BARKLEY PMHN P REVIEW PSYCHIATRIC-MENTAL HEALTH NP QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Psychopharmacology
Psychotherapy and Therapeutic Interventions
Assessment and Diagnosis
Clinical Decision-Making and Management
Ethical and Legal Principles
Professional Role and Policy
Advanced Pathophysiology
Research and Evidence-Based Practice
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical
decision-making skills of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) candidate. The exam covers a
broad spectrum of core competencies, including psychopharmacology, psychotherapy, advanced assessment, and
the application of ethical and legal standards in diverse clinical scenarios. Through a series of multiple-choice
questions, candidates will be evaluated on their ability to synthesize foundational theory with practical, real-world
application to provide safe, effective, and patient-centered care. This assessment emphasizes the integration of
evidence-based practice and professional standards to ensure exam readiness and clinical excellence.
SECTION ONE: QUESTIONS 1–100
,1. A 32-year-old patient with major depressive disorder has been on fluoxetine 20 mg daily for 8 weeks with
partial response. The PMHNP decides to augment the treatment. Which of the following is the most
appropriate evidence-based augmentation strategy?
A. Add bupropion 150 mg daily
B. Add aripiprazole 2 mg daily
C. Increase fluoxetine to 40 mg daily
D. Add lithium 300 mg twice daily
🟢 B. Add aripiprazole 2 mg daily
🔴 RATIONALE: Aripiprazole is an FDA-approved augmentation agent for major depressive disorder (MDD) and
has strong evidence for partial responders to SSRIs. While bupropion is also used, aripiprazole has more robust
data for this specific indication.
2. A 45-year-old patient with bipolar I disorder is maintained on lithium. During a routine visit, labs show a
serum lithium level of 1.4 mEq/L. The patient reports mild tremor and nausea. What is the most appropriate
initial action?
A. Reduce the lithium dose and recheck levels in 3 days
B. Administer intravenous fluids and hold the next dose
C. Instruct the patient to increase fluid intake to 3 liters per day
D. Obtain a stat serum creatinine and BUN
🟢 A. Reduce the lithium dose and recheck levels in 3 days
🔴 RATIONALE: A lithium level of 1.4 mEq/L is slightly above the therapeutic range of 0.6-1.2 mEq/L for
maintenance. Mild tremor and nausea are common side effects at this level. The most appropriate initial action
,is to reduce the dose and recheck the level to ensure it falls within the therapeutic range without causing
toxicity.
3. According to the DSM-5-TR criteria, which of the following symptoms is characteristic of a manic episode?
A. Depressed mood most of the day, nearly every day
B. Diminished ability to think or concentrate, indecisiveness
C. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
D. Recurrent, intrusive recollections of a traumatic event
🟢 C. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
🔴 RATIONALE: The core feature of a manic episode is a distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting
at least one week and present most of the day, nearly every day.
4. A patient with schizophrenia has been on clozapine for 6 months. Which of the following monitoring
parameters is mandated by the FDA's Risk Evaluation and Mitigation Strategy (REMS) program for
clozapine?
A. Complete blood count (CBC) every 2 weeks
B. Fasting blood glucose every month
C. Serum creatinine and BUN every 3 months
D. Electrocardiogram (ECG) every 6 months
🟢 A. Complete blood count (CBC) every 2 weeks
, 🔴 RATIONALE: The clozapine REMS program requires absolute neutrophil count (ANC) monitoring. For the first
6 months, it is monitored weekly, and then every 2 weeks for the next 6 months. The question specifies a
patient on clozapine for 6 months, making the bi-weekly CBC the correct mandated monitoring parameter. The
other options are general monitoring but not specific to the REMS program.
5. A 17-year-old patient presents with a 6-month history of excessive worry about academic performance,
social situations, and family health. The patient reports difficulty sleeping, muscle tension, and irritability.
Which of the following is the most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder (Social Phobia)
C. Generalized Anxiety Disorder
D. Obsessive-Compulsive Disorder
🟢 C. Generalized Anxiety Disorder
🔴 RATIONALE: The patient's symptoms of excessive, uncontrollable worry across multiple domains (academic,
social, family) along with associated symptoms of sleep disturbance, muscle tension, and irritability that have
persisted for more than 6 months meet the DSM-5-TR criteria for Generalized Anxiety Disorder (GAD).
6. A 60-year-old patient with a history of Parkinson's disease is experiencing visual hallucinations of children
in his home. His wife reports he is otherwise alert and oriented. Which of the following medications is most
likely contributing to these hallucinations?
