BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
Harriet is a well-established business woman who provides for her family. She was recently arrested for
stealing over $10,000 worth of merchandise from the mall. When Harriet is asked to describe her
behavior, she says: "It just comes on me quickly, and when it's done, I feel really good." She also
describes how she grew up poor and sees the theft as a way to "even the score" against those with
"empty wealth." Which of the following does not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. - (ANSWER)Although the patient may be rationalizing her
behavior as a righteous act, patients with kleptomania do not commit theft to express anger or
vengeance. Kleptomania is characterized as failing to resist the impulse to steal, and the stolen objects
are typically not needed. The act of stealing, which usually is performed alone, gives the person
gratification.
Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a long record of skipping
school, talking back to his teachers, and getting poor grades. His parents say he has often gotten in fights
with them, has frequently been caught sneaking girls into his room, and has run away from home on two
occasions. During the session, you notice Tony acts tough and aloof, not deigning to speak much. If you
suspect conduct disorder, which of the following conditions would you be least likely to include in your
differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder - (ANSWER)Borderline personality disorder is not considered a differential diagnosis
for conduct disorder, as indicated by the patient's truancy, defiance of authority figures, fights with
family members, poor academic performance, sexual promiscuity, running away from home, and "tough
guy" demeanor. Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all
considered potential differential diagnoses for conduct disorder, as are depressive disorders, attention-
deficit/hyperactivity disorder, and intermittent explosive disorder.
Which of these lab findings would be least expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
,BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol - (ANSWER)Depressive symptoms are associated with decreased, not
increased, levels of somatostatin in cerebrospinal fluid. Patients with depression may exhibit a decreased
thyroid-stimulating hormone response to thyrotropin-releasing hormone, as well as hypersecretion of
cortisol. Depressive symptoms are also associated with irregularities in growth hormone release, such as
reduced nocturnal secretion and diurnal hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is able to be observed at all times by hospital
staff during waking hours and when he sleeps, and is checked on every 15-30 minutes. Which of these
reasons would least indicate the need for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. - (ANSWER)Although ambivalence regarding
suicidal intent should be taken into account when considering level of observation in a patient, it
indicates a moderate risk, not a severe risk. Close observation should be employed with patients who
profess suicidal thoughts, are unable to commit to a "No Harm" contract, or experience withdrawal.
Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask him why he is here, he
says, "I'm here because I've had this increased craving for sex. I've been picking up strangers in bars, not
caring about using protection ... I don't know what it is. For the last week, I've just felt really driven. Keep
throwing myself into my work, don't feel much need for sleep, feel like my thoughts are running a
marathon in my head." The patient lives a "clean life," clarifying that he does not abuse any substance,
"not even coffee or cigarettes." He also does not have a history of mental disorders. Given the most
likely diagnosis, which of these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion - (ANSWER)The patient's recent involvement in risky pleasurable activity (e.g., unprotected
sex), increase in goal-driven activity at work, decreased need for sleep, and subjective experience of
racing thoughts all suggest a manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria for a major depressive episode.
Pharmacologic options for the treatment of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam).
,BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
You have determined that a patient's delirium stems from dehydration. As you begin treatment, you
realize the patient will require pharmacologic management for his agitation. Which of these agents
would be least appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam - (ANSWER)Lorazepam would not be the first choice to treat delirium in a dehydrated patient
because benzodiazepines may cause respiratory depression, especially in debilitated patients.
Antipsychotics such as haloperidol, quetiapine, and risperidone are considered the mainstay in managing
agitation in delirium patients; haloperidol is considered the standard of care, but newer agents such as
quetiapine and risperidone may be preferred due to reduced chance of side effects.
Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care. -
(ANSWER)Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
The most common method of suicide among inpatients is hanging, not self-inflicted wounds. When
"unsolvable" problems at work, school, or home motivate the ideation, inpatients are most likely to
attempt suicide either within the first 5 days at the hospital or shortly after discharge, not after a month.
