BARKLEY PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER (PMHNP) REVIEW
EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
CORE DOMAINS
• Neurobiology and Psychopharmacology
• Diagnostic Criteria and Differential Diagnosis (DSM-5-TR)
• Psychotherapeutic Interventions and Modalities
• Psychiatric Disorders Across the Lifespan
• Substance Use and Addiction Medicine
• Crisis Intervention and Suicide Risk Assessment
• Legal, Ethical, and Professional Standards
• Cultural Competence and Health Equity
• Collaborative Care and Interprofessional Practice
• Advanced Practice Nursing Roles and Scope
INTRODUCTION
This comprehensive review examination is designed to prepare candidates
for the Barkley PMHNP board certification examination, a rigorous
assessment of advanced practice psychiatric-mental health nursing
competence. The test covers the full spectrum of psychiatric practice
,including neurobiology, psychopharmacology, DSM-5-TR diagnostic
criteria, evidence-based psychotherapeutic interventions, and ethical-
legal principles in mental health care. Questions are structured to reflect
the complexity and clinical reasoning required in real-world psychiatric
practice, with emphasis on safety, patient-centered care, and collaborative
decision-making. Successful completion of this practice test indicates
readiness for board certification and entry into advanced psychiatric
nursing practice. This assessment serves as a valuable tool for identifying
knowledge gaps and strengthening clinical judgment.
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old patient with major depressive disorder has failed trials of
two SSRIs and one SNRI. Which medication should the PMHNP consider
next?
A. Mirtazapine
B. Bupropion
C. Vortioxetine
D. Tranylcypromine
D. Tranylcypromine
RATIONALE: Treatment-resistant depression (failure of at least two
antidepressants) may respond to a monoamine oxidase inhibitor (MAOI)
such as tranylcypromine, which is an effective agent for refractory
depression. Mirtazapine, bupropion, and vortioxetine are second-line
options but MAOIs are considered for true treatment resistance. MAOIs
require dietary restrictions to prevent hypertensive crisis.
Question 2
,A 45-year-old patient with bipolar disorder is prescribed lithium. Which
baseline laboratory tests should the PMHNP order before initiating
therapy?
A. Complete blood count and liver function tests
B. Renal function, thyroid function, and serum electrolytes
C. Lipid panel and fasting glucose
D. Cardiac enzymes and brain natriuretic peptide
B. Renal function, thyroid function, and serum electrolytes
RATIONALE: Lithium requires baseline assessment of renal function,
thyroid function, and electrolytes due to its narrow therapeutic range
and potential effects on kidneys and thyroid. Lithium can affect sodium
and fluid balance. CBC and liver function are not primary concerns for
lithium therapy.
Question 3
A 32-year-old patient with schizophrenia presents with involuntary
tongue protrusion and lip smacking after five years of antipsychotic
treatment. This movement disorder is best described as:
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
C. Tardive dyskinesia
RATIONALE: Tardive dyskinesia is a late-onset movement disorder
characterized by involuntary, repetitive movements of the face, tongue,
and limbs, developing after prolonged exposure to dopamine-blocking
medications. Acute dystonia occurs early in treatment. Akathisia is inner
restlessness with inability to sit still. Parkinsonism includes rigidity and
tremor.
, Question 4
A 16-year-old adolescent is prescribed fluoxetine for major depressive
disorder. The PMHNP should educate the patient and family about which
critical monitoring parameter?
A. Weight gain and metabolic changes
B. Increased risk of suicidal ideation and behavior
C. Liver function abnormalities
D. Hypertensive crisis with dietary tyramine
B. Increased risk of suicidal ideation and behavior
RATIONALE: The FDA Black Box Warning indicates that
antidepressants, including SSRIs, increase the risk of suicidal thinking
and behavior in children, adolescents, and young adults up to age 24.
Close monitoring during the first several weeks of treatment is essential.
Other side effects may occur but are not the primary safety concern in
this population.
Question 5
A 55-year-old patient with generalized anxiety disorder reports
excessive, uncontrollable worry about multiple topics for more than six
months. The patient also reports muscle tension, difficulty sleeping, and
restlessness. Which medication is first-line for this condition?
A. Alprazolam
B. Escitalopram
C. Hydroxyzine
D. Buspirone
B. Escitalopram
RATIONALE: SSRIs, such as escitalopram and sertraline, are first-line
pharmacological treatments for generalized anxiety disorder.
