Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state.
Does Psychotherapy Have a Biological Basis?
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis.
Learning Objectives
Students will:
Evaluate biological basis of psychotherapy treatments
Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments
To prepare:
Review this week’s Learning Resources.
Reflect on foundational concepts of psychotherapy.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.
NRNP6640 Psychotherapy With Individuals
Week 2 Discussion
Assessment Tools
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
Learning Objectives
Students will:
Analyze psychometric properties of assessment tools
Evaluate appropriate use of assessment tools in psychotherapy
Compare assessment tools used in psychotherapy
Note: By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
Consider the assessment tool assigned to you by the Course Instructor.
Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by comparing your assessment tool to theirs.
NRNP6640 Psychotherapy With Individuals
Week 5 Discussion
Posttraumatic Stress Disorder
It is estimated that more than 6% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Center for PTSD, 2010). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to substance abuse issues and even physical ailments. For this Discussion, as you examine the Thompson Family Case Study in this week’s Learning Resources, consider how you might assess and treat clients presenting with PTSD.
Learning Objectives
Students will:
Assess clients presenting with posttraumatic stress disorder
Analyze therapeutic approaches for treating clients presenting with posttraumatic stress disorder
Evaluate outcomes for clients with posttraumatic stress disorder
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
View the media Academic Year in Residence: Thompson Family Case Study, and assess the client in the case study.
For guidance on assessing the client, refer to pages 137–142 of the Wheeler text in this week’s Learning Resources.
Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post on or before Day 3 an explanation of your observations of the client William in Thompson Family Case Study, including behaviors that align to the PTSD criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.
NRNP6640 Psychotherapy With Individuals
Week 8 Discussion
Comparing Existential-Humanistic Therapy to Other Types of Therapy
Understanding the strengths of each type of therapy and which type of therapy is most appropriate for each client is an essential skill of the Psychiatric Mental Health Nurse Practitioner. In this Discussion, you will compare Existential-Humanistic therapy to a therapy you select from the previous weeks of this course. You will identify the strengths and challenges of each and describe a fictional client that you think is best suited for each.
Learning Objectives
Students will:
Compare types of psychotherapy
To prepare:
Review this week’s Learning Resources
Review this week’s media and consider the insights provided.
Review the other types of psychotherapy presented in this course and select the one that resonates with you the most at this time
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post a summary of the psychotherapy that you selected and explain why it resonates with you the most at this time. Then compare the psychotherapy you selected with existential-humanistic therapy. What are the strengths and challenges of each type of psychotherapy? Describe a fictional client that you think would be best suited for the therapy you selected and one fictional client you think would be best suited for existential-humanistic therapy. Explain why.
By Day 6
Respond to at least two of your colleagues by providing feedback based on an existential-humanistic therapeutic perspective. Support your feedback with evidence-based literature.
NRNP6640 Psychotherapy With Individuals
Week 9 Discussion
Counseling Adolescents
The adolescent population is often referred to as “young adults,” but in some ways, this is a misrepresentation. Adolescents are not children, but they are not yet adults either. This transition from childhood to adulthood often poses many unique challenges to working with adolescent clients, particularly in terms of disruptive behavior. In your role, you must overcome these behaviors to effectively counsel clients. For this Discussion, as you examine the Disruptive Behaviors media in this week’s Learning Resources, consider how you might assess and treat adolescent clients presenting with disruptive behavior.
Learning Objectives
Students will:
Assess clients presenting with disruptive behavior
Analyze therapeutic approaches for treating clients presenting with disruptive behavior
Evaluate outcomes for clients presenting with disruptive behavior
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
View the media, Disruptive Behaviors. Select one of the four case studies and assess the client.
For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.
Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.
NRNP6640 Psychotherapy With Individuals
Week 10 Discussion
Therapy with Older Adults
Clients who are older have often times been dealing with their mental health disorder their entire lives, whiles other disorders may be brought on through the aging process or the trauma of losing a lifelong partner. Treatment can be challenging for both the client and the therapist. For this Discussion, you will focus on therapeutic approaches for an older adult presented in a case study.
