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NURS 6650 Midterm Exam – Question and Answers

1. While in a family therapy session, a wife comments, “Instead of spending time with me, he is usually watching sports on television.” Using an emotionally focused family therapy approach, what is an appropriate response by a PMHNP using an evocative question technique?
2. The PMHNP is discussing problem-solving techniques with a married couple. What recommendation will the PMHNP provide to the couple?
3. The PMHNP is providing family therapy to two parents and their twin 14-year-old children. The children become defiant around bedtime and are still working on their homework late into the night. How does the PMHNP employ an experiential technique of family sculpting?
4. The PMHNP is assessing a married couple who disclosed on the intake form that they are having intimacy issues. During the assessment, the PMHNP asks the couple what brings them in today. The wife is quick to answer, “My husband doesn’t listen to me anymore.” Using the Mental Research Institute (MRI) assessment technique, how does the PMHNP respond to this?
5. The PMHNP is working with a married couple in a family session setting. The wife reports feeling upset because her husband does not pay attention to her. Which statement made by the PMHNP will challenge the wife to see things differently? 
6. A man calls a PMHNP to set up an initial appointment for family therapy.  He explains, “My wife lost her job several months ago. She has been angry and less patient with the kids. All of the stress is taking a toll on me. I can’t focus at the office and I’m mentally exhausted at home.” Based on this phone contact, who would the PMHNP most likely choose to see for the first session?
7. During a family therapy session, a 10-year-old girl says to her father, “You are at work all the time and are never around.” What is the most appropriate response by the PMHNP to improve communication?
8. The PMHNP is working with a married couple who have agreed to seek sex therapy due to the wife’s gradual decrease in interest in sex. The wife explains that she feels as though she cannot feel comfortable naked and enjoying being intimate. The PMHNP recognizes that the couple could possibly benefit from sensate focus. To apply the sensate focus exercise, the PMHNP suggests the couple first do what?
9. The PMHNP is meeting with a husband and wife who have separated but are trying to rekindle the marriage. The PMHNP asks the couple what they hope to gain from the sessions, and they provide the PMHNP with vague answers. What can the PMHNP can ask the couple to help them create better defined goals?
10. The PMHNP is working with a family consisting of a father, a mother, and a daughter who is a sophomore in high school. The issue being discussed has to do with the daughter’s emotional outbursts about wanting to spend more time with her friends. Recently, the daughter blew up at the parents over the fact that they wouldn’t let her go to a party, since older kids from the school were throwing it. This outburst led to arguments in the household, which led to the daughter getting grounded for 2 weeks. Which theory does the PMHNP recognize as the most applicable?
11. The PMHNP is meeting with a married couple. The woman feels very insecure, particularly when it comes to her husband working with women in his office. She reports, “My girlfriends say that it’s not attractive to be insecure like I am, so I’m really making the problem worse by being so insecure.” How can the PMHNP externalize the woman’s problem?
12. The PMHNP is meeting with a set of parents and their 12-year-old son, who according to the parents is fearful of “nearly everything.” The son admits that he does not like to ride his bike, play with his friends, or participate in activities such as sports, in which he could hurt himself or become dirty. What does the PMHNP say to the son to personify the problem using externalizing conversation techniques?
13. The PMHNP is meeting with the parents of a school-aged girl. The mother reports feeling frustrated, because they cannot get their daughter to do her homework. “All she wants to do is play on her phone,” the father reports. The mother tells the PMHNP that they have tried threatening her by telling her that she won’t be able to have her friends over and that she won’t be allowed to watch TV. Which of the following responses made by the PMHNP demonstrates use of the Premack principle?
14. The PMHNP is meeting with two women, ages 35 and 42, who are concerned about their mother’s use of alcohol. During the meeting, what question(s) should the PMHNP ask the mother to help uncover the potential drinking problem?
15. The PMHNP is meeting with a mother and her 9-year-old child. The child is upset that the father left the house and hasn’t been back in a long time. Which action will the PMHNP perform to employ the role-playing technique with the child?
16. The PMHNP is meeting with a family that consists of a mother and father and their two daughters, ages 8 and 10. During the session, the PMHNP hears one child say, “My sister never gets into trouble because she’s the smart one.” Which family therapy theory is most applicable to this family?
17. The PMHNP is meeting with a married couple who have recently had a baby. The transition of becoming new parents has caused a lot of friction and tension in the household. The wife wishes the husband would help out at least once with the nighttime feedings so she can get more than 3 hours of sleep at night. The husband feels like this is an unfair request, because the wife no longer works, but she still asks the husband to do a lot of errands during the day. What does the PMHNP do to create a quid pro quo contract between the husband and wife?
18. The PMHNP meets with the parents of a 3-year-old boy, who was adopted at 6 months of age. The parents ask the PMHNP if he will see the child individually for therapy sessions on a weekly basis, based on the fact that the parents are having difficulty getting their son to listen to them. Which statement made by the PMHNP supports the systems theory approach to treatment?
