NRNP 6645 Psychotherapy Midterm Exam
Walden University ACTUAL EXAM
2026/2027 | Walden NRNP 6645
Psychotherapy | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: MULTIPLE CHOICE (Single Answer) — 70 Questions
Q1: A PMHNP student begins working with a 28-year-old client with generalized anxiety disorder. The
client frequently arrives late and cancels sessions. Which initial response best demonstrates therapeutic
alliance building?
A. Implement a strict cancellation fee policy to enforce boundaries.
B. Explore with curiosity the client's feelings about coming to therapy. [CORRECT]
C. Refer the client to another therapist who uses a structured approach.
D. Confront the behavior as resistance requiring immediate interpretation.
Correct Answer: B
Rationale: Exploration without judgment builds alliance and addresses potential underlying
ambivalence, anxiety, or practical barriers. A imposes consequences before understanding the behavior.
C abandons the therapeutic relationship prematurely, missing an opportunity to model tolerance of
difficult feelings. D is confrontational and assumes psychodynamic resistance without evidence;
premature interpretation can rupture the alliance (Wheeler, 2020).
Q2: A client with borderline personality disorder (BPD) becomes enraged when the PMHNP is 2 minutes
late to session. From a DBT perspective, which intervention is most appropriate?
A. Set firmer boundaries about punctuality to model consistency.
B. Validate the client's emotional experience while maintaining therapist limits. [CORRECT]
C. Interpret the rage as displacement from early attachment trauma.
D. Terminate the session to prevent reinforcement of maladaptive behavior.
,Correct Answer: B
Rationale: DBT emphasizes validation plus change strategies. Validating the client's distress while
maintaining boundaries addresses emotional dysregulation without reinforcing invalidation (Linehan,
2015). A focuses only on structure without validation. C is a psychodynamic interpretation that may feel
invalidating to a dysregulated client. D is punitive and would likely escalate the crisis.
Q3: During the third session, a client with depression says, "My mother always told me I was worthless,
and she's right." Using a CBT framework, what is the most appropriate next step?
A. Challenge the thought immediately by asking for evidence against it.
B. Explore the client's relationship with their mother in depth.
C. Identify the automatic thought and examine its validity collaboratively. [CORRECT]
D. Reassure the client that their mother was wrong.
Correct Answer: C
Rationale: CBT involves collaborative empiricism—identifying automatic thoughts and examining
evidence together (Beck, 2020). A challenges too directly, potentially creating defensiveness. B is
psychodynamic exploration, not CBT. D provides reassurance without teaching the client to evaluate
their own cognitions, fostering dependency.
Q4: A PMHNP is conducting couples therapy. One partner dominates the conversation while the other
remains silent. Using a structural family therapy approach, what is the most appropriate intervention?
A. Ask the silent partner to share their feelings individually in a separate session.
B. Reframe the dominant partner's behavior as protective of the relationship.
C. Block the dominant partner and redirect to the silent partner to shift the hierarchy. [CORRECT]
D. Suggest the couple consider separation if communication cannot improve.
Correct Answer: C
Rationale: Structural family therapy (Minuchin) focuses on restructuring family hierarchy and
boundaries. Blocking the dominant partner and redirecting shifts the interactional pattern (Wheeler,
2020). A avoids addressing the systemic pattern. B reframes without structural intervention. D is
premature and outside the therapeutic framework.
Q5: A 19-year-old college student discloses during session that they have been sexually assaulted and
ask the PMHNP not to tell anyone. The assault occurred three weeks ago off-campus. What is the
PMHNP's legal and ethical obligation?
,A. Maintain complete confidentiality as requested by the client.
B. Report to campus authorities because the client is a minor.
C. Report to law enforcement because sexual assault is a crime.
D. Assess imminent danger, explain mandatory reporting limits, and offer support/resources. [CORRECT]
Correct Answer: D
Rationale: Sexual assault of an adult (age 19) does not automatically trigger mandatory reporting unless
the client is imminently suicidal, homicidal, or a minor is involved. The PMHNP must assess safety,
explain confidentiality limits, and provide trauma-informed support (APA Ethics Code; Wheeler, 2020). A
ignores the need for safety assessment. B is incorrect because the client is not a minor. C misapplies
mandatory reporting laws.
Q6: A client with PTSD reports frequent nightmares and hypervigilance. The PMHNP uses prolonged
exposure therapy. Which statement best describes the theoretical mechanism?
A. Systematic desensitization reduces anxiety through progressive muscle relaxation.
B. Habituation and emotional processing occur through repeated imaginal and in-vivo exposure.
[CORRECT]
C. Cognitive restructuring replaces trauma-related beliefs with positive affirmations.
D. Eye movements facilitate bilateral brain processing of traumatic memories.
Correct Answer: B
Rationale: Prolonged exposure therapy (Foa et al.) works through habituation (reduced anxiety over
repeated exposure) and emotional processing (modification of trauma-related fear structures). A
describes systematic desensitization, not PE. C describes CPT. D describes EMDR.
