uPDATEDBARKLEY DRT PMHNP
PRACTICUM 1 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS
Question 1
A patient with anorexia nervosa may exhibit comorbidity for all of these disorders
except:
1. Avoidant/restrictive food intake disorder
2. Generalized anxiety disorder
3. Obsessive-compulsive disorder
4. Major depressive disorder
Correct Answer
4. Major depressive disorder
Although avoidant/restrictive food intake disorder may precede anorexia nervosa in
some patients, avoidant/restrictive food intake disorder does not present with fear
of weight gain or body image disturbance and should not be diagnosed
concurrently with anorexia nervosa. Anorexia nervosa commonly presents with
psychiatric comorbidities such as generalized anxiety disorder, obsessive-
compulsive disorder, and major depressive disorder.
Page 1 of 119
,Question 2
Which of the following would not be an appropriate question to ask in order to gain
information about family roles?
1. "Did you breastfeed your children?"
2. "Do any other relatives live in your house?"
3. "What level of education did you complete?"
4. "How do you show affection for your children?"
Correct Answer
Although economic status is a common consideration in determining family
structure and roles, determining the patient's level of education is not necessary.
Asking whether any other relatives live in the house provides information on the
family's composition. How affection is demonstrated between relatives is another
key concern, as are child-rearing practices (e.g., whether a mother breastfed her
children). Other characteristics to explore include household rules, major events,
special rituals, views on alcohol and drugs, and religion.
Page 2 of 119
,Question 3
Gerry, a 65-year-old male, comes into the office saying that he has been feeling
"really low on energy and sad most of the time." When you ask him if any life-
changing events have occurred recently, he tells you that his wife passed away within
the past year. Which level of depression is Gerry most likely experiencing?
1. Mild
2. Severe
3. Transient
Moderate
Correct Answer
The patient is most likely experiencing mild depression, which is characterized by
depressive symptoms that coincide with grieving. Transient depression is
characterized by mood changes based on everyday disappointments. Moderate
depression is associated with symptoms of dysthymic disorder, whereas symptoms
of severe depression coincide with major depressive disorder or a bipolar disorder.
Question 1: Which of the following neurotransmitters is primarily implicated in the
pathophysiology of schizophrenia, specifically relating to positive symptoms through
hyperfunction in the mesolimbic pathway?
A. Serotonin
B. Gamma-aminobutyric acid (GABA)
C. Dopamine
D. Acetylcholine
CORRECT ANSWER: C. Dopamine
Rationale: Hyperactivity of dopamine in the mesolimbic pathway is strongly
associated with the positive symptoms of schizophrenia, such as hallucinations and
delusions. First-generation and second-generation antipsychotics primarily exert
their therapeutic effects by blocking dopamine D2 receptors in this pathway.
Question 2: A 35-year-old patient presents with a 2-month history of persistent low
mood, anhedonia, early morning awakening, and a 10-pound unintentional weight
loss. Which brain structure is primarily hypothesized to be involved in the
dysregulation of affective symptoms in major depressive disorder?
A. Cerebellum
B. Amygdala
C. Substantia nigra
D. Basal ganglia
Page 3 of 119
, CORRECT ANSWER: B. Amygdala
Rationale: The amygdala is critically involved in processing emotional significance
and emotional memory. In major depressive disorder, the amygdala often
demonstrates hyperreactivity, contributing to the persistent negative affect,
emotional dysregulation, and anxiety frequently seen in depressed patients.
Question 3: A psychiatric-mental health nurse practitioner (PMHNP) is evaluating
an adult patient who exhibits a coarse hand tremor, ataxia, confusion, and
gastrointestinal distress. The patient has been taking lithium carbonate for bipolar I
disorder for several years. Which concurrent medication prescription is most likely
to have precipitated this clinical picture?
A. Lisinopril
B. Ibuprofen
C. Acetaminophen
D. Levothyroxine
CORRECT ANSWER: B. Ibuprofen
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen,
decrease renal blood flow and inhibit prostaglandin synthesis, which significantly
decreases the renal clearance of lithium, leading to toxic serum accumulation and
acute lithium toxicity.
Question 4: Which diagnostic tool is considered the gold standard for assessing
objective cognitive impairment and tracking progression in a geriatric patient
suspected of having early-stage Alzheimer's dementia?
A. Beck Depression Inventory (BDI)
B. Patient Health Questionnaire-9 (PHQ-9)
C. Montreal Cognitive Assessment (MoCA)
D. CAGE Questionnaire
CORRECT ANSWER: C. Montreal Cognitive Assessment (MoCA)
Rationale: The MoCA is a widely validated screening tool specifically designed to
detect mild cognitive impairment and early dementia across multiple cognitive
domains (e.g., attention, executive functions, memory, language), making it more
sensitive than the Mini-Mental State Examination for early-stage pathology.
Question 5: An adult male client is brought to the emergency department by family
members who report that he has not slept for four days, speaks with pressured
speech, is hyperactive, and believes he has been chosen to save the global
economy. What is the most appropriate initial pharmacological intervention to
stabilize this patient?