19. The PMHNP is assessing a 19-year-old patient who reports feeling burdened and constrained by her family. “I feel like I can’t live my own life, and like I need their approval for everything I do,” she says during the assessment. Which response by the PMHNP supports the principles of family therapy?
20. The PMHNP has just completed an intake assessment on a 15-year-old patient and believes the patient would benefit from family therapy. How does the PMHNP describe the goals of the therapy to the patient and the patient’s parents?
21. A client in group therapy has been suffering from anxiety and is worried that she will have a panic attack again. Which of the following interventions demonstrates use of the principle of imparting knowledge?
22. The PMHNP meets with an older adult couple having marital problems. The husband and wife both admit to the PMHNP that it is difficult for them to speak to each other because of how much they disagree on things lately. The husband complains that the wife is always talking about their issues to their adult daughter. The wife reports that the husband does the same thing. Using the Bowen Family Systems Therapy model, what does the PMHNP interpret about this family dynamic?
23. The PMHNP is working with the parents of an 8-year-old. They are facing challenges with their daughter’s school because of her behavior toward other students. “Our daughter has become a problem,” they explain. Which statement(s) made by the PMHNP supports the use of the narrative therapy model?
24. The PMHNP is meeting with a single mother and her 19-year-old son who lives with her. The son complains that his mother is always nagging him. What is the PMHNP’s interpretation of this scenario according to a complementarity approach?
25. When using a cognitive behavioral approach, a PMHNP says to a group member, “Carla, it sounds like Greg thinks that you might want to try yoga for relaxation.” What would be an appropriate next statement by the PMHNP to Carla?
26. The PMHNP is performing an intake assessment on parents who had their son later in life. Since their son left for college 6 months ago, the couple reports arguing a lot and not getting along in general. When applying the theory of the family life cycle, what does the PMHNP say in response to this concern?
27. The PMHNP is meeting with a husband and wife and observes that the husband is able to maintain his composure while the wife becomes more teary and emotional throughout the session. Which principle is used to describe this observation?
28. A PMHNP is working with a mother and daughter to help them improve their communication skills. The mother explains that they have had numerous arguments caused by miscommunication lately. Using a structural family therapy approach, what is the appropriate response by the PMHNP?
29. During a family therapy session, the PMHNP identifies a significant amount of emotional fusion between the parents and their young adult son. The son admits that he tries to seek distance from his parents. This is why he moved out of state for college, though he still comes back to visit out of obligation. What does the PMHNP interpret about this scenario? 
30. The PMHNP is providing narrative therapy to a family. Although each family member assigns a “problem” to another, the PMHNP attempts to separate each person in the family from their problems. The goal is to find something they all have in common so the family can unite. What will the PMHNP do next to help facilitate this goal?
31. The PMHNP meets with a single mother and her son. The mother reports that the son is defiant when it comes to doing chores at home. “If he does not do his chores, then I don’t have a picture-perfect house, and I don’t feel like a good mother,” she explains. The PMHNP identifies this as a problem-saturated story. How does the PMHNP respond to the family?
32. The PMHNP is working with a family during their first therapy session. According to the Gestalt school of perception, what must the PMHNP do to change the group behavior?  
33. The PMHNP is meeting with a family composed of two parents and their two children. The PMHNP observes that the mother projects her concerns onto one of the children, and that child seems to conform to the parents’ way of thinking. The other child seems to be less involved in the family’s fusion. What action taken by the PMHNP demonstrates the use of the Bowen Family Systems Therapy model?
34. The PMHNP is meeting with an established patient who is trying to resolve issues between her and her husband. The woman convinces her husband to join her for this session. Using a solutions-focused approach, which of the following statements would be most appropriate for the PMHNP to make?
35. The PMHNP is meeting with a mother and her adult daughter, who report that they have had a hard time getting long. The adult daughter complains that her mother tells her what to do regarding her children, which puts strain on the adult daughter’s marriage. The mother denies this and explains that she is “only trying to help.” What does the PMHNP say to the mother or daughter to convey acceptance into this family?
36. A family is in therapy because they have been unable to resolve conflicts and are arguing frequently. When using a strategic family therapy approach, which of the following directives might the PMHNP suggest to create a sense of togetherness?
37. The PMHNP is assessing a family that consists of a mother and a father and their daughter Rachel. The family is discussing the issue of time management in the home, particularly involving the daughter’s extracurricular schedule. The mother asks, “Rachel, how many times has your father been late to pick you up from soccer?” What does the PMHNP take away from this interaction?
38. The PMHNP is working with a father and his teenage daughter. The father has full custody of his daughter as of recently. He reports that the two of them get into arguments all the time over curfew, chores, and the daughter’s lack of responsibility that “she gets from her mother.” The daughter feels like the father never listens to her. Which of the following actions taken by the PMHNP demonstrates unbalancing the relationship?
