Ultimate Barkley DRT PMHNP Practicum 1
Actual Exam 2026/2027 – A+ Graded Full-
Length Practice Exam with Verified Answers,
Detailed Clinical Rationales, DSM-5-TR-Aligned
Questions, and Instant Download – The
Ultimate Study Resource to Pass on Y
BARKLEY DRT PMHNP PRACTICUM 1 EXAM
SECTION 1: DIFFERENTIAL DIAGNOSIS & PSYCHIATRIC ASSESSMENT
1. A 32-year-old female presents with a 2-week history of depressed mood, anhedonia,
fatigue, hypersomnia, and increased appetite. She reports these symptoms began shortly
after the birth of her first child 6 weeks ago. She denies any suicidal ideation. Which of the
following is the MOST appropriate diagnosis?
• A. Major Depressive Disorder, severe with psychotic features
• B. Bipolar II Disorder, current episode depressed
• C. Adjustment Disorder with depressed mood
• D. Major Depressive Disorder with peripartum onset
Answer: D. Major Depressive Disorder with peripartum onset
Rationale: The peripartum onset specifier is used for major depressive episodes that begin
during pregnancy or within 4 weeks of delivery. However, clinical practice often extends this to
the first year postpartum. The patient's symptoms meet DSM-5-TR criteria for a major
depressive episode (depressed mood, anhedonia, fatigue, hypersomnia, appetite changes) and
are clearly temporally linked to childbirth. There is no evidence of psychotic features, mania, or
a clearly identifiable psychosocial stressor that would better explain the episode.
,2. A 24-year-old male is brought to the clinic by his mother. She reports that over the past 6
months, he has become increasingly suspicious that his coworkers are poisoning his food. He
has stopped eating at work and has installed multiple locks on his apartment door. He reports
hearing voices that comment on his actions and sometimes tell him he is worthless. He has
not slept well in weeks and appears disheveled. What is the MOST likely diagnosis?
• A. Schizoaffective Disorder
• B. Delusional Disorder
• C. Schizophrenia
• D. Substance-Induced Psychotic Disorder
Answer: C. Schizophrenia
Rationale: The patient meets DSM-5-TR criteria for Schizophrenia: two or more characteristic
symptoms (delusions, hallucinations, disorganized speech/behavior) for a significant portion of
time over at least 6 months. He exhibits persecutory delusions (poisoning), auditory
hallucinations (commenting voices), negative symptoms (disheveled appearance, social
withdrawal), and functional decline. The 6-month duration of continuous signs is a key
requirement.
3. A 45-year-old male with a history of alcohol use disorder reports feeling extremely anxious
in social situations. He avoids parties and work meetings, fearing he will say something stupid
and be judged negatively. He reports this has been a lifelong pattern. Which of the following
is the MOST likely diagnosis?
• A. Social Anxiety Disorder (Social Phobia)
• B. Panic Disorder
• C. Avoidant Personality Disorder
• D. Agoraphobia
Answer: C. Avoidant Personality Disorder
Rationale: The key distinction is the lifelong, pervasive pattern of social inhibition, feelings of
inadequacy, and hypersensitivity to negative evaluation, which is characteristic of Avoidant
Personality Disorder. Social Anxiety Disorder also involves fear of social situations, but the
symptoms are typically ego-dystonic and the patient recognizes the fear as excessive. The
lifelong pattern and pervasive nature of the symptoms point toward a personality disorder.
4. A 28-year-old female reports episodes of intense fear that come on suddenly, lasting about
10 minutes. During these episodes, she experiences palpitations, sweating, trembling,
,shortness of breath, and a fear of dying. She has been having these episodes weekly and has
started avoiding exercise and caffeine because they seem to trigger them. What is the MOST
likely diagnosis?
• A. Panic Disorder
• B. Generalized Anxiety Disorder
• C. Post-Traumatic Stress Disorder
• D. Specific Phobia
Answer: A. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks (intense fear
peaking within minutes, accompanied by palpitations, sweating, trembling, shortness of breath,
and fear of dying) followed by at least one month of persistent concern about having more
attacks or maladaptive behavior changes (avoiding exercise and caffeine).
5. A 19-year-old college student presents with recurrent, intrusive thoughts about
contamination. He reports washing his hands dozens of times a day to prevent his family from
getting sick. He recognizes these thoughts and behaviors are excessive but feels powerless to
stop them. What is the MOST likely diagnosis?
