ACTUAL Barkley PMHNP 2026 EXAM REVIEW
150 QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
Harriet is a well-established business woman who provides for her family. She was recently
arrested for stealing over $10,000 worth of merchandise from the mall. When Harriet is
asked to describe her behavior, she says: "It just comes on me quickly, and when it's done,
I feel really good." She also describes how she grew up poor and sees the theft as a way to
"even the score" against those with "empty wealth." Which of the following does not meet
the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. - SELECTED ANSWER 👀**** Although the
patient may be rationalizing her behavior as a righteous act, patients with kleptomania do
not commit theft to express anger or vengeance. Kleptomania is characterized as failing to
resist the impulse to steal, and the stolen objects are typically not needed. The act of
stealing, which usually is performed alone, gives the person gratification.
Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a long record
of skipping school, talking back to his teachers, and getting poor grades. His parents say he
has often gotten in fights with them, has frequently been caught sneaking girls into his room,
and has run away from home on two occasions. During the session, you notice Tony acts
tough and aloof, not deigning to speak much. If you suspect conduct disorder, which of the
following conditions would you be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder - SELECTED ANSWER 👀**** Borderline personality disorder is not
considered a differential diagnosis for conduct disorder, as indicated by the patient's
,truancy, defiance of authority figures, fights with family members, poor academic
performance, sexual promiscuity, running away from home, and "tough guy" demeanor.
Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all considered
potential differential diagnoses for conduct disorder, as are depressive disorders, attention-
deficit/hyperactivity disorder, and intermittent explosive disorder.
Which of these lab findings would be least expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol - SELECTED ANSWER 👀**** Depressive symptoms are
associated with decreased, not increased, levels of somatostatin in cerebrospinal fluid.
Patients with depression may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol. Depressive symptoms
are also associated with irregularities in growth hormone release, such as reduced
nocturnal secretion and diurnal hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is able to be observed at all
times by hospital staff during waking hours and when he sleeps, and is checked on every
15-30 minutes. Which of these reasons would least indicate the need for this level of
supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. - SELECTED ANSWER 👀****
Although ambivalence regarding suicidal intent should be taken into account when
considering level of observation in a patient, it indicates a moderate risk, not a severe risk.
Close observation should be employed with patients who profess suicidal thoughts, are
unable to commit to a "No Harm" contract, or experience withdrawal.
,Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask him why
he is here, he says, "I'm here because I've had this increased craving for sex. I've been
picking up strangers in bars, not caring about using protection ... I don't know what it is. For
the last week, I've just felt really driven. Keep throwing myself into my work, don't feel much
need for sleep, feel like my thoughts are running a marathon in my head." The patient lives
a "clean life," clarifying that he does not abuse any substance, "not even coffee or
cigarettes." He also does not have a history of mental disorders. Given the most likely
diagnosis, which of these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion - SELECTED ANSWER 👀**** The patient's recent involvement in risky
pleasurable activity (e.g., unprotected sex), increase in goal-driven activity at work,
decreased need for sleep, and subjective experience of racing thoughts all suggest a manic
episode; as such, bupropion, an antidepressant, would not be considered because the
patient has not displayed the diagnostic criteria for a major depressive episode.
Pharmacologic options for the treatment of manic episodes include anticonvulsants
(carbamazepine), antipsychotics (haloperidol), and benzodiazepines (lorazepam).
You have determined that a patient's delirium stems from dehydration. As you begin
treatment, you realize the patient will require pharmacologic management for his agitation.
Which of these agents would be least appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam - SELECTED ANSWER 👀**** Lorazepam would not be the first choice to treat
delirium in a dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as haloperidol,
quetiapine, and risperidone are considered the mainstay in managing agitation in delirium
patients; haloperidol is considered the standard of care, but newer agents such as
quetiapine and risperidone may be preferred due to reduced chance of side effects.
, Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in
care. - SELECTED ANSWER 👀**** Most inpatients who develop a suicide plan and follow
it have agreed to a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable" problems at work,
school, or home motivate the ideation, inpatients are most likely to attempt suicide either
within the first 5 days at the hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states that she
has been hearing voices, cannot remember anything, and refuses to take a shower or
change her clothes. He adds, "She used to be a very clean person and had a really good
memory." Which phase of schizophrenia is Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
Acute phase - SELECTED ANSWER 👀**** Auditory hallucinations, loss of memory, and
lack of personal hygiene are all markers of the acute phase of schizophrenia. Other signs
and symptoms of this stage include illogical thinking, inappropriate social behavior,
catatonic excitement, and poor concentration. The premorbid phase is indicated by
depression, sleep disturbance, and bedwetting. The prodromal phase is characterized by
suspiciousness, inappropriate expression of feeling, and feelings of unreality. Lastly, the
stable phase is symptomatically similar to the prodromal phase.
Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is a recent
immigrant from Haiti, you begin by giving him a cultural assessment. Which of the following
150 QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
Harriet is a well-established business woman who provides for her family. She was recently
arrested for stealing over $10,000 worth of merchandise from the mall. When Harriet is
asked to describe her behavior, she says: "It just comes on me quickly, and when it's done,
I feel really good." She also describes how she grew up poor and sees the theft as a way to
"even the score" against those with "empty wealth." Which of the following does not meet
the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. - SELECTED ANSWER 👀**** Although the
patient may be rationalizing her behavior as a righteous act, patients with kleptomania do
not commit theft to express anger or vengeance. Kleptomania is characterized as failing to
resist the impulse to steal, and the stolen objects are typically not needed. The act of
stealing, which usually is performed alone, gives the person gratification.
Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a long record
of skipping school, talking back to his teachers, and getting poor grades. His parents say he
has often gotten in fights with them, has frequently been caught sneaking girls into his room,
and has run away from home on two occasions. During the session, you notice Tony acts
tough and aloof, not deigning to speak much. If you suspect conduct disorder, which of the
following conditions would you be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder - SELECTED ANSWER 👀**** Borderline personality disorder is not
considered a differential diagnosis for conduct disorder, as indicated by the patient's
,truancy, defiance of authority figures, fights with family members, poor academic
performance, sexual promiscuity, running away from home, and "tough guy" demeanor.
Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all considered
potential differential diagnoses for conduct disorder, as are depressive disorders, attention-
deficit/hyperactivity disorder, and intermittent explosive disorder.
Which of these lab findings would be least expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol - SELECTED ANSWER 👀**** Depressive symptoms are
associated with decreased, not increased, levels of somatostatin in cerebrospinal fluid.
Patients with depression may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol. Depressive symptoms
are also associated with irregularities in growth hormone release, such as reduced
nocturnal secretion and diurnal hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is able to be observed at all
times by hospital staff during waking hours and when he sleeps, and is checked on every
15-30 minutes. Which of these reasons would least indicate the need for this level of
supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. - SELECTED ANSWER 👀****
Although ambivalence regarding suicidal intent should be taken into account when
considering level of observation in a patient, it indicates a moderate risk, not a severe risk.
Close observation should be employed with patients who profess suicidal thoughts, are
unable to commit to a "No Harm" contract, or experience withdrawal.
,Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask him why
he is here, he says, "I'm here because I've had this increased craving for sex. I've been
picking up strangers in bars, not caring about using protection ... I don't know what it is. For
the last week, I've just felt really driven. Keep throwing myself into my work, don't feel much
need for sleep, feel like my thoughts are running a marathon in my head." The patient lives
a "clean life," clarifying that he does not abuse any substance, "not even coffee or
cigarettes." He also does not have a history of mental disorders. Given the most likely
diagnosis, which of these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion - SELECTED ANSWER 👀**** The patient's recent involvement in risky
pleasurable activity (e.g., unprotected sex), increase in goal-driven activity at work,
decreased need for sleep, and subjective experience of racing thoughts all suggest a manic
episode; as such, bupropion, an antidepressant, would not be considered because the
patient has not displayed the diagnostic criteria for a major depressive episode.
Pharmacologic options for the treatment of manic episodes include anticonvulsants
(carbamazepine), antipsychotics (haloperidol), and benzodiazepines (lorazepam).
You have determined that a patient's delirium stems from dehydration. As you begin
treatment, you realize the patient will require pharmacologic management for his agitation.
Which of these agents would be least appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam - SELECTED ANSWER 👀**** Lorazepam would not be the first choice to treat
delirium in a dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as haloperidol,
quetiapine, and risperidone are considered the mainstay in managing agitation in delirium
patients; haloperidol is considered the standard of care, but newer agents such as
quetiapine and risperidone may be preferred due to reduced chance of side effects.
, Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in
care. - SELECTED ANSWER 👀**** Most inpatients who develop a suicide plan and follow
it have agreed to a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable" problems at work,
school, or home motivate the ideation, inpatients are most likely to attempt suicide either
within the first 5 days at the hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states that she
has been hearing voices, cannot remember anything, and refuses to take a shower or
change her clothes. He adds, "She used to be a very clean person and had a really good
memory." Which phase of schizophrenia is Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
Acute phase - SELECTED ANSWER 👀**** Auditory hallucinations, loss of memory, and
lack of personal hygiene are all markers of the acute phase of schizophrenia. Other signs
and symptoms of this stage include illogical thinking, inappropriate social behavior,
catatonic excitement, and poor concentration. The premorbid phase is indicated by
depression, sleep disturbance, and bedwetting. The prodromal phase is characterized by
suspiciousness, inappropriate expression of feeling, and feelings of unreality. Lastly, the
stable phase is symptomatically similar to the prodromal phase.
Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is a recent
immigrant from Haiti, you begin by giving him a cultural assessment. Which of the following