39. The PMHNP is working with a family in a group setting. When employing the experiential technique, what action will the PMHNP take with the family during the assessment?
40. The PMHNP is meeting with a family that consists of a husband, wife, and the wife’s mother and sister. The husband complains to the PMHNP that the way his mother-in-law and sister-in-law barge into their home whenever they want, without any warning, is becoming intrusive. He says, “Because, of course, everyone in the family has keys to our home.” Which pattern does the PMHNP identify in this family relationship?
41. The PMHNP is meeting with a single father and his adolescent daughter. They have been “butting heads” because of the daughter’s differing opinions about her curfew and social life. They haven’t been able to communicate well. The PMHNP tries an experiential technique of family drawing. What will the PMHNP have the father and daughter do for this technique?
42. The PMHNP is working with a patient who is sleep-deprived and depressed. Which of the following is an appropriate scaling question for the PMHNP to ask?
43. The PMHNP is working with the parents of an adolescent daughter. The parents complain that the daughter is misbehaving and having emotional outbursts on a nightly basis. However, the parents cannot agree on ways to discipline and deal with the daughter. This leads to arguments between them. What does the PMHNP do to support the strategic use of rituals?
44. The PMHNP is meeting with a mother and father for the first time in a family session. As soon as the session begins, the mother says, “I don’t know what to do anymore. Our son is flunking math. I think we should pull him out of football, but I don’t get any support in that decision. What would you do if you were us?” The PMHNP recognizes this as what?
45. The PMHNP is meeting with a family consisting of two parents and their 10-year-old son. The parents are concerned about the child’s behavior. “He keeps disobeying us. All he does is misbehave,” the mother cries. The PMHNP meets individually with the son for a few sessions to learn more about his behavior and identifies that he is participating in attention-seeking behaviors. When the PMHNP invites the parents and son back to a family group setting, what action made by the PMHNP supports the use of constructivism?
46. During the initial assessment of a newly married couple, the PMHNP learns that they decided to come to family therapy in order to address their communication problems. Which of the following actions taken by the PMHNP demonstrates the use of the solution-focused approach?
47. The PMHNP is working with a married couple who are having trouble communicating. The wife wants to ask for things from the husband, but she doesn’t want to be perceived as a nag. The husband wants to tell the wife that he needs alone time, but he doesn’t want to hurt her feelings. Which pretend technique can the PMHNP use with the couple?
48. The PMHNP is working with a family composed of two parents and their 16-year-old son. The parents report they have been experiencing conflict regarding the son’s defiant behavior in the home. Which action will the PMHNP employ as part of the early phase of the therapy?
49. The PMHNP wants to identify the unique outcomes of a married couple who are having arguments about finances. In particular, the wife is concerned about her husband splurging without consulting her. What question will the PMHNP ask to arrive at the unique outcomes?
50. A PMHNP is using a structural family therapy approach. During a family therapy session, a child says, “Is that what you really mean?” Tracking the phrase, the PMHNP discovers that the family often uses sarcasm when communicating. What is the appropriate next step by the PMHNP?
51. The PMHNP is working with parents who argue about ways to discipline their school-aged son. The PMHNP initiates enactment, telling the parents to discuss the disciplinary choices directly with each other. At what point does the PMHNP determine that the parents are demonstrating enmeshment?
52. Members of a therapy group have become aligned and are starting to take ownership of their group experience. They are sharing more and are being more open with each other. During the next session, the PMHNP decides to address termination of the group. Which of the following is the most appropriate response by the PMHNP when a group member expresses anxiety about termination?
53. During a family therapy session, the PMHNP hears the father say to the son, “You shouldn’t play video games where you shoot people.” According to the Bion school of thought, what is the content of the message that the father is trying to express?
54. The PMHNP is working with a single mother and her adolescent son. The mother reports to the PMHNP that all she wants is for her son to call her when he is going to be late to dinner, so that she doesn’t worry about where he is. The son explains that his mom is “too paranoid” and calls or texts him constantly throughout the day, even if it doesn’t have to do with his whereabouts. How can the PMHNP advise the mother and son to accommodate one another?
55. A couple and their 13-year-old daughter have been in family therapy. The mother explains that her daughter is unhappy at private school and would like to be in public school. The father has been listening quietly and then says, “We are upset that our daughter wants to leave private school.” When using a systemic family therapy approach, what is the appropriate response by the PMHNP to the father?
56. The PMHNP is meeting with a mother and her teenage daughter; they are having trouble getting along. The mother complains that the daughter is defiant and never listens or goes out whenever she wants to. The daughter complains that the mother is too strict and won’t let her see her friends. What does the PMHNP do to employ the use of the paradoxical intervention technique?
