BARKLEY PMHNP ULTIMATE EXAM — 200 ORIGINAL
PRACTICE QUESTIONS AND ANSWERS | 2026–2027
STUDY GUIDE
Section One — Questions 1–100
1. During an initial diagnostic evaluation, which finding or action most accurately
reflects major depressive disorder?
A) Six months of excessive worry
B) A single panic attack
C) One day of elevated energy
D) At least two weeks of depressed mood or anhedonia with associated symptoms
Correct Answer: D) At least two weeks of depressed mood or anhedonia with
associated symptoms
Rationale: The time course and core mood symptoms distinguish a major depressive
episode from brief emotional changes, panic episodes, and generalized anxiety. In this
assessment context, the strongest choice is at least two weeks of depressed mood or
anhedonia with associated symptoms. The alternatives instead describe different
conditions, incomplete approaches, or unsafe assumptions that do not answer the specific
question. A PMHNP should integrate this distinction with the full history, examination,
patient preferences, and appropriate follow-up rather than using one clue in isolation.
2. At a follow-up visit, which finding or action most accurately reflects bipolar i
disorder?
A) A lifetime manic episode
B) Persistent low-grade depression
C) Only recurrent hypomania
D) Mood shifts within a day
Correct Answer: A) A lifetime manic episode
Rationale: Bipolar I requires mania; hypomania without mania may support bipolar II when
depressive episode criteria are met. In this management context, the strongest choice is a
lifetime manic episode. The alternatives instead describe different conditions, incomplete
approaches, or unsafe assumptions that do not answer the specific question. A PMHNP
should integrate this distinction with the full history, examination, patient preferences, and
appropriate follow-up rather than using one clue in isolation.
,3. In an interprofessional case review, which finding or action most accurately reflects
bipolar ii disorder?
A) Only cyclothymic symptoms
B) One isolated depressive episode
C) Hypomania plus major depression without mania
D) A manic episode with psychosis
Correct Answer: C) Hypomania plus major depression without mania
Rationale: Bipolar II combines hypomania and major depression, and a history of mania
instead establishes bipolar I. In this assessment context, the strongest choice is hypomania
plus major depression without mania. The alternatives instead describe different
conditions, incomplete approaches, or unsafe assumptions that do not answer the specific
question. A PMHNP should integrate this distinction with the full history, examination,
patient preferences, and appropriate follow-up rather than using one clue in isolation.
4. While reviewing a clinical vignette, which finding or action most accurately reflects
generalized anxiety disorder?
A) Excessive difficult-to-control worry for at least six months
B) Intrusive obsessions only
C) A brief isolated panic attack
D) Fear limited to one object
Correct Answer: A) Excessive difficult-to-control worry for at least six months
Rationale: Generalized anxiety involves persistent, broad worry and related symptoms
rather than a circumscribed phobia or episodic panic. In this management context, the
strongest choice is excessive difficult-to-control worry for at least six months. The
alternatives instead describe different conditions, incomplete approaches, or unsafe
assumptions that do not answer the specific question. A PMHNP should integrate this
distinction with the full history, examination, patient preferences, and appropriate follow-up
rather than using one clue in isolation.
5. During treatment planning, which finding or action most accurately reflects panic
disorder?
A) Recurrent unexpected panic attacks with persistent concern or maladaptive change
B) Only fear of public speaking
C) Daily hallucinations
D) A single situational panic episode
Correct Answer: A) Recurrent unexpected panic attacks with persistent concern or
maladaptive change
Rationale: Panic disorder requires recurrent unexpected attacks and subsequent worry or
behavioral change, not merely one attack. In this assessment context, the strongest choice
is recurrent unexpected panic attacks with persistent concern or maladaptive change. The
,alternatives instead describe different conditions, incomplete approaches, or unsafe
assumptions that do not answer the specific question. A PMHNP should integrate this
distinction with the full history, examination, patient preferences, and appropriate follow-up
rather than using one clue in isolation.
6. When assessing a change in symptoms, which finding or action most accurately
reflects agoraphobia?
A) Fear of negative evaluation only
B) Fear of situations where escape or help may be difficult
C) Fear of weight gain
D) Fear of contamination only
Correct Answer: B) Fear of situations where escape or help may be difficult
Rationale: Agoraphobia centers on escape or help concerns across characteristic
situations and can occur with or without panic disorder. In this management context, the
strongest choice is fear of situations where escape or help may be difficult. The alternatives
instead describe different conditions, incomplete approaches, or unsafe assumptions that
do not answer the specific question. A PMHNP should integrate this distinction with the full
history, examination, patient preferences, and appropriate follow-up rather than using one
clue in isolation.