Page 4 of 119
PRACTICUM 1 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS
Question 1
A patient with anorexia nervosa may exhibit comorbidity for all of these disorders
except:
1. Avoidant/restrictive food intake disorder
2. Generalized anxiety disorder
3. Obsessive-compulsive disorder
4. Major depressive disorder
Correct Answer
4. Major depressive disorder
Although avoidant/restrictive food intake disorder may precede anorexia nervosa in
some patients, avoidant/restrictive food intake disorder does not present with fear
of weight gain or body image disturbance and should not be diagnosed
concurrently with anorexia nervosa. Anorexia nervosa commonly presents with
psychiatric comorbidities such as generalized anxiety disorder, obsessive-
compulsive disorder, and major depressive disorder.
Page 1 of 119
,Question 2
Which of the following would not be an appropriate question to ask in order to gain
information about family roles?
1. "Did you breastfeed your children?"
2. "Do any other relatives live in your house?"
3. "What level of education did you complete?"
4. "How do you show affection for your children?"
Correct Answer
Although economic status is a common consideration in determining family
structure and roles, determining the patient's level of education is not necessary.
Asking whether any other relatives live in the house provides information on the
family's composition. How affection is demonstrated between relatives is another
key concern, as are child-rearing practices (e.g., whether a mother breastfed her
children). Other characteristics to explore include household rules, major events,
special rituals, views on alcohol and drugs, and religion.
Page 2 of 119
,Question 3
Gerry, a 65-year-old male, comes into the office saying that he has been feeling
"really low on energy and sad most of the time." When you ask him if any life-
changing events have occurred recently, he tells you that his wife passed away within
the past year. Which level of depression is Gerry most likely experiencing?
1. Mild
2. Severe
3. Transient
Moderate
Correct Answer
The patient is most likely experiencing mild depression, which is characterized by
depressive symptoms that coincide with grieving. Transient depression is
characterized by mood changes based on everyday disappointments. Moderate
depression is associated with symptoms of dysthymic disorder, whereas symptoms
of severe depression coincide with major depressive disorder or a bipolar disorder.
Question 1: Which of the following neurotransmitters is primarily implicated in the
pathophysiology of schizophrenia, specifically relating to positive symptoms through
hyperfunction in the mesolimbic pathway?
A. Serotonin
B. Gamma-aminobutyric acid (GABA)
C. Dopamine
D. Acetylcholine
CORRECT ANSWER: C. Dopamine
Rationale: Hyperactivity of dopamine in the mesolimbic pathway is strongly
associated with the positive symptoms of schizophrenia, such as hallucinations and
delusions. First-generation and second-generation antipsychotics primarily exert
their therapeutic effects by blocking dopamine D2 receptors in this pathway.
Question 2: A 35-year-old patient presents with a 2-month history of persistent low
mood, anhedonia, early morning awakening, and a 10-pound unintentional weight
loss. Which brain structure is primarily hypothesized to be involved in the
dysregulation of affective symptoms in major depressive disorder?
A. Cerebellum
B. Amygdala
C. Substantia nigra
D. Basal ganglia
Page 3 of 119
, CORRECT ANSWER: B. Amygdala
Rationale: The amygdala is critically involved in processing emotional significance
and emotional memory. In major depressive disorder, the amygdala often
demonstrates hyperreactivity, contributing to the persistent negative affect,
emotional dysregulation, and anxiety frequently seen in depressed patients.
Question 3: A psychiatric-mental health nurse practitioner (PMHNP) is evaluating
an adult patient who exhibits a coarse hand tremor, ataxia, confusion, and
gastrointestinal distress. The patient has been taking lithium carbonate for bipolar I
disorder for several years. Which concurrent medication prescription is most likely
to have precipitated this clinical picture?
A. Lisinopril
B. Ibuprofen
C. Acetaminophen
D. Levothyroxine
CORRECT ANSWER: B. Ibuprofen
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen,
decrease renal blood flow and inhibit prostaglandin synthesis, which significantly
decreases the renal clearance of lithium, leading to toxic serum accumulation and
acute lithium toxicity.
Question 4: Which diagnostic tool is considered the gold standard for assessing
objective cognitive impairment and tracking progression in a geriatric patient
suspected of having early-stage Alzheimer's dementia?
A. Beck Depression Inventory (BDI)
B. Patient Health Questionnaire-9 (PHQ-9)
C. Montreal Cognitive Assessment (MoCA)
D. CAGE Questionnaire
CORRECT ANSWER: C. Montreal Cognitive Assessment (MoCA)
Rationale: The MoCA is a widely validated screening tool specifically designed to
detect mild cognitive impairment and early dementia across multiple cognitive
domains (e.g., attention, executive functions, memory, language), making it more
sensitive than the Mini-Mental State Examination for early-stage pathology.
Question 5: An adult male client is brought to the emergency department by family
members who report that he has not slept for four days, speaks with pressured
speech, is hyperactive, and believes he has been chosen to save the global
economy. What is the most appropriate initial pharmacological intervention to
stabilize this patient?
Page 4 of 119