Q7: During psychodynamic therapy, a client becomes angry with the PMHNP and says, "You're just like
my father—always judging me." This is best understood as:
A. Transference. [CORRECT]
B. Countertransference.
C. Projection.
D. Resistance.
Correct Answer: A
Rationale: Transference involves the client unconsciously redirecting feelings about a significant figure
(father) onto the therapist (Yalom, 2002). B (countertransference) refers to the therapist's reactions
toward the client. C (projection) involves attributing one's own unacceptable feelings to another. D
(resistance) is a broader defense against therapeutic progress.
, Q8: A PMHNP practicing from a humanistic/existential framework works with a client experiencing
existential anxiety about mortality. Which intervention is most consistent with this orientation?
A. Teach relaxation techniques to reduce anxiety symptoms.
B. Explore the client's personal meaning and values around life and death. [CORRECT]
C. Prescribe an SSRI to manage the anxiety.
D. Challenge irrational beliefs about death using cognitive techniques.
Correct Answer: B
Rationale: Existential therapy (Yalom) focuses on givens of existence (death, freedom, isolation,
meaninglessness) and helps clients find personal meaning. A is behavioral/symptom-focused. C is
pharmacological, not psychotherapeutic. D is CBT, not existential.
Q9: A client with bipolar I disorder in euthymic phase requests psychotherapy to prevent relapse. Which
modality has the strongest evidence base?
A. Psychodynamic psychotherapy
B. Interpersonal and Social Rhythm Therapy (IPSRT) [CORRECT]
C. Dialectical Behavior Therapy (DBT)
D. Supportive psychotherapy alone
Correct Answer: B
Rationale: IPSRT (Frank et al.) is specifically designed for bipolar disorder, targeting social rhythm
regularity and interpersonal issues to prevent relapse. A lacks strong evidence for bipolar maintenance.
C has evidence for BPD and emotion dysregulation but is not first-line for bipolar. D is supportive but
lacks the structured relapse prevention focus of IPSRT.
Q10: A PMHNP is working with a client from a collectivist culture who presents with somatic complaints
rather than emotional distress. The most culturally competent approach is:
A. Educate the client that somatization is a defense mechanism against emotional awareness.
B. Respect the cultural expression of distress and integrate somatic and psychological interventions.
[CORRECT]
C. Refer to a medical provider since the complaints are likely purely physical.
D. Use Western diagnostic criteria to reframe the symptoms as depression.
Correct Answer: B
Rationale: Many cultures express psychological distress somatically. Culturally competent care respects
the client's framework while integrating appropriate interventions (Wheeler, 2020; Sue & Sue). A
pathologizes cultural expression. C misses the psychological component. D imposes Western
frameworks without cultural attunement.
Walden University ACTUAL EXAM
2026/2027 | Walden NRNP 6645
Psychotherapy | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: MULTIPLE CHOICE (Single Answer) — 70 Questions
Q1: A PMHNP student begins working with a 28-year-old client with generalized anxiety disorder. The
client frequently arrives late and cancels sessions. Which initial response best demonstrates therapeutic
alliance building?
A. Implement a strict cancellation fee policy to enforce boundaries.
B. Explore with curiosity the client's feelings about coming to therapy. [CORRECT]
C. Refer the client to another therapist who uses a structured approach.
D. Confront the behavior as resistance requiring immediate interpretation.
Correct Answer: B
Rationale: Exploration without judgment builds alliance and addresses potential underlying
ambivalence, anxiety, or practical barriers. A imposes consequences before understanding the behavior.
C abandons the therapeutic relationship prematurely, missing an opportunity to model tolerance of
difficult feelings. D is confrontational and assumes psychodynamic resistance without evidence;
premature interpretation can rupture the alliance (Wheeler, 2020).
Q2: A client with borderline personality disorder (BPD) becomes enraged when the PMHNP is 2 minutes
late to session. From a DBT perspective, which intervention is most appropriate?
A. Set firmer boundaries about punctuality to model consistency.
B. Validate the client's emotional experience while maintaining therapist limits. [CORRECT]
C. Interpret the rage as displacement from early attachment trauma.
D. Terminate the session to prevent reinforcement of maladaptive behavior.
,Correct Answer: B
Rationale: DBT emphasizes validation plus change strategies. Validating the client's distress while
maintaining boundaries addresses emotional dysregulation without reinforcing invalidation (Linehan,
2015). A focuses only on structure without validation. C is a psychodynamic interpretation that may feel
invalidating to a dysregulated client. D is punitive and would likely escalate the crisis.
Q3: During the third session, a client with depression says, "My mother always told me I was worthless,
and she's right." Using a CBT framework, what is the most appropriate next step?
A. Challenge the thought immediately by asking for evidence against it.
B. Explore the client's relationship with their mother in depth.
C. Identify the automatic thought and examine its validity collaboratively. [CORRECT]
D. Reassure the client that their mother was wrong.
Correct Answer: C
Rationale: CBT involves collaborative empiricism—identifying automatic thoughts and examining
evidence together (Beck, 2020). A challenges too directly, potentially creating defensiveness. B is
psychodynamic exploration, not CBT. D provides reassurance without teaching the client to evaluate
their own cognitions, fostering dependency.
