• Question 1 When completing this exam, did you comply with Walden
University’s Code of Conduct including the expectations for academic integrity?
• Question 2 One member of a therapy group had been quiet for the first
several sessions. The member revealed to the other members feeling of
depression and emptiness. This week, the member was full of energy and talking
very quickly. The member became irritated with another member tried to
interrupt, started yelling, and then broke into a fit of laughter. Based on the
situation, what can the PMHNP determine about the member?
• Question 3 The PMHNP conducts a specialized individual interview with
a patient named Sandy. During this interview, Sandy expresses her want of the
other members to like her, and she has a deep dread for the first group
meeting. How does the PMHNP correctly interpret Sandy’s interpersonal
• Question 4 A PMHNP has been holding group therapy sessions for several
weeks and notices that a patient is timid and predictable in his or her
responses. When the patient does speak, he or she avoids saying anything to
contradict anyone in the group. Based on this information, what is an
appropriate question the PMHNP should ask herself?
• Question 5 When discussing the role of the consultant in the parenting
group session, Dr. Carlson explains that the consultant should use several
skills in order to help keep the group going and should enable group members to
become very engaged with one another. The consultant should use all of the
following skills to achieve this, except:
• Question 6 During an initial screening session, the PMHNP is
considering a patient for group therapy. The patient is recently divorced and
says he is lonely and depressed. What is the best referral by the PMHNP?
• Question 7 A PMHNP is leading a group therapy session for patients
with substance abuse problems. After a productive session in which all members
participated, the following week was not as productive. In order to help the
group members assume responsibility for evaluating the meeting, what is an
appropriate comment for the PMHNP to make?
• Question 8
Following the PMHNP’s
cancellation of a group session, he or she notices a decrease in compliance and
attendance within the group. What does the PMHNP identify as the group’s reason
The group did not expect to have time off, so it may take up to a month to get
back into a routine.
B. The group members may believe that the
group is not important to the PMHNP.
C. The PMHNP’s absence gave the members a
reason to also be absent.
D. The group members feel let down, because
the PMHNP cancelled a meeting.
• Question 9 A client has attended five group therapy sessions yet has
not engaged verbally with others in the group. The PMHNP has identified the
client as a “silent member.” Which statement is true about silent members as
related to group therapy?
• Question 10 For several months, a patient in group therapy always
participated in conversation but only shared positive stories about her own
life. During the next session, she finally confessed that she has been
depressed and cutting herself. What is the best response by the PMHNP?
• Question 11 A 14-year-old girl named Laura and her parents are meeting
with a PMHNP. The parents explain why they are there by saying, “Laura has been
unhappy since she moved to a new school. She has been moody and often talks
back to us.” Laura sits quietly and looks uncomfortable. Which is the best
response by the PMHNP?
• Question 12 Members of a therapy group have been meeting for several
weeks. While a member named Margaret is talking about how her spouse ignores
her when she tries to tell him what to do, another member named Nicole
interrupts and says, “Maybe he thinks you are being bossy.” Margaret replies by
saying, “At least I’m not an alcoholic like you are!” What is an appropriate
response by the PMHNP?
• Question 13 Group participation is an important aspect of how successful
group therapy will be. The PMHNP recognizes that the gender of group
participants can play a role in the likelihood of group participation. Which
statement about gender and group composition does the PMHNP take into account?
• Question 14 A patient has had a problem with substance use and has been
receiving treatment for addiction. Which additional step might the PMHMP
suggest to help the patient maintain abstinence from drugs during and after
• Question 15 Jane has been attending group therapy for the past year; she
and the therapist have determined that she has met her goals. Jane has been
arriving to group late or not coming to group at all. How does the PMHNP
correctly interpret Jane’s behavior?
• Question 16 Peter, a successful businessman, is introduced to the group
during the twelfth week. Following Peter’s introduction, Joseph, a long-term
member in the group, begins to lead the group and discuss all of the things
that he has personally accomplished. In what way does the PMHNP correctly interpret
Joseph’s behavior? D
• Question 17 When the counselor discussed assertiveness with the group
members, she began the session by providing definitions and asking group
members to line up consistent with where they feel they are currently in terms
of assertiveness. Why did she do this?
