BARKLEY DRT PMHNP PRACTICUM 1
2026/2027 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS.
1. A 28-year-old patient presents with a 6-month history of depressed mood,
anhedonia, and fatigue. They report difficulty sleeping and a 10-pound weight
loss. Which of the following is the most critical initial step in the PMHNP's
assessment?
A. Initiate a trial of an SSRI.
B. Order a comprehensive metabolic panel and thyroid function tests.
C. Assess for suicidal or homicidal ideation.
D. Refer the patient for cognitive-behavioral therapy (CBT).
C. Assess for suicidal or homicidal ideation.
Rationale: The safety of the patient is always the paramount concern. Before
any diagnostic or treatment planning can proceed, the PMHNP must assess for
risk of harm to self or others, as this determines the immediate level of care
required (e.g., inpatient hospitalization vs. outpatient follow-up).
2. A patient diagnosed with schizophrenia is experiencing acute agitation and
hallucinations. Which of the following medications would be the most
appropriate for rapid tranquilization in an emergency setting?
A. Clozapine (Clozaril)
B. Haloperidol (Haldol)
C. Lithium (Eskalith)
D. Fluoxetine (Prozac)
B. Haloperidol (Haldol).
Rationale: Haloperidol is a high-potency first-generation antipsychotic
available in an injectable form (IM), making it ideal for rapid management of acute
agitation and psychosis. Clozapine requires regular blood monitoring due to
,agranulocytosis risk, lithium is a mood stabilizer with a narrow therapeutic index,
and fluoxetine is an antidepressant, none of which are first-line for acute agitation.
3. A 35-year-old female patient is started on Sertraline (Zoloft) for major
depressive disorder. She returns after 2 weeks reporting no improvement in
mood but complains of nausea and headache. What is the most appropriate
action for the PMHNP?
A. Discontinue sertraline and switch to a different class of antidepressant.
B. Increase the dose of sertraline to accelerate the therapeutic effect.
C. Educate the patient that side effects often precede therapeutic benefits and
encourage her to continue the medication.
D. Add a benzodiazepine to manage the side effects.
C. Educate the patient that side effects often precede therapeutic benefits
and encourage her to continue the medication.
Rationale: SSRIs like sertraline typically take 4-6 weeks to achieve full
therapeutic effect, while side effects like nausea and headache often appear
within the first 1-2 weeks and may subside. It is crucial to educate the patient to
manage expectations and prevent premature discontinuation. Increasing the dose
is premature and may worsen side effects.
4. Which of the following is a core symptom of Generalized Anxiety Disorder
(GAD)?
A. Panic attacks.
B. Excessive, uncontrollable worry about multiple events or activities.
C. Fear of social situations.
D. Recurrent, intrusive thoughts.
B. Excessive, uncontrollable worry about multiple events or activities.
Rationale: The hallmark of GAD is chronic, pervasive, and difficult-to-control
worry about a variety of topics (e.g., work, health, finances). Panic attacks are
characteristic of Panic Disorder, fear of social situations is seen in Social Anxiety
Disorder, and intrusive thoughts are a hallmark of Obsessive-Compulsive Disorder.
,5. A PMHNP is conducting a mental status exam (MSE). The patient states, "The
CIA has planted a chip in my brain to read my thoughts." This is an example of
which type of delusion?
A. Delusion of grandeur.
B. Somatic delusion.
C. Delusion of persecution.
D. Delusion of reference.
C. Delusion of persecution.
Rationale: A delusion of persecution is a false belief that one is being
harassed, harmed, or conspired against. The belief about the CIA planting a chip is
a classic example. A delusion of grandeur involves an exaggerated sense of
importance, a somatic delusion involves a false belief about one's body, and a
delusion of reference is a belief that external events are referring to oneself.
6. Which of the following medications is a first-line treatment for Bipolar I
Disorder, manic episode?
A. Fluoxetine (Prozac).
B. Lithium (Eskalith).
C. Sertraline (Zoloft).
D. Buspirone (Buspar).
B. Lithium (Eskalith).
Rationale: Lithium is a classic and highly effective mood stabilizer and remains
a first-line treatment for acute mania and maintenance in Bipolar I Disorder.
