BARKLEY PMHNP 2026/2027 BOARD EXAM |
VERIFIED QUESTIONS & ANSWERS |
COMPLETE CERTIFICATION PREP STUDY
GUIDE
BARKLEY PMHNP 2026/2027 BOARD EXAM | VERIFIED QUESTIONS & ANSWERS |
COMPLETE CERTIFICATION PREP STUDY GUIDE
• This comprehensive study guide contains verified practice questions covering all
major domains of the PMHNP board exam, including pharmacology,
psychopathology, diagnostic criteria, therapeutic interventions, and evidence-based
treatment protocols.
• Study strategy: Work through these questions systematically to identify knowledge
gaps, review detailed rationales to strengthen understanding of clinical reasoning,
and repeat sections on weak topics until mastery is achieved.
QUESTION 1
A 45-year-old patient with major depressive disorder reports increased
appetite, significant weight gain, hypersomnia, and psychomotor retardation
over the past 3 weeks despite being on fluoxetine 40 mg daily for 8 weeks. The
PMHNP considers adding an atypical antipsychotic. Which medication
combination would be most appropriate given the patient's symptom
presentation?
A) Fluoxetine with quetiapine
B) Fluoxetine with haloperidol
C) Fluoxetine with risperidone
D) Fluoxetine with aripiprazole
E) Fluoxetine with paliperidone
✓ CORRECT ANSWER: A) Fluoxetine with quetiapine
RATIONALE: Quetiapine is an excellent choice for augmentation in treatment-
resistant depression, particularly for patients presenting with depressive symptoms
including hypersomnia and increased appetite. Quetiapine has demonstrated
,efficacy in bipolar depression and unipolar depression as an augmenting agent.
The atypical antipsychotics with the strongest evidence for depression
augmentation are quetiapine and aripiprazole, but quetiapine is preferred when
sedation and appetite suppression may be beneficial side effects. Haloperidol is a
typical antipsychotic with significant extrapyramidal side effects and is not first-line
for depression augmentation. Risperidone and paliperidone carry greater
metabolic risk and are less preferred for this indication without evidence of
psychotic features.
QUESTION 2
A 28-year-old patient with schizophrenia has been stable on olanzapine 15 mg
nightly for 18 months. Recent labs show fasting glucose 128 mg/dL (previously
95 mg/dL), weight gain of 18 pounds, and triglycerides 220 mg/dL. The PMHNP
is concerned about metabolic syndrome. Which intervention represents the
best initial management strategy?
A) Discontinue olanzapine immediately and switch to aripiprazole
B) Reduce olanzapine dose and add metformin for metabolic protection
C) Continue olanzapine but add a statin for lipid management
D) Initiate lifestyle modification including diet and exercise counseling and monitor
labs in 3 months
E) Switch to clozapine which has better metabolic profiles
✓ CORRECT ANSWER: D) Initiate lifestyle modification including diet and
exercise counseling and monitor labs in 3 months
RATIONALE: Before making medication changes in a stable patient, evidence-based
practice recommends implementing comprehensive lifestyle modifications as the
first-line intervention for metabolic abnormalities associated with antipsychotics.
This includes structured diet counseling, exercise programs, and close monitoring.
The patient is currently stable on olanzapine, and abrupt discontinuation poses risk
of symptom relapse. While metformin may eventually be considered, lifestyle
modification must be attempted first. Clozapine actually has metabolic risks similar
,to or greater than olanzapine and is not indicated here. A statin alone does not
address the underlying metabolic dysfunction. If lifestyle changes do not produce
adequate improvement within 3 months, then medication adjustment or addition
of metabolic agents would be considered.
QUESTION 3
A 34-year-old patient with bipolar I disorder is currently stable on lithium 900
mg daily with a serum level of 0.8 mEq/L. The patient reports tremor,
polyuria, and polydipsia. Which nursing intervention is most appropriate?
A) Increase lithium dose to achieve therapeutic level of 1.2 mEq/L
B) Initiate education about nephrogenic diabetes insipidus risk and ensure
adequate hydration
C) Discontinue lithium and switch to valproate
D) Reduce sodium intake to improve lithium retention
E) Add a diuretic to manage polyuria
✓ CORRECT ANSWER: B) Initiate education about nephrogenic diabetes
insipidus risk and ensure adequate hydration
RATIONALE: Polyuria and polydipsia are classic signs of lithium-induced
nephrogenic diabetes insipidus, which can develop with chronic lithium use. The
patient's lithium level is already in the therapeutic range at 0.8 mEq/L, so increasing
the dose would worsen the condition. Management includes patient education
about staying well-hydrated and maintaining consistent sodium and fluid intake.