• Question 18
A 21-year-old client with
narcissistic traits is noted to continuously disrupt the group by speaking
while others are speaking. It becomes evident that the client is purposely
disrupting the group and decreasing the group’s productivity. What does the
PMHNP identify as a cause of the client’s behavior?
• Question 19 A narcissistic patient was unhappy that other members did not
seem concerned about his or her dating problems, which the patient spent half
the session talking about. The patient confronted the group by saying, “All of
you are rude and uncaring!” When group members ignored this comment, the
patient said, “And no one said anything nice about my new haircut either!” What
is an appropriate response by the PMHNP?
• Question 20
During a group session, a member
turns to the PMHNP and says, “I need some advice. My manager asked me to take
on an extra project, and now I’m overwhelmed. I don’t want to seem incompetent,
so I agreed to the extra work. What do you recommend I do?” What is the best
response by the PMHNP in order to shape group behavior?B
“I am sorry to hear you feel overwhelmed, and I have several suggestions
that you might find helpful.”
“Let’s ask the group what they think. Does anyone have feedback about this
C. “Before I give recommendations, please
explain why turning down the project might make you seem incompetent.”?
• Question 21 In a group therapy session for patients with anxiety
problems, a patient named Eve was afraid to disclose to the other members that
she was a victim of sexual abuse. She kept the secret for months, although she
hinted at it to other members. During a meeting, another member tried to
pressure Eve to disclose her secret, but she was flustered and not ready to
share. What is an appropriate response by the PMHNP?
• Question 22
A PMHNP is leading a group
therapy session for patients with substance abuse problems. After one member
shares a problem, other members offer support, concern, and observations. The
PMHNP points out that the group is offering many truthful reactions and helpful
feedback. Which principle does this illustrate?
• Question 23 During an initial meeting, a PMHNP spends time speaking with
a patient who suffers from social anxiety. The therapist finds the patient
extremely loud and overbearing. The PMHNP’s negative feelings continue no
matter how hard he or she tries to feel differently toward the patient. What is
the most appropriate next step by the PMHNP?
• Question 24
The PMHNP recognizes that
hostility is unavoidable in a group and acknowledges that a frequent source of
hostility can be parataxic distortions. Which situation is likely to present a
parataxic distortion within the group?
• Question 25 During the “mid-group debrief” the clinical supervisor
focused on the following areas with the two counselors except:
• Question 26 Harold Wyman is a 74-year-old man who is trying to mend a
relationship with his adult daughter. Based on his intake assessment, the PMHNP
believes that the father has depression. The daughter and Harold meet with the
PMNHP, and the daughter explains that her father always appears mopey and
withdrawn and refuses to do anything about it. When asked, the father reports
feeling sad all the time. Which action will the PMNHP employ with Harold using
the interpersonal psychotherapy approach throughout the various sessions?
• Question 27 A patient who has been depressed is seeing a PMHNP for
individual therapy. The patient explains that he has been avoiding most social
activities for the past few months. He is divorced and has joint custody of his
10-year-old daughter. Based on this information, what recommendation by the
PMHNP would most benefit the patient?
• Question 28 The PMHNP explains during a discussion that subgrouping has
the potential to make group therapy more complicated and less rewarding. Tara,
a member of the group, angrily states, “Well, Jack and I have been meeting
outside of the group for weeks now.” What is the PMHNP’s most appropriate
• Question 29
Members of group therapy have
been meeting for several weeks. The PMHNP often starts sentences with a thank
you or compliment such as, “Good observation.” The PMHNP notices that some of
the group members having been starting their statements with compliments. To
which principle can the PMHNP attribute this process?
• Question 30 Many key principles assist with composing intensive
interactional psychotherapy groups. When composing a psychotherapy group,
utilizing the intensive interactional approach, which key principle does the PMHNP
identify as being false?