Learning Objectives
Students will:
Assess clients presenting with depression
Analyze therapeutic approaches for treating clients presenting with depression
Evaluate outcomes for clients presenting with depression
To prepare:·
Download and review the Week 10: Case Study from this week’s Learning Resources.
Review this week’s Learning Resources and reflect on the insights they provide.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:
Which diagnosis should be considered?
What is the DSM-V Coding for the diagnosis you are considering?
What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
What tests or tools should be considered to help identify the correct diagnosis?
What differential diagnosis should be considered?
What Treatment Strategy would you recommend?
What treatment would you prescribe and what is the rationale?
Safety
Psychopharmacology
Diagnostic Tests
Psychotherapy
Psychoeducation
What standard guidelines would you use to treat or assess this patient?
Clinical Note: Is depression a normal part of aging?
Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature.
NRNP6640 Psychotherapy With Individuals
Week 11 Discussion
Therapy for Clients With Personality Disorders
Clients with personality disorders often find it difficult to overcome their problems and function in daily life. Even when these clients are aware that they have a dysfunction with their personality and are open to counseling, treatment can be challenging for both the client and the therapist. For this Discussion, as you examine personality disorders, consider therapeutic approaches you might use with clients.
Learning Objectives
Students will:
Analyze therapeutic approaches to treating clients with personality disorders
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
Select one of the personality disorders from the DSM-5.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post a description of the personality disorder you selected. Explain a therapeutic approach (including psychotropic medications if appropriate) you might use to treat a client presenting with this disorder, including how you would share your diagnosis of this disorder to the client in order to avoid damaging the therapeutic relationship. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.
NRNP6640 Psychotherapy With Individuals
Week 3 Assignment
Applying Current Literature to Clinical Practice
Literature in psychotherapy differs from other areas of clinical practice. Generally, there are no clinical trials in psychotherapy because it is often neither appropriate nor ethical to have controls in psychotherapy research. This sometimes makes it more difficult to translate research findings into practice. In your role, however, you must be able to synthesize current literature and apply it to your own clients. For this Assignment, you begin practicing this skill by examining current literature on psychodynamic therapy and considering how it might translate into your own clinical practice.
Learning Objectives
Students will:
Evaluate the application of current literature to clinical practice
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
Select one of the psychodynamic therapy articles from the Learning Resources to evaluate for this Assignment.
Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.
The Assignment
In a 5- to 10-slide PowerPoint presentation, address the following:
Provide an overview of the article you selected.
What population is under consideration?
What was the specific intervention that was used? Is this a new intervention or one that was already used?
What were the author’s claims?
Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?
Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Support your position with evidence-based literature.
Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6640 Psychotherapy With Individuals
Week 4 Assignment
Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory
While cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) have many similarities, they are distinctly different therapeutic approaches. When assessing clients and selecting one of these therapies, you must recognize the importance of not only selecting the one that is best for the client, but also the approach that most aligns to your own skill set. For this Assignment, as you examine the similarities and differences between CBT and REBT, consider which therapeutic approach you might use with your clients.
Learning Objectives
Students will:
Compare cognitive behavioral therapy and rational emotive behavioral therapy
Recommend cognitive behavioral therapies for clients
To prepare:
Review the media in this week’s Learning Resources.
Reflect on the various forms of cognitive behavioral therapy.
The Assignment
In a 1- to 2-page paper, address the following:
Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.
Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.
Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature.
Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6640 Psychotherapy With Individuals
Week 6 Assignment
Assessing Clients With Addictive Disorders
Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.
Learning Objectives
Students will:
Assess clients presenting with addictive disorders
Analyze therapeutic approaches for treating clients with addictive disorders
Evaluate outcomes for clients with addictive disorders
To prepare:
Review this week’s Learning Resources and consider the insights they provide.
Review the Levy Family video Episodes 1 through 5.
The Assignment
In a 2- to 3-page paper, address the following:
After watching Episode 1, describe:
What is Mr. Levy’s perception of the problem?
What is Mrs. Levy’s perception of the problem?
What can be some of the implications of the problem on the family as a whole?
After watching Episode 2, describe:
What did you think of Mr. Levy’s social worker’s ideas?
What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?
After watching Episode 3, discuss the following:
What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?
Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
Discuss how you would have responded to this revelation.