NURSE PRACTITIONER (PMHNP) REVIEW
EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
CORE DOMAINS
• Neurobiology and Psychopharmacology
• Diagnostic Criteria and Differential Diagnosis (DSM-5-TR)
• Psychotherapeutic Interventions and Modalities
• Psychiatric Disorders Across the Lifespan
• Substance Use and Addiction Medicine
• Crisis Intervention and Suicide Risk Assessment
• Legal, Ethical, and Professional Standards
• Cultural Competence and Health Equity
• Collaborative Care and Interprofessional Practice
• Advanced Practice Nursing Roles and Scope
INTRODUCTION
This comprehensive review examination is designed to prepare candidates
for the Barkley PMHNP board certification examination, a rigorous
assessment of advanced practice psychiatric-mental health nursing
competence. The test covers the full spectrum of psychiatric practice
,including neurobiology, psychopharmacology, DSM-5-TR diagnostic
criteria, evidence-based psychotherapeutic interventions, and ethical-
legal principles in mental health care. Questions are structured to reflect
the complexity and clinical reasoning required in real-world psychiatric
practice, with emphasis on safety, patient-centered care, and collaborative
decision-making. Successful completion of this practice test indicates
readiness for board certification and entry into advanced psychiatric
nursing practice. This assessment serves as a valuable tool for identifying
knowledge gaps and strengthening clinical judgment.
SECTION ONE: QUESTIONS 1–100
Question 1
A 28-year-old patient with major depressive disorder has failed trials of
two SSRIs and one SNRI. Which medication should the PMHNP consider
next?
A. Mirtazapine
B. Bupropion
C. Vortioxetine
D. Tranylcypromine
D. Tranylcypromine
RATIONALE: Treatment-resistant depression (failure of at least two
antidepressants) may respond to a monoamine oxidase inhibitor (MAOI)
such as tranylcypromine, which is an effective agent for refractory
depression. Mirtazapine, bupropion, and vortioxetine are second-line
options but MAOIs are considered for true treatment resistance. MAOIs
require dietary restrictions to prevent hypertensive crisis.
Question 2
,A 45-year-old patient with bipolar disorder is prescribed lithium. Which
baseline laboratory tests should the PMHNP order before initiating
therapy?
A. Complete blood count and liver function tests
B. Renal function, thyroid function, and serum electrolytes
C. Lipid panel and fasting glucose
D. Cardiac enzymes and brain natriuretic peptide
B. Renal function, thyroid function, and serum electrolytes
RATIONALE: Lithium requires baseline assessment of renal function,
thyroid function, and electrolytes due to its narrow therapeutic range
and potential effects on kidneys and thyroid. Lithium can affect sodium
and fluid balance. CBC and liver function are not primary concerns for
lithium therapy.
Question 3
A 32-year-old patient with schizophrenia presents with involuntary
tongue protrusion and lip smacking after five years of antipsychotic
treatment. This movement disorder is best described as:
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
C. Tardive dyskinesia
RATIONALE: Tardive dyskinesia is a late-onset movement disorder
characterized by involuntary, repetitive movements of the face, tongue,
and limbs, developing after prolonged exposure to dopamine-blocking
medications. Acute dystonia occurs early in treatment. Akathisia is inner
restlessness with inability to sit still. Parkinsonism includes rigidity and
tremor.
, Question 4
A 16-year-old adolescent is prescribed fluoxetine for major depressive
disorder. The PMHNP should educate the patient and family about which
critical monitoring parameter?
A. Weight gain and metabolic changes
B. Increased risk of suicidal ideation and behavior
C. Liver function abnormalities
D. Hypertensive crisis with dietary tyramine
B. Increased risk of suicidal ideation and behavior
RATIONALE: The FDA Black Box Warning indicates that
antidepressants, including SSRIs, increase the risk of suicidal thinking
and behavior in children, adolescents, and young adults up to age 24.
Close monitoring during the first several weeks of treatment is essential.
Other side effects may occur but are not the primary safety concern in
this population.
Question 5
A 55-year-old patient with generalized anxiety disorder reports
excessive, uncontrollable worry about multiple topics for more than six
months. The patient also reports muscle tension, difficulty sleeping, and
restlessness. Which medication is first-line for this condition?
A. Alprazolam
B. Escitalopram
C. Hydroxyzine
D. Buspirone
B. Escitalopram
RATIONALE: SSRIs, such as escitalopram and sertraline, are first-line
pharmacological treatments for generalized anxiety disorder.
