NSG 526 EXAM 2 2026/2027 | Clinical Modalities Advanced
Psychiatric Nursing | Actual Questions & Answers | Wilkes
University | Pass Guaranteed - A+ Graded
Q1: A 28-year-old patient with borderline personality disorder engages in self-harm
behaviors during periods of emotional dysregulation. During individual therapy, the
patient becomes angry when the therapist sets boundaries around session timing,
stating, "You don't care about me like my last therapist did." This is an example of:
A. Therapeutic alliance rupture requiring immediate termination
B. Splitting as a defense mechanism manifesting in the therapeutic relationship
C. Appropriate testing of boundaries expected in supportive therapy
D. Countertransference reaction by the patient toward the therapist
Correct Answer: B
Rationale: This scenario demonstrates splitting, a primitive defense mechanism
characteristic of borderline personality disorder where individuals view others as "all
good" or "all bad." The patient idealizes the previous therapist ("cared about me") while
devaluing the current therapist ("doesn't care"), unable to integrate ambivalent feelings.
This is a transference phenomenon, not countertransference (D), which refers to the
therapist's emotional reaction. Option A is incorrect because ruptures are expected in
BPD treatment and, when managed properly, become therapeutic opportunities. Option
C mischaracterizes the behavior as appropriate; while testing occurs, the all-or-nothing
cognitive distortion indicates splitting. The PMHNP should maintain consistent
boundaries while exploring the patient's fears of abandonment and helping integrate
mixed feelings.
,Q2: In Dialectical Behavior Therapy (DBT), which core skill module specifically
addresses the ability to tolerate painful emotions without engaging in destructive
behaviors?
A. Mindfulness
B. Interpersonal Effectiveness
C. Distress Tolerance
D. Emotion Regulation
Correct Answer: C
Rationale: Distress Tolerance skills in DBT are specifically designed to help patients
accept and tolerate painful emotions and situations without resorting to maladaptive
behaviors such as self-harm, substance use, or suicidal acts. Skills include radical
acceptance, distraction techniques (ACCEPTS), self-soothing, and pros/cons analysis.
While Mindfulness (A) provides the foundation for all skills, Emotion Regulation (D)
focuses on changing emotional responses, and Interpersonal Effectiveness (B) targets
relationship skills. The question specifically asks about tolerating (accepting without
change) rather than regulating (modifying) emotions, making Distress Tolerance the
correct answer. This distinction is crucial for exam success and clinical application in
treating patients with high emotional dysregulation.
Q3: A psychiatric-mental health nurse practitioner is leading a psychotherapy group for
adults with depression. During the fourth session, two members begin discussing their
shared negative experiences with psychiatric medications outside the group's stated
purpose. Other members appear uncomfortable. The most appropriate leader
intervention is:
,A. Allow the discussion to continue as it builds group cohesion through shared
experience
B. Redirect the discussion to the group's therapeutic goals while validating members'
concerns
C. Ask the two members to leave the group for violating the contract
D. Privately confront the members after session about their inappropriate behavior
Correct Answer: B
Rationale: This scenario occurs during the transition stage of group development
(Tuckman's model: forming, storming, norming, performing, adjourning), where
members test boundaries and resist group structure. The leader's role is to maintain the
group framework (here, psychotherapy for depression with specific goals) while
validating the underlying emotion (frustration with treatment). Option A fails to protect
the group's therapeutic focus; medication discussions, while relevant, may trigger other
members and deviate from evidence-based psychotherapy interventions. Option C is
punitive and premature for a normative boundary test. Option D misses the opportunity
for in-the-moment processing that benefits all members. The correct intervention
balances structure with empathy, modeling how to manage difficult conversations
within boundaries.
Q4: According to Structural Family Therapy (Minuchin), a family where the parents
consistently defer to their 16-year-old son regarding major financial and household
decisions demonstrates which dysfunctional pattern?
A. Enmeshment
B. Disengagement
, C. Cross-generational coalition
D. Rigid triangulation
Correct Answer: C
Rationale: Cross-generational coalition (or parent-child coalition) occurs when a child is
inappropriately elevated to a position of power or intimacy that excludes the other
parent, undermining the hierarchical structure essential for healthy family functioning.
Here, the son holds executive power (financial/household decisions) that should belong
to the parental subsystem. This detours the parental relationship and places
inappropriate developmental demands on the adolescent. Enmeshment (A) involves
diffuse boundaries and over-involvement but doesn't necessarily imply hierarchical
inversion. Disengagement (B) involves rigid boundaries and emotional distance. Rigid
triangulation (D) involves a third person drawn into conflict between two others, but
doesn't capture the power imbalance and generational boundary violation described.
Treatment would focus on restructuring the parental hierarchy and blocking the son's
interference in parental functions.