Describe how this information would inform your therapeutic approach. What would you say/do next?
In Episode 5, Mr. Levy’s therapist is having issues with his story.
Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
Support your approach with evidence-based literature.
Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK6Assgn+last name+first initial.(extension)” as the name.
Click the Week 6 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 6 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6640 Psychotherapy With Individuals
Week 7 Assignment
Supportive Psychotherapy Versus Interpersonal Psychotherapy
Although supportive psychotherapy and interpersonal psychotherapy share some similarities, these therapeutic approaches have many differences. When assessing clients and selecting therapies, it is important to recognize these differences and how they may impact your clients. For this Assignment, as you compare supportive and interpersonal psychotherapy, consider which therapeutic approach you might use with your clients.
Learning Objectives
Students will:
Compare supportive psychotherapy and interpersonal psychotherapy
Recommend therapeutic approaches for clients presenting for psychotherapy
To prepare:
Review the media in this week’s Learning Resources.
Reflect on supportive and interpersonal psychotherapeutic approaches.
The Assignment
In a 1- to 2-page paper, address the following:
Briefly describe how supportive and interpersonal psychotherapies are similar.
Explain at least three differences between these therapies. Include how these differences might impact your practice as a mental health counselor.
Explain which therapeutic approach you might use with clients and why. Support your approach with evidence-based literature.
Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://academicguides.waldenu.edu/writingcenter/templates ). All papers submitted must use this formatting.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
NRNP6640 Psychotherapy With Individuals
MIDTERM EXAM
Question 1The 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?
Question 2A 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?
Question 3A middle-aged man who works over 50 hours a week is being seen for depression and anger management. He states, “I am even more frustrated when I come home and my wife wants to argue about stupid stuff. All I want to do is come home, take a shower, and eat. Is that too much to ask?” The PMHNP explains that people can be assertive, aggressive, and passive. She encourages the patient to be more assertive and begins role-play with assertive training. The PMHNP determines that the patient is beginning to understand when he states:
Question 4The 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?
Question 5A 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?
Question 6A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development?
Question 7The 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?
Question 8The 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:
Question 9When 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 patient is, “I understand that you are upset. [Summarizes diagnosis, treatment recommendations, and follow-up plan.] We can continue the conversation next week. How does this time next Monday work for you?”
Question 10A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance?
Question 11In your office, you see a 58-year-old patient with PTSD who reports having nightmares, making it impossible for her to sleep. What recommendations based on principles of sleep hygiene will the PMHNP make?
Question 12A 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 ____________.
Question 13During a clinical assessment of a 15-year-old patient, the PMHNP asks, “How can I help you?” The patient answers by saying, “Honestly, I don’t really think I need any help.” Which of the following is the most appropriate response by the PMHNP?
Question 14A 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 _________.
Question 15A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing _____________.
Question 16The PMHNP employs psychodynamic psychotherapy with a patient who experiences anxiety and depression. As the process enters the psychoanalytic end of the psychodynamic continuum, the PMNHP will focus on:
Question 17The PMHNP has a session with a patient who was injured and traumatized from an explosion at the industrial plant where he used to work. During the session, an outside noise startles the patient and he experiences a flashback of the loud boom from the explosion. The PMHNP witnesses the patient present with anxiety and belabored breathing. What is the appropriate action of the PMHNP?
Question 18The 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?
Question 19At the initial interview with a patient, the PMHNP reviews the condition of receiving services, including limits that will be imposed on confidentiality. During the discussion, the patient shares information that the PMHNP is legally required to report.
True or false: If the PMHNP does not report information that s/he is legally required to report, state laws govern the consequences which include penalties for not reporting, especially child and elder abuse.
Question 20A 16-year-old female patient has had a stable therapeutic relationship with the PMHNP for several months. The PMHNP notices what appears to be fresh cigarette burns on the patient’s arm. When asked, the patient admits to this self-injurious behavior. Although the patient is still depressed, her mood seems to be somewhat better this week. True or false: The PMHNP would most likely consider this patient stabilized and ready to move to Stage II.