• Question 31 Members of a therapy group have been meeting for several
months. During group therapy, a patient is bossy and controlling. During this week’s
session, she is confronted by another group member about her behavior and
replies, “This is not how I normally act. You are not my family and friends. I
don’t act the same way around them.” What can the PMHNP deduce from her
• Question 32
The PMHNP is meeting with an
older married couple. The couple reports having concerns about becoming
dependent on their adult children someday, since several of their other friends
have had to move in with their kids. They make it clear to the PMHNP that they
aren’t keen on therapy or taking medicine but would be willing to try some
alternative therapies. What does the PMHNP suggest for evidence-based CAM modalities?
• Question 33 The PMHNP understands that conflicts within the psychotherapy
group can be troublesome for clients and have the potential to reduce the
effectiveness of the group process. As it pertains to group meetings, the PMHNP
understands which statement to be true about conflict?
• Question 34 During a group therapy session, a member comments that
another member named Ted had no compassion. Ted replies, “Why does it matter if
I care one way or another. I can’t solve their problems.” The other member
starts crying and blames Ted for this. He shrugs and answers, “I don’t
understand why you are crying.” Based on this information, what is the most
likely determination the PMHNP can make about Ted?
• Question 35
During a first group therapy
session, a member is outgoing and participates actively. Based on this
information, what is an appropriate prediction about this group member by the
• Question 36
A PMHNP has a therapy group in
which many members have been dropping out over the past several weeks. Members
have complained that they do not feel part of the group. What is an appropriate
step for the PMHNP to take?
• Question 37
A PNHNP is holding a group
therapy session for a father and his 10-year-old son, whom the father explains
has been acting out lately. The son says, “He is always telling me what to do
and never listens when I have an idea.” Which solution would the PMHNP most
likely suggest as an approach to the problem?
B. Intrapersonal skills training
C. Psychological testing
D. Individual therapy
• Question 38
A patient has attended three
group therapy sessions and has remained silent throughout each. The patient
has, however, been listening to the other members. When the therapist makes eye
contact with the patient, he or she forces a smile but has clenched fists. What
is the most appropriate response by the PMHNP to help the patient? A
“Your clenched fists indicate that you might be tense or angry about
B. “If you do not feel comfortable
speaking, I think it would be best if you just listen.”
C. “Today, we are all going to focus on
what you want to get out of group therapy.”?
D. “Since it is our fourth therapy
session, I expect everyone to join in the conversation.”
• Question 39 A member in group therapy named Tom asked others for
suggestions to a problem he was having. He did not think a suggestion by a
member named Steve would work, and for the rest of session, the group took
sides arguing why the idea would work or would not work. The session ended with
Tom agreeing to try the suggestion and report back to the group the following
week. Based on this session, what is an appropriate step by the PMHNP?B
• Question 40
A patient named Tyrone was
nervous sharing personal information with the group. To compensate, he makes
comments on other members’ problems as if he were the therapist. Another member
of the group asked him, “Do you think you’re better than everyone here?” What
might the PMHNP help Tyrone gain from this exchange?
• Question 41
A patient in group therapy
discloses her concern about feeling suicidal again in the future. Using the
principle of universality, what is an appropriate step by the PMHNP?
• Question 42 In the parent consultation session, the parent discusses her
son “Blake” who has changed since his 13th birthday. Dr. Carlson discusses the
power conflict that the parent appears to be getting into with her son. When
they discuss approaches they can use to help Blake experience increased
responsibility, Dr. Carlson explains that the parent must make a commitment
with her son by agreeing to:
• Question 43
A patient in group therapy,
Monique, describes another member, Anna, as bossy and selfish; however, the
PMHNP does not notice this behavior at all. In addition, other members have
expressed how thoughtful and caring Anna is to them. Based on this information,
what is an appropriate observation by the PMHNP?
• Question 44
During a group therapy session,
a member shares that she often feels lonely and depressed. She has been turning
down invitations to spend time with friends lately, because she does not want
to leave the house. What is an appropriate step for the PMHNP to take?