Antidepressants like fluoxetine and sertraline can trigger a manic switch.
Buspirone is an anxiolytic and is not effective for mania.
7. A patient on Clozapine (Clozaril) reports a sore throat and fever. What is the
PMHNP's priority action?
A. Reassure the patient that this is a common side effect.
B. Immediately order a complete blood count (CBC) with absolute neutrophil
count (ANC).
, C. Tell the patient to take acetaminophen and rest.
D. Decrease the dose of clozapine.
B. Immediately order a complete blood count (CBC) with absolute neutrophil
count (ANC).
Rationale: Sore throat and fever are classic signs of infection and could
indicate severe neutropenia or agranulocytosis, a life-threatening side effect of
clozapine. The priority is to immediately check the patient's white blood cell
count, specifically the ANC, and hold the clozapine until results are known.
8. Which of the following is a key feature that distinguishes Major Depressive
Disorder (MDD) from Persistent Depressive Disorder (PDD)?
A. The severity of symptoms.
B. The presence of anhedonia.
C. The duration of symptoms.
D. The response to medication.
C. The duration of symptoms.
Rationale: The primary distinguishing factor is duration. MDD is characterized
by discrete episodes of at least 2 weeks, whereas PDD (dysthymia) is a chronic,
low-grade depression lasting for at least 2 years in adults. While severity can differ,
the chronicity is the defining feature for PDD.
9. A PMHNP is assessing a child for ADHD. Which of the following is a common
assessment tool used specifically for this purpose?
A. PHQ-9.
B. GAD-7.
C. Vanderbilt Assessment Scales.
D. MMSE.
C. Vanderbilt Assessment Scales.
Rationale: The Vanderbilt Assessment Scales are widely used and validated
tools for assessing ADHD symptoms and comorbidities in children and
adolescents, with both parent and teacher versions. The PHQ-9 and GAD-7 are for
2026/2027 ACTUAL QUESTIONS WITH
VERIFIED ANSWERS.
1. A 28-year-old patient presents with a 6-month history of depressed mood,
anhedonia, and fatigue. They report difficulty sleeping and a 10-pound weight
loss. Which of the following is the most critical initial step in the PMHNP's
assessment?
A. Initiate a trial of an SSRI.
B. Order a comprehensive metabolic panel and thyroid function tests.
C. Assess for suicidal or homicidal ideation.
D. Refer the patient for cognitive-behavioral therapy (CBT).
C. Assess for suicidal or homicidal ideation.
Rationale: The safety of the patient is always the paramount concern. Before
any diagnostic or treatment planning can proceed, the PMHNP must assess for
risk of harm to self or others, as this determines the immediate level of care
required (e.g., inpatient hospitalization vs. outpatient follow-up).
2. A patient diagnosed with schizophrenia is experiencing acute agitation and
hallucinations. Which of the following medications would be the most
appropriate for rapid tranquilization in an emergency setting?
A. Clozapine (Clozaril)
B. Haloperidol (Haldol)
C. Lithium (Eskalith)
D. Fluoxetine (Prozac)
B. Haloperidol (Haldol).
Rationale: Haloperidol is a high-potency first-generation antipsychotic
available in an injectable form (IM), making it ideal for rapid management of acute
agitation and psychosis. Clozapine requires regular blood monitoring due to
,agranulocytosis risk, lithium is a mood stabilizer with a narrow therapeutic index,
and fluoxetine is an antidepressant, none of which are first-line for acute agitation.
3. A 35-year-old female patient is started on Sertraline (Zoloft) for major
depressive disorder. She returns after 2 weeks reporting no improvement in
mood but complains of nausea and headache. What is the most appropriate
action for the PMHNP?
A. Discontinue sertraline and switch to a different class of antidepressant.
B. Increase the dose of sertraline to accelerate the therapeutic effect.
C. Educate the patient that side effects often precede therapeutic benefits and
encourage her to continue the medication.
