BARKLEY PMHNP 2026 ULTIMATE EXAM REVIEW
AND HIGH-YIELD QUESTIONS WITH CORRECT
ANSWERS– GUARANTEED PASS
EXAM OVERVIEW
Feature Detail
Total
350 questions
Questions
Format Single-best-answer, multiple-choice (SATA questions included)
Passing Score 350 out of 500 (ANCC)
Content Scientific Foundation (22%), Advanced Practice Skills (27%), Diagnosis & Treatment (22%
Domains Psychotherapy & Related Theories (11%), Ethics/Legal/Cultural Care (17%)
SECTION 1: NEUROBIOLOGY & PSYCHOPHARMACOLOGY
(Questions 1-80)
1. Which neurotransmitter is most closely associated with the regulation of mood,
appetite, and sleep, and is the primary target of SSRIs?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Answer: C
,Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs
increase serotonin availability by blocking reuptake, alleviating depressive symptoms.
Dopamine relates more to reward and motivation, GABA to inhibition, and acetylcholine
to cognition .
2. A patient on long-term haloperidol presents with bradykinesia and rigidity.
Which intervention is most appropriate?
A) Add benztropine
B) Increase haloperidol dose
C) Switch to aripiprazole
D) Add propranolol
Answer: A
Rationale: Benztropine is an anticholinergic that treats antipsychotic-induced
extrapyramidal symptoms (EPS) by restoring the dopamine-acetylcholine balance in the
basal ganglia. Increasing the dose worsens EPS, and switching to aripiprazole is not first-
line for acute EPS management .
3. A patient on fluoxetine reports insomnia. What is the best next step?
A) Add trazodone 50 mg at bedtime
B) Switch to paroxetine
C) Increase fluoxetine to 60 mg
D) Add bupropion
Answer: A
,Rationale: Low-dose trazodone (25-100 mg) is safe and effective for SSRI-induced
insomnia. Paroxetine is more sedating but switching may destabilize treatment. A higher
fluoxetine dose may worsen insomnia, and bupropion is activating .
4. A patient on venlafaxine 225 mg daily develops new-onset hypertension
(150/95). What is the mechanism?
A) Serotonin syndrome
B) Norepinephrine reuptake inhibition at high doses
C) Dopamine agonism
D) Anticholinergic effects
Answer: B
Rationale: At doses greater than 150 mg, venlafaxine significantly inhibits
norepinephrine reuptake, increasing blood pressure. Serotonin syndrome presents with
agitation, hyperthermia, and clonus. Venlafaxine has no significant dopamine effects .
5. Which antipsychotic has the highest risk of metabolic syndrome?
A) Aripiprazole
B) Ziprasidone
C) Olanzapine
D) Lurasidone
Answer: C
, Rationale: Olanzapine causes significant weight gain, dyslipidemia, and hyperglycemia.
Aripiprazole and ziprasidone have low metabolic risk profiles, and lurasidone has
minimal metabolic effects .
6. A patient on clozapine reports drooling, especially at night. Best management?
A) Reduce clozapine dose
B) Add glycopyrrolate
C) Switch to risperidone
D) Add benztropine
Answer: B
Rationale: Glycopyrrolate is an anticholinergic that reduces sialorrhea without crossing
the blood-brain barrier, avoiding cognitive side effects. Dose reduction may cause
relapse, and switching is not first-line for a manageable side effect .
7. A patient on lithium has a level of 1.4 mEq/L and reports nausea, coarse tremor,
and confusion. What is the next step?
A) Add thiazide diuretic
B) Hold lithium for 24 hours then restart at a lower dose
C) Add NSAID for tremor
D) Increase fluid intake
Answer: B
AND HIGH-YIELD QUESTIONS WITH CORRECT
ANSWERS– GUARANTEED PASS
EXAM OVERVIEW
Feature Detail
Total
350 questions
Questions
Format Single-best-answer, multiple-choice (SATA questions included)
Passing Score 350 out of 500 (ANCC)
Content Scientific Foundation (22%), Advanced Practice Skills (27%), Diagnosis & Treatment (22%
Domains Psychotherapy & Related Theories (11%), Ethics/Legal/Cultural Care (17%)
SECTION 1: NEUROBIOLOGY & PSYCHOPHARMACOLOGY
(Questions 1-80)
1. Which neurotransmitter is most closely associated with the regulation of mood,
appetite, and sleep, and is the primary target of SSRIs?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Answer: C
,Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs
increase serotonin availability by blocking reuptake, alleviating depressive symptoms.
Dopamine relates more to reward and motivation, GABA to inhibition, and acetylcholine
to cognition .
2. A patient on long-term haloperidol presents with bradykinesia and rigidity.
Which intervention is most appropriate?
A) Add benztropine
B) Increase haloperidol dose
C) Switch to aripiprazole
D) Add propranolol
Answer: A
Rationale: Benztropine is an anticholinergic that treats antipsychotic-induced
extrapyramidal symptoms (EPS) by restoring the dopamine-acetylcholine balance in the
basal ganglia. Increasing the dose worsens EPS, and switching to aripiprazole is not first-
line for acute EPS management .
3. A patient on fluoxetine reports insomnia. What is the best next step?
A) Add trazodone 50 mg at bedtime
B) Switch to paroxetine
C) Increase fluoxetine to 60 mg
D) Add bupropion
Answer: A
,Rationale: Low-dose trazodone (25-100 mg) is safe and effective for SSRI-induced
insomnia. Paroxetine is more sedating but switching may destabilize treatment. A higher
fluoxetine dose may worsen insomnia, and bupropion is activating .
4. A patient on venlafaxine 225 mg daily develops new-onset hypertension
(150/95). What is the mechanism?
A) Serotonin syndrome
B) Norepinephrine reuptake inhibition at high doses
C) Dopamine agonism
D) Anticholinergic effects
Answer: B
Rationale: At doses greater than 150 mg, venlafaxine significantly inhibits
norepinephrine reuptake, increasing blood pressure. Serotonin syndrome presents with
agitation, hyperthermia, and clonus. Venlafaxine has no significant dopamine effects .
5. Which antipsychotic has the highest risk of metabolic syndrome?
A) Aripiprazole
B) Ziprasidone
C) Olanzapine
D) Lurasidone
Answer: C
, Rationale: Olanzapine causes significant weight gain, dyslipidemia, and hyperglycemia.
Aripiprazole and ziprasidone have low metabolic risk profiles, and lurasidone has
minimal metabolic effects .
6. A patient on clozapine reports drooling, especially at night. Best management?
A) Reduce clozapine dose
B) Add glycopyrrolate
C) Switch to risperidone
D) Add benztropine
Answer: B
Rationale: Glycopyrrolate is an anticholinergic that reduces sialorrhea without crossing
the blood-brain barrier, avoiding cognitive side effects. Dose reduction may cause
relapse, and switching is not first-line for a manageable side effect .
7. A patient on lithium has a level of 1.4 mEq/L and reports nausea, coarse tremor,
and confusion. What is the next step?
A) Add thiazide diuretic
B) Hold lithium for 24 hours then restart at a lower dose
C) Add NSAID for tremor
D) Increase fluid intake
Answer: B