• Question 45
The social microcosm theory is a
theory that relates to group composition. In accordance with this theory, the
PMHNP is aware that the group must consist of which of the following?
• Question 46
A client is observed discussing
many problems and complaints during group therapy. However, when other group
members attempt to offer advice, the client does not accept it. Based on this
observation, what can the PMHNP determine about the client?
• Question 47
The PMHNP is meeting with an
adult woman and her father, who is 85 years old. The father stays quiet most of
the session. The daughter explains he is mad at her for “bringing him to a see
a shrink.” The daughter reports that things have been tense in the house since
her father moved in. The father has a history of depression, though he does not
take any medication for it. In addition, lately the father seems to never
sleep. “I hear him rummaging around in the kitchen, the garage, the living
room, at all hours of the night. Sometimes he’ll nap during the day, but not
much. This is putting a strain on my marriage, because my husband can’t sleep
with all of this going on.” Which therapeutic approach does the PMHNP identify
as most appropriate for the 85-year-old father?
• Question 48
A patient in group therapy named
Ted shares personal information for the first time. He seems nervous but
continues to talk. How might the PMHNP use nonverbal positive reinforcement to
support Ted’s feeling more comfortable?
• Question 49
A 36-year-old client attends
group therapy regularly but is consistently tardy. The client explains that job
and family obligations interfere with attendance to the group. What is the most
appropriate intervention by the PMHNP?
• Question 50
group member who suffers from depression and anxiety says during the session,
“I don’t see how any of this is going to help. I am still too anxious to leave
the house and do the things I want to do.” What is an appropriate response by
• Question 51 A PMHNP is putting together a heterogeneous, interactional
therapy group. During an initial screening, a patient explains that he is
unemployed because he keeps getting fired from new jobs after several months.
The therapist asks, “Why do you think those companies let you go?” The
patient’s reply is, “Those companies are all terrible. They don’t know how to
treat employees.” After asking the patient if he thought about his role in
getting fired, the patient says, “Why should I? I am not part of the problem.”
Based on this information, what is an appropriate observation by the PMHNP?
• Question 52
One group member is identified
by the PMHNP as the monopolist of the group. Which behavior does the PMHNP believe
this member is most likely to display?
• Question 53 The PMHNP provides cognitive behavioral therapy (CBT) to an
older adult patient with depression. The patient’s 41-year-old daughter and
32-year-old son attend one of his sessions with the PMHNP so that they can
learn more about how to help their father. What does the PMHNP say to the
daughter and son about the goals of their father’s CBT?
• Question 54
In a group therapy session for
adolescents, a 15-year-old patient says he has trouble making conversation with
people he does not know well. Based on the principle of development of
socializing techniques, what explicit approach might the PMHNP take?
• Question 55 A PMHNP is treating a 7-year-old child exhibiting signs of
aggression and attention problems. Before suggesting an intervention using a
common elements approach, what may the PMHNP consider?
• Question 56 A PMHNP is meeting with the mother of a 10-year-old boy named
Malik, who has been depressed since his parents’ divorce. The mother explains
that her goal for treatment is to help Malik feel better so he can become his
“usual outgoing self.” She insists that she does not want him on medication.
Which is the best response by the PMHNP?
• Question 57 A PNHNP is holding a group therapy session. Today, several
members have expressed fears about being unlovable. Based on this information,
what is an appropriate step by the PMHNP to raise the members’ self-esteem?
• Question 58 During an initial meeting, a patient who has been discussing
suicide says to the PMHNP, “I’m so depressed that I don’t want to leave my
house. All I want to do is stay in bed.”
type of therapy would the PMHNP most likely recommend to this patient?
• Question 59 During his second group therapy session, a member, who was
quiet the previous week, becomes very judgmental. He criticizes another member by
saying, “Mary, you are always late because you don’t respect our group.” Then
he adds, “In fact, all of you are disrespectful and uncaring.” What is an appropriate
step by the PMHNP?
