Barkley PMHNP Ultimate Exam Review 2026 – 200 High‑Yield
Questions & Answers
1. A 32‑year‑old female presents with depressed mood, anhedonia, weight gain, hypersomnia, and
heavy sensation in her arms and legs. Symptoms worsen in winter and improve in spring. Which
medication is FDA‑approved as first‑line for this condition?
- A) Fluoxetine
- B) Bupropion
- C) Agomelatine
- D) Bupropion extended‑release
Answer: D) Bupropion extended‑release
Explanation: The symptoms describe seasonal affective disorder (SAD). Bupropion XL is FDA‑approved
for prevention of SAD. Light therapy is also first‑line, but among medications, bupropion has indication.
2. A 45‑year‑old male with bipolar I disorder is stabilized on lithium but develops a fine tremor, polyuria,
and a serum lithium level of 1.2 mEq/L. What is the most appropriate next step?
- A) Increase lithium dose
- B) Add propranolol for tremor
- C) Switch to valproate
- D) Check thyroid and renal function
Answer: D) Check thyroid and renal function
Explanation: Polyuria suggests nephrogenic diabetes insipidus; long‑term lithium can cause renal and
thyroid dysfunction. Before changing therapy, evaluate renal (BUN, creatinine, urine specific gravity) and
thyroid (TSH).
,3. Which of the following is a core symptom of autism spectrum disorder (ASD) according to DSM‑5‑TR?
- A) Hyperactive behavior
- B) Intellectual disability
- C) Deficits in social‑emotional reciprocity
- D) Onset after age 5 years
Answer: C) Deficits in social‑emotional reciprocity
Explanation: ASD diagnostic criteria include persistent deficits in social communication and interaction
across multiple contexts, including social‑emotional reciprocity. Onset is in early developmental period.
4. A patient with panic disorder is started on sertraline. After 3 days, he reports increased anxiety,
jitteriness, and insomnia. What is the best next step?
- A) Discontinue sertraline immediately
- B) Add clonazepam temporarily and continue sertraline
- C) Switch to fluoxetine
- D) Increase sertraline dose
Answer: B) Add clonazepam temporarily and continue sertraline
Explanation: Initial worsening of anxiety (jitteriness syndrome) is common with SSRIs. Adding a
short‑course benzodiazepine can bridge until therapeutic effect (4‑6 weeks). Do not stop SSRI abruptly.
5. Which medication is most likely to cause QT prolongation?
- A) Sertraline
- B) Citalopram
- C) Fluoxetine
,- D) Paroxetine
Answer: B) Citalopram
Explanation: Citalopram causes dose‑dependent QT prolongation. Maximum recommended dose is 40
mg/day (20 mg/day for >60 years). Escitalopram has lower risk.
6. A 28‑year‑old female with bulimia nervosa has a BMI of 19, purges by self‑induced vomiting 3 times
daily. Which medication is FDA‑approved for bulimia?
- A) Topiramate
- B) Fluoxetine
- C) Lisdexamfetamine
- D) Olanzapine
Answer: B) Fluoxetine
Explanation: Fluoxetine (60 mg/day) is FDA‑approved for bulimia nervosa. It reduces binge‑purge cycles.
Topiramate is off‑label; lisdexamfetamine is for binge eating disorder; olanzapine not approved.
7. Which of the following is a first‑line treatment for generalized anxiety disorder (GAD)?
- A) Buspirone
- B) Clonazepam
- C) Duloxetine
- D) Hydroxyzine
Answer: C) Duloxetine
Explanation: First‑line pharmacotherapy for GAD includes SSRIs (escitalopram, paroxetine) and SNRIs
(duloxetine, venlafaxine). Buspirone is second‑line; benzodiazepines are not first‑line.
, 8. A patient with schizophrenia has been on clozapine for 6 months. Routine monitoring should include:
- A) CBC with differential every week for first 6 months, then every 2 weeks
- B) Liver function tests monthly
- C) EKG every 3 months
- D) Serum creatinine weekly
Answer: A) CBC with differential every week for first 6 months, then every 2 weeks
Explanation: Clozapine REMS requires absolute neutrophil count (ANC) monitoring: weekly for first 6
months, then every 2 weeks up to one year, then monthly. Risk of agranulocytosis.
9. Which personality disorder is characterized by a pervasive pattern of instability in interpersonal
relationships, self‑image, affect, and marked impulsivity?
- A) Histrionic personality disorder
- B) Borderline personality disorder
- C) Narcissistic personality disorder
- D) Antisocial personality disorder
Answer: B) Borderline personality disorder
Explanation: DSM‑5‑TR criteria for borderline PD include frantic efforts to avoid abandonment, identity
disturbance, impulsivity, recurrent suicidal behavior, affective instability, and chronic emptiness.