• A. Generalized Anxiety Disorder
• B. Obsessive-Compulsive Disorder
• C. Illness Anxiety Disorder
• D. Specific Phobia
Answer: B. Obsessive-Compulsive Disorder
Rationale: The patient has obsessions (intrusive, unwanted thoughts about contamination) and
compulsions (excessive hand washing) that are time-consuming (more than 1 hour per day) and
cause clinically significant distress. He recognizes the behavior as excessive, which is also
characteristic of OCD.
6. According to the DSM-5-TR, which of the following is NOT a specifier for Major Depressive
Disorder?
• A. With anxious distress
• B. With mixed features
• C. With peripartum onset
, • D. With psychotic features
Answer: B. With mixed features
Rationale: While "with mixed features" is a specifier for Bipolar I and Bipolar II disorders, it is
also a specifier for Major Depressive Disorder. The question asks for what is NOT a specifier for
MDD. All four listed are specifiers for MDD. The challenge here is to recognize that mixed
features are part of the MDD criteria.
7. What is the first step in the 6-step differential diagnosis process in psychiatric-mental
health practice?
• A. Determine the primary psychiatric diagnosis
• B. Rule out malingering or factitious disorder
• C. Rule out substance-related causes
• D. Rule out a general medical condition
Answer: B. Rule out malingering or factitious disorder
Rationale: The 6-step differential diagnosis process is: Step 1: Rule out malingering or factitious
disorder. Step 2: Rule out substance-related causes. Step 3: Rule out a general medical
condition. Step 4: Determine the primary psychiatric diagnosis. Step 5: Differentiate from other
psychiatric disorders. Step 6: Establish the specific diagnosis, specifiers, and severity .
8. A 34-year-old female presents with episodic palpitations, sweating, trembling, and a fear of
losing control. These episodes began suddenly and are unpredictable. She has started
avoiding public transportation. What is the MOST likely diagnosis?
• A. Panic Disorder with agoraphobia
• B. Agoraphobia
• C. Specific Phobia
• D. Generalized Anxiety Disorder
Answer: A. Panic Disorder with agoraphobia
Rationale: The patient has recurrent, unexpected panic attacks followed by at least one month
of concern about having more attacks and maladaptive behavior changes (avoiding public
transportation). The avoidance of situations where escape might be difficult is characteristic of
agoraphobia, making "Panic Disorder with agoraphobia" the most accurate diagnosis.
9. A 60-year-old male with a history of hypertension and type 2 diabetes presents with a 6-
month history of progressive memory loss, difficulty finding words, and personality changes.
Actual Exam 2026/2027 – A+ Graded Full-
Length Practice Exam with Verified Answers,
Detailed Clinical Rationales, DSM-5-TR-Aligned
Questions, and Instant Download – The
Ultimate Study Resource to Pass on Y
BARKLEY DRT PMHNP PRACTICUM 1 EXAM
SECTION 1: DIFFERENTIAL DIAGNOSIS & PSYCHIATRIC ASSESSMENT
1. A 32-year-old female presents with a 2-week history of depressed mood, anhedonia,
fatigue, hypersomnia, and increased appetite. She reports these symptoms began shortly
after the birth of her first child 6 weeks ago. She denies any suicidal ideation. Which of the
following is the MOST appropriate diagnosis?
• A. Major Depressive Disorder, severe with psychotic features
• B. Bipolar II Disorder, current episode depressed
• C. Adjustment Disorder with depressed mood
• D. Major Depressive Disorder with peripartum onset
Answer: D. Major Depressive Disorder with peripartum onset
Rationale: The peripartum onset specifier is used for major depressive episodes that begin
during pregnancy or within 4 weeks of delivery. However, clinical practice often extends this to
the first year postpartum. The patient's symptoms meet DSM-5-TR criteria for a major
depressive episode (depressed mood, anhedonia, fatigue, hypersomnia, appetite changes) and
are clearly temporally linked to childbirth. There is no evidence of psychotic features, mania, or
a clearly identifiable psychosocial stressor that would better explain the episode.
,2. A 24-year-old male is brought to the clinic by his mother. She reports that over the past 6
months, he has become increasingly suspicious that his coworkers are poisoning his food. He
has stopped eating at work and has installed multiple locks on his apartment door. He reports
hearing voices that comment on his actions and sometimes tell him he is worthless. He has
not slept well in weeks and appears disheveled. What is the MOST likely diagnosis?
• A. Schizoaffective Disorder
• B. Delusional Disorder
• C. Schizophrenia
• D. Substance-Induced Psychotic Disorder
Answer: C. Schizophrenia
Rationale: The patient meets DSM-5-TR criteria for Schizophrenia: two or more characteristic
symptoms (delusions, hallucinations, disorganized speech/behavior) for a significant portion of
time over at least 6 months. He exhibits persecutory delusions (poisoning), auditory
hallucinations (commenting voices), negative symptoms (disheveled appearance, social
withdrawal), and functional decline. The 6-month duration of continuous signs is a key
requirement.
