BARKLEY DRT PMHNP EXAM DIAGNOSTIC READINESS
TEST PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER STUDY GUIDE
Question 1
A 45-year-old patient presents with anhedonia, fatigue, and sleep
disturbances for the last two months. As a PMHNP, which initial diagnostic
step is most appropriate?
A) Order a brain MRI
B) Conduct a comprehensive psychiatric interview
C) Begin antidepressant therapy immediately
D) Recommend mindfulness training
Answer: B) Conduct a comprehensive psychiatric interview
Explanation: A comprehensive psychiatric interview allows for
thorough assessment of history, symptoms, and differential
diagnoses before initiating treatment. Imaging is reserved for
suspected neurological causes, and interventions should follow a
confirmed assessment.
Question 2
A 24-year-old graduate student presents with a 10-month history of
persistent low mood, anhedonia, profound fatigue, sleeping 12 hours daily,
15-pound weight gain, and "leadon paralysis." He denies mood reactivity.
,What is the most likely specifier for his Major Depressive Disorder?
A) With atypical features
B) With melancholic features
C) With catatonic features
D) With seasonal pattern
Answer: B) With melancholic features
Explanation: Melancholic features require distinct quality of
depressed mood, lack of mood reactivity, and at least three of:
morning worsening, early morning awakening, psychomotor
retardation, significant anorexia/weight loss, excessive guilt, or
worse mood in the morning. While hypersomnia and weight gain are
associated with atypical features, the lack of mood reactivity points
to melancholia.
Question 3
A patient reports episodes of feeling "outside of herself," watching her
life from a distance, for 6 months. These episodes cause significant
distress. She denies trauma history, panic attacks, or substance use.
What is the most likely diagnosis?
A) Panic disorder
B) Agoraphobia
C) Depersonalization/derealization disorder
D) Social anxiety disorder
Answer: C) Depersonalization/derealization disorder
Explanation: Depersonalization/derealization disorder is
,characterized by persistent or recurrent episodes of feeling
detached from oneself (depersonalization) or one's surroundings
(derealization) while reality testing remains intact. Panic disorder
involves recurrent unexpected attacks with anxiety about future
attacks; avoidance of public places suggests agoraphobia.
Question 4
A 28-year-old female with a history of PTSD presents with flashbacks,
hypervigilance, and nightmares. She reports using alcohol to help her
sleep. What is the most appropriate first-line pharmacologic intervention
for her nightmares?
A) Quetiapine 25 mg at bedtime
B) Prazosin 1 mg at bedtime
C) Trazodone 50 mg at bedtime
D) Hydroxyzine 25 mg at bedtime
Answer: B) Prazosin 1 mg at bedtime
Explanation: Prazosin is an alpha-1 antagonist with robust evidence
for reducing trauma-related nightmares in PTSD. While trazodone
and quetiapine are used for sleep, prazosin is the guideline-
supported first-line agent specifically for PTSD-associated
nightmares.
Question 5
During a suicide intervention with your 28-year-old male patient, to which
agreement should you ask for his consent, verbally or in writing?
A) No-harm contract
, B) Safety plan
C) Medication contract
D) Confidentiality agreement
Answer: B) Safety plan
Explanation: A safety plan is a collaboratively developed,
personalized list of coping strategies and resources to use during a
suicidal crisis. It is the standard of care, whereas "no-harm
contracts" are no longer recommended due to lack of evidence for
effectiveness.
Question 6
A 32-year-old woman is diagnosed with Generalized Anxiety Disorder
(GAD). She has a history of alcohol use disorder and is currently 6
months sober. Which medication is the most appropriate first-line
treatment?
A) Alprazolam
B) Diazepam
C) Buspirone
D) Lorazepam
Answer: C) Buspirone
Explanation: Buspirone is a non-benzodiazepine anxiolytic that is
effective for GAD and has no abuse potential, making it ideal for
patients with a history of substance use disorder. Benzodiazepines
like alprazolam, diazepam, and lorazepam carry a high risk of
dependence and are contraindicated in this population.