The rate of suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states that she has been
hearing voices, cannot remember anything, and refuses to take a shower or change her clothes. He adds,
"She used to be a very clean person and had a really good memory." Which phase of schizophrenia is
Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
, BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
Acute phase - (ANSWER)Auditory hallucinations, loss of memory, and lack of personal hygiene are all
markers of the acute phase of schizophrenia. Other signs and symptoms of this stage include illogical
thinking, inappropriate social behavior, catatonic excitement, and poor concentration. The premorbid
phase is indicated by depression, sleep disturbance, and bedwetting. The prodromal phase is
characterized by suspiciousness, inappropriate expression of feeling, and feelings of unreality. Lastly, the
stable phase is symptomatically similar to the prodromal phase.
Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is a recent immigrant
from Haiti, you begin by giving him a cultural assessment. Which of the following questions would be
least helpful in gaining information about Leon's health beliefs and practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?" - (ANSWER)Although many patients have a
demographic preference for their primary care provider, merely asking if the patient believes that you
"will help him" would not provide information regarding his general health beliefs. The statement would
more likely provide an opinion based solely on the patient's perception of the nurse practitioner (NP).
Asking about the patient's attitude regarding disability and illness, preventative health practices, and
taboos and cultural attitudes with regards to modesty and special procedures would all yield beneficial
information to help the NP understand the patient's beliefs about health and healthcare.
Which of these patients would most likely receive rehabilitation under the multisystemic therapy model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment - (ANSWER)Multisystemic
therapy is a rehabilitation model aimed at treating children and adolescents with serious mental illness;
under this model, parents and teachers are taught skills to manage mental disorders so that the patient
does not need to be removed from the community for hospitalization. Multisystemic therapy is not
aimed at adults and does not directly focus on community reintegration or finding employment.
Clozapine use requires rigorous dosing and monitoring in patients. Which of the following is the proper
instruction for a patient being initiated on clozapine therapy for schizophrenia?
QUESTIONS WITH VERIFIED ANSWERS.
Harriet is a well-established business woman who provides for her family. She was recently arrested for
stealing over $10,000 worth of merchandise from the mall. When Harriet is asked to describe her
behavior, she says: "It just comes on me quickly, and when it's done, I feel really good." She also
describes how she grew up poor and sees the theft as a way to "even the score" against those with
"empty wealth." Which of the following does not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. - (ANSWER)Although the patient may be rationalizing her
behavior as a righteous act, patients with kleptomania do not commit theft to express anger or
vengeance. Kleptomania is characterized as failing to resist the impulse to steal, and the stolen objects
are typically not needed. The act of stealing, which usually is performed alone, gives the person
gratification.
Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a long record of skipping
school, talking back to his teachers, and getting poor grades. His parents say he has often gotten in fights
with them, has frequently been caught sneaking girls into his room, and has run away from home on two
occasions. During the session, you notice Tony acts tough and aloof, not deigning to speak much. If you
suspect conduct disorder, which of the following conditions would you be least likely to include in your
differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder - (ANSWER)Borderline personality disorder is not considered a differential diagnosis
for conduct disorder, as indicated by the patient's truancy, defiance of authority figures, fights with
family members, poor academic performance, sexual promiscuity, running away from home, and "tough
guy" demeanor. Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all
considered potential differential diagnoses for conduct disorder, as are depressive disorders, attention-
deficit/hyperactivity disorder, and intermittent explosive disorder.
Which of these lab findings would be least expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
,BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol - (ANSWER)Depressive symptoms are associated with decreased, not
increased, levels of somatostatin in cerebrospinal fluid. Patients with depression may exhibit a decreased
thyroid-stimulating hormone response to thyrotropin-releasing hormone, as well as hypersecretion of
cortisol. Depressive symptoms are also associated with irregularities in growth hormone release, such as
reduced nocturnal secretion and diurnal hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is able to be observed at all times by hospital
staff during waking hours and when he sleeps, and is checked on every 15-30 minutes. Which of these
reasons would least indicate the need for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. - (ANSWER)Although ambivalence regarding
suicidal intent should be taken into account when considering level of observation in a patient, it
indicates a moderate risk, not a severe risk. Close observation should be employed with patients who
profess suicidal thoughts, are unable to commit to a "No Harm" contract, or experience withdrawal.
Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask him why he is here, he
says, "I'm here because I've had this increased craving for sex. I've been picking up strangers in bars, not
caring about using protection ... I don't know what it is. For the last week, I've just felt really driven. Keep
throwing myself into my work, don't feel much need for sleep, feel like my thoughts are running a
marathon in my head." The patient lives a "clean life," clarifying that he does not abuse any substance,
"not even coffee or cigarettes." He also does not have a history of mental disorders. Given the most
likely diagnosis, which of these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion - (ANSWER)The patient's recent involvement in risky pleasurable activity (e.g., unprotected
sex), increase in goal-driven activity at work, decreased need for sleep, and subjective experience of
racing thoughts all suggest a manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria for a major depressive episode.
Pharmacologic options for the treatment of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam).
,BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
You have determined that a patient's delirium stems from dehydration. As you begin treatment, you
realize the patient will require pharmacologic management for his agitation. Which of these agents
would be least appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam - (ANSWER)Lorazepam would not be the first choice to treat delirium in a dehydrated patient
because benzodiazepines may cause respiratory depression, especially in debilitated patients.
Antipsychotics such as haloperidol, quetiapine, and risperidone are considered the mainstay in managing
agitation in delirium patients; haloperidol is considered the standard of care, but newer agents such as
quetiapine and risperidone may be preferred due to reduced chance of side effects.
Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care. -
(ANSWER)Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
The most common method of suicide among inpatients is hanging, not self-inflicted wounds. When
"unsolvable" problems at work, school, or home motivate the ideation, inpatients are most likely to
attempt suicide either within the first 5 days at the hospital or shortly after discharge, not after a month.
The rate of suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states that she has been
hearing voices, cannot remember anything, and refuses to take a shower or change her clothes. He adds,
"She used to be a very clean person and had a really good memory." Which phase of schizophrenia is
Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
, BARKLEY DRT PMHNP PRACTICUM 1 2026/2027 ACTUAL
QUESTIONS WITH VERIFIED ANSWERS.
Acute phase - (ANSWER)Auditory hallucinations, loss of memory, and lack of personal hygiene are all
markers of the acute phase of schizophrenia. Other signs and symptoms of this stage include illogical
thinking, inappropriate social behavior, catatonic excitement, and poor concentration. The premorbid
phase is indicated by depression, sleep disturbance, and bedwetting. The prodromal phase is
characterized by suspiciousness, inappropriate expression of feeling, and feelings of unreality. Lastly, the
stable phase is symptomatically similar to the prodromal phase.
Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is a recent immigrant
from Haiti, you begin by giving him a cultural assessment. Which of the following questions would be
least helpful in gaining information about Leon's health beliefs and practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?" - (ANSWER)Although many patients have a
demographic preference for their primary care provider, merely asking if the patient believes that you
"will help him" would not provide information regarding his general health beliefs. The statement would
more likely provide an opinion based solely on the patient's perception of the nurse practitioner (NP).
Asking about the patient's attitude regarding disability and illness, preventative health practices, and
taboos and cultural attitudes with regards to modesty and special procedures would all yield beneficial
information to help the NP understand the patient's beliefs about health and healthcare.
Which of these patients would most likely receive rehabilitation under the multisystemic therapy model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment - (ANSWER)Multisystemic
therapy is a rehabilitation model aimed at treating children and adolescents with serious mental illness;
under this model, parents and teachers are taught skills to manage mental disorders so that the patient
does not need to be removed from the community for hospitalization. Multisystemic therapy is not
aimed at adults and does not directly focus on community reintegration or finding employment.
Clozapine use requires rigorous dosing and monitoring in patients. Which of the following is the proper
instruction for a patient being initiated on clozapine therapy for schizophrenia?