Q4: A PMHNP is conducting couples therapy. One partner dominates the conversation while the other
remains silent. Using a structural family therapy approach, what is the most appropriate intervention?
A. Ask the silent partner to share their feelings individually in a separate session.
B. Reframe the dominant partner's behavior as protective of the relationship.
C. Block the dominant partner and redirect to the silent partner to shift the hierarchy. [CORRECT]
D. Suggest the couple consider separation if communication cannot improve.
Correct Answer: C
Rationale: Structural family therapy (Minuchin) focuses on restructuring family hierarchy and
boundaries. Blocking the dominant partner and redirecting shifts the interactional pattern (Wheeler,
2020). A avoids addressing the systemic pattern. B reframes without structural intervention. D is
premature and outside the therapeutic framework.
Q5: A 19-year-old college student discloses during session that they have been sexually assaulted and
ask the PMHNP not to tell anyone. The assault occurred three weeks ago off-campus. What is the
PMHNP's legal and ethical obligation?
,A. Maintain complete confidentiality as requested by the client.
B. Report to campus authorities because the client is a minor.
C. Report to law enforcement because sexual assault is a crime.
D. Assess imminent danger, explain mandatory reporting limits, and offer support/resources. [CORRECT]
Correct Answer: D
Rationale: Sexual assault of an adult (age 19) does not automatically trigger mandatory reporting unless
the client is imminently suicidal, homicidal, or a minor is involved. The PMHNP must assess safety,
explain confidentiality limits, and provide trauma-informed support (APA Ethics Code; Wheeler, 2020). A
ignores the need for safety assessment. B is incorrect because the client is not a minor. C misapplies
mandatory reporting laws.
Q6: A client with PTSD reports frequent nightmares and hypervigilance. The PMHNP uses prolonged
exposure therapy. Which statement best describes the theoretical mechanism?
A. Systematic desensitization reduces anxiety through progressive muscle relaxation.
B. Habituation and emotional processing occur through repeated imaginal and in-vivo exposure.
[CORRECT]
C. Cognitive restructuring replaces trauma-related beliefs with positive affirmations.
D. Eye movements facilitate bilateral brain processing of traumatic memories.
Correct Answer: B
Rationale: Prolonged exposure therapy (Foa et al.) works through habituation (reduced anxiety over
repeated exposure) and emotional processing (modification of trauma-related fear structures). A
describes systematic desensitization, not PE. C describes CPT. D describes EMDR.
Q7: During psychodynamic therapy, a client becomes angry with the PMHNP and says, "You're just like
my father—always judging me." This is best understood as:
A. Transference. [CORRECT]
B. Countertransference.
C. Projection.
D. Resistance.
Correct Answer: A
Rationale: Transference involves the client unconsciously redirecting feelings about a significant figure
(father) onto the therapist (Yalom, 2002). B (countertransference) refers to the therapist's reactions
toward the client. C (projection) involves attributing one's own unacceptable feelings to another. D
(resistance) is a broader defense against therapeutic progress.
, Q8: A PMHNP practicing from a humanistic/existential framework works with a client experiencing
existential anxiety about mortality. Which intervention is most consistent with this orientation?
A. Teach relaxation techniques to reduce anxiety symptoms.
B. Explore the client's personal meaning and values around life and death. [CORRECT]
C. Prescribe an SSRI to manage the anxiety.
D. Challenge irrational beliefs about death using cognitive techniques.
Correct Answer: B
Rationale: Existential therapy (Yalom) focuses on givens of existence (death, freedom, isolation,
meaninglessness) and helps clients find personal meaning. A is behavioral/symptom-focused. C is
pharmacological, not psychotherapeutic. D is CBT, not existential.
Q9: A client with bipolar I disorder in euthymic phase requests psychotherapy to prevent relapse. Which
modality has the strongest evidence base?
A. Psychodynamic psychotherapy
B. Interpersonal and Social Rhythm Therapy (IPSRT) [CORRECT]
C. Dialectical Behavior Therapy (DBT)
D. Supportive psychotherapy alone
Correct Answer: B
Rationale: IPSRT (Frank et al.) is specifically designed for bipolar disorder, targeting social rhythm
regularity and interpersonal issues to prevent relapse. A lacks strong evidence for bipolar maintenance.
C has evidence for BPD and emotion dysregulation but is not first-line for bipolar. D is supportive but
lacks the structured relapse prevention focus of IPSRT.
Q10: A PMHNP is working with a client from a collectivist culture who presents with somatic complaints
rather than emotional distress. The most culturally competent approach is:
A. Educate the client that somatization is a defense mechanism against emotional awareness.
B. Respect the cultural expression of distress and integrate somatic and psychological interventions.
[CORRECT]
C. Refer to a medical provider since the complaints are likely purely physical.
D. Use Western diagnostic criteria to reframe the symptoms as depression.
Correct Answer: B
Rationale: Many cultures express psychological distress somatically. Culturally competent care respects
the client's framework while integrating appropriate interventions (Wheeler, 2020; Sue & Sue). A
pathologizes cultural expression. C misses the psychological component. D imposes Western
frameworks without cultural attunement.