57. The PMHNP is working with a father and his son, who is 7 years old. According to the father, the son frequently experiences outbursts and poor impulse control. Using the differentiation of self-concept, what advice does the PMHNP offer the child?
58. During a family therapy session, the mother says, “I don’t know why my son is always in trouble at school. He does what he wants to do.” The father adds, “He’s almost 14 years old. It’s up to him to get his life in order.” What is the most appropriate intervention by the PMHNP?
59. The PMHNP is assessing a young husband and wife who just had their first baby. Ever since having the baby, the couple has been arguing more frequently, which the husband believes is the result of sleep deprivation. Also, the husband believes the wife has post-partum depression. Using the Bowen Family Systems Therapy model, what does the PMHNP do as part of the assessment? Select all that apply.
60. The PMHNP is leading a group session when a group member who is usually quiet angrily interrupts another group member. He then apologizes for his outburst and explains that he has been having a hard time since his only child left for college. Using a person-centered approach to group psychotherapy, which of the following is the most appropriate response by the PMHNP?
61. The PMHNP is working with 12-year-old twin sisters. Their parents report that the twins got into a big fight recently, which they haven’t been able to overcome. Which cognitive interaction can the PMHNP use to help the sisters gain a new perspective of the argument to help soften their own opinion of it?
62. The PMHNP is meeting with a family that consists of a mother, father, and son. The son reports, “Whenever Mom gets upset with Dad, she vents to me about it.” Which concept describes the mother’s behavior in this scenario?
63. The PMHNP is providing family therapy to a married couple having an issue with communication. Using the structural family model, what does the PMNHP have the couple do as part of enactment?
64. A PMHNP has integrated group treatment into his practice. After the orientation phase, group members have been exchanging ideas. One member says, “I think you should confront your son and ask why he is so disrespectful.” Another member responds by saying, “That is a terrible idea. If you confront him, he will just be angry with you.” The first member then replies, “You are not the expert here!” The rest of the group members then start taking sides as the debate continues. What step should the PMHNP take to help group development?
65. A group member realizes he gets anxious when making small talk and tends to talk only about himself. Using the principle of development of socializing techniques, what might the PMHNP recommend that the group do next?
66. The PMHNP meets with the parents of a 6-year-old; they are having a difficult time with their child’s behavior. The PMHNP aims to bring the family together and asks the parents to think about one of the challenging issues they face with their child. The PMHNP says, “Imagine this situation happening as a scene in a movie, one that you can rewind and watch again. Watch this scene again, this time paying attention to what you feel, what you see, and what you hear.” The parents are then asked to re-experience the same scene from the child’s point of view. Continuing to use Satir’s technique of the experiential model, what does the PMNHP have the parents do next?
67. A PMHNP learns that the family has been experiencing dysfunction because a mother and her teenage son have been getting easily annoyed and yelling at each other. When using a strategic family therapy approach, which directive should the PMHNP suggest to solve the problem?
68. The PMHNP works with a husband and a wife, but in separate sessions, to address marital issues. One day, the wife asks the PMHNP how her husband is progressing with his therapy. Which response made by the PMHNP is most appropriate?
69. The PMHNP is providing marital therapy to a husband and wife who have been married for 6 years. They are attending therapy sessions, because they both want to get their marriage back on track. They report that lately they have not been communicating well or meeting each other’s needs. What does the PMHNP suggest to the couple when applying a behavior exchange technique?
70. The PMHNP is working with a family that includes two parents and their two children. The PMHNP defined the problem and goal in a previous session. Today, the PMHNP wants to find out whether the family has experienced any attempted solutions. What does the PMHNP identify as an attempted solution that actually perpetuates the family problem?
71. The PMHNP is meeting with a woman and her 11-year-old child, who was a victim of sexual abuse. The offender is the child’s stepfather, who is currently in jail. What action does the PMHNP employ with the child and mother during the first session?
72. The PMHNP is meeting with parents who are having difficulty disciplining their child at home during his emotional and behavioral outbursts. The mother feels that the father is too strict but realizes that she is tired of getting “walked on” by their child. Which statement made by the PMHNP demonstrates the use of internal family systems therapy model?
73. Using a systemic family therapy approach, a PMHNP is meeting with a couple for an initial session and is asking each member to describe why he or she came to family therapy. After creating a genogram, the PMHNP says, “I can see that the men in your family are often the sole providers, and the women have been in charge of running the household.” Which is the most appropriate next response by the PMHNP?
74. Which of the following is an exception question that the PMHNP can ask when working with a patient who is having trouble managing stress at work?
75. During family therapy, a husband says to his spouse, “When you ignore me, I can’t help but shout.” Using an emotionally focused family therapy approach, the PMHNP comments to the husband, “You feel like you are invisible and need to be heard.” Why does the PMHNP make this comment?