3. A 45-year-old male with a history of alcohol use disorder reports feeling extremely anxious
in social situations. He avoids parties and work meetings, fearing he will say something stupid
and be judged negatively. He reports this has been a lifelong pattern. Which of the following
is the MOST likely diagnosis?
• A. Social Anxiety Disorder (Social Phobia)
• B. Panic Disorder
• C. Avoidant Personality Disorder
• D. Agoraphobia
Answer: C. Avoidant Personality Disorder
Rationale: The key distinction is the lifelong, pervasive pattern of social inhibition, feelings of
inadequacy, and hypersensitivity to negative evaluation, which is characteristic of Avoidant
Personality Disorder. Social Anxiety Disorder also involves fear of social situations, but the
symptoms are typically ego-dystonic and the patient recognizes the fear as excessive. The
lifelong pattern and pervasive nature of the symptoms point toward a personality disorder.
4. A 28-year-old female reports episodes of intense fear that come on suddenly, lasting about
10 minutes. During these episodes, she experiences palpitations, sweating, trembling,
,shortness of breath, and a fear of dying. She has been having these episodes weekly and has
started avoiding exercise and caffeine because they seem to trigger them. What is the MOST
likely diagnosis?
• A. Panic Disorder
• B. Generalized Anxiety Disorder
• C. Post-Traumatic Stress Disorder
• D. Specific Phobia
Answer: A. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks (intense fear
peaking within minutes, accompanied by palpitations, sweating, trembling, shortness of breath,
and fear of dying) followed by at least one month of persistent concern about having more
attacks or maladaptive behavior changes (avoiding exercise and caffeine).
5. A 19-year-old college student presents with recurrent, intrusive thoughts about
contamination. He reports washing his hands dozens of times a day to prevent his family from
getting sick. He recognizes these thoughts and behaviors are excessive but feels powerless to
stop them. What is the MOST likely diagnosis?
• A. Generalized Anxiety Disorder
• B. Obsessive-Compulsive Disorder
• C. Illness Anxiety Disorder
• D. Specific Phobia
Answer: B. Obsessive-Compulsive Disorder
Rationale: The patient has obsessions (intrusive, unwanted thoughts about contamination) and
compulsions (excessive hand washing) that are time-consuming (more than 1 hour per day) and
cause clinically significant distress. He recognizes the behavior as excessive, which is also
characteristic of OCD.
6. According to the DSM-5-TR, which of the following is NOT a specifier for Major Depressive
Disorder?
• A. With anxious distress
• B. With mixed features
• C. With peripartum onset
, • D. With psychotic features
Answer: B. With mixed features
Rationale: While "with mixed features" is a specifier for Bipolar I and Bipolar II disorders, it is
also a specifier for Major Depressive Disorder. The question asks for what is NOT a specifier for
MDD. All four listed are specifiers for MDD. The challenge here is to recognize that mixed
features are part of the MDD criteria.
7. What is the first step in the 6-step differential diagnosis process in psychiatric-mental
health practice?
• A. Determine the primary psychiatric diagnosis
• B. Rule out malingering or factitious disorder
• C. Rule out substance-related causes
• D. Rule out a general medical condition
Answer: B. Rule out malingering or factitious disorder
Rationale: The 6-step differential diagnosis process is: Step 1: Rule out malingering or factitious
disorder. Step 2: Rule out substance-related causes. Step 3: Rule out a general medical
condition. Step 4: Determine the primary psychiatric diagnosis. Step 5: Differentiate from other
psychiatric disorders. Step 6: Establish the specific diagnosis, specifiers, and severity .
8. A 34-year-old female presents with episodic palpitations, sweating, trembling, and a fear of
losing control. These episodes began suddenly and are unpredictable. She has started
avoiding public transportation. What is the MOST likely diagnosis?
• A. Panic Disorder with agoraphobia
• B. Agoraphobia
• C. Specific Phobia
• D. Generalized Anxiety Disorder
Answer: A. Panic Disorder with agoraphobia
Rationale: The patient has recurrent, unexpected panic attacks followed by at least one month
of concern about having more attacks and maladaptive behavior changes (avoiding public
transportation). The avoidance of situations where escape might be difficult is characteristic of
agoraphobia, making "Panic Disorder with agoraphobia" the most accurate diagnosis.
9. A 60-year-old male with a history of hypertension and type 2 diabetes presents with a 6-
month history of progressive memory loss, difficulty finding words, and personality changes.
