kept by the mental health professional for their
own reference and contain detailed contents of the conversations. They are afforded
extra protection and require a separate authorization from the patient for release
compared to the general medical record.
10. A patient has made significant progress and no longer meets criteria for the
diagnosis of Generalized Anxiety Disorder. However, the patient insists on continuing
therapy indefinitely to discuss "life philosophy." The PMHNP’s decision should be
based on:
A. Keeping the patient due to financial need.
B. The medical necessity of continued treatment.
C. The patient’s demand for service.
D. Avoiding an abandonment lawsuit.
– Latest Release | Walden University | Professor Verified | Already Graded A+)
Domain I: Foundational Concepts in Psychotherapy
1. A PMHNP is treating a patient who confesses to having detailed, violent fantasies
about a specific co-worker. The patient has not made any threats or purchased
weapons. Which ethical duty guides the PMHNP’s decision regarding confidentiality?
A. Duty to protect
B. Duty to warn
C. Duty to maintain confidentiality unless an imminent threat exists
D. Duty to report workplace harassment
C. Duty to maintain confidentiality unless an imminent threat exists
Confidentiality is fundamental to psychotherapy. While the Tarasoff ruling established
the "duty to warn" (and later the "duty to protect") potential victims, these duties
generally apply when there is a specific, imminent threat of bodily harm to an
identifiable person. Mere fantasies without a specific plan, capability, or immediate
intent typically do not meet the threshold for breaching confidentiality.
2. During an initial session, a PMHNP explains the risks, benefits, and alternatives to
treatment, including the possibility that symptoms might worsen before improving.
Which legal and ethical concept is being demonstrated?
A. Informed consent
B. Privileged communication
C. Malpractice liability
D. Beneficence
A. Informed consent
Informed consent is a legal and ethical requirement that ensures the patient
understands the nature of the treatment, including potential risks, benefits,
,alternatives, and the limits of confidentiality. It respects the patient's autonomy and
right to make informed decisions about their care.
3. A therapist accepts an invitation to attend a former patient's wedding 6 months
after termination. What is the most clinically appropriate consideration regarding this
boundary crossing?
A. It is always ethical because the treatment has ended.
B. It is a dual relationship that could be exploitative or harmful.
C. It is acceptable if the therapist pays for their own meal.
D. It is recommended to strengthen the therapeutic alliance.
B. It is a dual relationship that could be exploitative or harmful.
Even after termination, social relationships with former clients can be problematic.
They constitute dual relationships that can impair professional judgment, exploit the
patient's vulnerability, or obscure the boundaries of the therapeutic relationship.
Generally, such interactions are discouraged.
4. A PMHNP is conducting telepsychiatry with a patient located in a different state.
Which regulatory mechanism allows the PMHNP to practice across state lines
without obtaining a full license in that state?
A. HIPAA
B. PSYPACT
C. The Ryan Haight Act
D. Medicare Part B
B. PSYPACT
The Psychology Interjurisdictional Compact (PSYPACT) is an agreement between
states that allows psychologists and, increasingly, other licensed mental health
practitioners (depending on state legislation) to practice telepsychology and conduct
in-person face-to-face practice across state lines, provided specific requirements are
met.
5. According to Carl Rogers, which condition is NOT considered one of the three
"core conditions" necessary for therapeutic change?
A. Congruence (Genuineness)
,B. Unconditional positive regard
C. Empathic understanding
D. Directive guidance
D. Directive guidance
Rogers' person-centered therapy posits that three conditions are necessary and
sufficient for therapeutic change: congruence (genuineness), unconditional positive
regard, and empathic understanding. Directive guidance is contrary to the
nondirective nature of person-centered therapy.
6. A patient cancels their session and arrives early the following week with an
expensive gift for the therapist. The PMHNP’s best course of action is to:
A. Accept the gift to avoid hurting the patient’s feelings.
B. Refuse the gift and explore the meaning behind it in the next session.
C. Accept the gift but report it to the state board.
D. Sell the gift and donate the money to charity without telling the patient.
B. Refuse the gift and explore the meaning behind it in the next session.
Accepting significant gifts can create dual relationships and boundary violations. The
standard of care is to refuse the gift gently but firmly, while using the opportunity to
explore the patient's motivations, feelings, and the therapeutic dynamic in session.
7. A patient states, "I think you are the only one who understands me, unlike my
spouse who is incompetent." This statement exemplifies:
A. Countertransference
B. Transference
C. Resistance
D. Projection
B. Transference
Transference occurs when the patient unconsciously redirects feelings, desires, and
expectations from significant figures in their past (like parents) onto the therapist.
Viewing the therapist as "the only one who understands" while devaluing the spouse
is a classic displacement of past relational patterns.
, 8. The PMHNP finds themselves feeling unusually angry and critical toward a patient
who is late and disrespectful. The therapist recognizes these feelings as:
A. Transference
B. Countertransference
C. Projective identification
D. Boundary violation
B. Countertransference
Countertransference refers to the therapist's unconscious emotional reactions to the
patient, often influenced by the therapist's own past or unresolved issues.
Recognizing these feelings is crucial for managing them and preventing them from
interfering with treatment.
9. Which documentation requirement specifically separates notes kept by the
psychotherapist regarding the contents of therapy sessions from the general medical
record?
A. HIPAA Privacy Rule
B. Tarasoff duty
C. Psychotherapy notes protection
D. Informed consent
C. Psychotherapy notes protection
HIPAA defines "psychotherapy notes" (or process notes) separately from the rest of
the medical record. These notes are kept by the mental health professional for their
own reference and contain detailed contents of the conversations. They are afforded
extra protection and require a separate authorization from the patient for release
compared to the general medical record.
10. A patient has made significant progress and no longer meets criteria for the
diagnosis of Generalized Anxiety Disorder. However, the patient insists on continuing
therapy indefinitely to discuss "life philosophy." The PMHNP’s decision should be
based on:
A. Keeping the patient due to financial need.
B. The medical necessity of continued treatment.
C. The patient’s demand for service.
D. Avoiding an abandonment lawsuit.
