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Barkley PMHNP Diagnostic Readiness Test (DRT)
#1 | 100 Practice Questions and Rationales
SECTION 1 – ASSESSMENT & DIAGNOSIS (Q1–25)
1. A 45-year-old man presents with a 6-month history of low mood, anhedonia,
weight gain, hypersomnia, and leaden paralysis in his limbs. He reports that his
mood briefly brightens in response to positive events. Which specifier best
describes his depression?
A. Melancholic features
B. Atypical features
C. Catatonic features
D. Anxious distress
: Correct Answer : B
Rationale: Atypical depression is characterized by mood reactivity, increased
appetite/weight, hypersomnia, leaden paralysis, and long-standing rejection
sensitivity. Melancholic features include a lack of mood reactivity and profound
anhedonia.
2. A 30-year-old woman reports recurrent, unexpected panic attacks and
persistent worry about having more attacks for the past 2 months. She avoids
crowded places and often checks for the nearest exit. The most likely diagnosis
is:
A. Agoraphobia
B. Panic disorder
C. Generalized anxiety disorder
D. Social anxiety disorder
: Correct Answer : B
Rationale: Recurrent unexpected panic attacks plus at least one month of
persistent worry about additional attacks or maladaptive behavioral changes is
diagnostic for panic disorder. Agoraphobia may co-occur but is not required for
the diagnosis.
pg. 1
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3. A 12-year-old boy has difficulty sustaining attention, often fidgets, blurts out
answers, and interrupts others. Symptoms are present at school and home and
have been noted for 8 months. According to DSM-5-TR, the diagnosis is:
A. Oppositional defiant disorder
B. Attention-deficit/hyperactivity disorder, combined presentation
C. Autism spectrum disorder
D. Specific learning disorder
: Correct Answer : B
Rationale: ADHD combined presentation requires symptoms of both inattention
and hyperactivity/impulsivity in at least two settings for ≥6 months, with onset
before age 12.
4. A 72-year-old hospitalized patient develops acute confusion, fluctuating level
of consciousness, and visual hallucinations over 2 days. He was alert and
oriented on admission. The most likely diagnosis is:
A. Alzheimer’s disease
B. Delirium
C. Lewy body dementia
D. Major depressive episode with psychotic features
: Correct Answer : B
Rationale: Delirium is an acute, fluctuating disturbance in attention and
awareness, often with an identifiable medical cause. Dementia is chronic and
progressive with a clear sensorium until later stages.
5. A 25-year-old woman believes her thoughts are being broadcast so that
others can hear them. She also hears voices commenting on her actions. These
symptoms have been present for 2 months, causing significant social and
occupational dysfunction. She does not have a mood episode. The most likely
diagnosis is:
A. Brief psychotic disorder
B. Schizophreniform disorder
pg. 2
,3
C. Schizophrenia
D. Schizoaffective disorder
: Correct Answer : B
Rationale: Symptom duration is >1 month but <6 months, meeting criteria for
schizophreniform disorder. Schizophrenia requires ≥6 months of symptoms.
Schizoaffective disorder requires a co-occurring mood episode.
6. A 40-year-old man with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. The PMHNP suspects Wernicke
encephalopathy. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Thiamine (Vitamin B1)
C. Folate
D. Vitamin D
: Correct Answer : B
Rationale: Wernicke encephalopathy is caused by thiamine deficiency, commonly
seen in alcohol use disorder, and presents with the classic triad of confusion,
ataxia, and ophthalmoplegia.
7. Which of the following is a positive symptom of schizophrenia?
A. Flat affect
B. Anhedonia
C. Auditory hallucinations
D. Alogia
: Correct Answer : C
Rationale: Positive symptoms include hallucinations, delusions, disorganized
speech, and grossly disorganized or catatonic behavior. Negative symptoms
include affective flattening, alogia, avolition, anhedonia, and asociality.
8. A 6-year-old child has limited eye contact, does not engage in imaginative
play, lines up toys, and has delayed speech. The PMHNP suspects autism
pg. 3
, 4
spectrum disorder. Which screening tool is appropriate for this age?
A. PHQ-9
B. M-CHAT-R/F
C. CAGE-AID
D. GAD-7
: Correct Answer : B
Rationale: The Modified Checklist for Autism in Toddlers, Revised with Follow-Up
(M-CHAT-R/F) is a validated screening tool for ASD in children 16–30 months. For
older children, other tools like the SCQ or ADOS are used; but the M-CHAT-R/F is
commonly used for early screening.
9. A 50-year-old woman with a history of bipolar I disorder presents with an
elevated mood, grandiosity, decreased need for sleep, and pressured speech for
the past 5 days. She is currently on lithium and quetiapine. The PMHNP should
first:
A. Increase lithium
B. Discontinue the antidepressant that may have triggered mania
C. Add an antipsychotic
D. Obtain a serum lithium level and evaluate for triggers
: Correct Answer : D
Rationale: While treating the acute mania is important, first assessing medication
adherence, lithium level, and potential triggers (substance use, stressors) is
critical before adjusting medications.