7. In a consultation with a primary care clinician, which finding or action most
accurately reflects social anxiety disorder?
A) Excessive fear of illness without social concern
B) Unexpected panic without triggers
C) Fear of elevators alone
D) Fear of scrutiny or negative evaluation in social situations
Correct Answer: D) Fear of scrutiny or negative evaluation in social situations
Rationale: Social anxiety is tied to possible scrutiny, whereas specific phobias involve
particular objects or situations. In this assessment context, the strongest choice is fear of
scrutiny or negative evaluation in social situations. The alternatives instead describe
different conditions, incomplete approaches, or unsafe assumptions that do not answer the
specific question. A PMHNP should integrate this distinction with the full history,
examination, patient preferences, and appropriate follow-up rather than using one clue in
isolation.
, 8. While counseling a patient and family, which finding or action most accurately
reflects obsessive-compulsive disorder?
A) Enjoyable repetitive hobbies
B) Obsessions and compulsions that are time-consuming or impairing
C) Only fixed delusions
D) Ordinary preference for order
Correct Answer: B) Obsessions and compulsions that are time-consuming or impairing
Rationale: OCD symptoms are intrusive or driven and cause distress or impairment, unlike
voluntary routines. In this management context, the strongest choice is obsessions and
compulsions that are time-consuming or impairing. The alternatives instead describe
different conditions, incomplete approaches, or unsafe assumptions that do not answer the
specific question. A PMHNP should integrate this distinction with the full history,
examination, patient preferences, and appropriate follow-up rather than using one clue in
isolation.
9. During an initial diagnostic evaluation, which finding or action most accurately
reflects posttraumatic stress disorder?
A) Only persistent generalized worry
B) Stress after a minor inconvenience
C) Trauma exposure with intrusion, avoidance, negative changes, and arousal beyond one
month
D) Mania after sleep loss
Correct Answer: C) Trauma exposure with intrusion, avoidance, negative changes, and
arousal beyond one month
Rationale: PTSD requires qualifying trauma and symptom clusters lasting more than one
month; acute stress disorder has a shorter duration. In this assessment context, the
strongest choice is trauma exposure with intrusion, avoidance, negative changes, and
arousal beyond one month. The alternatives instead describe different conditions,
incomplete approaches, or unsafe assumptions that do not answer the specific question. A
PMHNP should integrate this distinction with the full history, examination, patient
preferences, and appropriate follow-up rather than using one clue in isolation.
PRACTICE QUESTIONS AND ANSWERS | 2026–2027
STUDY GUIDE
Section One — Questions 1–100
1. During an initial diagnostic evaluation, which finding or action most accurately
reflects major depressive disorder?
A) Six months of excessive worry
B) A single panic attack
C) One day of elevated energy
D) At least two weeks of depressed mood or anhedonia with associated symptoms
Correct Answer: D) At least two weeks of depressed mood or anhedonia with
associated symptoms
Rationale: The time course and core mood symptoms distinguish a major depressive
episode from brief emotional changes, panic episodes, and generalized anxiety. In this
assessment context, the strongest choice is at least two weeks of depressed mood or
anhedonia with associated symptoms. The alternatives instead describe different
conditions, incomplete approaches, or unsafe assumptions that do not answer the specific
question. A PMHNP should integrate this distinction with the full history, examination,
patient preferences, and appropriate follow-up rather than using one clue in isolation.
2. At a follow-up visit, which finding or action most accurately reflects bipolar i
disorder?
A) A lifetime manic episode
B) Persistent low-grade depression
C) Only recurrent hypomania
D) Mood shifts within a day
Correct Answer: A) A lifetime manic episode
Rationale: Bipolar I requires mania; hypomania without mania may support bipolar II when
depressive episode criteria are met. In this management context, the strongest choice is a
lifetime manic episode. The alternatives instead describe different conditions, incomplete
approaches, or unsafe assumptions that do not answer the specific question. A PMHNP
should integrate this distinction with the full history, examination, patient preferences, and
appropriate follow-up rather than using one clue in isolation.
,3. In an interprofessional case review, which finding or action most accurately reflects
bipolar ii disorder?
A) Only cyclothymic symptoms
B) One isolated depressive episode
C) Hypomania plus major depression without mania
D) A manic episode with psychosis
Correct Answer: C) Hypomania plus major depression without mania
Rationale: Bipolar II combines hypomania and major depression, and a history of mania
instead establishes bipolar I. In this assessment context, the strongest choice is hypomania
plus major depression without mania. The alternatives instead describe different
conditions, incomplete approaches, or unsafe assumptions that do not answer the specific
question. A PMHNP should integrate this distinction with the full history, examination,
patient preferences, and appropriate follow-up rather than using one clue in isolation.