D. Add a benzodiazepine to manage the side effects.
C. Educate the patient that side effects often precede therapeutic benefits
and encourage her to continue the medication.
Rationale: SSRIs like sertraline typically take 4-6 weeks to achieve full
therapeutic effect, while side effects like nausea and headache often appear
within the first 1-2 weeks and may subside. It is crucial to educate the patient to
manage expectations and prevent premature discontinuation. Increasing the dose
is premature and may worsen side effects.
4. Which of the following is a core symptom of Generalized Anxiety Disorder
(GAD)?
A. Panic attacks.
B. Excessive, uncontrollable worry about multiple events or activities.
C. Fear of social situations.
D. Recurrent, intrusive thoughts.
B. Excessive, uncontrollable worry about multiple events or activities.
Rationale: The hallmark of GAD is chronic, pervasive, and difficult-to-control
worry about a variety of topics (e.g., work, health, finances). Panic attacks are
characteristic of Panic Disorder, fear of social situations is seen in Social Anxiety
Disorder, and intrusive thoughts are a hallmark of Obsessive-Compulsive Disorder.
,5. A PMHNP is conducting a mental status exam (MSE). The patient states, "The
CIA has planted a chip in my brain to read my thoughts." This is an example of
which type of delusion?
A. Delusion of grandeur.
B. Somatic delusion.
C. Delusion of persecution.
D. Delusion of reference.
C. Delusion of persecution.
Rationale: A delusion of persecution is a false belief that one is being
harassed, harmed, or conspired against. The belief about the CIA planting a chip is
a classic example. A delusion of grandeur involves an exaggerated sense of
importance, a somatic delusion involves a false belief about one's body, and a
delusion of reference is a belief that external events are referring to oneself.
6. Which of the following medications is a first-line treatment for Bipolar I
Disorder, manic episode?
A. Fluoxetine (Prozac).
B. Lithium (Eskalith).
C. Sertraline (Zoloft).
D. Buspirone (Buspar).
B. Lithium (Eskalith).
Rationale: Lithium is a classic and highly effective mood stabilizer and remains
a first-line treatment for acute mania and maintenance in Bipolar I Disorder.
Antidepressants like fluoxetine and sertraline can trigger a manic switch.
Buspirone is an anxiolytic and is not effective for mania.
7. A patient on Clozapine (Clozaril) reports a sore throat and fever. What is the
PMHNP's priority action?
A. Reassure the patient that this is a common side effect.
B. Immediately order a complete blood count (CBC) with absolute neutrophil
count (ANC).
, C. Tell the patient to take acetaminophen and rest.
D. Decrease the dose of clozapine.
B. Immediately order a complete blood count (CBC) with absolute neutrophil
count (ANC).
Rationale: Sore throat and fever are classic signs of infection and could
indicate severe neutropenia or agranulocytosis, a life-threatening side effect of
clozapine. The priority is to immediately check the patient's white blood cell
count, specifically the ANC, and hold the clozapine until results are known.
8. Which of the following is a key feature that distinguishes Major Depressive
Disorder (MDD) from Persistent Depressive Disorder (PDD)?
A. The severity of symptoms.
B. The presence of anhedonia.
C. The duration of symptoms.
D. The response to medication.
C. The duration of symptoms.
Rationale: The primary distinguishing factor is duration. MDD is characterized
by discrete episodes of at least 2 weeks, whereas PDD (dysthymia) is a chronic,
low-grade depression lasting for at least 2 years in adults. While severity can differ,
the chronicity is the defining feature for PDD.
9. A PMHNP is assessing a child for ADHD. Which of the following is a common
assessment tool used specifically for this purpose?
A. PHQ-9.
B. GAD-7.
C. Vanderbilt Assessment Scales.
D. MMSE.
C. Vanderbilt Assessment Scales.
Rationale: The Vanderbilt Assessment Scales are widely used and validated
tools for assessing ADHD symptoms and comorbidities in children and
adolescents, with both parent and teacher versions. The PHQ-9 and GAD-7 are for
