PMHNP Therapy Exercise and Techniques, Exams of Nursing

Download PMHNP Therapy Exercise and Techniques and more Exams Nursing in PDF only on Docsity! • Question 2 1 out of 1 points • Question 3 1 out of 1 points • Question 4 1 out of 1 points NURSING NP 6640-MIDTERM EXAMINATION QUESTIONS WITH VERIFIED ANSWERS SOLVED BY EXPERT • Question 1 1 out of 1 points A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says: Selecte d Answer: A. “Identify an image of a safe place that makes you feel calm.” The PMHNP is working with a patient who has dissociative disorder and requests pharmacological interventions for dealing with her trauma. What education does the PMHNP provide to the patient regarding medication therapy? Selecte d Answer : C. “The medication may provide symptom relief, but you still need psychotherapy.” The patient attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not make any progress mitigating nightmares and hyper arousal. Which behavioral strategy does the PMHNP suggest next? Selecte d Answer: D. All of the above After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should: Selecte d Answer: C. Limit disclosure to the extent legally possible • Question 5 1 out of 1 points The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support • Question 11 1 out of 1 points • Question 12 1 out of 1 points • Question 13 1 out of 1 points • Question 14 1 out of 1 points Psychodynamic psychotherapy properly for this patient? Selecte d Answer: D. All of the above The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make? Selecte d Answer: D. A and B The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient? Selecte d Answer: D. All of the above The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action would be to: Selecte d Answer: C. Say, “I noticed a change. Can you tell me what happened?” The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient’s transference to enhance emotional processing by: Selecte d Answer: D. Increasing the number of sessions per week When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Ye • Q u e st io n 1 5 0 ou t of 0 po int s • Question 16 1 out of 1 points • Question 17 1 out of 1 points • Question 18 1 out of 1 points • Question 19 1 out of 1 points • Question 20 1 out of 1 points Answer: s An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents’ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP to use to get more information? Selecte d Answer: D. Impact of Event Scale A PMHNP is treating a 50-year-old patient who suffers from depression. When he was growing up, he was often responsible for taking care of his three younger siblings. Since then, the patient puts other people’s needs before his own. Based on this information, the PMHNP would conclude that his interpersonal style is . Selecte d Answer: A. overly nurturing The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make? Selecte d Answer: C. “It takes me a while to warm up to people; people often wear masks.” A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development? Selecte d Answer: D. All of the above. The PMHNP is meeting with a new patient who is a young veteran back from serving two tours overseas. When reviewing the patient’s health history file that was sent from the VA, the PMHNP learns that several Q u e st io n 1 5 months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental • Question 25 1 out of 1 points • Question 26 1 out of 1 points • Question 27 1 out of 1 points • Question 28 1 out of 1 points Selecte d Answer : D. Have the patient use the relaxation response (take a deep breath, exhale long, and slow down) When the patient comes into the office, she says, “I just saw a friend of mine out in the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be fine. He has mild depression.” Which of the following statement is correct related to confidentiality rights? Selecte d Answer: A. The PMHNP was not protecting patient confidentially rights. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle? Selecte d Answer: A. Encouraging catharsis A PMHNP is caring for a 21-year-old woman who is suffering from anxiety and is having difficulty managing stress. Which of the following would be an appropriate step by the PMHNP? Selecte d Answer: D. All of the above The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history? Selecte d Answer: B. Construct a timeline of the patient’s life • Question 29 1 out of 1 points • Question 30 1 out of 1 points • Question 31 1 out of 1 points • Question 32 0 out of 1 points • Question 33 1 out of 1 points The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy (CBT) strategy does the PMHNP employ? Selecte d Answer: B. Stress inoculation therapy The PMHNP is working with a patient who seems dissatisfied with the therapeutic relationship. The PMHNP invites the patient to discuss her feelings regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they are experiencing an alliance rupture. How does the PMHNP repair the therapeutic alliance? Selecte d Answer: D. All of the above Your patient is a 65-year-old male who has a strained relationship with his son and daughter. His children refuse to participate in a family session. The PMHNP asks the patient to draw his family genogram as a next step to . Selecte d Answer: C. Provide background information for the patient’s family structure The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach? Selecte d Answer: D. Suggesting that the patient start going to church to help find more solace. The PMHNP is caring for a patient with dissociated self-state that the PMHNP identifies as being associated with traumatic experiences in the patient’s past. What approach does the PMHNP use with the patient that is crucial to the psychodynamic therapy process? What is the most appropriate explanation for the reaction that the PMHNP is experiencing? Selected C. • Question 39 1 out of 1 points • Question 40 1 out of 1 points • Question 41 1 out of 1 points • Question 42 0 out of 1 points • Question 43 1 out of 1 points Answer: Concordant identification A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance? Selecte d Answer: D. All of the above A PMHNP is treating a 45-year-old female patient who is upset that her brother has not been calling since his divorce. When asked to describe her brother and what prompts him not to call as frequently, she says, “Everything is about him, not me. I think he’s jealous that I have a good marriage and he wants me to be unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based on this information, the PMHNP can conclude that the patient . Selecte d Answer: A. May lack ability to see independent motivations The PMHNP is working with a 56-year-old man who is being seen because of his anxiety and depression. During the therapy sessions, the PMHNP assists the patient in discussing his experiences and expanding on his thoughts and feelings. He tells the PMHNP stories about how he used to be teased by his coworkers at the office for becoming too anxious in large conference rooms. The PMHNP listens to the patient and helps focus on his strengths to promote