Barkley PMHNP Certification Review |
Psychiatric Mental Health Nurse
Practitioner Exam Study Guide &
Practice Materials
Section I: Psychiatric Assessment and Differential Diagnosis (Questions 1–35)
1. Which of the following is a core component of the psychiatric mental status
examination?
• A. Only the patient's medical history
• B. Appearance, behavior, speech, mood, affect, thought process, thought
content, perception, cognition, and insight/judgment
• C. Only laboratory values
• D. Only the physical examination
• Rationale: The mental status examination systematically assesses
appearance, behavior, speech, mood, affect, thought process and content,
perceptual disturbances, cognition, and insight/judgment to support
diagnostic formulation.
2. When assessing a patient for suicidal ideation, the clinician should:
• A. Avoid asking directly about suicide to prevent suggesting the idea
• B. Ask directly about ideation, plan, intent, and means, and assess
protective factors
• C. Rely solely on the patient's spontaneous report
• D. Document only if the patient is actively suicidal
, • Rationale: Direct, nonjudgmental inquiry about suicidal ideation, plan,
intent, and access to means is a standard of care. Assessing protective
factors and risk severity guides safety planning and level of care.
3. Which screening tool is commonly used to assess depression severity in
adults?
• A. MMSE
• B. PHQ-9
• C. CIWA-Ar
• D. AIMS
• Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a validated
self-report instrument widely used to screen for and monitor the severity of
depressive symptoms in clinical settings.
4. A patient describes hearing voices commenting on their actions. This is an
example of:
• A. A delusion
• B. An auditory hallucination
• C. An idea of reference
• D. Circumstantial thought process
• Rationale: Hallucinations are perceptual experiences occurring without
external stimuli. Commenting voices are a form of auditory hallucination
often associated with psychotic disorders.
5. A 32-year-old female with a history of panic disorder presents with
complaints of sudden, intense episodes of fear accompanied by palpitations,
sweating, and a fear of dying. She reports avoiding gyms and crowded places for
the past six months. Which of the following is the most appropriate first-line
pharmacological intervention?
, • A. Sertraline
• B. Alprazolam
• C. Propranolol
• D. Buspirone
• Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline
are the first-line pharmacological treatment for Panic Disorder. They are
effective in reducing the frequency and intensity of panic attacks and
agoraphobic avoidance. While benzodiazepines (Alprazolam) are effective,
they are not first-line due to dependence risks. Propranolol is used for
performance anxiety, and Buspirone is more effective for generalized
anxiety than panic disorder.
6. A 45-year-old male with Major Depressive Disorder (MDD) has been on
fluoxetine 40 mg daily for 8 weeks with partial response. He reports significant
sexual dysfunction. Which of the following strategies is most appropriate to
address this side effect while maintaining antidepressant efficacy?
• A. Add bupropion 150 mg daily
• B. Switch to phenelzine
• C. Discontinue fluoxetine abruptly
• D. Add hydroxyzine 25 mg daily
• Rationale: Bupropion is often added to SSRIs like fluoxetine to
counteract SSRI-induced sexual dysfunction due to its dopaminergic and
noradrenergic effects. Switching to an MAOI (phenelzine) carries dietary
restrictions and is not first-line for this issue. Abrupt discontinuation of
fluoxetine can cause withdrawal. Hydroxyzine is an antihistamine used for
anxiety, not sexual dysfunction.
7. A 28-year-old woman with a history of bulimia nervosa is prescribed
fluoxetine. What is the primary mechanism of action by which fluoxetine is
thought to reduce binge-purge cycles in this population?
, • A. Antagonism of 5-HT2A receptors
• B. Inhibition of serotonin reuptake in the synaptic cleft
• C. Blockade of dopamine D2 receptors
• D. Enhancement of GABA-A receptor activity
• Rationale: Fluoxetine, an SSRI, inhibits the reuptake of serotonin,
increasing its availability in the synaptic cleft. This serotonergic
enhancement is believed to reduce impulsive behaviors and binge-purge
cycles in bulimia nervosa.
8. A child is diagnosed with ADHD, combined presentation. The PMHNP is
considering starting a long-acting stimulant. What is the most significant
advantage of using a long-acting formulation over a short-acting formulation for
this patient?
• A. Lower cost per dose
• B. Reduced need for school-day dosing
• C. Fewer side effects
• D. Faster onset of action
• Rationale: Long-acting stimulant formulations offer the advantage of
once-daily dosing, which eliminates the need for a dose during the school
day, improving convenience, adherence, and confidentiality for the child.
