Barkley PMHNP Chapter Quiz 20:
Comprehensive Examination on
Substance-Related and Addictive
Disorders, Eating Disorders, and Impulse-
Control Disorders in Psychiatric-Mental
Health Nurse Practitioner Practice a well
detailed one written and
graded A+ upgraded
Instructions
This comprehensive 150-question multiple-choice examination is designed for PMHNP
candidates preparing for national certification. Questions are written at an
advanced/hard difficulty level and reflect the content covered in Barkley PMHNP
Chapter 20, which encompasses substance-related and addictive disorders, eating
disorders, and disruptive/impulse-control disorders. Each question includes one correct
answer with a detailed rationale.
,SECTION A: Substance-Related and Addictive Disorders
(Questions 1-55)
1. A 34-year-old male presents with a 10-year history of daily alcohol
consumption. He reports needing to drink twice as much as he did five years ago
to achieve the same effect. This clinical phenomenon is BEST described as:
A. Withdrawal
B. Tolerance
C. Dependence
D. Intoxication
Correct Answer: B. Tolerance
Rationale: Tolerance is defined as the need for markedly increased amounts of a
substance to achieve the desired effect or a markedly diminished effect with continued
use of the same amount. This patient's need for increased alcohol consumption to
achieve the same effect is the classic definition of tolerance. Withdrawal refers to
symptoms that occur when substance use is reduced or stopped. Dependence
encompasses a broader pattern including tolerance, withdrawal, and compulsive use.
Intoxication refers to the acute effects of substance use.
2. A patient with alcohol use disorder is admitted for detoxification. Which
medication is the FIRST-LINE treatment for alcohol withdrawal syndrome to
prevent seizures and delirium tremens?
A. Naltrexone
B. Acamprosate
,C. Chlordiazepoxide
D. Disulfiram
Correct Answer: C. Chlordiazepoxide
Rationale: Benzodiazepines, particularly chlordiazepoxide (Librium) and lorazepam, are
the first-line treatment for alcohol withdrawal syndrome. They are GABA-agonists that
cross-tolerate with alcohol and prevent withdrawal seizures and progression to delirium
tremens. Naltrexone, acamprosate, and disulfiram are used for relapse prevention, not
acute withdrawal management.
3. A 28-year-old woman reports using heroin daily for the past two years. She
presents with rhinorrhea, lacrimation, yawning, piloerection, and severe muscle
cramps approximately 8 hours after her last use. These symptoms are
characteristic of:
A. Opioid intoxication
B. Opioid withdrawal
C. Opioid tolerance
D. Opioid-induced psychotic disorder
Correct Answer: B. Opioid withdrawal
Rationale: The symptoms described—rhinorrhea, lacrimation, yawning, piloerection
("cold turkey"), and muscle cramps—are classic signs of opioid withdrawal. These
symptoms typically begin 6-12 hours after the last opioid use, peak at 48-72 hours, and
gradually resolve over 5-10 days. Opioid intoxication would present with euphoria,
pupillary constriction, and respiratory depression.
, 4. Which FDA-approved medication is considered the GOLD STANDARD for
maintenance treatment of opioid use disorder and is available in both oral and
long-acting injectable formulations?
A. Naloxone
B. Buprenorphine
C. Methadone
D. Naltrexone
Correct Answer: C. Methadone
Rationale: Methadone is a full opioid agonist that has been the gold standard for opioid
maintenance treatment for decades. It is available in oral formulations and, in some
settings, as a long-acting injectable. Buprenorphine is a partial agonist also used for
maintenance but is not considered the gold standard. Naloxone is an opioid antagonist
used for overdose reversal. Naltrexone is an antagonist used for relapse prevention.
5. A patient with alcohol use disorder who wishes to maintain abstinence is started
on naltrexone. The PMHNP explains that this medication works by:
A. Causing an adverse reaction if alcohol is consumed
B. Reducing alcohol cravings by blocking opioid receptors
C. Reducing withdrawal symptoms during detoxification
D. Increasing GABA activity in the central nervous system
Correct Answer: B. Reducing alcohol cravings by blocking opioid receptors
Rationale: Naltrexone is an opioid receptor antagonist that reduces the rewarding
effects of alcohol by blocking opioid receptors involved in the brain's reward pathway.