Q5: A patient with obsessive-compulsive disorder reports spending 4 hours daily
checking locks and appliances. In implementing Exposure and Response Prevention
(ERP), the nurse practitioner should:
A. Begin with the most anxiety-provoking exposure to maximize habituation
B. Teach relaxation techniques to use when anxiety reaches intolerable levels during
exposure
C. Develop a hierarchy of feared situations and prevent the compulsive response
Psychiatric Nursing | Actual Questions & Answers | Wilkes
University | Pass Guaranteed - A+ Graded
Q1: A 28-year-old patient with borderline personality disorder engages in self-harm
behaviors during periods of emotional dysregulation. During individual therapy, the
patient becomes angry when the therapist sets boundaries around session timing,
stating, "You don't care about me like my last therapist did." This is an example of:
A. Therapeutic alliance rupture requiring immediate termination
B. Splitting as a defense mechanism manifesting in the therapeutic relationship
C. Appropriate testing of boundaries expected in supportive therapy
D. Countertransference reaction by the patient toward the therapist
Correct Answer: B
Rationale: This scenario demonstrates splitting, a primitive defense mechanism
characteristic of borderline personality disorder where individuals view others as "all
good" or "all bad." The patient idealizes the previous therapist ("cared about me") while
devaluing the current therapist ("doesn't care"), unable to integrate ambivalent feelings.
This is a transference phenomenon, not countertransference (D), which refers to the
therapist's emotional reaction. Option A is incorrect because ruptures are expected in
BPD treatment and, when managed properly, become therapeutic opportunities. Option
C mischaracterizes the behavior as appropriate; while testing occurs, the all-or-nothing
cognitive distortion indicates splitting. The PMHNP should maintain consistent
boundaries while exploring the patient's fears of abandonment and helping integrate
mixed feelings.
,Q2: In Dialectical Behavior Therapy (DBT), which core skill module specifically
addresses the ability to tolerate painful emotions without engaging in destructive
behaviors?
A. Mindfulness
B. Interpersonal Effectiveness
C. Distress Tolerance
D. Emotion Regulation
Correct Answer: C
Rationale: Distress Tolerance skills in DBT are specifically designed to help patients
accept and tolerate painful emotions and situations without resorting to maladaptive
behaviors such as self-harm, substance use, or suicidal acts. Skills include radical
acceptance, distraction techniques (ACCEPTS), self-soothing, and pros/cons analysis.
While Mindfulness (A) provides the foundation for all skills, Emotion Regulation (D)
focuses on changing emotional responses, and Interpersonal Effectiveness (B) targets
relationship skills. The question specifically asks about tolerating (accepting without
change) rather than regulating (modifying) emotions, making Distress Tolerance the
correct answer. This distinction is crucial for exam success and clinical application in
treating patients with high emotional dysregulation.
Q3: A psychiatric-mental health nurse practitioner is leading a psychotherapy group for
adults with depression. During the fourth session, two members begin discussing their
shared negative experiences with psychiatric medications outside the group's stated
purpose. Other members appear uncomfortable. The most appropriate leader
intervention is:
,A. Allow the discussion to continue as it builds group cohesion through shared
experience
B. Redirect the discussion to the group's therapeutic goals while validating members'
concerns
C. Ask the two members to leave the group for violating the contract
D. Privately confront the members after session about their inappropriate behavior
Correct Answer: B
Rationale: This scenario occurs during the transition stage of group development
(Tuckman's model: forming, storming, norming, performing, adjourning), where
members test boundaries and resist group structure. The leader's role is to maintain the
group framework (here, psychotherapy for depression with specific goals) while
validating the underlying emotion (frustration with treatment). Option A fails to protect
the group's therapeutic focus; medication discussions, while relevant, may trigger other
members and deviate from evidence-based psychotherapy interventions. Option C is
punitive and premature for a normative boundary test. Option D misses the opportunity
for in-the-moment processing that benefits all members. The correct intervention
balances structure with empathy, modeling how to manage difficult conversations
within boundaries.
Q4: According to Structural Family Therapy (Minuchin), a family where the parents
consistently defer to their 16-year-old son regarding major financial and household
decisions demonstrates which dysfunctional pattern?
A. Enmeshment
B. Disengagement
, C. Cross-generational coalition
D. Rigid triangulation
Correct Answer: C
Rationale: Cross-generational coalition (or parent-child coalition) occurs when a child is
inappropriately elevated to a position of power or intimacy that excludes the other
parent, undermining the hierarchical structure essential for healthy family functioning.
Here, the son holds executive power (financial/household decisions) that should belong
to the parental subsystem. This detours the parental relationship and places
inappropriate developmental demands on the adolescent. Enmeshment (A) involves
diffuse boundaries and over-involvement but doesn't necessarily imply hierarchical
inversion. Disengagement (B) involves rigid boundaries and emotional distance. Rigid
triangulation (D) involves a third person drawn into conflict between two others, but
doesn't capture the power imbalance and generational boundary violation described.
Treatment would focus on restructuring the parental hierarchy and blocking the son's
interference in parental functions.
Q5: A patient with obsessive-compulsive disorder reports spending 4 hours daily
checking locks and appliances. In implementing Exposure and Response Prevention
(ERP), the nurse practitioner should:
A. Begin with the most anxiety-provoking exposure to maximize habituation
B. Teach relaxation techniques to use when anxiety reaches intolerable levels during
exposure
C. Develop a hierarchy of feared situations and prevent the compulsive response
