LATEST BARKLEY DRT PMHNP PRACTICUM 1
EXAM 2025 WITH VERIFIED ANSWERS
Adam, a 23-year-old male, is undergoing an STD test at your
clinic. When you ask him why he is here, he says, "I'm here
because I've had this increased craving for sex. I've been
picking up strangers in bars, not caring about using protection
... I don't know what it is. For the last week, I've just felt really
driven. Keep throwing myself into my work, don't feel much
need for sleep, feel like my thoughts are running a marathon in
my head." The patient lives a "clean life," clarifying that he does
not abuse any substance, "not even coffee or cigarettes." He also
does not have a history of mental disorders. Given the most
likely diagnosis, which of these medications would you least
likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
The patient's recent involvement in risky pleasurable activity (e.g.,
unprotected sex), increase in goal-driven activity at work, decreased
need for sleep, and subjective experience of racing thoughts all suggest
a manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria
for a major depressive episode. Pharmacologic options for the treatment
of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam).
Harriet is a well-established business woman who provides for
her family. She was recently arrested for stealing over $10,000
worth of merchandise from the mall. When Harriet is asked to
describe her behavior, she says: "It just comes on me quickly,
and when it's done, I feel really good." She also describes how
she grew up poor and sees the theft as a way to "even the score"
,against those with "empty wealth." Which of the following does
not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive.
Although the patient may be rationalizing her behavior as a righteous
act, patients with kleptomania do not commit theft to express anger or
vengeance. Kleptomania is characterized as failing to resist the impulse
to steal, and the stolen objects are typically not needed. The act of
stealing, which usually is performed alone, gives the person
gratification.
Tony, a 16-year-old male, has been sent to your clinic for
counseling. He has a long record of skipping school, talking
back to his teachers, and getting poor grades. His parents say
he has often gotten in fights with them, has frequently been
caught sneaking girls into his room, and has run away from
home on two occasions. During the session, you notice Tony
acts tough and aloof, not deigning to speak much. If you suspect
conduct disorder, which of the following conditions would you
be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
Borderline personality disorder is not considered a differential
diagnosis for conduct disorder, as indicated by the patient's truancy,
defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home,
and "tough guy" demeanor. Oppositional defiant disorder, bipolar
disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders,
attention-deficit/hyperactivity disorder, and intermittent explosive
disorder.
,Which of these lab findings would be least expected in a patient
with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
Depressive symptoms are associated with decreased, not increased,
levels of somatostatin in cerebrospinal fluid. Patients with depression
may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol.
Depressive symptoms are also associated with irregularities in growth
hormone release, such as reduced nocturnal secretion and diurnal
hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is
able to be observed at all times by hospital staff during waking
hours and when he sleeps, and is checked on every 15-30
minutes. Which of these reasons would least indicate the need
for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
Although ambivalence regarding suicidal intent should be taken into
account when considering level of observation in a patient, it indicates a
moderate risk, not a severe risk. Close observation should be employed
with patients who profess suicidal thoughts, are unable to commit to a
"No Harm" contract, or experience withdrawal.
You have determined that a patient's delirium stems from
dehydration. As you begin treatment, you realize the patient
will require pharmacologic management for his agitation.
Which of these agents would be least appropriate in this
situation?
Risperidone
, Haloperidol
Quetiapine
Lorazepam
Lorazepam would not be the first choice to treat delirium in a
dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as
haloperidol, quetiapine, and risperidone are considered the mainstay in
managing agitation in delirium patients; haloperidol is considered the
standard of care, but newer agents such as quetiapine and risperidone
may be preferred due to reduced chance of side effects.
Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have
agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit
suicide.
Patients who attempt suicide due to "unsolvable" problems
usually do so after a month in care.
Most inpatients who develop a suicide plan and follow it have agreed to
a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are
most likely to attempt suicide either within the first 5 days at the
hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and
risk would be higher in patients with schizophrenia or an untreated
anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her
boyfriend. He states that she has been hearing voices, cannot
remember anything, and refuses to take a shower or change her
clothes. He adds, "She used to be a very clean person and had a
really good memory." Which phase of schizophrenia is Cam most
likely experiencing?
