BARKLEY DRT PMHNP PRACTICUM 1
2026/2027 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS
Section I: Psychiatric Assessment & Diagnostic Reasoning (Questions 1–35)
1. A 52-year-old patient presents with 3 weeks of depressed mood, insomnia, and
poor concentration. The PMHNP's initial priority is to:
A. Initiate an SSRI immediately
B. Conduct a comprehensive psychiatric interview including risk assessment
C. Order a brain MRI to rule out organic causes
D. Refer to a psychotherapist for CBT
Correct Answer: B
Rationale: A comprehensive interview with risk assessment is the
foundational first step before any intervention. Suicide risk must be assessed
at every initial encounter regardless of presentation. Imaging is reserved for
neurological red flags, and medication should never precede adequate
assessment.
2. Which finding during a mental status exam best differentiates delusions from
obsessions?
A. Delusions are always auditory; obsessions are visual
B. Delusions are ego-syntonic; obsessions are ego-dystonic
C. Delusions are brief; obsessions are chronic
D. Delusions involve memory; obsessions involve perception
Correct Answer: B
Rationale: Delusions are fixed false beliefs consistent with the patient's
self-concept (ego-syntonic), while obsessions are intrusive, unwanted, and
,recognized as irrational (ego-dystonic). This distinction is critical for
differentiating psychotic disorders from OCD.
3. A 34-year-old woman reports 6 months of feeling detached from her body,
"like I'm watching a movie of my life." She denies trauma, panic, or substance use.
Reality testing remains intact. The most likely diagnosis is:
A. Panic Disorder
B. PTSD
C. Depersonalization/Derealization Disorder
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale: Depersonalization/Derealization Disorder involves persistent
episodes with intact reality testing and no required trauma history. The
absence of panic attacks rules out Panic Disorder; the absence of a traumatic
stressor rules out PTSD.
4. A patient describes hearing voices commenting on their behavior for 8 months.
They also report 4 days of elevated mood and decreased need for sleep. The most
likely diagnosis is:
A. Bipolar I Disorder with psychotic features
B. Schizoaffective Disorder
C. Schizophrenia
D. Brief Psychotic Disorder
Correct Answer: B
Rationale: Schizoaffective Disorder requires psychotic symptoms for ≥2
weeks in the absence of mood episodes, plus mood episodes for the majority of
the illness duration. Bipolar I with psychotic features would have psychosis
only during mood episodes.
,5. A 28-year-old male presents with 10 months of social withdrawal, flat affect,
and odd beliefs. He has no mood symptoms. Which assessment tool is most
appropriate for initial symptom quantification?
A. PHQ-9
B. PANSS
C. GAD-7
D. MDQ
Correct Answer: B
Rationale: The Positive and Negative Syndrome Scale (PANSS) is
specifically designed to quantify psychotic symptoms. PHQ-9 measures
depression, GAD-7 measures anxiety, and MDQ screens for bipolar disorder.
6. Which statement best describes the purpose of the mental status examination
in psychiatric practice?
A. It replaces the need for a full psychiatric history
B. It provides a cross-sectional description of the patient's current functioning
C. It is only necessary for inpatient evaluations
D. It establishes the definitive DSM-5 diagnosis
Correct Answer: B
Rationale: The MSE is a structured, cross-sectional assessment of
appearance, behavior, cognition, and thought processes at a specific point in
time. It complements—but does not replace—the psychiatric history.
7. A patient reports that "the government has implanted a chip in my brain to
monitor my thoughts." This is best characterized as:
A. Somatic delusion
B. Persecutory delusion
C. Thought broadcasting
D. Grandiose delusion
, Correct Answer: B
Rationale: A persecutory delusion involves the belief that one is being
targeted, harmed, or monitored by others. Somatic delusions focus on bodily
functions; thought broadcasting involves the belief that one's thoughts are
audible to others.
8. Which of the following is the most appropriate initial screening tool for alcohol
use disorder in a busy PMHNP practice?
A. MMSE
B. AUDIT-C
C. PANSS
D. YMRS
Correct Answer: B
Rationale: The AUDIT-C is a validated, brief (3-item) screening tool for
hazardous drinking and alcohol use disorders. The MMSE assesses cognition;
PANSS and YMRS assess psychosis and mania, respectively.