Question 21The PMHNP is meeting with a 42-year-old man with depression brought on by the recent passing of his wife. As he describes the circumstances surrounding his late wife’s death, the PMHNP begins to feel sad. The sadness lingers for several hours, and the PMHNP finds it difficult to focus on other patients for the rest of the day. What is the most appropriate explanation for the reaction that the PMHNP is experiencing?
Question 22A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative?
Question 23The 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?
Question 24A 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:
Question 25The 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?
Question 26The 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?
Question 27The 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?
Question 28The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points:
Question 29A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors. By creating a presence of acceptance and using good listening skills, the PMHNP’s overall goal is to __________.
Question 30When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
Question 31A PMHNP is preparing confidentiality forms for his patients. What is the most appropriate first step he should take?
Question 32A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “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.
Question 33The PMHNP is treating a 35-year-old male officer in the military. He discloses that both of his parents are deceased and that he loved them. However, he says that he had feelings of inadequacy because his parents held him to a standard that he could never achieve. He went on to say that nothing he did ever felt good enough. The PMHNP assesses that this patient has perfect creases in his uniform with no strings or tags out of place; she also notices that he has perfect posture and questions him about ritualistic behaviors. She suspects that this patient has maladaptive responses to the expectations placed on him as a teenager and young adult. Which statements made by the patient would verify the PMHNP’s suspicion?
Question 34The 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 months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis and understands that which therapeutic approach will be the most effective as a first-line treatment modality?
Question 35The 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?
Question 36The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient’s need to use the elevator. What is the PMHNP’s best plan of action?
Question 37The 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:
Question 38The PMHNP is working with a patient who witnessed her father pass away after suffering for several months from terminal cancer. The PMHNP sees this as a traumatic event. The patient reports sometimes feeling out of touch with surroundings; almost as if things feel like a dream. “Sometimes that sensation lingers for a while,” the patient says, “and other times I snap out of it quickly.” What does the PMHNP infer about the condition based on psychotherapy concepts for trauma?
Question 39An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment.
True or false: After speaking with the patient, an appropriate screening tool for the PMHNP to use would be the Geriatric Depression Scale.
Question 40When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion?
Question 41During 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:
Question 42The patient attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not make any progress mitigating nightmares and hyperarousal. Which behavioral strategy does the PMHNP suggest next?
Question 43An 11-year-old patient has been exhibiting low self-esteem at school and acting out. According to Maslow’s hierarchy of needs, which of the following questions would best be addressed first by the PMHNP?
Question 44The 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?
Question 45A 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?
Question 46The 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?
Question 47After 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:
Question 48An 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?
Question 49One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy?
Question 50A 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?
Question 51A 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 __________.
Question 52A 65-year-old patient has suffered the loss of his wife. He is in a state of hyperarousal with increased sympathetic nervous system arousal. One or more interventions may help the patient to deal with this arousal. To decrease sympathetic nervous system arousal, the PMHNP’s treatment strategy is ___________.
Question 53The 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?
Question 54The PMHNP is having a therapy session with Charlotte, a 20-year-old victim of date rape. The patient states, “I shouldn’t have been there; I should have just gone home. This was all my fault; how could I have been so stupid?” Using the Socratic method, what is the PMHNP’s best response?
Question 55The 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 the therapeutic relationship, the PMNHP:
Question 56The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model?
Question 57During 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?
Question 58During a therapy session with an 18-year-old female the PMHNP learns 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, 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?
Question 59During 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)?
Question 60True 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.
Question 61You 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?
Question 62The 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?
Question 63A 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 64The 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 ___________ :
Question 65A 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?
Question 66True 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.
Question 67The 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:
Question 68The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with the child to continue making therapeutic progress?
Question 69Your 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 _______________.
Question 70The 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 71The PMHNP is working with a patient who experiences anxiety around her parents that later leads to poor impulse control. What will the PMHNP do to employ psychodynamic psychotherapy properly for this patient?
Question 72The 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?
Question 73When 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?
Question 74The 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?
Question 75During a therapy session the patient is asked how she currently deals with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by asking how well this has been working out for her. The patient states, “Well, to be honest, it just feels like I’m drowning, you know what I mean.” Illustrating idiosyncratic meaning, the PMHNP responds with:
Question 76The 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?
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