Barkley DRT PMHNP 2025 | Real Exam Questions and
Correct Verified Answers & Rationales
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?
a. Harriet views her shoplifting as a righteous act.
b. Harriet's stealing is described as pleasurable.
c. Harriet is well-off and can support her family's needs.
d. Harriet's stealing is described as impulsive.
->>> CORRECT ANSWER a. Harriet views her shoplifting as a righteous act.
RATIONALE: 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?
,a. Borderline personality disorder
b. Oppositional defiant disorder
c. Adjustment disorder with disturbance of conduct
d. Bipolar disorder
->>> CORRECT ANSWER a. Borderline personality disorder
RATIONALE: 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?
a. Decreased nocturnal growth hormone secretion
b. Decreased thyroid-stimulating hormone response
c. Increased somatostatin in cerebrospinal fluid
d. Increased secretion of cortisol
->>> CORRECT ANSWER c. Increased somatostatin in cerebrospinal fluid
RATIONALE: 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?
a. Jeremy has expressed suicidal thoughts.
b. Jeremy experiences withdrawal from alcohol and cocaine.
c. Jeremy is ambivalent about his intent to commit suicide.
d. Jeremy was unable to commit to a "No Harm" contract.
->>> CORRECT ANSWER c. Jeremy is ambivalent about his intent to
commit suicide.
RATIONALE: 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.
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?
a. Lorazepam
b. Haloperidol
c. Carbamazepine
d. Bupropion
->>> CORRECT ANSWER d. Bupropion
RATIONALE: 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).
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?
a. Risperidone
b. Haloperidol
c. Quetiapine
d. Lorazepam
->>> CORRECT ANSWER d. Lorazepam
Correct Verified Answers & Rationales
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?
a. Harriet views her shoplifting as a righteous act.
b. Harriet's stealing is described as pleasurable.
c. Harriet is well-off and can support her family's needs.
d. Harriet's stealing is described as impulsive.
->>> CORRECT ANSWER a. Harriet views her shoplifting as a righteous act.
RATIONALE: 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?
,a. Borderline personality disorder
b. Oppositional defiant disorder
c. Adjustment disorder with disturbance of conduct
d. Bipolar disorder
->>> CORRECT ANSWER a. Borderline personality disorder
RATIONALE: 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?
a. Decreased nocturnal growth hormone secretion
b. Decreased thyroid-stimulating hormone response
c. Increased somatostatin in cerebrospinal fluid
d. Increased secretion of cortisol
->>> CORRECT ANSWER c. Increased somatostatin in cerebrospinal fluid
RATIONALE: 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?
a. Jeremy has expressed suicidal thoughts.
b. Jeremy experiences withdrawal from alcohol and cocaine.
c. Jeremy is ambivalent about his intent to commit suicide.
d. Jeremy was unable to commit to a "No Harm" contract.
->>> CORRECT ANSWER c. Jeremy is ambivalent about his intent to
commit suicide.
RATIONALE: 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.
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?
a. Lorazepam
b. Haloperidol
c. Carbamazepine
d. Bupropion
->>> CORRECT ANSWER d. Bupropion
RATIONALE: 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).
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?
a. Risperidone
b. Haloperidol
c. Quetiapine
d. Lorazepam
->>> CORRECT ANSWER d. Lorazepam
