A 21-year-old client with narcissistic traits is noted to continuously disrupt the group

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?

A. The client has a fear of losing his or her identity. B. The client prefers one-to-one interactions.

C. The client wants to be the leader of the group. D. The client lacks effective communication skills.

Question 2

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?

A. Stop the conversation and intervene

B. Ask Nicole how she feels about the incident

C. Remind members about important group norms D. All of the above

Question 3

During the “mid-group debrief” the clinical supervisor focused on the following areas with the two counselors except:

A. What they did well in engaging the group members.

B. The mistakes that they made in the group and how they can fix them.

C. Observations on how the group members overcame uncertainty with activities. D. Feedback from each of the counselors who participated in the group.

Question 4

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?

1. Peggy, a 54-year-old woman, acting as a surrogate to Susan, who is a younger and newer member of the group
2. Jerry, a Mexican medical doctor who denies his heritage and Carlos, a proud Mexican warehouse employee
3. Spencer, a Caucasian politician with a history of substance abuse, and a Caucasian therapist
4. A successful entrepreneur and an aspiring spoken-word poet

Question 5

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?

A. Role-playing exercises

B. Intrapersonal skills training C. Psychological testing

D. Individual therapy

Question 6

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?

1. Helping the patient and children understand the skills for daily living
2. Educating the patient and children about how to maintain a meaningful relationship
3. Teaching the patient and children concrete suggestions for managing anxiety related to dementia
4. A and B

Question 7

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?

A. “Would other members please share your experiences?”

B. “I’m going to discuss the physiological cause of panic attacks.”

C. “I would like to ask everyone to keep a journal of their panic attacks.” D. All of the above

Question 8

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:

A. Addressing structure by being clear about what the group will and will not do

B. Establishing links with the commonalities shared by group members

C. Achieving the pre-determined agenda by manipulating questions and session content D. Helping others see that they are not alone and that others may share their concerns

Question 9

The anticipation of the first meeting among psychotherapy group attendees may cause feelings of dread and uneasiness among clients. How does the PMHNP demonstrate awareness and promote the success of this first psychotherapy meeting?

A. By conducting a standardized evaluation for the clients participating in this group B. By assigning roles for each member at the beginning of the first meeting

C. By calling clients who will be attending to remind them of the group a week prior D. By asking each member what his or her fears are as he or she joins the group

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 group cohesiveness?

A. “Everyone cares about the group except for you.” B. “That is insulting to everyone, including myself.” C. “I believe you owe us all an apology, Maria.”

D. “This group is important to many people here.”

Question 11

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?

A. The therapist’s own characteristics B. The child’s goals for treatment

C. How willing the child is to change D. None of the above

Question 12

A 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 the PMHNP?

A. “Don’t forget about the progress you made last week by joining a yoga class.”

B. “We just heard from another member about his improvement from being in the group.” C. “Remember the power of positive expectations to help you deal with your goals.”

D. All of the above

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:

1. To help individuals see how unique they are and how they “personalize” themselves through unique variations of their name.
2. To help groups members stay connected to one another while remaining their own unique people.
3. To help members see how connected they are to their parents by understanding how their names came about.
4. To provide at least one explanation for one of the things members would like to achieve in group.

Question 14

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?

1. “I am sorry to hear you feel overwhelmed, and I have several suggestions that you might find helpful.”
2. “Let’s ask the group what they think. Does anyone have feedback about this situation?”
3. “Before I give recommendations, please explain why turning down the project might make you seem incompetent.”
4. All of the above

Question 15

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?

1. Males and females of different ages, education levels, socioeconomic statuses, and professions
2. Males and females of similar ages, backgrounds, diagnoses, and social status
3. Males and females with an attraction to the group, aiming for a cohesive and socially compatible group
4. All males or all females with an ability to offer consistent group interactions

Question 16

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 for noncompliance?

1. The group did not expect to have time off, so it may take up to a month to get back into a routine.
2. The group members may believe that the group is not important to the PMHNP.
3. The PMHNP’s absence gave the members a reason to also be absent.
4. The group members feel let down, because the PMHNP cancelled a meeting.

Question 17

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?

A. Direct advice

B. Imitative behavior C. Installation of hope D. Altruism

Question 18

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?

A. Listen carefully and elicit each family member to tell their narrative

B. Ask the family for their ideas in bringing about a change to the problem C. Have the family draw pictures of their lives after they reach their goal D. All of the above

Question 19

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?

