BARKLEY DRT PMHNP PRACTICUM ONE
FINAL STUDY GUIDE 2026 TESTED
ANSWERS GRADED A+
⩥ 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
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
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.
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
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
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.
FINAL STUDY GUIDE 2026 TESTED
ANSWERS GRADED A+
⩥ 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
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
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.
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
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
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.
