Page 1 of 63
BARKLEY DRT FOR PMHNP EXAM – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PMHNP
Prepare effectively for the Barkley DRT for PMHNP Exam with this focused study
resource. It supports review of psychiatric mental health assessment, diagnostic
reasoning, differential diagnosis, clinical decision-making, and evidence-based
treatment principles. Use the material to reinforce your knowledge, review high-yield
topics, and identify areas that may require additional study. This resource is suited for
PMHNP students, psychiatric-mental health nursing learners, and candidates
preparing for the Barkley DRT examination.
MULTIPLE CHOICE.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIFFERENTIAL DIAGNOSIS
(Questions 1–40)
Question 1:
During a suicide intervention with your 28-year-old male patient, to which
agreement should you ask for his consent, verbally or in writing?
A) A "no-harm" contract
B) A safety plan agreement
C) A treatment adherence contract
D) A confidentiality waiver
Answer: B
Rationale: A safety plan is an evidence-based, collaborative intervention that
includes specific coping strategies, sources of support, and emergency
contacts. Unlike "no-harm" contracts, which have not been shown to reduce
suicide risk, a safety plan is a practical, actionable agreement that empowers
the patient and provides clear steps to follow during a crisis.
, Page 2 of 63
Question 2:
A 28-year-old female with a history of PTSD presents with flashbacks,
hypervigilance, and nightmares. What is the MOST appropriate first-line
treatment?
A) Benzodiazepines
B) Trauma-focused cognitive behavioral therapy (TF-CBT)
C) SSRIs alone
D) Psychoanalysis
Answer: B
Rationale: Trauma-focused CBT (TF-CBT) and prolonged exposure therapy are
considered first-line, evidence-based treatments for PTSD. While SSRIs (such
as sertraline and paroxetine) are also recommended, psychotherapy is often
the preferred initial approach, especially for patients who are motivated to
engage in therapy.
Question 3:
A patient presents with constant feelings of worry, nervousness, and heat
intolerance. Which of the following is the most likely differential diagnosis?
A) Hyperthyroidism
B) Hypoglycemia
C) Diabetes mellitus type 1
D) Diabetes mellitus type 2
Answer: A
Rationale: The combination of anxiety symptoms (worry, nervousness) with
physical symptoms such as heat intolerance is classic for hyperthyroidism.
Thyroid function tests (TSH, free T4) should be ordered to rule out this medical
cause before attributing symptoms solely to an anxiety disorder.
Question 4:
When a patient has a sudden inability to recall important personal
information, it is defined as:
, Page 3 of 63
A) Dissociative amnesia
B) Dissociative fugue
C) Depersonalization disorder
D) Factitious disorder
Answer: A
Rationale: Dissociative amnesia is characterized by an inability to recall
important autobiographical information, typically of a traumatic or stressful
nature, that is too extensive to be explained by ordinary forgetfulness.
Dissociative fugue involves amnesia with unexpected travel or bewildered
wandering.
Question 5:
A 39-year-old man was diagnosed with generalized anxiety disorder six
months ago and has been taking citalopram. Based on his symptoms, which
of the following is the most likely differential diagnosis?
A) Hyperthyroidism
B) Hypoglycemia
C) Diabetes mellitus type 1
D) Diabetes mellitus type 2
Answer: A
Rationale: This question emphasizes the importance of ruling out medical
causes of anxiety. Hyperthyroidism can present with anxiety symptoms that
may be mistaken for a primary anxiety disorder. A thorough medical workup is
essential before diagnosing a psychiatric condition.
Question 6:
A comprehensive psychiatric interview allows for a thorough assessment of
history, symptoms, and differential diagnoses before initiating
treatment. Imaging is reserved for:
A) All psychiatric patients
B) Suspected neurological causes
, Page 4 of 63
C) Patients with a history of trauma
D) Patients over the age of 65
Answer: B
Rationale: Neuroimaging (CT, MRI) is not routinely indicated for most
psychiatric evaluations. It is reserved for cases where there is suspicion of an
underlying neurological condition, such as a brain tumor, stroke, or other
structural abnormality that could explain the presenting symptoms.
Question 7:
A patient who takes desipramine regularly presents with a recent onset of
cardiac dysrhythmia and severe hypotension. What is the most likely cause?
A) Tricyclic antidepressant (TCA) toxicity
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) Hypertensive crisis
Answer: A
Rationale: Desipramine is a tricyclic antidepressant (TCA) that can cause
cardiotoxicity, including dysrhythmias and hypotension, especially in
overdose or with elevated serum levels. TCAs block sodium channels in the
heart, leading to QRS prolongation and arrhythmias.
Question 8:
Which of the following findings should prompt referral to primary care for
evaluation of cardiovascular problems?
A) Palpitations and tachycardia with anxiety
B) Chest pain with exertion
C) Hypertension without symptoms
D) All of the above
Answer: D
Rationale: Any cardiovascular symptoms, including palpitations, tachycardia,
chest pain, or hypertension, warrant medical evaluation to rule out underlying
BARKLEY DRT FOR PMHNP EXAM – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PMHNP
Prepare effectively for the Barkley DRT for PMHNP Exam with this focused study
resource. It supports review of psychiatric mental health assessment, diagnostic
reasoning, differential diagnosis, clinical decision-making, and evidence-based
treatment principles. Use the material to reinforce your knowledge, review high-yield
topics, and identify areas that may require additional study. This resource is suited for
PMHNP students, psychiatric-mental health nursing learners, and candidates
preparing for the Barkley DRT examination.
MULTIPLE CHOICE.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIFFERENTIAL DIAGNOSIS
(Questions 1–40)
Question 1:
During a suicide intervention with your 28-year-old male patient, to which
agreement should you ask for his consent, verbally or in writing?
A) A "no-harm" contract
B) A safety plan agreement
C) A treatment adherence contract
D) A confidentiality waiver
Answer: B
Rationale: A safety plan is an evidence-based, collaborative intervention that
includes specific coping strategies, sources of support, and emergency
contacts. Unlike "no-harm" contracts, which have not been shown to reduce
suicide risk, a safety plan is a practical, actionable agreement that empowers
the patient and provides clear steps to follow during a crisis.
, Page 2 of 63
Question 2:
A 28-year-old female with a history of PTSD presents with flashbacks,
hypervigilance, and nightmares. What is the MOST appropriate first-line
treatment?
A) Benzodiazepines
B) Trauma-focused cognitive behavioral therapy (TF-CBT)
C) SSRIs alone
D) Psychoanalysis
Answer: B
Rationale: Trauma-focused CBT (TF-CBT) and prolonged exposure therapy are
considered first-line, evidence-based treatments for PTSD. While SSRIs (such
as sertraline and paroxetine) are also recommended, psychotherapy is often
the preferred initial approach, especially for patients who are motivated to
engage in therapy.
Question 3:
A patient presents with constant feelings of worry, nervousness, and heat
intolerance. Which of the following is the most likely differential diagnosis?
A) Hyperthyroidism
B) Hypoglycemia
C) Diabetes mellitus type 1
D) Diabetes mellitus type 2
Answer: A
Rationale: The combination of anxiety symptoms (worry, nervousness) with
physical symptoms such as heat intolerance is classic for hyperthyroidism.
Thyroid function tests (TSH, free T4) should be ordered to rule out this medical
cause before attributing symptoms solely to an anxiety disorder.
Question 4:
When a patient has a sudden inability to recall important personal
information, it is defined as:
, Page 3 of 63
A) Dissociative amnesia
B) Dissociative fugue
C) Depersonalization disorder
D) Factitious disorder
Answer: A
Rationale: Dissociative amnesia is characterized by an inability to recall
important autobiographical information, typically of a traumatic or stressful
nature, that is too extensive to be explained by ordinary forgetfulness.
Dissociative fugue involves amnesia with unexpected travel or bewildered
wandering.
Question 5:
A 39-year-old man was diagnosed with generalized anxiety disorder six
months ago and has been taking citalopram. Based on his symptoms, which
of the following is the most likely differential diagnosis?
A) Hyperthyroidism
B) Hypoglycemia
C) Diabetes mellitus type 1
D) Diabetes mellitus type 2
Answer: A
Rationale: This question emphasizes the importance of ruling out medical
causes of anxiety. Hyperthyroidism can present with anxiety symptoms that
may be mistaken for a primary anxiety disorder. A thorough medical workup is
essential before diagnosing a psychiatric condition.
Question 6:
A comprehensive psychiatric interview allows for a thorough assessment of
history, symptoms, and differential diagnoses before initiating
treatment. Imaging is reserved for:
A) All psychiatric patients
B) Suspected neurological causes
, Page 4 of 63
C) Patients with a history of trauma
D) Patients over the age of 65
Answer: B
Rationale: Neuroimaging (CT, MRI) is not routinely indicated for most
psychiatric evaluations. It is reserved for cases where there is suspicion of an
underlying neurological condition, such as a brain tumor, stroke, or other
structural abnormality that could explain the presenting symptoms.
Question 7:
A patient who takes desipramine regularly presents with a recent onset of
cardiac dysrhythmia and severe hypotension. What is the most likely cause?
A) Tricyclic antidepressant (TCA) toxicity
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) Hypertensive crisis
Answer: A
Rationale: Desipramine is a tricyclic antidepressant (TCA) that can cause
cardiotoxicity, including dysrhythmias and hypotension, especially in
overdose or with elevated serum levels. TCAs block sodium channels in the
heart, leading to QRS prolongation and arrhythmias.
Question 8:
Which of the following findings should prompt referral to primary care for
evaluation of cardiovascular problems?
A) Palpitations and tachycardia with anxiety
B) Chest pain with exertion
C) Hypertension without symptoms
D) All of the above
Answer: D
Rationale: Any cardiovascular symptoms, including palpitations, tachycardia,
chest pain, or hypertension, warrant medical evaluation to rule out underlying