This leads to decreased cravings and reduced likelihood of relapse. Disulfiram causes an
Comprehensive Examination on
Substance-Related and Addictive
Disorders, Eating Disorders, and Impulse-
Control Disorders in Psychiatric-Mental
Health Nurse Practitioner Practice a well
detailed one written and
graded A+ upgraded
Instructions
This comprehensive 150-question multiple-choice examination is designed for PMHNP
candidates preparing for national certification. Questions are written at an
advanced/hard difficulty level and reflect the content covered in Barkley PMHNP
Chapter 20, which encompasses substance-related and addictive disorders, eating
disorders, and disruptive/impulse-control disorders. Each question includes one correct
answer with a detailed rationale.
,SECTION A: Substance-Related and Addictive Disorders
(Questions 1-55)
1. A 34-year-old male presents with a 10-year history of daily alcohol
consumption. He reports needing to drink twice as much as he did five years ago
to achieve the same effect. This clinical phenomenon is BEST described as:
A. Withdrawal
B. Tolerance
C. Dependence
D. Intoxication
Correct Answer: B. Tolerance
Rationale: Tolerance is defined as the need for markedly increased amounts of a
substance to achieve the desired effect or a markedly diminished effect with continued
use of the same amount. This patient's need for increased alcohol consumption to
achieve the same effect is the classic definition of tolerance. Withdrawal refers to
symptoms that occur when substance use is reduced or stopped. Dependence
encompasses a broader pattern including tolerance, withdrawal, and compulsive use.
Intoxication refers to the acute effects of substance use.
2. A patient with alcohol use disorder is admitted for detoxification. Which
medication is the FIRST-LINE treatment for alcohol withdrawal syndrome to
prevent seizures and delirium tremens?
A. Naltrexone
B. Acamprosate
,C. Chlordiazepoxide
D. Disulfiram
Correct Answer: C. Chlordiazepoxide
Rationale: Benzodiazepines, particularly chlordiazepoxide (Librium) and lorazepam, are
the first-line treatment for alcohol withdrawal syndrome. They are GABA-agonists that
cross-tolerate with alcohol and prevent withdrawal seizures and progression to delirium
tremens. Naltrexone, acamprosate, and disulfiram are used for relapse prevention, not
acute withdrawal management.
3. A 28-year-old woman reports using heroin daily for the past two years. She
presents with rhinorrhea, lacrimation, yawning, piloerection, and severe muscle
cramps approximately 8 hours after her last use. These symptoms are
characteristic of:
A. Opioid intoxication
B. Opioid withdrawal
C. Opioid tolerance
D. Opioid-induced psychotic disorder
Correct Answer: B. Opioid withdrawal
Rationale: The symptoms described—rhinorrhea, lacrimation, yawning, piloerection
("cold turkey"), and muscle cramps—are classic signs of opioid withdrawal. These
symptoms typically begin 6-12 hours after the last opioid use, peak at 48-72 hours, and
gradually resolve over 5-10 days. Opioid intoxication would present with euphoria,
pupillary constriction, and respiratory depression.
, 4. Which FDA-approved medication is considered the GOLD STANDARD for
maintenance treatment of opioid use disorder and is available in both oral and
long-acting injectable formulations?
A. Naloxone
B. Buprenorphine
C. Methadone
D. Naltrexone
Correct Answer: C. Methadone
Rationale: Methadone is a full opioid agonist that has been the gold standard for opioid
maintenance treatment for decades. It is available in oral formulations and, in some
settings, as a long-acting injectable. Buprenorphine is a partial agonist also used for
maintenance but is not considered the gold standard. Naloxone is an opioid antagonist
used for overdose reversal. Naltrexone is an antagonist used for relapse prevention.
5. A patient with alcohol use disorder who wishes to maintain abstinence is started
on naltrexone. The PMHNP explains that this medication works by:
A. Causing an adverse reaction if alcohol is consumed
B. Reducing alcohol cravings by blocking opioid receptors
C. Reducing withdrawal symptoms during detoxification
D. Increasing GABA activity in the central nervous system
Correct Answer: B. Reducing alcohol cravings by blocking opioid receptors
Rationale: Naltrexone is an opioid receptor antagonist that reduces the rewarding
effects of alcohol by blocking opioid receptors involved in the brain's reward pathway.
This leads to decreased cravings and reduced likelihood of relapse. Disulfiram causes an
