BARKLEY PMHNP EXAMINATION
[Question With Answers with Complete
Rationales]2026/2027
1. 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. - Answer>>-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.
2. 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. - Answer>>-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?
Borderline personality disorder
Oppositional defiant disorder
Adjustment disorder with disturbance of conduct
Bipolar disorder
3. 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.
, - Answer>>-Which of these lab findings would be least expected in a patient with
depression?
Decreased nocturnal growth hormone secretion
Decreased thyroid-stimulating hormone response
Increased somatostatin in cerebrospinal fluid
Increased secretion of cortisol
4. 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. - Answer>>-
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?
Jeremy has expressed suicidal thoughts.
Jeremy experiences withdrawal from alcohol and cocaine.
Jeremy is ambivalent about his intent to commit suicide.
Jeremy was unable to commit to a "No Harm" contract.
5. 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). - Answer>>-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
6. 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. - Answer>>-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
7. 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. - Answer>>-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.
8. Auditory hallucinations, loss of memory, and lack of personal hygiene are all markers of
the acute phase of schizophrenia. Other signs and symptoms of this stage include illogical
thinking, inappropriate social behavior, catatonic excitement, and poor concentration.
The premorbid phase is indicated by depression, sleep disturbance, and bedwetting. The
prodromal phase is characterized by suspiciousness, inappropriate expression of feeling,
and feelings of unreality. Lastly, the stable phase is symptomatically similar to the
prodromal phase. - Answer>>-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?
Premorbid phase
Prodromal phase
Stable phase
Acute phase
9. Although many patients have a demographic preference for their primary care provider,
merely asking if the patient believes that you "will help him" would not provide
information regarding his general health beliefs. The statement would more likely
provide an opinion based solely on the patient's perception of the nurse practitioner (NP).
Asking about the patient's attitude regarding disability and illness, preventative health
practices, and taboos and cultural attitudes with regards to modesty and special
procedures would all yield beneficial information to help the NP understand the patient's
, beliefs about health and healthcare. - Answer>>-Leon presents to the clinic with findings
suggestive of bipolar disorder. As Leon is a recent immigrant from Haiti, you begin by
giving him a cultural assessment. Which of the following questions would be least
helpful in gaining information about Leon's health beliefs and practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?"
10. Multisystemic therapy is a rehabilitation model aimed at treating children and adolescents
with serious mental illness; under this model, parents and teachers are taught skills to
manage mental disorders so that the patient does not need to be removed from the
community for hospitalization. Multisystemic therapy is not aimed at adults and does not
directly focus on community reintegration or finding employment. - Answer>>-Which of
these patients would most likely receive rehabilitation under the multisystemic therapy
model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment
11. When initiating a schizophrenia patient on clozapine, the patient should be instructed to
titrate daily dosage by 25-50 mg to a target dosage of 300-450 mg/day, rather than 600-
900 mg/day, and a single dose should never exceed 450 mg. The maximum allowable
daily dose is 900 mg/day, but this dosage should not be targeted until the patient has
reached a targeted daily dose of 300-450 mg/day. The patient should also be instructed to
return for weekly complete blood count to monitor white blood count in order to prevent
agranulocytosis. - Answer>>-Clozapine use requires rigorous dosing and monitoring in
patients. Which of the following is the proper instruction for a patient being initiated on
clozapine therapy for schizophrenia?
Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
Instruct the patient to return weekly for a complete blood count to monitor red blood cell
levels
Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900 mg/day
Dosage should never exceed 450 mg at one time
12. Although a fine hand tremor is a potential side effect of therapeutic use of lithium, a
coarse hand tremor is suggestive of lithium toxicity. Diarrhea and other gastrointestinal
complications may occur with toxicity but are expected with normal doses of lithium.
Other side effects associated with therapeutic use of lithium include polyuria,
dermatologic disturbances, polydipsia, and weight gain. - Answer>>-Which of these side
effects would be of greatest concern for a patient taking lithium?