self-understanding. Which principle best accounts for the PMHNP’s interactions with the patient? Selecte d Answer: A. Therapeutic communication During cognitive behavioral therapy (CBT), a 64-year-old male patient, states, “My wife hates me! She’s just waiting for me to die.” Using Socratic dialogue (SD) the PMHNP demonstrates understanding of analysis when she responds: Selecte d Answer: B. “Where is the evidence that your wife hates you?” A PMHNP is taking a history and wants to assess how the patient copes with adversity. To do so, the therapist asks questions about the patient’s belief system. What would be an appropriate question to ask? • Question 49 1 out of 1 points • Question 50 1 out of 1 points • Question 51 1 out of 1 points • Question 52 1 out of 1 points “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he’s had finding employment. True or false: If the patient’s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient confidentiality and not disclose information. Selecte d Answer: Tr ue e The PMHNP is caring for a patient who seems to seek affection and attention from the PMHNP and others in the clinic, as well as displays heightened emotional responses to feelings of being excluded. What therapeutic approach does the PMHNP use to decrease autonomic arousal in the patient? Selecte d Answer: C. A safe-place exercise The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept? Selecte d Answer: A. Counter transfer emcee The PMHNP is working with a patient who is living in poverty and abusing substances. According to the treatment hierarchy framework, what needs does the PMHNP need to attend to first? Selecte d Answer: A. Provide safety through case management strategies A PMHNP’s patients have already signed confidentiality agreements, including limits that will be imposed on confidentiality. Months later, the state’s laws have changed that affect confidentiality promises the PMHNP has already made. What is an appropriate step for the PMHNP to take after finding out this information? Selecte d Answer: D. All of the above • Question 53 1 out of 1 points • Question 54 1 out of 1 points • Question 55 1 out of 1 points • Question 56 1 out of 1 points • Question 57 1 out of 1 points A 41-year-old male patient is meeting with the PMHNP and reveals that he is homosexual. He begins telling the PMHNP about his feelings as a homosexual, middle-aged man. The PMHNP nods understandingly. Before long, the patient asks, “Are you gay? Are you married? Do you have kids?” What is the best response by the PMHNP? Selecte d Answer : B. Mention that the patient seems quite curious, and ask him to discuss more about himself The PMHNP is working with a 43-year-old male patient who develops idiosyncratic transference over weeks of therapy. The best way for the PMHNP to respond to this patient is to : Selecte d Answer: B. Use empathy A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I’d like to go back to school to do what you Do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments? Selecte d Answer: C. “You may want to explore the requirements for becoming a PMNHP.” The PMHNP is caring for a patient who has acute stress disorder after experiencing a traumatic event 1 week prior. The PMHNP wants to begin with a therapeutic framework that follows the adaptive information processing (AIP) model. What is the priority action for the PMHNP to take? Selecte d Answer: A. Focus on the patient’s safety and stabilization The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient’s intense emotional reactions? • Question 62 1 out of 1 points • Question 63 1 out of 1 points • Question 64 1 out of 1 points • Question 65 1 out of 1 points • Question 66 1 out of 1 points A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial? Selecte d Answer: C. Dialectical behavior therapy True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style. Selecte d Answer: Fall s e A 35-year-old patient has been seeking treatment for depression for several months. The PMHNP does an assessment to see if processing has led to adaptive change. The patient’s self-references are positive in relation to past events, work is productive, relationships are adaptive, and there is congruence between behavior, thoughts, and affect. Based on this information, the PMHNP decides the patient . Selecte d Answer: C. Is ready to move to Stage III, future visioning The PMHNP has been assisting a shy and timid 23-year-old male patient struggling with esteem and self-concept issues. Over the weekend, this patient was given the task of completing an exercise that would usually cause him distress and shame, also called a shame-attacking exercise. The PMHNP determines that this task has successfully been achieved when the patient states: Selecte d Answer: A. “I was able to eat in public yesterday despite how loudly I chew.” One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy? Selecte d Answer: B. “Restrict the amount of time you spend in bed.” • Question 67 1 out of 1 points • Question 68 0 out of 1 points • Question 69 1 out of 1 points • Question 70 1 out of 1 points • Question 71 1 out of 1 points During cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get so frustrated sometimes and I just blow up at everybody!” Which response by the PMHNP demonstrates translation of Socratic dialogue (SD)? Selecte d Answer : B. “When you say blow up, what exactly does blow up mean and how does it feel to you?” During a session, the PMHNP asks a patient with a history of sexual abuse to recall the relationship she had as a child with her parents. The patient responds by saying she has a headache and her stomach hurts, and starts talking about her physical ailments. What is the appropriate response by the PMHNP? Selecte d Answer: B. Explain why it is important for the patient to discuss these memories openly True or false: If after a third round of processing followed by stabilization, a patient has increased anxiety that requires further interventions aimed at stabilization, the therapeutic relationship can no longer successfully provide therapeutic change. Selecte d Answer: Fall s e The PMHNP is working with a patient who has insomnia and battles going to sleep. The patient reports consistent self-defeating behaviors, and hates trying to go to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical intervention? Selecte d Answer: B. Telling the patient to resist sleep and stay awake When conducting an initial assessment, a PMHNP has finished conducting a mental status examination with 10 minutes left in the session. The patient is distressed and would like to continue sharing her personal history. True or false: An appropriate response that the PMHNP might tell the that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, • Question 76 1 out of 1 points Withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which diagnosis is likely possible? Selecte d Answer: C. Borderline personality disorder The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle? Select ed d Answe r: D. Maintaining the frame 32. The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?