TEST PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER STUDY GUIDE
Question 1
A 45-year-old patient presents with anhedonia, fatigue, and sleep
disturbances for the last two months. As a PMHNP, which initial diagnostic
step is most appropriate?
A) Order a brain MRI
B) Conduct a comprehensive psychiatric interview
C) Begin antidepressant therapy immediately
D) Recommend mindfulness training
Answer: B) Conduct a comprehensive psychiatric interview
Explanation: A comprehensive psychiatric interview allows for
thorough assessment of history, symptoms, and differential
diagnoses before initiating treatment. Imaging is reserved for
suspected neurological causes, and interventions should follow a
confirmed assessment.
Question 2
A 24-year-old graduate student presents with a 10-month history of
persistent low mood, anhedonia, profound fatigue, sleeping 12 hours daily,
15-pound weight gain, and "leadon paralysis." He denies mood reactivity.
,What is the most likely specifier for his Major Depressive Disorder?
A) With atypical features
B) With melancholic features
C) With catatonic features
D) With seasonal pattern
Answer: B) With melancholic features
Explanation: Melancholic features require distinct quality of
depressed mood, lack of mood reactivity, and at least three of:
morning worsening, early morning awakening, psychomotor
retardation, significant anorexia/weight loss, excessive guilt, or
worse mood in the morning. While hypersomnia and weight gain are
associated with atypical features, the lack of mood reactivity points
to melancholia.
Question 3
A patient reports episodes of feeling "outside of herself," watching her
life from a distance, for 6 months. These episodes cause significant
distress. She denies trauma history, panic attacks, or substance use.
What is the most likely diagnosis?
A) Panic disorder
B) Agoraphobia
C) Depersonalization/derealization disorder
D) Social anxiety disorder
Answer: C) Depersonalization/derealization disorder
Explanation: Depersonalization/derealization disorder is
,characterized by persistent or recurrent episodes of feeling
detached from oneself (depersonalization) or one's surroundings
(derealization) while reality testing remains intact. Panic disorder
involves recurrent unexpected attacks with anxiety about future
attacks; avoidance of public places suggests agoraphobia.
Question 4
A 28-year-old female with a history of PTSD presents with flashbacks,
hypervigilance, and nightmares. She reports using alcohol to help her
sleep. What is the most appropriate first-line pharmacologic intervention
for her nightmares?
A) Quetiapine 25 mg at bedtime
B) Prazosin 1 mg at bedtime
C) Trazodone 50 mg at bedtime
D) Hydroxyzine 25 mg at bedtime
Answer: B) Prazosin 1 mg at bedtime
Explanation: Prazosin is an alpha-1 antagonist with robust evidence
for reducing trauma-related nightmares in PTSD. While trazodone
and quetiapine are used for sleep, prazosin is the guideline-
supported first-line agent specifically for PTSD-associated
nightmares.
Question 5
During a suicide intervention with your 28-year-old male patient, to which
agreement should you ask for his consent, verbally or in writing?
A) No-harm contract
, B) Safety plan
C) Medication contract
D) Confidentiality agreement
Answer: B) Safety plan
Explanation: A safety plan is a collaboratively developed,
personalized list of coping strategies and resources to use during a
suicidal crisis. It is the standard of care, whereas "no-harm
contracts" are no longer recommended due to lack of evidence for
effectiveness.
Question 6
A 32-year-old woman is diagnosed with Generalized Anxiety Disorder
(GAD). She has a history of alcohol use disorder and is currently 6
months sober. Which medication is the most appropriate first-line
treatment?
A) Alprazolam
B) Diazepam
C) Buspirone
D) Lorazepam
Answer: C) Buspirone
Explanation: Buspirone is a non-benzodiazepine anxiolytic that is
effective for GAD and has no abuse potential, making it ideal for
patients with a history of substance use disorder. Benzodiazepines
like alprazolam, diazepam, and lorazepam carry a high risk of
dependence and are contraindicated in this population.