9. A 45-year-old patient with treatment-resistant depression develops new
auditory hallucinations. Current medication: venlafaxine 225 mg daily. The most
appropriate next step is:
A. Increase venlafaxine to 300 mg
B. Initiate a comprehensive metabolic and neurological workup
C. Add risperidone 0.5 mg for psychotic augmentation
D. Switch to an MAOI immediately
Correct Answer: B
Rationale: New-onset hallucinations in a middle-aged adult warrant
investigation for organic causes (tumor, metabolic disturbance, substance use)
before attributing them to a primary psychiatric disorder. Increasing the
2026/2027 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS
Section I: Psychiatric Assessment & Diagnostic Reasoning (Questions 1–35)
1. A 52-year-old patient presents with 3 weeks of depressed mood, insomnia, and
poor concentration. The PMHNP's initial priority is to:
A. Initiate an SSRI immediately
B. Conduct a comprehensive psychiatric interview including risk assessment
C. Order a brain MRI to rule out organic causes
D. Refer to a psychotherapist for CBT
Correct Answer: B
Rationale: A comprehensive interview with risk assessment is the
foundational first step before any intervention. Suicide risk must be assessed
at every initial encounter regardless of presentation. Imaging is reserved for
neurological red flags, and medication should never precede adequate
assessment.
2. Which finding during a mental status exam best differentiates delusions from
obsessions?
A. Delusions are always auditory; obsessions are visual
B. Delusions are ego-syntonic; obsessions are ego-dystonic
C. Delusions are brief; obsessions are chronic
D. Delusions involve memory; obsessions involve perception
Correct Answer: B
Rationale: Delusions are fixed false beliefs consistent with the patient's
self-concept (ego-syntonic), while obsessions are intrusive, unwanted, and
,recognized as irrational (ego-dystonic). This distinction is critical for
differentiating psychotic disorders from OCD.
3. A 34-year-old woman reports 6 months of feeling detached from her body,
"like I'm watching a movie of my life." She denies trauma, panic, or substance use.
Reality testing remains intact. The most likely diagnosis is:
A. Panic Disorder
B. PTSD
C. Depersonalization/Derealization Disorder
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale: Depersonalization/Derealization Disorder involves persistent
episodes with intact reality testing and no required trauma history. The
absence of panic attacks rules out Panic Disorder; the absence of a traumatic
stressor rules out PTSD.
4. A patient describes hearing voices commenting on their behavior for 8 months.
They also report 4 days of elevated mood and decreased need for sleep. The most
likely diagnosis is:
A. Bipolar I Disorder with psychotic features
B. Schizoaffective Disorder
C. Schizophrenia
D. Brief Psychotic Disorder
Correct Answer: B
Rationale: Schizoaffective Disorder requires psychotic symptoms for ≥2
weeks in the absence of mood episodes, plus mood episodes for the majority of
the illness duration. Bipolar I with psychotic features would have psychosis
only during mood episodes.
,5. A 28-year-old male presents with 10 months of social withdrawal, flat affect,
and odd beliefs. He has no mood symptoms. Which assessment tool is most
appropriate for initial symptom quantification?
A. PHQ-9
B. PANSS
C. GAD-7
D. MDQ
Correct Answer: B
Rationale: The Positive and Negative Syndrome Scale (PANSS) is
specifically designed to quantify psychotic symptoms. PHQ-9 measures
depression, GAD-7 measures anxiety, and MDQ screens for bipolar disorder.
6. Which statement best describes the purpose of the mental status examination
in psychiatric practice?
A. It replaces the need for a full psychiatric history
B. It provides a cross-sectional description of the patient's current functioning
C. It is only necessary for inpatient evaluations
D. It establishes the definitive DSM-5 diagnosis
Correct Answer: B
Rationale: The MSE is a structured, cross-sectional assessment of
appearance, behavior, cognition, and thought processes at a specific point in
time. It complements—but does not replace—the psychiatric history.
7. A patient reports that "the government has implanted a chip in my brain to
monitor my thoughts." This is best characterized as:
A. Somatic delusion
B. Persecutory delusion
C. Thought broadcasting
D. Grandiose delusion
, Correct Answer: B
Rationale: A persecutory delusion involves the belief that one is being
targeted, harmed, or monitored by others. Somatic delusions focus on bodily
functions; thought broadcasting involves the belief that one's thoughts are
audible to others.
8. Which of the following is the most appropriate initial screening tool for alcohol
use disorder in a busy PMHNP practice?
A. MMSE
B. AUDIT-C
C. PANSS
D. YMRS
Correct Answer: B
Rationale: The AUDIT-C is a validated, brief (3-item) screening tool for
hazardous drinking and alcohol use disorders. The MMSE assesses cognition;
PANSS and YMRS assess psychosis and mania, respectively.
9. A 45-year-old patient with treatment-resistant depression develops new
auditory hallucinations. Current medication: venlafaxine 225 mg daily. The most
appropriate next step is:
A. Increase venlafaxine to 300 mg
B. Initiate a comprehensive metabolic and neurological workup
C. Add risperidone 0.5 mg for psychotic augmentation
D. Switch to an MAOI immediately
Correct Answer: B
Rationale: New-onset hallucinations in a middle-aged adult warrant
investigation for organic causes (tumor, metabolic disturbance, substance use)
before attributing them to a primary psychiatric disorder. Increasing the