The tremor and polyuria/polydipsia are manageable side effects that do not
warrant discontinuation of an effective mood stabilizer. Adding diuretics would
worsen polyuria. Reducing sodium increases lithium retention and risk of toxicity.
Amiloride (a potassium-sparing diuretic) can be added if nephrogenic diabetes
insipidus becomes problematic, but education and hydration management are
appropriate initial interventions.
, QUESTION 4
A 19-year-old first-episode psychosis patient presents with command
hallucinations telling him to harm himself, disorganized speech, and bizarre
delusions. He has been medication-naive. Which antipsychotic would be most
appropriate as first-line treatment?
A) Clozapine 12.5 mg daily
B) Risperidone 2 mg daily
C) Chlorpromazine 100 mg three times daily
D) Haloperidol 5 mg intramuscularly
E) Paliperidone palmitate 234 mg intramuscularly monthly
✓ CORRECT ANSWER: B) Risperidone 2 mg daily
RATIONALE: For first-episode psychosis, second-generation (atypical) antipsychotics
are recommended as first-line therapy due to superior efficacy and tolerability
compared to first-generation agents. Risperidone at 2 mg daily is an appropriate
starting dose that can be titrated based on response and tolerability. Clozapine is
reserved for treatment-resistant psychosis (after failure of at least two
antipsychotics) due to the need for regular blood monitoring and risk of
agranulocytosis. Chlorpromazine and haloperidol are first-generation
antipsychotics with significant extrapyramidal side effects and tardive dyskinesia
risk, making them less favorable for first-episode treatment. Paliperidone palmitate
is a long-acting injection best reserved for patients with established psychosis and
compliance issues, not first-line for medication-naive patients.
QUESTION 5
A 52-year-old patient with generalized anxiety disorder has been on sertraline
100 mg daily for 6 months with partial response. The PMHNP considers
augmentation therapy. Which augmentation strategy has the strongest
evidence base?
A) Add buspirone 15 mg twice daily
VERIFIED QUESTIONS & ANSWERS |
COMPLETE CERTIFICATION PREP STUDY
GUIDE
BARKLEY PMHNP 2026/2027 BOARD EXAM | VERIFIED QUESTIONS & ANSWERS |
COMPLETE CERTIFICATION PREP STUDY GUIDE
• This comprehensive study guide contains verified practice questions covering all
major domains of the PMHNP board exam, including pharmacology,
psychopathology, diagnostic criteria, therapeutic interventions, and evidence-based
treatment protocols.
• Study strategy: Work through these questions systematically to identify knowledge
gaps, review detailed rationales to strengthen understanding of clinical reasoning,
and repeat sections on weak topics until mastery is achieved.
QUESTION 1
A 45-year-old patient with major depressive disorder reports increased
appetite, significant weight gain, hypersomnia, and psychomotor retardation
over the past 3 weeks despite being on fluoxetine 40 mg daily for 8 weeks. The
PMHNP considers adding an atypical antipsychotic. Which medication
combination would be most appropriate given the patient's symptom
presentation?
A) Fluoxetine with quetiapine
B) Fluoxetine with haloperidol
C) Fluoxetine with risperidone
D) Fluoxetine with aripiprazole
E) Fluoxetine with paliperidone
✓ CORRECT ANSWER: A) Fluoxetine with quetiapine
RATIONALE: Quetiapine is an excellent choice for augmentation in treatment-
resistant depression, particularly for patients presenting with depressive symptoms
including hypersomnia and increased appetite. Quetiapine has demonstrated
,efficacy in bipolar depression and unipolar depression as an augmenting agent.
The atypical antipsychotics with the strongest evidence for depression
augmentation are quetiapine and aripiprazole, but quetiapine is preferred when
sedation and appetite suppression may be beneficial side effects. Haloperidol is a
typical antipsychotic with significant extrapyramidal side effects and is not first-line
for depression augmentation. Risperidone and paliperidone carry greater
metabolic risk and are less preferred for this indication without evidence of
psychotic features.
QUESTION 2
A 28-year-old patient with schizophrenia has been stable on olanzapine 15 mg
nightly for 18 months. Recent labs show fasting glucose 128 mg/dL (previously
95 mg/dL), weight gain of 18 pounds, and triglycerides 220 mg/dL. The PMHNP
is concerned about metabolic syndrome. Which intervention represents the
best initial management strategy?
A) Discontinue olanzapine immediately and switch to aripiprazole
B) Reduce olanzapine dose and add metformin for metabolic protection
C) Continue olanzapine but add a statin for lipid management
D) Initiate lifestyle modification including diet and exercise counseling and monitor
labs in 3 months
E) Switch to clozapine which has better metabolic profiles
✓ CORRECT ANSWER: D) Initiate lifestyle modification including diet and
exercise counseling and monitor labs in 3 months
RATIONALE: Before making medication changes in a stable patient, evidence-based
practice recommends implementing comprehensive lifestyle modifications as the
first-line intervention for metabolic abnormalities associated with antipsychotics.
This includes structured diet counseling, exercise programs, and close monitoring.
The patient is currently stable on olanzapine, and abrupt discontinuation poses risk
of symptom relapse. While metformin may eventually be considered, lifestyle
modification must be attempted first. Clozapine actually has metabolic risks similar
,to or greater than olanzapine and is not indicated here. A statin alone does not
address the underlying metabolic dysfunction. If lifestyle changes do not produce
adequate improvement within 3 months, then medication adjustment or addition
of metabolic agents would be considered.
QUESTION 3
A 34-year-old patient with bipolar I disorder is currently stable on lithium 900
mg daily with a serum level of 0.8 mEq/L. The patient reports tremor,
polyuria, and polydipsia. Which nursing intervention is most appropriate?
A) Increase lithium dose to achieve therapeutic level of 1.2 mEq/L
B) Initiate education about nephrogenic diabetes insipidus risk and ensure
adequate hydration
C) Discontinue lithium and switch to valproate
D) Reduce sodium intake to improve lithium retention
E) Add a diuretic to manage polyuria
✓ CORRECT ANSWER: B) Initiate education about nephrogenic diabetes
insipidus risk and ensure adequate hydration
RATIONALE: Polyuria and polydipsia are classic signs of lithium-induced
nephrogenic diabetes insipidus, which can develop with chronic lithium use. The
patient's lithium level is already in the therapeutic range at 0.8 mEq/L, so increasing
the dose would worsen the condition. Management includes patient education
about staying well-hydrated and maintaining consistent sodium and fluid intake.
The tremor and polyuria/polydipsia are manageable side effects that do not
warrant discontinuation of an effective mood stabilizer. Adding diuretics would
worsen polyuria. Reducing sodium increases lithium retention and risk of toxicity.
Amiloride (a potassium-sparing diuretic) can be added if nephrogenic diabetes
insipidus becomes problematic, but education and hydration management are
appropriate initial interventions.
, QUESTION 4
A 19-year-old first-episode psychosis patient presents with command
hallucinations telling him to harm himself, disorganized speech, and bizarre
delusions. He has been medication-naive. Which antipsychotic would be most
appropriate as first-line treatment?
A) Clozapine 12.5 mg daily
B) Risperidone 2 mg daily
C) Chlorpromazine 100 mg three times daily
D) Haloperidol 5 mg intramuscularly
E) Paliperidone palmitate 234 mg intramuscularly monthly
✓ CORRECT ANSWER: B) Risperidone 2 mg daily
RATIONALE: For first-episode psychosis, second-generation (atypical) antipsychotics
are recommended as first-line therapy due to superior efficacy and tolerability
compared to first-generation agents. Risperidone at 2 mg daily is an appropriate
starting dose that can be titrated based on response and tolerability. Clozapine is
reserved for treatment-resistant psychosis (after failure of at least two
antipsychotics) due to the need for regular blood monitoring and risk of
agranulocytosis. Chlorpromazine and haloperidol are first-generation
antipsychotics with significant extrapyramidal side effects and tardive dyskinesia
risk, making them less favorable for first-episode treatment. Paliperidone palmitate
is a long-acting injection best reserved for patients with established psychosis and
compliance issues, not first-line for medication-naive patients.
QUESTION 5
A 52-year-old patient with generalized anxiety disorder has been on sertraline
100 mg daily for 6 months with partial response. The PMHNP considers
augmentation therapy. Which augmentation strategy has the strongest
evidence base?
A) Add buspirone 15 mg twice daily
