Barkley DRT PMHNP Exam 2026/2027 | Diagnostic Readiness Test Practice Questions & Correct Answers

Barkley DRT PMHNP Exam 2026/2027 |
Diagnostic Readiness Test Practice
Questions & Correct Answers
BARKLEY DRT PMHNP EXAM 2026/2027

Diagnostic Readiness Test Practice Questions & Correct Answers



DOCUMENT OVERVIEW

• 200 comprehensive practice questions designed to mirror the actual PMHNP
certification exam format with complete diagnostic criteria, differential diagnosis
scenarios, and clinical decision-making case studies

• Study methodology: Work through questions systematically by topic, review
detailed rationales to understand clinical reasoning, identify weak areas, and repeat
challenging sections—focus on understanding concepts rather than memorization
for long-term retention




SECTION 1: MAJOR DEPRESSIVE DISORDER & MOOD DISORDERS

QUESTION 1

A 34-year-old woman presents to the clinic reporting persistent sadness, loss
of interest in activities, significant weight gain, hypersomnia, and feelings of
worthlessness for the past 8 months. She reports no prior psychiatric history.
Which of the following symptoms would disqualify a Major Depressive
Disorder diagnosis?

A) Recent death of a close family member (bereavement)

B) Psychomotor retardation

C) Concentration difficulties

D) Anhedonia

E) Social withdrawal

,✓ CORRECT ANSWER: A) Recent death of a close family member (bereavement)

RATIONALE: According to DSM-5 criteria, a Major Depressive Episode should not
be diagnosed if the depressive symptoms occur in the immediate aftermath of
bereavement (grief-related depression), with a few exceptions for complicated grief.
However, if bereavement persists beyond 2 months or includes specific depressive
features like psychomotor retardation, feelings of worthlessness, or suicidal
ideation, MDD diagnosis may still apply. Bereavement is the primary exclusionary
feature in the initial phase. Options B, C, D, and E are all core diagnostic criteria for
MDD and would support the diagnosis.



QUESTION 2

A 51-year-old male patient has experienced persistent depressed mood,
anhedonia, and vegetative symptoms (sleep disturbance, appetite loss, low
energy) for 3 weeks. He also reports intermittent weeks with elevated mood,
increased goal-directed activity, and decreased need for sleep lasting 4-5
days. What is the most likely diagnosis?

A) Major Depressive Disorder, Single Episode

B) Persistent Depressive Disorder (Dysthymia)

C) Bipolar II Disorder

D) Bipolar I Disorder

E) Cyclothymia

✓ CORRECT ANSWER: C) Bipolar II Disorder

RATIONALE: Bipolar II Disorder is characterized by the presence of at least one
Major Depressive Episode and at least one Hypomanic Episode. A Hypomanic
Episode requires a minimum of 4 consecutive days of elevated or expansive mood
with at least 3 symptoms of mania (decreased need for sleep, increased goal-
directed activity). This patient's presentation of depression with hypomanic
episodes lasting 4-5 days fits Bipolar II criteria. Bipolar I Disorder requires at least
one Manic Episode (lasting ≥7 days) with more severe symptoms and functional

,impairment. Dysthymia and Cyclothymia involve more chronic, milder
presentations.



QUESTION 3

A 28-year-old woman meets full criteria for Major Depressive Disorder with a
current episode lasting 4 months. What additional information would be most
helpful to determine if antidepressant monotherapy or augmentation
strategy would be appropriate?

A) Her body mass index and genetic predisposition to obesity

B) Previous treatment response history and presence of psychotic features

C) Her relationship status and employment history

D) Her dietary preferences and exercise habits

E) Her family's vacation plans and social calendar

✓ CORRECT ANSWER: B) Previous treatment response history and presence of
psychotic features

RATIONALE: When treating Major Depressive Disorder, critical clinical factors
include: 1) Previous response to medications (if depression is treatment-resistant,
monotherapy may be insufficient), and 2) Presence of psychotic features (would
require different medication approach—antipsychotic augmentation or
antipsychotic monotherapy). These factors directly guide pharmacological strategy.
The other options, while relevant to holistic patient care, do not directly inform the
choice between monotherapy versus augmentation.



QUESTION 4

A 45-year-old patient with Persistent Depressive Disorder (Dysthymia) has
had symptoms for 7 years. He now meets full criteria for Major Depressive
Episode superimposed on the dysthymia. What is this condition called?

A) Double Depression

, B) Complicated Depression

C) Recurrent Depression with Dysthymic Features

D) Chronic Major Depressive Disorder

E) Treatment-Resistant Depression

✓ CORRECT ANSWER: A) Double Depression

RATIONALE: Double Depression is the clinical term describing a Major Depressive
Episode occurring in a patient with pre-existing Persistent Depressive Disorder
(Dysthymia). The chronic, low-grade depression (dysthymia) is the baseline, and
episodic major depressive episodes are superimposed on top. This condition
typically requires more aggressive treatment and has a higher risk of relapse. The
terminology "double" refers to having two layers of depressive illness
simultaneously.



QUESTION 5

A 32-year-old male presents with a 2-week history of depressed mood,
anhedonia, insomnia, fatigue, feelings of worthlessness, concentration
problems, and passive suicidal ideation. He reports a significant stressor 1
week prior. What specifier would be most appropriate for this presentation?

A) With anxious distress

B) With peripartum onset

C) With seasonal pattern

D) With mixed features

E) With prominent guilt

✓ CORRECT ANSWER: A) With anxious distress

RATIONALE: The question doesn't explicitly state anxiety symptoms, but given only
2 weeks of symptoms following a clear stressor, this may not yet meet full MDD
criteria (typically 2 weeks minimum) unless multiple symptoms coexist. However,
the prompt includes standard MDD symptoms. The specifiers are applied to Major