PMHNP EXAM – BARKLEY DRT DOCUMENTATION REVIEW TOOL
EXAM NEWEST EXAM PREPARATION WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES |
ALREADY GRADED A+||BRAND NEW VERSION!!
SECTION 1: CRISIS INTERVENTION & SUICIDE ASSESSMENT
QUESTION 1
During a suicide intervention with your 28-year-old male patient, to which
agreement should
you ask for his consent, verbally or in writing?
A. "No Harm" contract
B. "No Suicide" contract
C. "Prevention" Contract
D. "Affirming Life" contract
ANSWER: A
RATIONALE: Healthcare professionals are obligated to ask suicidal patients to
agree to a "No Harm" contract, verbally or in writing, detailing specifically that the
patient will refrain from harming themselves. This is the standard clinical tool
used in suicide prevention interventions and establishes a clear commitment to
safety.
QUESTION 2
Which of the following is the most critical initial intervention for a patient
expressing suicidal
ideation with a specific plan?
A. Schedule a follow-up appointment in 2 weeks
B. Initiate safety assessment and protective measures
C. Prescribe an antidepressant
D. Recommend journaling of thoughts
ANSWER: B
1
,RATIONALE: Safety always comes first. A patient with suicidal ideation and a
specific plan is at imminent risk and requires immediate assessment and
protective interventions. This includes removing means of self-harm, developing a
safety plan, and considering hospitalization if necessary. Scheduling a follow-up,
prescribing medication, or recommending journaling would
delay necessary crisis intervention and potentially place the patient at greater
risk.
QUESTION 3
Warning signs of impending suicide include all of the following EXCEPT:
A. Giving away possessions
B. Expressing hopelessness
C. Increased social engagement
D. History of prior attempts
E. Sudden mood improvement after depression
ANSWER: C
RATIONALE: Warning signs include giving away possessions, expressing
hopelessness, history of prior attempts, and sudden mood improvement after
depression (which may indicate a decision to act). Increased social engagement
alone is not a warning sign; in fact, withdrawal and isolation are more concerning.
The presence of multiple warning signs should prompt immediate clinical
evaluation.
QUESTION 4
The counseling keystones relevant to assessment of a crisis include which of the
following?
A. Identifying the hazard and precipitating event
B. Empathy, confrontation, and immediacy
C. Identifying coping mechanisms
D. Situational support
ANSWER: B
2
,RATIONALE: Three of the counseling keystones relevant to assessment of a crisis
are empathy, confrontation, and immediacy. Empathy establishes rapport and
validates the patient's experience. Confrontation addresses reality and denial.
Immediacy focuses on the present moment and current feelings. These
techniques are essential in crisis intervention to stabilize the patient and address
acute distress.
QUESTION 5
A patient with which of the following findings should be referred to primary care
for
cardiovascular problems?
A. Blood pressure of 130/85 mmHg
B. Systolic blood pressure of 110 mmHg
C. Diastolic blood pressure of 70 mmHg
D. Low density lipoprotein level (LDL) of 69 mg/dl
ANSWER: A
RATIONALE: A blood pressure of 130/85 mmHg is considered elevated and falls
into the prehypertension or stage 1 hypertension category, requiring primary care
referral for cardiovascular evaluation. An LDL of 69 mg/dl is desirable and does
not warrant referral. Normal systolic readings below 120 mmHg and normal
diastolic readings below 80 mmHg are not concerning. Prolonged elevated blood
pressure increases the risk of cardiovascular events and requires medical
management.
QUESTION 6
During a crisis intervention, which therapeutic communication technique is most
appropriate
for a patient who is actively suicidal?
A. Offering reassurance that everything will be fine
B. Asking open-ended questions about their feelings
C. Directly asking about suicidal thoughts and plans
D. Changing the subject to reduce anxiety
3
, ANSWER: C
RATIONALE: Directly asking about suicidal thoughts and plans is essential and
does not increase the risk of suicide. Research consistently shows that asking
about suicide does not implant the idea. Open-ended questions are appropriate
but direct questioning about intent, plan, and means is the priority for safety
assessment. Offering false reassurance minimizes the
patient's distress, and changing the subject avoids addressing the crisis.
QUESTION 7
A patient with command hallucinations telling them to harm themselves requires
which
intervention first?
A. Increase antipsychotic dose
B. Initiate safety assessment and protective measures
C. Encourage journaling of thoughts
D. Schedule group therapy
ANSWER: B
RATIONALE: Command hallucinations to self-harm indicate imminent risk
requiring immediate assessment and protective interventions. Safety is always
the highest priority. While medication adjustment and therapy are important
long-term interventions, they do not address the immediate danger. The clinician
must first ensure the patient's safety, which may involve
hospitalization and removing access to means of self-harm.
QUESTION 8
Which of the following is a protective factor against suicide?