• Question 60 A PMHNP notices that adolescents in a therapy group have not
been getting along. They are divided into two main groups and each
automatically dislikes members of the other group. What is an appropriate step
for the PMHNP to take?
• Question 61 A PMHNP is treating an 8-year-old child who was at a cousin’s
house during a domestic violence situation. Using a common factors model, the
PMHNP wants to pay attention to cultivating the relationship with the parents
and child. After the child talks about how nervous he or she has been since
witnessing the trauma, what is an appropriate response by the PMHNP?
• Question 62
A client diagnosed with
depression has begun to feel despair and expresses a desire to leave the group
because he or she does not believe it is helpful. Which action by the PMHNP
will most likely contribute to the client staying in the group?
• Question 63
A PMHNP is treating a patient in
individual therapy and thinks the patient may be a good candidate for group
therapy. The patient is motivated to start group therapy, which meets twice a
month. Then the patient adds, “I can come to the first two meetings, but then
will be away on business for at least a month, maybe longer. But then I can
come to the at least one meeting before my next trip.” Based on this
information, what is the most likely recommendation by the PMHNP? B
• Question 64
During therapy, a patient named
Maria states she is unhappy that other members did not express missing her
while she was away the previous week. She confronted the PMHNP by saying,
“Nobody here cares about this stupid group!” What might the PMHNP say to increase
• Question 65
A PMHNP is meeting with parents and their 10-year-old child. The child is having trouble paying attention at
school and has been getting easily frustrated at home when doing homework,
which often results in everyone arguing. What step might the PMHNP take as part
of a family-centered, solution-oriented approach?
• Question 66
A PMHNP is creating a therapy group and is including a patient with borderline personality disorder. Which
action would most likely reduce the patient’s chance of separation anxiety?
• Question 67
When forming a group for
therapy, which action would the PMHNP likely take as a predictor for group
• Question 68
The PMHNP is working with an older adult woman and her adult children. The children report that the mother was diagnosed with dementia, and they are all concerned about her welfare. The
plan is for the mother to move in with one of the children, but they are still
worried about how the mother will manage during the day when she is left alone.
What does the PMHNP identify as the
focus of the family therapy?
• Question 69
Gregory is a middle-aged veteran participant in a group led by the PMHNP. Since Gregory has been attending group, he frequently interrupts others and seems to take much of the group time
for himself. The PMHNP identifies Gregory as a monopolist and confronts him.
She explains that she does not want him to talk less; instead, she actually
encourages him to talk more. What is the likely cause of the PMHNP’s
• Question 70
Two PMHNPs are in charge of a therapy group that has experienced several maladaptive interpersonal dramas lately. One of the patients has been described by other members as
argumentative. After a particularly awkward session, one of the therapists
feels that his own interpersonal distortion of the session may be clouding his
observation. What is an appropriate step by that PMHNP?
• Question 71
A patient in group therapy for
people dealing with panic disorder is describing a recent panic attack. He
says, “During this attack, I felt like I was dying.” What is an appropriate
response by the PMHNP using didactic instruction?
• Question 72
The PMHNP is meeting with a
married couple. The husband is 81 years old, and the wife is 78 years old. They
tell the PMHNP that many of their friends have passed away over the last couple
of years, and it’s making them feel sentimental about their lives and the fact
that they are getting older. Hearing this, the PMHNP uses a life review
approach with the couple. What action will the PMHNP employ?
• Question 73
During the first group meeting,
a client states, “I am here because I am very shy. I don’t mesh well with
others and I rarely get invitations to go anywhere.” Which statement about the
client’s reason for seeking help and treatment best applies?
• Question 74
According to Dr. Carlson, since
Adler talked about how the social setting in which we live influences our
lives, the best way parents can change their children’s behavior is to change:
• Question 75
Self-disclosure is a very
important part of group therapy. Which of the following conditions does the
PMHNP identify in his or her own life as a possible hindrance to
• Question 76 The leader begins a group meeting by doing the “names
activity.” At the completion of the activity, the leader explains that the
activity is useful for all of the following reasons, except: