Barkley PMHNP Chapter Quiz 2 (v2.0): Safety
Needs, Therapeutic Alliance, and Frame of Care
Comprehensive 150-Question Multiple-Choice
Examination a well detailed one
written and graded A+ upgraded
Instructions to the Examinee:
This examination consists of 150 multiple-choice questions designed to assess advanced
knowledge of safety needs, therapeutic alliance, and framework of care in psychiatric-mental
health nursing practice. Each question has one best answer. Select the single best response.
Questions are written at an advanced/professional level and include conceptual, application-
based, and clinical scenario items.
SECTION A: SAFETY NEEDS AND RISK ASSESSMENT (Questions 1–40)
1. A 29-year-old male with schizophrenia is brought to the emergency department by police
after he was found standing on a bridge ledge. He reports hearing a voice telling him to
"jump." What is the PRIORITY action?
A. Obtain a detailed psychiatric history from family members
B. Ensure immediate physical safety and initiate a comprehensive suicide risk assessment
C. Administer haloperidol 10 mg IM immediately
D. Place the patient in four-point restraints
,Correct Answer: B
Rationale: Physical safety is the priority in any emergency. A comprehensive suicide risk
assessment must be conducted immediately to determine the level of risk and appropriate
interventions.
2. A 55-year-old female with major depressive disorder reports, "I've been thinking about
how to end my life, but I haven't decided yet." Which of the following represents the MOST
appropriate next question?
A. "How long have you been feeling this way?"
B. "Do you have a specific method in mind?"
C. "Are you taking your medications as prescribed?"
D. "Have you been sleeping and eating adequately?"
Correct Answer: B
Rationale: After a patient endorses suicidal ideation, the clinician must assess for plan, intent,
and means. Asking about a specific method is essential for risk stratification.
3. Which of the following is a NON-MODIFIABLE risk factor for suicide?
A. Untreated depression
B. Access to firearms
C. Male gender
D. Substance use disorder
Correct Answer: C
Rationale: Male gender is a non-modifiable risk factor for suicide. Untreated depression, access
to firearms, and substance use disorders are modifiable risk factors that can be addressed
through treatment and safety planning.
4. A 32-year-old female with borderline personality disorder has a history of multiple
superficial self-cutting episodes. She reports feeling "empty" and "numb." She denies suicidal
intent. What is the MOST appropriate intervention?
A. Admit the patient to the psychiatric unit for safety
B. Explore the function of the self-harm behavior and develop alternative coping strategies
C. Prescribe an antipsychotic medication
D. Refer the patient for dialectical behavior therapy only
,Correct Answer: B
Rationale: For patients with non-suicidal self-injury, exploring the function of the behavior and
developing alternative coping strategies is appropriate. Hospitalization is not indicated for
chronic self-harm without suicidal intent.
5. A 68-year-old male with vascular dementia and depression lives with his wife who is his
primary caregiver. He has been increasingly agitated and has threatened to "hurt" his wife.
What is the MOST appropriate safety intervention?
A. Increase the dose of his antidepressant
B. Hospitalize for safety evaluation and management
C. Prescribe a benzodiazepine for agitation
D. Refer the wife to a caregiver support group
Correct Answer: B
Rationale: Threats of violence toward a caregiver in a patient with dementia and depression
require hospitalization for safety evaluation. The safety of both the patient and caregiver must
be addressed.
6. A PMHNP is conducting a suicide risk assessment on a 45-year-old male with alcohol use
disorder. Which question is MOST important for assessing imminent risk?
A. "How much alcohol do you drink per day?"
B. "Do you have a firearm or other lethal means in your home?"
C. "Have you ever been treated for depression?"
D. "Do you have a family history of suicide?"
Correct Answer: B
Rationale: Access to lethal means, particularly firearms, is one of the strongest predictors of
suicide completion. This question is critical for assessing imminent risk.
7. A 22-year-old female with anorexia nervosa has a BMI of 14.8 kg/m² and reports feeling
"fine." She has no active suicidal ideation but has a history of self-harm. What is the PRIMARY
safety concern?
A. Risk of suicide
B. Medical instability including cardiac arrhythmias and electrolyte imbalances
, C. Risk of elopement
D. Risk of self-harm
Correct Answer: B
Rationale: Severe malnutrition (BMI <16) in anorexia nervosa carries significant risk of medical
instability, including cardiac arrhythmias and electrolyte imbalances. Physiologic safety needs
take priority.
8. A patient with schizophrenia is stabilized on clozapine. Which laboratory parameter
requires MONTHLY monitoring for patient safety?
A. Complete blood count (CBC) with differential
B. Liver function tests
C. Renal function tests
D. Thyroid function tests
Correct Answer: A
Rationale: Clozapine requires regular CBC monitoring due to the risk of agranulocytosis.
Monitoring is essential for patient safety.
9. A 38-year-old female with bipolar I disorder is in a manic episode. She has not slept for five
days, is spending money recklessly, and has been making threats toward her ex-husband.
What is the PRIORITY intervention?
A. Administer a mood stabilizer
B. Hospitalize for safety and stabilization
C. Schedule a follow-up appointment in three days
D. Contact the ex-husband to warn him
Correct Answer: B
Rationale: This patient is experiencing a manic episode with sleep deprivation, reckless
behavior, and threats toward others. Hospitalization is indicated for safety and stabilization.
10. The PMHNP is assessing a patient who reports passive suicidal ideation but no plan. The
patient has a history of one prior suicide attempt by overdose and has a prescription for a
large quantity of benzodiazepines. What is the MOST appropriate safety intervention?
Needs, Therapeutic Alliance, and Frame of Care
Comprehensive 150-Question Multiple-Choice
Examination a well detailed one
written and graded A+ upgraded
Instructions to the Examinee:
This examination consists of 150 multiple-choice questions designed to assess advanced
knowledge of safety needs, therapeutic alliance, and framework of care in psychiatric-mental
health nursing practice. Each question has one best answer. Select the single best response.
Questions are written at an advanced/professional level and include conceptual, application-
based, and clinical scenario items.
SECTION A: SAFETY NEEDS AND RISK ASSESSMENT (Questions 1–40)
1. A 29-year-old male with schizophrenia is brought to the emergency department by police
after he was found standing on a bridge ledge. He reports hearing a voice telling him to
"jump." What is the PRIORITY action?
A. Obtain a detailed psychiatric history from family members
B. Ensure immediate physical safety and initiate a comprehensive suicide risk assessment
C. Administer haloperidol 10 mg IM immediately
D. Place the patient in four-point restraints
,Correct Answer: B
Rationale: Physical safety is the priority in any emergency. A comprehensive suicide risk
assessment must be conducted immediately to determine the level of risk and appropriate
interventions.
2. A 55-year-old female with major depressive disorder reports, "I've been thinking about
how to end my life, but I haven't decided yet." Which of the following represents the MOST
appropriate next question?
A. "How long have you been feeling this way?"
B. "Do you have a specific method in mind?"
C. "Are you taking your medications as prescribed?"
D. "Have you been sleeping and eating adequately?"
Correct Answer: B
Rationale: After a patient endorses suicidal ideation, the clinician must assess for plan, intent,
and means. Asking about a specific method is essential for risk stratification.
3. Which of the following is a NON-MODIFIABLE risk factor for suicide?
A. Untreated depression
B. Access to firearms
C. Male gender
D. Substance use disorder
Correct Answer: C
Rationale: Male gender is a non-modifiable risk factor for suicide. Untreated depression, access
to firearms, and substance use disorders are modifiable risk factors that can be addressed
through treatment and safety planning.
4. A 32-year-old female with borderline personality disorder has a history of multiple
superficial self-cutting episodes. She reports feeling "empty" and "numb." She denies suicidal
intent. What is the MOST appropriate intervention?
A. Admit the patient to the psychiatric unit for safety
B. Explore the function of the self-harm behavior and develop alternative coping strategies
C. Prescribe an antipsychotic medication
D. Refer the patient for dialectical behavior therapy only
,Correct Answer: B
Rationale: For patients with non-suicidal self-injury, exploring the function of the behavior and
developing alternative coping strategies is appropriate. Hospitalization is not indicated for
chronic self-harm without suicidal intent.
5. A 68-year-old male with vascular dementia and depression lives with his wife who is his
primary caregiver. He has been increasingly agitated and has threatened to "hurt" his wife.
What is the MOST appropriate safety intervention?
A. Increase the dose of his antidepressant
B. Hospitalize for safety evaluation and management
C. Prescribe a benzodiazepine for agitation
D. Refer the wife to a caregiver support group
Correct Answer: B
Rationale: Threats of violence toward a caregiver in a patient with dementia and depression
require hospitalization for safety evaluation. The safety of both the patient and caregiver must
be addressed.
6. A PMHNP is conducting a suicide risk assessment on a 45-year-old male with alcohol use
disorder. Which question is MOST important for assessing imminent risk?
A. "How much alcohol do you drink per day?"
B. "Do you have a firearm or other lethal means in your home?"
C. "Have you ever been treated for depression?"
D. "Do you have a family history of suicide?"
Correct Answer: B
Rationale: Access to lethal means, particularly firearms, is one of the strongest predictors of
suicide completion. This question is critical for assessing imminent risk.
7. A 22-year-old female with anorexia nervosa has a BMI of 14.8 kg/m² and reports feeling
"fine." She has no active suicidal ideation but has a history of self-harm. What is the PRIMARY
safety concern?
A. Risk of suicide
B. Medical instability including cardiac arrhythmias and electrolyte imbalances
, C. Risk of elopement
D. Risk of self-harm
Correct Answer: B
Rationale: Severe malnutrition (BMI <16) in anorexia nervosa carries significant risk of medical
instability, including cardiac arrhythmias and electrolyte imbalances. Physiologic safety needs
take priority.
8. A patient with schizophrenia is stabilized on clozapine. Which laboratory parameter
requires MONTHLY monitoring for patient safety?
A. Complete blood count (CBC) with differential
B. Liver function tests
C. Renal function tests
D. Thyroid function tests
Correct Answer: A
Rationale: Clozapine requires regular CBC monitoring due to the risk of agranulocytosis.
Monitoring is essential for patient safety.
9. A 38-year-old female with bipolar I disorder is in a manic episode. She has not slept for five
days, is spending money recklessly, and has been making threats toward her ex-husband.
What is the PRIORITY intervention?
A. Administer a mood stabilizer
B. Hospitalize for safety and stabilization
C. Schedule a follow-up appointment in three days
D. Contact the ex-husband to warn him
Correct Answer: B
Rationale: This patient is experiencing a manic episode with sleep deprivation, reckless
behavior, and threats toward others. Hospitalization is indicated for safety and stabilization.
10. The PMHNP is assessing a patient who reports passive suicidal ideation but no plan. The
patient has a history of one prior suicide attempt by overdose and has a prescription for a
large quantity of benzodiazepines. What is the MOST appropriate safety intervention?
