Barkley DRT PMHNP 2026/2027 – Complete 250+
Practice Questions & Answers with Verified
Answers & Detailed Rationales | Diagnostic
Readiness Test Psychiatric-Mental Health Nurse
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SECTION 1: ASSESSMENT & DIFFERENTIAL DIAGNOSIS (Questions 1-45)
Question 1
A 35-year-old patient presents with persistent low mood, fatigue, and anhedonia for 3
months. Which is the most likely diagnosis?
A) Bipolar I Disorder
B) Major Depressive Disorder
C) Persistent Depressive Disorder (Dysthymia)
D) Adjustment Disorder
Correct Answer: C
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by depressed
mood for at least 2 years in adults, with symptoms present more days than not. The
scenario describes chronic symptoms lasting 3 months—while shorter than 2 years, the
presentation suggests persistent subthreshold depression . MDD requires a discrete
episode lasting at least 2 weeks, not months. Bipolar I Disorder requires a history of
mania. Adjustment Disorder is tied to a specific stressor and resolves within 6 months.
Question 2
A 28-year-old patient presents with excessive worry about multiple life domains for 8
months, accompanied by irritability, muscle tension, and sleep disturbance. What is the
most likely diagnosis?
A) Panic Disorder
B) Generalized Anxiety Disorder
,C) Adjustment Disorder
D) Social Anxiety Disorder
Correct Answer: B
Rationale: Generalized Anxiety Disorder is characterized by excessive, uncontrollable
worry occurring more days than not for at least 6 months, with associated symptoms of
restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep
disturbance . Panic Disorder involves recurrent unexpected panic attacks. Social Anxiety
Disorder involves fear of social scrutiny. Adjustment Disorder is related to a specific
stressor.
Question 3
A 30-year-old male presents with flat affect, social withdrawal, and impaired motivation
for 6 months. There are no psychotic symptoms. What is the most likely diagnosis?
A) Schizophrenia
B) Schizoaffective Disorder
C) Major Depressive Disorder with psychotic features
D) Schizoid Personality Disorder
Correct Answer: D
Rationale: Schizoid Personality Disorder is characterized by a long-standing pattern of
social detachment, restricted emotional expression, and limited desire for close
relationships. The absence of psychotic symptoms rules out Schizophrenia and
Schizoaffective Disorder. The presentation is chronic and personality-based rather than
an acute episode .
Question 4
A 45-year-old patient presents with sudden onset of severe panic attacks, palpitations,
sweating, and fear of dying. These episodes have occurred repeatedly over the past
month. What is the most likely diagnosis?
A) Generalized Anxiety Disorder
B) Panic Disorder
,C) Social Anxiety Disorder
D) Specific Phobia
Correct Answer: B
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks—
sudden surges of intense fear with symptoms including palpitations, sweating, and fear
of dying. The key feature is the recurrence of unexpected attacks and subsequent
concern about having more attacks . GAD involves chronic worry. Social Anxiety
Disorder involves fear of social situations. Specific Phobia involves fear of a specific
object or situation.
Question 5
True or False: SSRIs are first-line pharmacotherapy for Generalized Anxiety Disorder
(GAD).
A) True
B) False
Correct Answer: A
Rationale: SSRIs (e.g., escitalopram, sertraline, paroxetine) are first-line agents for GAD
due to their efficacy and tolerability profile. SNRIs (venlafaxine, duloxetine) are also first-
line. Buspirone and pregabalin are additional options .
Question 6
Which of the following is NOT a criterion for a diagnosis of Major Depressive Disorder?
A) Depressed mood most of the day, nearly every day
B) Markedly diminished interest or pleasure in all activities
C) Inflated self-esteem or grandiosity
D) Significant weight loss or weight gain
Correct Answer: C
Rationale: Inflated self-esteem or grandiosity is a criterion for a manic episode, not
Major Depressive Disorder. MDD criteria include depressed mood, anhedonia,
, significant weight change, sleep disturbances, psychomotor changes, fatigue,
worthlessness/guilt, diminished concentration, and recurrent thoughts of death.
Question 7
A patient presents with depressive symptoms following the loss of a job 3 weeks ago.
Symptoms include depressed mood and insomnia, but no significant weight change or
suicidal ideation. What is the most appropriate diagnosis?
A) Major Depressive Disorder
B) Persistent Depressive Disorder
C) Adjustment Disorder
D) Bipolar II Disorder
Correct Answer: C
Rationale: Adjustment Disorder is characterized by emotional or behavioral symptoms
in response to an identifiable stressor that occur within 3 months of the stressor onset.
The symptoms do not meet criteria for another mental disorder and are not an
exacerbation of a pre-existing condition. The job loss within 3 weeks makes this the
most appropriate diagnosis.
Question 8
The presence of command hallucinations to self-harm in a patient with schizophrenia
indicates:
A) The patient should be left to journal their thoughts
B) The patient should be scheduled for group therapy
C) Safety assessment and protective measures are the highest priority
D) Antipsychotic dose should be increased immediately
Correct Answer: C
Rationale: Safety always comes first. Command hallucinations to self-harm or harm
others indicate imminent risk requiring immediate assessment and protective
interventions . The patient may need hospitalization to ensure safety. While medication
adjustment may be necessary, it is not the immediate priority.