Skin rash
Coarse hand tremor
Polyuria
Diarrhea
[Question With Answers with Complete
Rationales]2026/2027
1. 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. - Answer>>-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.
2. 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. - Answer>>-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?
Borderline personality disorder
Oppositional defiant disorder
Adjustment disorder with disturbance of conduct
Bipolar disorder
3. 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.
, - Answer>>-Which of these lab findings would be least expected in a patient with
depression?
Decreased nocturnal growth hormone secretion
Decreased thyroid-stimulating hormone response
Increased somatostatin in cerebrospinal fluid
Increased secretion of cortisol
4. 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. - Answer>>-
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?
Jeremy has expressed suicidal thoughts.
Jeremy experiences withdrawal from alcohol and cocaine.
Jeremy is ambivalent about his intent to commit suicide.
Jeremy was unable to commit to a "No Harm" contract.
5. 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). - Answer>>-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
6. 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. - Answer>>-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
7. 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. - Answer>>-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.
8. Auditory hallucinations, loss of memory, and lack of personal hygiene are all markers of
the acute phase of schizophrenia. Other signs and symptoms of this stage include illogical
thinking, inappropriate social behavior, catatonic excitement, and poor concentration.
The premorbid phase is indicated by depression, sleep disturbance, and bedwetting. The
prodromal phase is characterized by suspiciousness, inappropriate expression of feeling,
and feelings of unreality. Lastly, the stable phase is symptomatically similar to the
prodromal phase. - Answer>>-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?
Premorbid phase
Prodromal phase
Stable phase
Acute phase
9. Although many patients have a demographic preference for their primary care provider,
merely asking if the patient believes that you "will help him" would not provide
information regarding his general health beliefs. The statement would more likely
provide an opinion based solely on the patient's perception of the nurse practitioner (NP).
Asking about the patient's attitude regarding disability and illness, preventative health
practices, and taboos and cultural attitudes with regards to modesty and special
procedures would all yield beneficial information to help the NP understand the patient's
, beliefs about health and healthcare. - Answer>>-Leon presents to the clinic with findings
suggestive of bipolar disorder. As Leon is a recent immigrant from Haiti, you begin by
giving him a cultural assessment. Which of the following questions would be least
helpful in gaining information about Leon's health beliefs and practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?"
10. Multisystemic therapy is a rehabilitation model aimed at treating children and adolescents
with serious mental illness; under this model, parents and teachers are taught skills to
manage mental disorders so that the patient does not need to be removed from the
community for hospitalization. Multisystemic therapy is not aimed at adults and does not
directly focus on community reintegration or finding employment. - Answer>>-Which of
these patients would most likely receive rehabilitation under the multisystemic therapy
model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment
11. When initiating a schizophrenia patient on clozapine, the patient should be instructed to
titrate daily dosage by 25-50 mg to a target dosage of 300-450 mg/day, rather than 600-
900 mg/day, and a single dose should never exceed 450 mg. The maximum allowable
daily dose is 900 mg/day, but this dosage should not be targeted until the patient has
reached a targeted daily dose of 300-450 mg/day. The patient should also be instructed to
return for weekly complete blood count to monitor white blood count in order to prevent
agranulocytosis. - Answer>>-Clozapine use requires rigorous dosing and monitoring in
patients. Which of the following is the proper instruction for a patient being initiated on
clozapine therapy for schizophrenia?
Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
Instruct the patient to return weekly for a complete blood count to monitor red blood cell
levels
Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900 mg/day
Dosage should never exceed 450 mg at one time
12. Although a fine hand tremor is a potential side effect of therapeutic use of lithium, a
coarse hand tremor is suggestive of lithium toxicity. Diarrhea and other gastrointestinal
complications may occur with toxicity but are expected with normal doses of lithium.
Other side effects associated with therapeutic use of lithium include polyuria,
dermatologic disturbances, polydipsia, and weight gain. - Answer>>-Which of these side
effects would be of greatest concern for a patient taking lithium?
Skin rash
Coarse hand tremor
Polyuria
Diarrhea
