BARKLEY PMHNP TEST BANK 2026/2027 |
VERIFIED QUESTIONS & ANSWERS |
COMPLETE PSYCHIATRIC NP EXAM REVIEW
BARKLEY PMHNP TEST BANK 2026/2027 | VERIFIED QUESTIONS & ANSWERS |
COMPLETE PSYCHIATRIC NP EXAM REVIEW
• Comprehensive exam review designed to reinforce core psychiatric nursing
concepts across major diagnostic categories, psychopharmacology, and clinical
management strategies
• Study strategically by reviewing rationales carefully to understand not just
what is correct, but why—building clinical judgment essential for PMHNP
certification
1. A 34-year-old female presents with persistent sadness, anhedonia, and
feelings of worthlessness that have lasted 8 weeks. She reports poor
concentration and sleep disturbance. Which diagnostic criteria must be
present to confirm Major Depressive Disorder?
A) Presence of at least 3 symptoms for a minimum of 2 weeks
B) Presence of at least 5 symptoms for a minimum of 2 weeks including either
depressed mood or loss of interest/pleasure
C) Presence of at least 4 symptoms for a minimum of 1 month
D) Presence of depressed mood alone for at least 6 months
E) Presence of any depressive symptoms without specific duration requirements
B) Presence of at least 5 symptoms for a minimum of 2 weeks including
either depressed mood or loss of interest/pleasure
Rationale: According to DSM-5 diagnostic criteria for Major Depressive Disorder, a
minimum of 5 symptoms must be present during a 2-week period, with at least one
being either depressed mood or anhedonia (loss of interest/pleasure). The nine
possible symptoms include sleep disturbance, psychomotor changes, fatigue,
guilt/worthlessness, concentration difficulties, appetite changes, and suicidal
,ideation. The 2-week duration is the minimum threshold, distinguishing this from
brief depressive episodes.
2. A 28-year-old male with a 10-year history of panic disorder is experiencing
increased anxiety despite being on sertraline 100mg daily for 6 months. He
reports 4-5 panic attacks per week with anticipatory anxiety. What is the
most appropriate next intervention?
A) Immediately taper sertraline and switch to fluoxetine
B) Increase sertraline to 150mg and add cognitive behavioral therapy
C) Add benzodiazepines as monotherapy and discontinue sertraline
D) Switch to MAOIs as first-line treatment for resistant anxiety
E) Recommend only lifestyle modifications without pharmacologic adjustment
B) Increase sertraline to 150mg and add cognitive behavioral therapy
Rationale: When an SSRI provides partial response but inadequate symptom
control, dose optimization to the maximum recommended level (sertraline max
200mg) combined with evidence-based psychotherapy is the standard approach.
Cognitive Behavioral Therapy (CBT), particularly exposure-based interventions, is
considered first-line psychotherapy for panic disorder. Abruptly switching
medications is not indicated when a partial response is occurring. Benzodiazepines
should be used cautiously and briefly, not as monotherapy. SSRIs remain first-line
pharmacologic treatment.
3. A 45-year-old woman presents with grandiose delusions, decreased need
for sleep (3-4 hours without fatigue), racing thoughts, and pressured speech
lasting 10 days. She has no psychiatric history. What is the priority diagnostic
consideration?
A) Bipolar I Disorder, Current Episode Manic
B) Bipolar II Disorder with hypomanic episode
,C) Primary psychotic disorder
D) Rule out secondary causes before diagnosing a primary mood disorder
E) Major Depressive Disorder with psychotic features
D) Rule out secondary causes before diagnosing a primary mood disorder
Rationale: When evaluating a first episode of manic symptoms in a patient with no
psychiatric history, medical etiologies must be systematically excluded first.
Secondary mania can result from thyroid dysfunction, drug effects (stimulants,
corticosteroids), infections, neurologic conditions (MS, epilepsy), sleep deprivation,
or metabolic abnormalities. A comprehensive medical workup including labs (CBC,
CMP, TSH, vitamin B12), neuroimaging if indicated, substance screening, and
medication review should precede psychiatric diagnosis. Only after medical causes
are ruled out should primary Bipolar Disorder be diagnosed.
4. A 19-year-old college student has experienced social withdrawal, bizarre
behaviors, disorganized speech, and responding to internal stimuli for 3
months. He denies substance use. Which first-generation antipsychotic
carries the LOWEST risk of extrapyramidal side effects?
A) Haloperidol
B) Perphenazine
C) Chlorpromazine
D) Fluphenazine
E) Thiothixene
C) Chlorpromazine
Rationale: Among first-generation (typical) antipsychotics, chlorpromazine has the
lowest potency and thus carries the lowest risk of extrapyramidal side effects (EPS).