1. Jane is depressed and could benefit from individual therapy.
2. Jane is being rebellious, because she no longer needs help from the group.
3. Jane is showing signs of independence, because she will no longer be attending group soon.
4. Jane is showing signs of regression due to the termination phase.

Question 20

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?

1. Avoiding certain discussions that bring back painful memories, because the client prefers to process these thoughts alone
2. Talking excessively and inserting him- or herself into conversations even when they do not involve him or her
3. Participating in several different groups due to the belief that one group will be ineffective
4. Engaging in therapeutic communication with individuals who the client perceives to be just like him or her because they are able to relate to each other

Question 21

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.” What type of therapy would the PMHNP most likely recommend to this patient?

A. An interactionally focused heterogeneous therapy group B. A structured homogeneous group for chronic suicidality C. A short-term cognitive therapy addiction group

D. None of the above

Question 22

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 PMHNP?

A. The member is covering up insecurities.

B. The member may be influential in the group. C. The member may not be popular in the group. D. The member may be envied by others.

Question 23

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?

A. A long-term heterogeneous interactional group B. Inpatient cognitive analytic group therapy

C. Brief, problem-oriented group therapy

D. A short-term group for chronic depression

Question 24

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?

A. Monique has interpersonal distortions of Anna.

B. Monique is uncomfortable in large social situations. C. Anna is not showing her true personality to the group. D. The therapist has a distorted perception of Anna.

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Question 25

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?

A. He is a help-rejecting complainer.

B. He suffers from depression.

C. He is protecting himself from group behaviors/emotions. D. He has borderline personality disorder.

Question 26

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?

1. The client believes they are all there to get help and cannot accept advice from someone who the client believes is just like him or her.
2. The client does not really have these problems or complaints; he or she is doing this in an attempt to get attention.
3. The client is a help-rejecting client and will continue to present problems and then refuse the help of others.
4. The client has so many problems and complaints that he or she is unable to focus on just one to address.

Question 27

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?

A. Encourage Eve to share her secret by showing authority and empathy B. Remain quiet and allow the group to take charge of the meeting

C. Have group members conduct a role play to get Eve to self-disclose D. Tell the group it is OK that Eve does not yet feel safe enough to share

Question 28

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?

A. The patient is able to participate in the group task and would benefit from it. B. The patient is able to participate in the group task but may be harmed by it. C. The patient should decide if he would feel comfortable joining group therapy. D. The patient will likely not benefit from group therapy and should not join.

Question 29

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?

A. Asking Harold to quantify his feelings of sadness on a scale from 1 to 10

B. Teaching Harold about more effective ways to communicate with his daughter

C. Having Harold think about the link between his sadness and other areas in his life D. All of the above

Question 30

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?

A. Staring intently at Ted while raising an eyebrow

B. Looking at other members rather than directly at Ted C. Leaning forward and nodding as Ted shares his story D. Ignoring any members who are not listening to Ted

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Question 31

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?

1. Assuring the patient that the group is concerned and complimenting the haircut
2. Encouraging other group members to tell the patient how this behavior makes them feel
3. Asking members to spend the rest of the session helping the patient with his or her problems
4. Allowing group members to continue to ignore the patient’s rant, because it is inappropriate

Question 32

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?

A. Recommend the patient join the PMHNP’s therapy group for anxiety disorders B. Suggest the patient see the PMHNP for individual therapy before group therapy C. Refer the patient to another therapist who has a suitable therapy group

D. Ask another therapist for impartial advice regarding treating the patient

Question 33

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?

A. “How would you compare today’s meeting with last week’s?” B. “Can you see that today’s meeting was not that productive?” C. “I wonder why everyone was so reluctant to work hard today.” D. “Next week, we will try to have a more intensive interaction.”

Question 34

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?

A. Encourage other members who have similar concerns to share their feelings B. Tell the patient to believe that she will continue to make progress in the future C. Explain to the patient the mental health benefits of group therapy

D. Have the patient work to correctively relive early familial conflicts

Question 35

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?

A. Couples therapy B. Group therapy

C. Family therapy

D. None of the above

Question 36

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?

1. Encouraging the client to attend one more group meeting to see how much he or she is needed
2. Conducting an individual interview to discuss stressors within the group
3. Telling the client that everyone has those feelings and must “stick it out” for things to get better
4. Referring the client to a different group because he or she obviously will not do well within this one

Question 37

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 behavior?