A. History of multiple suicide attempts
B. Strong social support system
C. Access to firearms
D. Chronic pain
4
EXAM NEWEST EXAM PREPARATION WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES |
ALREADY GRADED A+||BRAND NEW VERSION!!
SECTION 1: CRISIS INTERVENTION & SUICIDE ASSESSMENT
QUESTION 1
During a suicide intervention with your 28-year-old male patient, to which
agreement should
you ask for his consent, verbally or in writing?
A. "No Harm" contract
B. "No Suicide" contract
C. "Prevention" Contract
D. "Affirming Life" contract
ANSWER: A
RATIONALE: Healthcare professionals are obligated to ask suicidal patients to
agree to a "No Harm" contract, verbally or in writing, detailing specifically that the
patient will refrain from harming themselves. This is the standard clinical tool
used in suicide prevention interventions and establishes a clear commitment to
safety.
QUESTION 2
Which of the following is the most critical initial intervention for a patient
expressing suicidal
ideation with a specific plan?
A. Schedule a follow-up appointment in 2 weeks
B. Initiate safety assessment and protective measures
C. Prescribe an antidepressant
D. Recommend journaling of thoughts
ANSWER: B
1
,RATIONALE: Safety always comes first. A patient with suicidal ideation and a
specific plan is at imminent risk and requires immediate assessment and
protective interventions. This includes removing means of self-harm, developing a
safety plan, and considering hospitalization if necessary. Scheduling a follow-up,
prescribing medication, or recommending journaling would
delay necessary crisis intervention and potentially place the patient at greater
risk.
QUESTION 3
Warning signs of impending suicide include all of the following EXCEPT:
A. Giving away possessions
B. Expressing hopelessness
C. Increased social engagement
D. History of prior attempts
E. Sudden mood improvement after depression
ANSWER: C
RATIONALE: Warning signs include giving away possessions, expressing
hopelessness, history of prior attempts, and sudden mood improvement after
depression (which may indicate a decision to act). Increased social engagement
alone is not a warning sign; in fact, withdrawal and isolation are more concerning.
The presence of multiple warning signs should prompt immediate clinical
evaluation.
QUESTION 4
The counseling keystones relevant to assessment of a crisis include which of the
following?
A. Identifying the hazard and precipitating event
B. Empathy, confrontation, and immediacy
C. Identifying coping mechanisms
D. Situational support
ANSWER: B
2
,RATIONALE: Three of the counseling keystones relevant to assessment of a crisis
are empathy, confrontation, and immediacy. Empathy establishes rapport and
validates the patient's experience. Confrontation addresses reality and denial.
Immediacy focuses on the present moment and current feelings. These
techniques are essential in crisis intervention to stabilize the patient and address
acute distress.
QUESTION 5
A patient with which of the following findings should be referred to primary care
for
cardiovascular problems?
A. Blood pressure of 130/85 mmHg
B. Systolic blood pressure of 110 mmHg
C. Diastolic blood pressure of 70 mmHg
D. Low density lipoprotein level (LDL) of 69 mg/dl
ANSWER: A
RATIONALE: A blood pressure of 130/85 mmHg is considered elevated and falls
into the prehypertension or stage 1 hypertension category, requiring primary care
referral for cardiovascular evaluation. An LDL of 69 mg/dl is desirable and does
not warrant referral. Normal systolic readings below 120 mmHg and normal
diastolic readings below 80 mmHg are not concerning. Prolonged elevated blood
pressure increases the risk of cardiovascular events and requires medical
management.
QUESTION 6
During a crisis intervention, which therapeutic communication technique is most
appropriate
for a patient who is actively suicidal?
A. Offering reassurance that everything will be fine
B. Asking open-ended questions about their feelings
C. Directly asking about suicidal thoughts and plans
D. Changing the subject to reduce anxiety
3
, ANSWER: C
RATIONALE: Directly asking about suicidal thoughts and plans is essential and
does not increase the risk of suicide. Research consistently shows that asking
about suicide does not implant the idea. Open-ended questions are appropriate
but direct questioning about intent, plan, and means is the priority for safety
assessment. Offering false reassurance minimizes the
patient's distress, and changing the subject avoids addressing the crisis.
QUESTION 7
A patient with command hallucinations telling them to harm themselves requires
which
intervention first?
A. Increase antipsychotic dose
B. Initiate safety assessment and protective measures
C. Encourage journaling of thoughts
D. Schedule group therapy
ANSWER: B
RATIONALE: Command hallucinations to self-harm indicate imminent risk
requiring immediate assessment and protective interventions. Safety is always
the highest priority. While medication adjustment and therapy are important
long-term interventions, they do not address the immediate danger. The clinician
must first ensure the patient's safety, which may involve
hospitalization and removing access to means of self-harm.
QUESTION 8
Which of the following is a protective factor against suicide?
A. History of multiple suicide attempts
B. Strong social support system
C. Access to firearms
D. Chronic pain
4