Practice Questions & Answers with Verified
Answers & Detailed Rationales | Diagnostic
Readiness Test Psychiatric-Mental Health Nurse
Practitioner | 100% Pass Guarantee
SECTION 1: ASSESSMENT & DIFFERENTIAL DIAGNOSIS (Questions 1-45)
Question 1
A 35-year-old patient presents with persistent low mood, fatigue, and anhedonia for 3
months. Which is the most likely diagnosis?
A) Bipolar I Disorder
B) Major Depressive Disorder
C) Persistent Depressive Disorder (Dysthymia)
D) Adjustment Disorder
Correct Answer: C
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by depressed
mood for at least 2 years in adults, with symptoms present more days than not. The
scenario describes chronic symptoms lasting 3 months—while shorter than 2 years, the
presentation suggests persistent subthreshold depression . MDD requires a discrete
episode lasting at least 2 weeks, not months. Bipolar I Disorder requires a history of
mania. Adjustment Disorder is tied to a specific stressor and resolves within 6 months.
Question 2
A 28-year-old patient presents with excessive worry about multiple life domains for 8
months, accompanied by irritability, muscle tension, and sleep disturbance. What is the
most likely diagnosis?
A) Panic Disorder
B) Generalized Anxiety Disorder
,C) Adjustment Disorder
D) Social Anxiety Disorder
Correct Answer: B
Rationale: Generalized Anxiety Disorder is characterized by excessive, uncontrollable
worry occurring more days than not for at least 6 months, with associated symptoms of
restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep
disturbance . Panic Disorder involves recurrent unexpected panic attacks. Social Anxiety
Disorder involves fear of social scrutiny. Adjustment Disorder is related to a specific
stressor.
Question 3
A 30-year-old male presents with flat affect, social withdrawal, and impaired motivation
for 6 months. There are no psychotic symptoms. What is the most likely diagnosis?
A) Schizophrenia
B) Schizoaffective Disorder
C) Major Depressive Disorder with psychotic features
D) Schizoid Personality Disorder
Correct Answer: D
Rationale: Schizoid Personality Disorder is characterized by a long-standing pattern of
social detachment, restricted emotional expression, and limited desire for close
relationships. The absence of psychotic symptoms rules out Schizophrenia and
Schizoaffective Disorder. The presentation is chronic and personality-based rather than
an acute episode .
Question 4
A 45-year-old patient presents with sudden onset of severe panic attacks, palpitations,
sweating, and fear of dying. These episodes have occurred repeatedly over the past
month. What is the most likely diagnosis?
A) Generalized Anxiety Disorder
B) Panic Disorder
,C) Social Anxiety Disorder
D) Specific Phobia
Correct Answer: B
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks—
sudden surges of intense fear with symptoms including palpitations, sweating, and fear
of dying. The key feature is the recurrence of unexpected attacks and subsequent
concern about having more attacks . GAD involves chronic worry. Social Anxiety
Disorder involves fear of social situations. Specific Phobia involves fear of a specific
object or situation.
Question 5
True or False: SSRIs are first-line pharmacotherapy for Generalized Anxiety Disorder
(GAD).
A) True
B) False
Correct Answer: A
Rationale: SSRIs (e.g., escitalopram, sertraline, paroxetine) are first-line agents for GAD
due to their efficacy and tolerability profile. SNRIs (venlafaxine, duloxetine) are also first-
line. Buspirone and pregabalin are additional options .
Question 6
Which of the following is NOT a criterion for a diagnosis of Major Depressive Disorder?
A) Depressed mood most of the day, nearly every day
B) Markedly diminished interest or pleasure in all activities
C) Inflated self-esteem or grandiosity
D) Significant weight loss or weight gain
Correct Answer: C
Rationale: Inflated self-esteem or grandiosity is a criterion for a manic episode, not
Major Depressive Disorder. MDD criteria include depressed mood, anhedonia,
, significant weight change, sleep disturbances, psychomotor changes, fatigue,
worthlessness/guilt, diminished concentration, and recurrent thoughts of death.
Question 7
A patient presents with depressive symptoms following the loss of a job 3 weeks ago.
Symptoms include depressed mood and insomnia, but no significant weight change or
suicidal ideation. What is the most appropriate diagnosis?
A) Major Depressive Disorder
B) Persistent Depressive Disorder
C) Adjustment Disorder
D) Bipolar II Disorder
Correct Answer: C
Rationale: Adjustment Disorder is characterized by emotional or behavioral symptoms
in response to an identifiable stressor that occur within 3 months of the stressor onset.
The symptoms do not meet criteria for another mental disorder and are not an
exacerbation of a pre-existing condition. The job loss within 3 weeks makes this the
most appropriate diagnosis.
Question 8
The presence of command hallucinations to self-harm in a patient with schizophrenia
indicates:
A) The patient should be left to journal their thoughts
B) The patient should be scheduled for group therapy
C) Safety assessment and protective measures are the highest priority
D) Antipsychotic dose should be increased immediately
Correct Answer: C
Rationale: Safety always comes first. Command hallucinations to self-harm or harm
others indicate imminent risk requiring immediate assessment and protective
interventions . The patient may need hospitalization to ensure safety. While medication
adjustment may be necessary, it is not the immediate priority.