10. A 35-year-old woman reports cleaning rituals that take 2 hours daily,
intrusive thoughts about harming her child, and significant distress. She
recognizes these thoughts are irrational. The most likely diagnosis is:
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder
C. Postpartum depression with anxiety
D. Specific phobia
pg. 4
Barkley PMHNP Diagnostic Readiness Test (DRT)
#1 | 100 Practice Questions and Rationales
SECTION 1 – ASSESSMENT & DIAGNOSIS (Q1–25)
1. A 45-year-old man presents with a 6-month history of low mood, anhedonia,
weight gain, hypersomnia, and leaden paralysis in his limbs. He reports that his
mood briefly brightens in response to positive events. Which specifier best
describes his depression?
A. Melancholic features
B. Atypical features
C. Catatonic features
D. Anxious distress
: Correct Answer : B
Rationale: Atypical depression is characterized by mood reactivity, increased
appetite/weight, hypersomnia, leaden paralysis, and long-standing rejection
sensitivity. Melancholic features include a lack of mood reactivity and profound
anhedonia.
2. A 30-year-old woman reports recurrent, unexpected panic attacks and
persistent worry about having more attacks for the past 2 months. She avoids
crowded places and often checks for the nearest exit. The most likely diagnosis
is:
A. Agoraphobia
B. Panic disorder
C. Generalized anxiety disorder
D. Social anxiety disorder
: Correct Answer : B
Rationale: Recurrent unexpected panic attacks plus at least one month of
persistent worry about additional attacks or maladaptive behavioral changes is
diagnostic for panic disorder. Agoraphobia may co-occur but is not required for
the diagnosis.
pg. 1
,2
3. A 12-year-old boy has difficulty sustaining attention, often fidgets, blurts out
answers, and interrupts others. Symptoms are present at school and home and
have been noted for 8 months. According to DSM-5-TR, the diagnosis is:
A. Oppositional defiant disorder
B. Attention-deficit/hyperactivity disorder, combined presentation
C. Autism spectrum disorder
D. Specific learning disorder
: Correct Answer : B
Rationale: ADHD combined presentation requires symptoms of both inattention
and hyperactivity/impulsivity in at least two settings for ≥6 months, with onset
before age 12.
4. A 72-year-old hospitalized patient develops acute confusion, fluctuating level
of consciousness, and visual hallucinations over 2 days. He was alert and
oriented on admission. The most likely diagnosis is:
A. Alzheimer’s disease
B. Delirium
C. Lewy body dementia
D. Major depressive episode with psychotic features
: Correct Answer : B
Rationale: Delirium is an acute, fluctuating disturbance in attention and
awareness, often with an identifiable medical cause. Dementia is chronic and
progressive with a clear sensorium until later stages.
5. A 25-year-old woman believes her thoughts are being broadcast so that
others can hear them. She also hears voices commenting on her actions. These
symptoms have been present for 2 months, causing significant social and
occupational dysfunction. She does not have a mood episode. The most likely
diagnosis is:
A. Brief psychotic disorder
B. Schizophreniform disorder
pg. 2
,3
C. Schizophrenia
D. Schizoaffective disorder
: Correct Answer : B
Rationale: Symptom duration is >1 month but <6 months, meeting criteria for
schizophreniform disorder. Schizophrenia requires ≥6 months of symptoms.
Schizoaffective disorder requires a co-occurring mood episode.
6. A 40-year-old man with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. The PMHNP suspects Wernicke
encephalopathy. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Thiamine (Vitamin B1)
C. Folate
D. Vitamin D
: Correct Answer : B
Rationale: Wernicke encephalopathy is caused by thiamine deficiency, commonly
seen in alcohol use disorder, and presents with the classic triad of confusion,
ataxia, and ophthalmoplegia.
7. Which of the following is a positive symptom of schizophrenia?
A. Flat affect
B. Anhedonia
C. Auditory hallucinations
D. Alogia
: Correct Answer : C
Rationale: Positive symptoms include hallucinations, delusions, disorganized
speech, and grossly disorganized or catatonic behavior. Negative symptoms
include affective flattening, alogia, avolition, anhedonia, and asociality.
8. A 6-year-old child has limited eye contact, does not engage in imaginative
play, lines up toys, and has delayed speech. The PMHNP suspects autism
pg. 3
, 4
spectrum disorder. Which screening tool is appropriate for this age?
A. PHQ-9
B. M-CHAT-R/F
C. CAGE-AID
D. GAD-7
: Correct Answer : B
Rationale: The Modified Checklist for Autism in Toddlers, Revised with Follow-Up
(M-CHAT-R/F) is a validated screening tool for ASD in children 16–30 months. For
older children, other tools like the SCQ or ADOS are used; but the M-CHAT-R/F is
commonly used for early screening.
9. A 50-year-old woman with a history of bipolar I disorder presents with an
elevated mood, grandiosity, decreased need for sleep, and pressured speech for
the past 5 days. She is currently on lithium and quetiapine. The PMHNP should
first:
A. Increase lithium
B. Discontinue the antidepressant that may have triggered mania
C. Add an antipsychotic
D. Obtain a serum lithium level and evaluate for triggers
: Correct Answer : D
Rationale: While treating the acute mania is important, first assessing medication
adherence, lithium level, and potential triggers (substance use, stressors) is
critical before adjusting medications.
10. A 35-year-old woman reports cleaning rituals that take 2 hours daily,
intrusive thoughts about harming her child, and significant distress. She
recognizes these thoughts are irrational. The most likely diagnosis is:
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder
C. Postpartum depression with anxiety
D. Specific phobia
pg. 4