4. While reviewing a clinical vignette, which finding or action most accurately reflects
generalized anxiety disorder?
A) Excessive difficult-to-control worry for at least six months
B) Intrusive obsessions only
C) A brief isolated panic attack
D) Fear limited to one object
Correct Answer: A) Excessive difficult-to-control worry for at least six months
Rationale: Generalized anxiety involves persistent, broad worry and related symptoms
rather than a circumscribed phobia or episodic panic. In this management context, the
strongest choice is excessive difficult-to-control worry for at least six months. The
alternatives instead describe different conditions, incomplete approaches, or unsafe
assumptions that do not answer the specific question. A PMHNP should integrate this
distinction with the full history, examination, patient preferences, and appropriate follow-up
rather than using one clue in isolation.
5. During treatment planning, which finding or action most accurately reflects panic
disorder?
A) Recurrent unexpected panic attacks with persistent concern or maladaptive change
B) Only fear of public speaking
C) Daily hallucinations
D) A single situational panic episode
Correct Answer: A) Recurrent unexpected panic attacks with persistent concern or
maladaptive change
Rationale: Panic disorder requires recurrent unexpected attacks and subsequent worry or
behavioral change, not merely one attack. In this assessment context, the strongest choice
is recurrent unexpected panic attacks with persistent concern or maladaptive change. The
,alternatives instead describe different conditions, incomplete approaches, or unsafe
assumptions that do not answer the specific question. A PMHNP should integrate this
distinction with the full history, examination, patient preferences, and appropriate follow-up
rather than using one clue in isolation.
6. When assessing a change in symptoms, which finding or action most accurately
reflects agoraphobia?
A) Fear of negative evaluation only
B) Fear of situations where escape or help may be difficult
C) Fear of weight gain
D) Fear of contamination only
Correct Answer: B) Fear of situations where escape or help may be difficult
Rationale: Agoraphobia centers on escape or help concerns across characteristic
situations and can occur with or without panic disorder. In this management context, the
strongest choice is fear of situations where escape or help may be difficult. The alternatives
instead describe different conditions, incomplete approaches, or unsafe assumptions that
do not answer the specific question. A PMHNP should integrate this distinction with the full
history, examination, patient preferences, and appropriate follow-up rather than using one
clue in isolation.
7. In a consultation with a primary care clinician, which finding or action most
accurately reflects social anxiety disorder?
A) Excessive fear of illness without social concern
B) Unexpected panic without triggers
C) Fear of elevators alone
D) Fear of scrutiny or negative evaluation in social situations
Correct Answer: D) Fear of scrutiny or negative evaluation in social situations
Rationale: Social anxiety is tied to possible scrutiny, whereas specific phobias involve
particular objects or situations. In this assessment context, the strongest choice is fear of
scrutiny or negative evaluation in social situations. The alternatives instead describe
different conditions, incomplete approaches, or unsafe assumptions that do not answer the
specific question. A PMHNP should integrate this distinction with the full history,
examination, patient preferences, and appropriate follow-up rather than using one clue in
isolation.
, 8. While counseling a patient and family, which finding or action most accurately
reflects obsessive-compulsive disorder?
A) Enjoyable repetitive hobbies
B) Obsessions and compulsions that are time-consuming or impairing
C) Only fixed delusions
D) Ordinary preference for order
Correct Answer: B) Obsessions and compulsions that are time-consuming or impairing
Rationale: OCD symptoms are intrusive or driven and cause distress or impairment, unlike
voluntary routines. In this management context, the strongest choice is obsessions and
compulsions that are time-consuming or impairing. The alternatives instead describe
different conditions, incomplete approaches, or unsafe assumptions that do not answer the
specific question. A PMHNP should integrate this distinction with the full history,
examination, patient preferences, and appropriate follow-up rather than using one clue in
isolation.
9. During an initial diagnostic evaluation, which finding or action most accurately
reflects posttraumatic stress disorder?
A) Only persistent generalized worry
B) Stress after a minor inconvenience
C) Trauma exposure with intrusion, avoidance, negative changes, and arousal beyond one
month
D) Mania after sleep loss
Correct Answer: C) Trauma exposure with intrusion, avoidance, negative changes, and
arousal beyond one month
Rationale: PTSD requires qualifying trauma and symptom clusters lasting more than one
month; acute stress disorder has a shorter duration. In this assessment context, the
strongest choice is trauma exposure with intrusion, avoidance, negative changes, and
arousal beyond one month. The alternatives instead describe different conditions,
incomplete approaches, or unsafe assumptions that do not answer the specific question. A
PMHNP should integrate this distinction with the full history, examination, patient
preferences, and appropriate follow-up rather than using one clue in isolation.