EXAM 2025 WITH VERIFIED ANSWERS
Adam, a 23-year-old male, is undergoing an STD test at your
clinic. When you ask him why he is here, he says, "I'm here
because I've had this increased craving for sex. I've been
picking up strangers in bars, not caring about using protection
... I don't know what it is. For the last week, I've just felt really
driven. Keep throwing myself into my work, don't feel much
need for sleep, feel like my thoughts are running a marathon in
my head." The patient lives a "clean life," clarifying that he does
not abuse any substance, "not even coffee or cigarettes." He also
does not have a history of mental disorders. Given the most
likely diagnosis, which of these medications would you least
likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
The patient's recent involvement in risky pleasurable activity (e.g.,
unprotected sex), increase in goal-driven activity at work, decreased
need for sleep, and subjective experience of racing thoughts all suggest
a manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria
for a major depressive episode. Pharmacologic options for the treatment
of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam).
Harriet is a well-established business woman who provides for
her family. She was recently arrested for stealing over $10,000
worth of merchandise from the mall. When Harriet is asked to
describe her behavior, she says: "It just comes on me quickly,
and when it's done, I feel really good." She also describes how
she grew up poor and sees the theft as a way to "even the score"
,against those with "empty wealth." Which of the following does
not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive.
Although the patient may be rationalizing her behavior as a righteous
act, patients with kleptomania do not commit theft to express anger or
vengeance. Kleptomania is characterized as failing to resist the impulse
to steal, and the stolen objects are typically not needed. The act of
stealing, which usually is performed alone, gives the person
gratification.
Tony, a 16-year-old male, has been sent to your clinic for
counseling. He has a long record of skipping school, talking
back to his teachers, and getting poor grades. His parents say
he has often gotten in fights with them, has frequently been
caught sneaking girls into his room, and has run away from
home on two occasions. During the session, you notice Tony
acts tough and aloof, not deigning to speak much. If you suspect
conduct disorder, which of the following conditions would you
be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
Borderline personality disorder is not considered a differential
diagnosis for conduct disorder, as indicated by the patient's truancy,
defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home,
and "tough guy" demeanor. Oppositional defiant disorder, bipolar
disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders,
attention-deficit/hyperactivity disorder, and intermittent explosive
disorder.
,Which of these lab findings would be least expected in a patient
with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
Depressive symptoms are associated with decreased, not increased,
levels of somatostatin in cerebrospinal fluid. Patients with depression
may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol.
Depressive symptoms are also associated with irregularities in growth
hormone release, such as reduced nocturnal secretion and diurnal
hypersecretion.
Jeremy, a suicidal inpatient, is under close observation. He is
able to be observed at all times by hospital staff during waking
hours and when he sleeps, and is checked on every 15-30
minutes. Which of these reasons would least indicate the need
for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
Although ambivalence regarding suicidal intent should be taken into
account when considering level of observation in a patient, it indicates a
moderate risk, not a severe risk. Close observation should be employed
with patients who profess suicidal thoughts, are unable to commit to a
"No Harm" contract, or experience withdrawal.
You have determined that a patient's delirium stems from
dehydration. As you begin treatment, you realize the patient
will require pharmacologic management for his agitation.
Which of these agents would be least appropriate in this
situation?
Risperidone
, Haloperidol
Quetiapine
Lorazepam
Lorazepam would not be the first choice to treat delirium in a
dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as
haloperidol, quetiapine, and risperidone are considered the mainstay in
managing agitation in delirium patients; haloperidol is considered the
standard of care, but newer agents such as quetiapine and risperidone
may be preferred due to reduced chance of side effects.
Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have
agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit
suicide.
Patients who attempt suicide due to "unsolvable" problems
usually do so after a month in care.
Most inpatients who develop a suicide plan and follow it have agreed to
a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are
most likely to attempt suicide either within the first 5 days at the
hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and
risk would be higher in patients with schizophrenia or an untreated
anxiety disorder.
Cam, a 23-year-old female, is brought to the hospital by her
boyfriend. He states that she has been hearing voices, cannot
remember anything, and refuses to take a shower or change her
clothes. He adds, "She used to be a very clean person and had a
really good memory." Which phase of schizophrenia is Cam most
likely experiencing?