9. During a suicide intervention with a 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
Psychiatric Mental Health Nurse
Practitioner Exam Study Guide &
Practice Materials
Section I: Psychiatric Assessment and Differential Diagnosis (Questions 1–35)
1. Which of the following is a core component of the psychiatric mental status
examination?
• A. Only the patient's medical history
• B. Appearance, behavior, speech, mood, affect, thought process, thought
content, perception, cognition, and insight/judgment
• C. Only laboratory values
• D. Only the physical examination
• Rationale: The mental status examination systematically assesses
appearance, behavior, speech, mood, affect, thought process and content,
perceptual disturbances, cognition, and insight/judgment to support
diagnostic formulation.
2. When assessing a patient for suicidal ideation, the clinician should:
• A. Avoid asking directly about suicide to prevent suggesting the idea
• B. Ask directly about ideation, plan, intent, and means, and assess
protective factors
• C. Rely solely on the patient's spontaneous report
• D. Document only if the patient is actively suicidal
, • Rationale: Direct, nonjudgmental inquiry about suicidal ideation, plan,
intent, and access to means is a standard of care. Assessing protective
factors and risk severity guides safety planning and level of care.
3. Which screening tool is commonly used to assess depression severity in
adults?
• A. MMSE
• B. PHQ-9
• C. CIWA-Ar
• D. AIMS
• Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a validated
self-report instrument widely used to screen for and monitor the severity of
depressive symptoms in clinical settings.
4. A patient describes hearing voices commenting on their actions. This is an
example of:
• A. A delusion
• B. An auditory hallucination
• C. An idea of reference
• D. Circumstantial thought process
• Rationale: Hallucinations are perceptual experiences occurring without
external stimuli. Commenting voices are a form of auditory hallucination
often associated with psychotic disorders.
5. A 32-year-old female with a history of panic disorder presents with
complaints of sudden, intense episodes of fear accompanied by palpitations,
sweating, and a fear of dying. She reports avoiding gyms and crowded places for
the past six months. Which of the following is the most appropriate first-line
pharmacological intervention?
, • A. Sertraline
• B. Alprazolam
• C. Propranolol
• D. Buspirone
• Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline
are the first-line pharmacological treatment for Panic Disorder. They are
effective in reducing the frequency and intensity of panic attacks and
agoraphobic avoidance. While benzodiazepines (Alprazolam) are effective,
they are not first-line due to dependence risks. Propranolol is used for
performance anxiety, and Buspirone is more effective for generalized
anxiety than panic disorder.
6. A 45-year-old male with Major Depressive Disorder (MDD) has been on
fluoxetine 40 mg daily for 8 weeks with partial response. He reports significant
sexual dysfunction. Which of the following strategies is most appropriate to
address this side effect while maintaining antidepressant efficacy?
• A. Add bupropion 150 mg daily
• B. Switch to phenelzine
• C. Discontinue fluoxetine abruptly
• D. Add hydroxyzine 25 mg daily
• Rationale: Bupropion is often added to SSRIs like fluoxetine to
counteract SSRI-induced sexual dysfunction due to its dopaminergic and
noradrenergic effects. Switching to an MAOI (phenelzine) carries dietary
restrictions and is not first-line for this issue. Abrupt discontinuation of
fluoxetine can cause withdrawal. Hydroxyzine is an antihistamine used for
anxiety, not sexual dysfunction.
7. A 28-year-old woman with a history of bulimia nervosa is prescribed
fluoxetine. What is the primary mechanism of action by which fluoxetine is
thought to reduce binge-purge cycles in this population?
, • A. Antagonism of 5-HT2A receptors
• B. Inhibition of serotonin reuptake in the synaptic cleft
• C. Blockade of dopamine D2 receptors
• D. Enhancement of GABA-A receptor activity
• Rationale: Fluoxetine, an SSRI, inhibits the reuptake of serotonin,
increasing its availability in the synaptic cleft. This serotonergic
enhancement is believed to reduce impulsive behaviors and binge-purge
cycles in bulimia nervosa.
8. A child is diagnosed with ADHD, combined presentation. The PMHNP is
considering starting a long-acting stimulant. What is the most significant
advantage of using a long-acting formulation over a short-acting formulation for
this patient?
• A. Lower cost per dose
• B. Reduced need for school-day dosing
• C. Fewer side effects
• D. Faster onset of action
• Rationale: Long-acting stimulant formulations offer the advantage of
once-daily dosing, which eliminates the need for a dose during the school
day, improving convenience, adherence, and confidentiality for the child.
9. During a suicide intervention with a 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
