Barkley-Style PMHNP Review FLORIDA STATE FIRE
INSTRUCTOR 3 ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES |
GRADED A+
Section I — Assessment, Diagnosis & Neurobiology
1. A patient reports hearing a voice saying, “You are worthless,” but recognizes that the voice is
not real. Which term best describes this experience?
A. Delusion
B. Illusion
C. Hallucination
D. Obsession
Answer: C. Hallucination
Rationale: A hallucination is a sensory perception occurring without an external stimulus.
Auditory hallucinations are particularly common in psychotic disorders. An illusion is a
misinterpretation of a real stimulus.
2. Which neurotransmitter is most strongly associated with the pathophysiology of
schizophrenia?
A. Dopamine
B. Acetylcholine
C. GABA only
D. Histamine
Answer: A. Dopamine
,Rationale: Dysregulation of dopamine transmission is central to current neurobiological models
of schizophrenia. Excess dopamine activity in mesolimbic pathways is associated with positive
symptoms, while reduced mesocortical dopamine activity may contribute to negative and
cognitive symptoms.
3. Which finding most strongly suggests delirium rather than dementia?
A. Gradual memory impairment
B. Preserved attention
C. Acute fluctuating level of consciousness
D. Progressive decline over several years
Answer: C. Acute fluctuating level of consciousness
Rationale: Delirium typically develops acutely and is characterized by impaired attention and
fluctuating cognition/awareness. Dementia generally has a chronic, progressive course.
4. A patient with depression reports loss of interest, fatigue, poor concentration, and feelings of
worthlessness for 3 weeks. Which diagnosis is most likely?
A. Adjustment disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Persistent depressive disorder
Answer: B. Major depressive disorder
Rationale: A major depressive episode requires at least 2 weeks of clinically significant
depressive symptoms, including depressed mood or anhedonia, with associated functional
impairment.
5. Which symptom is considered a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Answer: C. Avolition
,Rationale: Negative symptoms include diminished emotional expression, avolition, alogia,
anhedonia, and social withdrawal. Hallucinations and delusions are positive symptoms.
6. A patient believes the television broadcaster is sending personal messages specifically to
them. This is an example of:
A. Thought broadcasting
B. Ideas of reference
C. Thought insertion
D. Somatic delusion
Answer: B. Ideas of reference
Rationale: Ideas of reference occur when a person incorrectly interprets neutral events as
having special personal significance.
7. Which finding is most concerning during a suicide assessment?
A. Passive death wish without intent
B. Family history of depression
C. Specific plan with access to lethal means
D. Mild insomnia
Answer: C. Specific plan with access to lethal means
Rationale: A specific suicide plan combined with access to the intended means substantially
increases immediate risk and requires urgent safety intervention.
8. Which question is most appropriate when assessing suicidal ideation?
A. “You aren't thinking about suicide, are you?”
B. “Do you have thoughts of killing yourself?”
C. “You wouldn't hurt yourself, correct?”
D. “Why would you want to die?”
Answer: B. “Do you have thoughts of killing yourself?”
Rationale: Direct, clear questions about suicide are appropriate and do not cause suicidal
behavior. The clinician should then assess intent, plan, means, timing, previous attempts,
protective factors, and safety.
, 9. Which mental status examination finding describes circumstantiality?
A. Rapidly shifting between unrelated topics
B. Repeating another person's words
C. Eventually answering the question after excessive detail
D. Inability to produce speech
Answer: C. Eventually answering the question after excessive detail
Rationale: Circumstantial speech includes excessive detail but eventually returns to the original
point. Tangential speech moves away from the question without returning to it.
10. A patient has markedly increased energy, decreased need for sleep, grandiosity, pressured
speech, and risky spending for 10 days with significant impairment. Which diagnosis is most
likely?
A. Major depressive disorder
B. Bipolar I disorder
C. Cyclothymic disorder
D. Generalized anxiety disorder
Answer: B. Bipolar I disorder
Rationale: Bipolar I disorder requires at least one manic episode. The episode may be severe
enough to cause marked impairment or require hospitalization.
Section II — Psychopharmacology
11. Which medication is considered a first-line pharmacologic treatment for major depressive
disorder?
A. Fluoxetine
B. Haloperidol
C. Alprazolam
D. Benztropine
Answer: A. Fluoxetine
Rationale: SSRIs such as fluoxetine are commonly used first-line for major depressive disorder
because of their efficacy, tolerability, and safety relative to many older antidepressants.
