,Barkley PMHNP Board Preparation Exam Questions
and Answers with Rationale 2026/2027
Question 1
A 42-year-old male with a history of alcohol use disorder is
brought to the emergency department by emergency medical
services after being found unresponsive. Examination reveals
pinpoint pupils, a respiratory rate of 6 breaths per minute,
bradycardia, and cold, clammy skin. What is the immediate life-
saving intervention?
A. Intravenous naloxone administration combined with
bag-valve-mask ventilation and airway support
B. Immediate administration of oral activated charcoal
C. Emergency initiation of electroconvulsive therapy
D. Administration of high-dose intravenous
benzodiazepines
Correct Answer: A. Intravenous naloxone administration
combined with bag-valve-mask ventilation and airway support
Rationale: Acute opioid overdose causes life-threatening central
nervous system and respiratory depression. The immediate
clinical priority is securing the airway and restoring adequate
ventilation, paired with titrated doses of the competitive opioid
receptor antagonist naloxone.
Question 2
A 35-year-old female with bipolar I disorder is stabilized on
lithium carbonate and presents for a routine 6-month psychiatric
evaluation. She reports increased thirst and frequent urination
,over the past several months. Laboratory tests reveal a normal
serum lithium level, normal serum creatinine, normal BUN, and
a high 24-hour urine volume with low specific gravity. What is
the most likely diagnosis?
A. Syndrome of inappropriate antidiuretic hormone
secretion (SIADH)
B. Lithium-induced nephrogenic diabetes insipidus
C. Acute tubular necrosis
D. Chronic tubulointerstitial nephritis with renal failure
Correct Answer: B. Lithium-induced nephrogenic diabetes
insipidus
Rationale: Lithium interferes with the renal collecting
tubule's response to antidiuretic hormone (ADH), inducing
nephrogenic diabetes insipidus. This classically presents
with marked polyuria and polydipsia while maintaining
normal filtration markers like serum creatinine and BUN,
as well as normal serum lithium levels.
Question 3
A 29-year-old female is initiated on a selective serotonin
reuptake inhibitor (SSRI) for major depressive disorder. Two
weeks later, she presents with severe restlessness, an inability to
sit still, constant pacing, and profound subjective inner
jitteriness. This side effect is best classified as:
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Parkinsonism
, Correct Answer: A. Akathisia
Rationale: Akathisia is a common extrapyramidal side
effect characterized by inner subjective restlessness and a
compulsive motor need to move or pace. It can be triggered
by medications like SSRIs due to serotonergic inhibition of
dopaminergic pathways. It is distinguished from anxiety by
its core physical motor restlessness and tight temporal
association with drug initiation or dose increases.
Question 4
A 55-year-old male with treatment-resistant schizophrenia is
maintained on clozapine therapy. Along with mandatory
Absolute Neutrophil Count (ANC) tracking through the REMS
program, which severe, non-hematological gastrointestinal
adverse effect requires proactive clinical monitoring and
preventative bowel regimens?
A. Severe constipation and bowel obstruction risk
B. Spontaneous acute pancreatitis
C. Microscopic colitis
D. Chronic viral hepatitis
Correct Answer: A. Severe constipation and bowel obstruction
risk
Rationale: Clozapine possesses potent anticholinergic
properties that significantly slow intestinal motility. This
puts patients at high risk for life-threatening constipation,
paralytic ileus, bowel impaction, and ischemic colitis.
Proactive bowel regimens and routine monitoring for bowel
habits are mandatory.
and Answers with Rationale 2026/2027
Question 1
A 42-year-old male with a history of alcohol use disorder is
brought to the emergency department by emergency medical
services after being found unresponsive. Examination reveals
pinpoint pupils, a respiratory rate of 6 breaths per minute,
bradycardia, and cold, clammy skin. What is the immediate life-
saving intervention?
A. Intravenous naloxone administration combined with
bag-valve-mask ventilation and airway support
B. Immediate administration of oral activated charcoal
C. Emergency initiation of electroconvulsive therapy
D. Administration of high-dose intravenous
benzodiazepines
Correct Answer: A. Intravenous naloxone administration
combined with bag-valve-mask ventilation and airway support
Rationale: Acute opioid overdose causes life-threatening central
nervous system and respiratory depression. The immediate
clinical priority is securing the airway and restoring adequate
ventilation, paired with titrated doses of the competitive opioid
receptor antagonist naloxone.
Question 2
A 35-year-old female with bipolar I disorder is stabilized on
lithium carbonate and presents for a routine 6-month psychiatric
evaluation. She reports increased thirst and frequent urination
,over the past several months. Laboratory tests reveal a normal
serum lithium level, normal serum creatinine, normal BUN, and
a high 24-hour urine volume with low specific gravity. What is
the most likely diagnosis?
A. Syndrome of inappropriate antidiuretic hormone
secretion (SIADH)
B. Lithium-induced nephrogenic diabetes insipidus
C. Acute tubular necrosis
D. Chronic tubulointerstitial nephritis with renal failure
Correct Answer: B. Lithium-induced nephrogenic diabetes
insipidus
Rationale: Lithium interferes with the renal collecting
tubule's response to antidiuretic hormone (ADH), inducing
nephrogenic diabetes insipidus. This classically presents
with marked polyuria and polydipsia while maintaining
normal filtration markers like serum creatinine and BUN,
as well as normal serum lithium levels.
Question 3
A 29-year-old female is initiated on a selective serotonin
reuptake inhibitor (SSRI) for major depressive disorder. Two
weeks later, she presents with severe restlessness, an inability to
sit still, constant pacing, and profound subjective inner
jitteriness. This side effect is best classified as:
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Parkinsonism
, Correct Answer: A. Akathisia
Rationale: Akathisia is a common extrapyramidal side
effect characterized by inner subjective restlessness and a
compulsive motor need to move or pace. It can be triggered
by medications like SSRIs due to serotonergic inhibition of
dopaminergic pathways. It is distinguished from anxiety by
its core physical motor restlessness and tight temporal
association with drug initiation or dose increases.
Question 4
A 55-year-old male with treatment-resistant schizophrenia is
maintained on clozapine therapy. Along with mandatory
Absolute Neutrophil Count (ANC) tracking through the REMS
program, which severe, non-hematological gastrointestinal
adverse effect requires proactive clinical monitoring and
preventative bowel regimens?
A. Severe constipation and bowel obstruction risk
B. Spontaneous acute pancreatitis
C. Microscopic colitis
D. Chronic viral hepatitis
Correct Answer: A. Severe constipation and bowel obstruction
risk
Rationale: Clozapine possesses potent anticholinergic
properties that significantly slow intestinal motility. This
puts patients at high risk for life-threatening constipation,
paralytic ileus, bowel impaction, and ischemic colitis.
Proactive bowel regimens and routine monitoring for bowel
habits are mandatory.