A. Levodopa
B. Donepezil
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Psychopharmacology
Psychotherapy and Therapeutic Interventions
Assessment and Diagnosis
Clinical Decision-Making and Management
Ethical and Legal Principles
Professional Role and Policy
Advanced Pathophysiology
Research and Evidence-Based Practice
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical
decision-making skills of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) candidate. The exam covers a
broad spectrum of core competencies, including psychopharmacology, psychotherapy, advanced assessment, and
the application of ethical and legal standards in diverse clinical scenarios. Through a series of multiple-choice
questions, candidates will be evaluated on their ability to synthesize foundational theory with practical, real-world
application to provide safe, effective, and patient-centered care. This assessment emphasizes the integration of
evidence-based practice and professional standards to ensure exam readiness and clinical excellence.
SECTION ONE: QUESTIONS 1–100
,1. A 32-year-old patient with major depressive disorder has been on fluoxetine 20 mg daily for 8 weeks with
partial response. The PMHNP decides to augment the treatment. Which of the following is the most
appropriate evidence-based augmentation strategy?
A. Add bupropion 150 mg daily
B. Add aripiprazole 2 mg daily
C. Increase fluoxetine to 40 mg daily
D. Add lithium 300 mg twice daily
🟢 B. Add aripiprazole 2 mg daily
🔴 RATIONALE: Aripiprazole is an FDA-approved augmentation agent for major depressive disorder (MDD) and
has strong evidence for partial responders to SSRIs. While bupropion is also used, aripiprazole has more robust
data for this specific indication.
2. A 45-year-old patient with bipolar I disorder is maintained on lithium. During a routine visit, labs show a
serum lithium level of 1.4 mEq/L. The patient reports mild tremor and nausea. What is the most appropriate
initial action?
A. Reduce the lithium dose and recheck levels in 3 days
B. Administer intravenous fluids and hold the next dose
C. Instruct the patient to increase fluid intake to 3 liters per day
D. Obtain a stat serum creatinine and BUN
🟢 A. Reduce the lithium dose and recheck levels in 3 days
🔴 RATIONALE: A lithium level of 1.4 mEq/L is slightly above the therapeutic range of 0.6-1.2 mEq/L for
maintenance. Mild tremor and nausea are common side effects at this level. The most appropriate initial action
,is to reduce the dose and recheck the level to ensure it falls within the therapeutic range without causing
toxicity.
3. According to the DSM-5-TR criteria, which of the following symptoms is characteristic of a manic episode?
A. Depressed mood most of the day, nearly every day
B. Diminished ability to think or concentrate, indecisiveness
C. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
D. Recurrent, intrusive recollections of a traumatic event
🟢 C. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
🔴 RATIONALE: The core feature of a manic episode is a distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting
at least one week and present most of the day, nearly every day.
4. A patient with schizophrenia has been on clozapine for 6 months. Which of the following monitoring
parameters is mandated by the FDA's Risk Evaluation and Mitigation Strategy (REMS) program for
clozapine?
A. Complete blood count (CBC) every 2 weeks
B. Fasting blood glucose every month
C. Serum creatinine and BUN every 3 months
D. Electrocardiogram (ECG) every 6 months
🟢 A. Complete blood count (CBC) every 2 weeks
, 🔴 RATIONALE: The clozapine REMS program requires absolute neutrophil count (ANC) monitoring. For the first
6 months, it is monitored weekly, and then every 2 weeks for the next 6 months. The question specifies a
patient on clozapine for 6 months, making the bi-weekly CBC the correct mandated monitoring parameter. The
other options are general monitoring but not specific to the REMS program.
5. A 17-year-old patient presents with a 6-month history of excessive worry about academic performance,
social situations, and family health. The patient reports difficulty sleeping, muscle tension, and irritability.
Which of the following is the most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder (Social Phobia)
C. Generalized Anxiety Disorder
D. Obsessive-Compulsive Disorder
🟢 C. Generalized Anxiety Disorder
🔴 RATIONALE: The patient's symptoms of excessive, uncontrollable worry across multiple domains (academic,
social, family) along with associated symptoms of sleep disturbance, muscle tension, and irritability that have
persisted for more than 6 months meet the DSM-5-TR criteria for Generalized Anxiety Disorder (GAD).
6. A 60-year-old patient with a history of Parkinson's disease is experiencing visual hallucinations of children
in his home. His wife reports he is otherwise alert and oriented. Which of the following medications is most
likely contributing to these hallucinations?
A. Levodopa
B. Donepezil