INSTRUCTOR 3 ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES |
GRADED A+
Section I — Assessment, Diagnosis & Neurobiology
1. A patient reports hearing a voice saying, “You are worthless,” but recognizes that the voice is
not real. Which term best describes this experience?
A. Delusion
B. Illusion
C. Hallucination
D. Obsession
Answer: C. Hallucination
Rationale: A hallucination is a sensory perception occurring without an external stimulus.
Auditory hallucinations are particularly common in psychotic disorders. An illusion is a
misinterpretation of a real stimulus.
2. Which neurotransmitter is most strongly associated with the pathophysiology of
schizophrenia?
A. Dopamine
B. Acetylcholine
C. GABA only
D. Histamine
Answer: A. Dopamine
,Rationale: Dysregulation of dopamine transmission is central to current neurobiological models
of schizophrenia. Excess dopamine activity in mesolimbic pathways is associated with positive
symptoms, while reduced mesocortical dopamine activity may contribute to negative and
cognitive symptoms.
3. Which finding most strongly suggests delirium rather than dementia?
A. Gradual memory impairment
B. Preserved attention
C. Acute fluctuating level of consciousness
D. Progressive decline over several years
Answer: C. Acute fluctuating level of consciousness
Rationale: Delirium typically develops acutely and is characterized by impaired attention and
fluctuating cognition/awareness. Dementia generally has a chronic, progressive course.
4. A patient with depression reports loss of interest, fatigue, poor concentration, and feelings of
worthlessness for 3 weeks. Which diagnosis is most likely?
A. Adjustment disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Persistent depressive disorder
Answer: B. Major depressive disorder
Rationale: A major depressive episode requires at least 2 weeks of clinically significant
depressive symptoms, including depressed mood or anhedonia, with associated functional
impairment.
5. Which symptom is considered a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Answer: C. Avolition
,Rationale: Negative symptoms include diminished emotional expression, avolition, alogia,
anhedonia, and social withdrawal. Hallucinations and delusions are positive symptoms.
6. A patient believes the television broadcaster is sending personal messages specifically to
them. This is an example of:
A. Thought broadcasting
B. Ideas of reference
C. Thought insertion
D. Somatic delusion
Answer: B. Ideas of reference
Rationale: Ideas of reference occur when a person incorrectly interprets neutral events as
having special personal significance.
7. Which finding is most concerning during a suicide assessment?
A. Passive death wish without intent
B. Family history of depression
C. Specific plan with access to lethal means
D. Mild insomnia
Answer: C. Specific plan with access to lethal means
Rationale: A specific suicide plan combined with access to the intended means substantially
increases immediate risk and requires urgent safety intervention.
8. Which question is most appropriate when assessing suicidal ideation?
A. “You aren't thinking about suicide, are you?”
B. “Do you have thoughts of killing yourself?”
C. “You wouldn't hurt yourself, correct?”
D. “Why would you want to die?”
Answer: B. “Do you have thoughts of killing yourself?”
Rationale: Direct, clear questions about suicide are appropriate and do not cause suicidal
behavior. The clinician should then assess intent, plan, means, timing, previous attempts,
protective factors, and safety.
, 9. Which mental status examination finding describes circumstantiality?
A. Rapidly shifting between unrelated topics
B. Repeating another person's words
C. Eventually answering the question after excessive detail
D. Inability to produce speech
Answer: C. Eventually answering the question after excessive detail
Rationale: Circumstantial speech includes excessive detail but eventually returns to the original
point. Tangential speech moves away from the question without returning to it.
10. A patient has markedly increased energy, decreased need for sleep, grandiosity, pressured
speech, and risky spending for 10 days with significant impairment. Which diagnosis is most
likely?
A. Major depressive disorder
B. Bipolar I disorder
C. Cyclothymic disorder
D. Generalized anxiety disorder
Answer: B. Bipolar I disorder
Rationale: Bipolar I disorder requires at least one manic episode. The episode may be severe
enough to cause marked impairment or require hospitalization.
Section II — Psychopharmacology
11. Which medication is considered a first-line pharmacologic treatment for major depressive
disorder?
A. Fluoxetine
B. Haloperidol
C. Alprazolam
D. Benztropine
Answer: A. Fluoxetine
Rationale: SSRIs such as fluoxetine are commonly used first-line for major depressive disorder
because of their efficacy, tolerability, and safety relative to many older antidepressants.
