BARKLEY DRT PMHNP PRACTICUM 1 PRE-TEST: 200 A+ PRACTICE QUESTIONS WITH VERIFIED ANSWERS – FULL-SPECTRUM REVIEW OF PSYCHOPHARMACOLOGY, CLUSTER A/B/C PERSONALITY DISORDERS, AND CLINICAL DECISION-MAKING FOR THE FNP/PMHNP STUDENT

BARKLEY DRT PMHNP PRACTICUM 1 PRE-TEST: 200 A+ PRACTICE QUESTIONS WITH VERIFIED ANSWERS – FULL-SPECTRUM REVIEW OF PSYCHOPHARMACOLOGY, CLUSTER A/B/C PERSONALITY DISORDERS, AND CLINICAL DECISION-MAKING FOR THE FNP/PMHNP STUDENT QUESTION 1: A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor concentration for 3 weeks. She also has increased appetite and sleeps 11 hours per night. What is the most likely diagnosis? A) Major depressive disorder, melancholic features B) Major depressive disorder, atypical features C) Persistent depressive disorder D) Bipolar II disorder, current episode depressed CORRECT ANSWER: B) Major depressive disorder, atypical features RATIONALE: Atypical features of MDD include hypersomnia, hyperphagia (increased appetite), leaden paralysis, and mood reactivity. Melancholic features involve early morning awakening, anorexia, and worse mood in the morning. Persistent depressive disorder requires ≥2 years of symptoms. There is no history of hypomania, so bipolar II is not supported. ________________________________________ QUESTION 2: A patient experiences recurrent panic attacks followed by 4 months of persistent worry about having another attack. He avoids the gym where the first attack occurred. What diagnosis best fits? A) Panic disorder B) Agoraphobia C) Social anxiety disorder D) Panic disorder with agoraphobia CORRECT ANSWER: D) Panic disorder with agoraphobia RATIONALE: The patient meets criteria for panic disorder (recurrent unexpected panic attacks + ≥1 month of worry/behavior change) and also avoids a specific place (gym) due to fear of difficulty escaping – meeting agoraphobia criteria. Panic disorder alone would not include avoidance. Agoraphobia alone can occur without panic attacks. ________________________________________ QUESTION 3: A 45-year-old male with schizophrenia has been on haloperidol for 2 years. He now presents with repetitive, involuntary movements of his tongue, lips, and face. Which condition is MOST likely? A) Akathisia B) Neuroleptic malignant syndrome C) Parkinson's disease D) Tardive dyskinesia E) Acute dystonia CORRECT ANSWER: D) Tardive dyskinesia RATIONALE: Tardive dyskinesia (TD) is a late-onset movement disorder associated with prolonged use of dopamine receptor-blocking agents such as haloperidol. It is characterized by repetitive, involuntary orofacial movements and can be irreversible. Valbenazine (Ingrezza) or deutetrabenazine (Austedo) are FDA-approved treatments. ________________________________________ QUESTION 4: A 22-year-old college student presents with recurrent, unexpected panic attacks, persistent worry about future attacks, and avoidance of places where attacks have occurred for 5 months. What is the BEST first-line pharmacological treatment? A) Alprazolam (Xanax) B) Buspirone (Buspar) C) Sertraline (Zoloft) D) Propranolol (Inderal) E) Clonazepam (Klonopin) CORRECT ANSWER: C) Sertraline (Zoloft) RATIONALE: SSRIs such as sertraline are the first-line pharmacological treatment for panic disorder per APA guidelines. Benzodiazepines may provide short-term relief but are not recommended as first-line due to dependence risk. Buspirone is effective for GAD but not panic disorder. ________________________________________ QUESTION 5: A 16-year-old is brought in by parents for evaluation. She has restricted food intake, intense fear of gaining weight, distorted body image, and her BMI is 15.5. Which diagnosis is MOST appropriate? A) Bulimia nervosa B) Binge eating disorder C) Avoidant/restrictive food intake disorder (ARFID) D) Anorexia nervosa, restricting type E) Body dysmorphic disorder CORRECT ANSWER: D) Anorexia nervosa, restricting type RATIONALE: Anorexia nervosa is characterized by restricted energy intake, intense fear of weight gain, and distorted body image leading to significantly low body weight (BMI 17.5 in adults). The restricting subtype does not involve binge/purge behaviors. ARFID lacks the fear of weight gain and body image distortion. ________________________________________ QUESTION 6: A PMHNP is evaluating a patient who takes lithium. The patient's serum lithium level is 1.8 mEq/L and presents with coarse tremor, confusion, and nausea. What is the PRIORITY intervention? A) Reduce the lithium dose by half B) Administer activated charcoal C) Discontinue lithium and initiate hemodialysis D) Switch to valproate immediately E) Increase fluid intake and monitor CORRECT ANSWER: C) Discontinue lithium and initiate hemodialysis RATIONALE: Lithium levels above 1.5 mEq/L indicate toxicity, and levels above 1.5–2.0 mEq/L with neurological symptoms (coarse tremor, confusion) require immediate discontinuation. Hemodialysis is indicated for severe toxicity (levels 2.5 mEq/L or severe symptoms at lower levels). Toxic signs include SHALT: Slurred speech, Hyperreflexia, Ataxia, Large tremors, Tachycardia. ________________________________________ QUESTION 7: A 68-year-old presents with progressive memory loss, getting lost in familiar places, difficulty with ADLs, and personality changes over 2 years. Her daughter reports she has been aggressive and confused at night. Which diagnosis is MOST likely? A) Delirium B) Major depressive disorder with psychotic features C) Alzheimer's disease (major neurocognitive disorder) D) Vascular neurocognitive disorder E) Frontotemporal neurocognitive disorder CORRECT ANSWER: C) Alzheimer's disease (major neurocognitive disorder) RATIONALE: Alzheimer's disease is the most common cause of major neurocognitive disorder, characterized by progressive memory loss, executive dysfunction, difficulty with ADLs, and personality changes. Delirium has an acute onset and fluctuating course. Vascular NCD has a stepwise progression. Frontotemporal NCD typically presents with prominent behavioral/personality changes earlier than memory loss. ________________________________________ QUESTION 8: A patient with major depressive disorder (MDD) has failed two SSRIs. Which of the following should the PMHNP consider next? A) Increase the dose of the most recent SSRI beyond the FDA maximum B) Switch to an SNRI (e.g., venlafaxine) or augment with bupropion or mirtazapine C) Discontinue all antidepressants and start monotherapy with alprazolam D) Begin electroconvulsive therapy (ECT) as first-line treatment CORRECT ANSWER: B) Switch to an SNRI (e.g., venlafaxine) or augment with bupropion or mirtazapine