Questions & Answers
1. A 32‑year‑old female presents with depressed mood, anhedonia, weight gain, hypersomnia, and
heavy sensation in her arms and legs. Symptoms worsen in winter and improve in spring. Which
medication is FDA‑approved as first‑line for this condition?
- A) Fluoxetine
- B) Bupropion
- C) Agomelatine
- D) Bupropion extended‑release
Answer: D) Bupropion extended‑release
Explanation: The symptoms describe seasonal affective disorder (SAD). Bupropion XL is FDA‑approved
for prevention of SAD. Light therapy is also first‑line, but among medications, bupropion has indication.
2. A 45‑year‑old male with bipolar I disorder is stabilized on lithium but develops a fine tremor, polyuria,
and a serum lithium level of 1.2 mEq/L. What is the most appropriate next step?
- A) Increase lithium dose
- B) Add propranolol for tremor
- C) Switch to valproate
- D) Check thyroid and renal function
Answer: D) Check thyroid and renal function
Explanation: Polyuria suggests nephrogenic diabetes insipidus; long‑term lithium can cause renal and
thyroid dysfunction. Before changing therapy, evaluate renal (BUN, creatinine, urine specific gravity) and
thyroid (TSH).
,3. Which of the following is a core symptom of autism spectrum disorder (ASD) according to DSM‑5‑TR?
- A) Hyperactive behavior
- B) Intellectual disability
- C) Deficits in social‑emotional reciprocity
- D) Onset after age 5 years
Answer: C) Deficits in social‑emotional reciprocity
Explanation: ASD diagnostic criteria include persistent deficits in social communication and interaction
across multiple contexts, including social‑emotional reciprocity. Onset is in early developmental period.
4. A patient with panic disorder is started on sertraline. After 3 days, he reports increased anxiety,
jitteriness, and insomnia. What is the best next step?
- A) Discontinue sertraline immediately
- B) Add clonazepam temporarily and continue sertraline
- C) Switch to fluoxetine
- D) Increase sertraline dose
Answer: B) Add clonazepam temporarily and continue sertraline
Explanation: Initial worsening of anxiety (jitteriness syndrome) is common with SSRIs. Adding a
short‑course benzodiazepine can bridge until therapeutic effect (4‑6 weeks). Do not stop SSRI abruptly.
5. Which medication is most likely to cause QT prolongation?
- A) Sertraline
- B) Citalopram
- C) Fluoxetine
,- D) Paroxetine
Answer: B) Citalopram
Explanation: Citalopram causes dose‑dependent QT prolongation. Maximum recommended dose is 40
mg/day (20 mg/day for >60 years). Escitalopram has lower risk.
6. A 28‑year‑old female with bulimia nervosa has a BMI of 19, purges by self‑induced vomiting 3 times
daily. Which medication is FDA‑approved for bulimia?
- A) Topiramate
- B) Fluoxetine
- C) Lisdexamfetamine
- D) Olanzapine
Answer: B) Fluoxetine
Explanation: Fluoxetine (60 mg/day) is FDA‑approved for bulimia nervosa. It reduces binge‑purge cycles.
Topiramate is off‑label; lisdexamfetamine is for binge eating disorder; olanzapine not approved.
7. Which of the following is a first‑line treatment for generalized anxiety disorder (GAD)?
- A) Buspirone
- B) Clonazepam
- C) Duloxetine
- D) Hydroxyzine
Answer: C) Duloxetine
Explanation: First‑line pharmacotherapy for GAD includes SSRIs (escitalopram, paroxetine) and SNRIs
(duloxetine, venlafaxine). Buspirone is second‑line; benzodiazepines are not first‑line.
, 8. A patient with schizophrenia has been on clozapine for 6 months. Routine monitoring should include:
- A) CBC with differential every week for first 6 months, then every 2 weeks
- B) Liver function tests monthly
- C) EKG every 3 months
- D) Serum creatinine weekly
Answer: A) CBC with differential every week for first 6 months, then every 2 weeks
Explanation: Clozapine REMS requires absolute neutrophil count (ANC) monitoring: weekly for first 6
months, then every 2 weeks up to one year, then monthly. Risk of agranulocytosis.
9. Which personality disorder is characterized by a pervasive pattern of instability in interpersonal
relationships, self‑image, affect, and marked impulsivity?
- A) Histrionic personality disorder
- B) Borderline personality disorder
- C) Narcissistic personality disorder
- D) Antisocial personality disorder
Answer: B) Borderline personality disorder
Explanation: DSM‑5‑TR criteria for borderline PD include frantic efforts to avoid abandonment, identity
disturbance, impulsivity, recurrent suicidal behavior, affective instability, and chronic emptiness.