A. She is only bossy and controlling with the group. B. She is displaying her true interpersonal behavior. C. Her mother or father is bossy and controlling.

D. She is actually shy and meek outside of the group.

Question 38

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 self-disclosure?

A. The PMHNP has a 5-year-old daughter, and the client is a convicted pedophile. B. The PMHNP has been employed in this field for less than a year.

C. The PMHNP had to cancel a meeting two months ago.

D. The PMHNP monitors what is disclosed to ensure that too much is not disclosed.

Question 39

The homogenous mode of composition involves a theory that relates to group composition. When applying this theory, the PMHNP is aware that the group will most likely consist of which of the following?

1. Males and females of different ages, education levels, socioeconomic statuses, and professions
2. Males and females of similar ages, backgrounds, diagnoses, and social status
3. Males and females with an attraction to the group, aiming for a cohesive and socially compatible group
4. Males and females with an ability to offer consistent self-reflection and group interactions

Question 40

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?

A. Help the group reduce conflict and disagreement

B. Have a structured intervention to improve cohesiveness

C. Praise the group for their open expression and supportiveness D. All of the above

Question 41

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?

A. The member is simply having a bad day.

B. The member is exhibiting bipolar behaviors. C. The member is a habitual monopolist.

D. The member has narcissistic tendencies.

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:

A. “Think through” B. “Do it”

C. “Weigh options” D. “Try again”

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Question 43

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?

A. Cognitive behavioral therapy

B. Complementary and alternative therapies C. Reminiscence and life review therapy

D. Interpersonal psychotherapy

Question 44

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?

A. To learn the underlying meaning of the statements B. To ask about his actual motivations and aspirations C. To help reveal the impact of the behavior on others D. All of the above

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?

A. Remind the group about the importance of being supportive

B. Give the group an activity to complete as a whole group

C. Have a co-therapist join the group to help resolve the problems D. Suggest that the leaders of each clique come to individual therapy

Question 46

A PMHNP is evaluating a patient who has problems with authority and has trouble accepting criticism. The patient is aware of these problems and wants to change. Based on this, what is an appropriate action by the PMHNP?

1. Treat the patient in individual therapy rather than in group therapy
2. Accept the patient for inclusion as a group therapy member
3. Have the patient start group therapy if he or she can resolve problems with authority
4. Ask the patient to start group therapy if he or she takes full responsibility for the problems

Question 47

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 circumplex?

A. Sandy is likely to resist engagement and devalue the group.

B. Sandy is likely to view members of the group as friendly.

C. Sandy is likely to be passive aggressive during group.

D. Sandy is likely to prematurely view members of the group as hostile.

Question 48

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?

1. Silent members can progress as much as others in the group if they are able to process vicariously through other members in the group.
2. Silent members are silent because they have attended group therapy before and most likely have lost trust in self-disclosure to others.
3. Silent members have learned to observe the behaviors of others; this allows them to make effective contributions and promote growth within the group.
4. Silent members usually will hinder the group while hindering their own growth within the group.

Question 49

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 something.”

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 50

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?

A. Be candid with members of the group about his personal dilemma

B. Take a leave from the co-therapy group until the problem is resolved

C. Compare his reaction to the session with the other therapist’s reaction

D. Suggest that the argumentative group member come to individual therapy

Question 51

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?

1. The client is using the ego defense mechanism of “projection,” which must be addressed to get to the root of the problem.
2. The client may benefit from individual therapy, because he or she is shy and this could hinder group therapy.
3. The client is aware of his or her current issue and will do very well in group therapy.
4. The client suffers from boredom, which is a serious condition that must be addressed and treated.

Question 52

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 treatment?

A. Narcotics Anonymous

B. Primary care monitoring C. Inpatient hospital services D. Workplace screenings

Question 53

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 response?

1. “I understand, Tara. If you two have not had any problems, and group therapy has been effective for you, it’s possible that you are an exception to the rule.”
2. “Tara, you and Jack have to be very careful not to get involved sexually. In group, you both should only focus on yourselves.”
3. “Subgrouping can cause issues with loyalty. For example, what if Jack told you something that made you feel uncomfortable. Would you be able to address that in group?”
4. “I apologize if my statement upset you. Who initiated your and Jack’s subgroup?”

Question 54

A PMHNP is treating a patient in individual therapy and thinks the patient may be a good