However, it carries the highest risk of sedation and anticholinergic effects. High-
potency typical antipsychotics (haloperidol, fluphenazine, perphenazine) are more
likely to cause acute dystonia, akathisia, parkinsonism, and tardive dyskinesia.
, Second-generation antipsychotics are generally preferred for first-episode
psychosis due to lower EPS risk, but if using first-generation agents, chlorpromazine
would be the choice to minimize movement disorders.
5. A 52-year-old male with Generalized Anxiety Disorder has been on
lorazepam 2mg three times daily for 18 months. He now reports tolerance
and requests dose increase. What is the most appropriate response?
A) Increase lorazepam to 4mg three times daily
B) Initiate buspirone 15mg daily and slowly taper lorazepam
C) Switch to alprazolam for better efficacy
D) Continue same dose and add another benzodiazepine for synergy
E) Abruptly discontinue and start cognitive behavioral therapy only
B) Initiate buspiron 15mg daily and slowly taper lorazepam
Rationale: Long-term benzodiazepine use is associated with tolerance,
dependence, and cognitive impairment. When tolerance develops, increasing the
dose perpetuates the problem rather than solving it. Buspirone is an azapirone
anxiolytic that is not habit-forming and does not interact with benzodiazepines,
making it ideal for transitioning away from chronic benzodiazepine use. A slow
taper of lorazepam (typically reducing by 10-25% every 1-2 weeks) prevents
withdrawal symptoms including seizures. CBT should also be added. Switching
between benzodiazepines or adding multiple agents worsens dependence risk.
6. A 31-year-old woman with Posttraumatic Stress Disorder reports intrusive
memories of a motor vehicle accident, hypervigilance, and avoidance of
driving for 14 months. She was prescribed paroxetine 3 months ago. Which
additional evidence-based intervention should be recommended?
A) Increase paroxetine dose until symptoms fully resolve
B) Prolonged Exposure Therapy or Cognitive Processing Therapy
VERIFIED QUESTIONS & ANSWERS |
COMPLETE PSYCHIATRIC NP EXAM REVIEW
BARKLEY PMHNP TEST BANK 2026/2027 | VERIFIED QUESTIONS & ANSWERS |
COMPLETE PSYCHIATRIC NP EXAM REVIEW
• Comprehensive exam review designed to reinforce core psychiatric nursing
concepts across major diagnostic categories, psychopharmacology, and clinical
management strategies
• Study strategically by reviewing rationales carefully to understand not just
what is correct, but why—building clinical judgment essential for PMHNP
certification
1. A 34-year-old female presents with persistent sadness, anhedonia, and
feelings of worthlessness that have lasted 8 weeks. She reports poor
concentration and sleep disturbance. Which diagnostic criteria must be
present to confirm Major Depressive Disorder?
A) Presence of at least 3 symptoms for a minimum of 2 weeks
B) Presence of at least 5 symptoms for a minimum of 2 weeks including either
depressed mood or loss of interest/pleasure
C) Presence of at least 4 symptoms for a minimum of 1 month
D) Presence of depressed mood alone for at least 6 months
E) Presence of any depressive symptoms without specific duration requirements
B) Presence of at least 5 symptoms for a minimum of 2 weeks including
either depressed mood or loss of interest/pleasure
Rationale: According to DSM-5 diagnostic criteria for Major Depressive Disorder, a
minimum of 5 symptoms must be present during a 2-week period, with at least one
being either depressed mood or anhedonia (loss of interest/pleasure). The nine
possible symptoms include sleep disturbance, psychomotor changes, fatigue,
guilt/worthlessness, concentration difficulties, appetite changes, and suicidal
,ideation. The 2-week duration is the minimum threshold, distinguishing this from
brief depressive episodes.
2. A 28-year-old male with a 10-year history of panic disorder is experiencing
increased anxiety despite being on sertraline 100mg daily for 6 months. He
reports 4-5 panic attacks per week with anticipatory anxiety. What is the
most appropriate next intervention?
A) Immediately taper sertraline and switch to fluoxetine
B) Increase sertraline to 150mg and add cognitive behavioral therapy
C) Add benzodiazepines as monotherapy and discontinue sertraline
D) Switch to MAOIs as first-line treatment for resistant anxiety
E) Recommend only lifestyle modifications without pharmacologic adjustment
B) Increase sertraline to 150mg and add cognitive behavioral therapy
Rationale: When an SSRI provides partial response but inadequate symptom
control, dose optimization to the maximum recommended level (sertraline max
200mg) combined with evidence-based psychotherapy is the standard approach.
Cognitive Behavioral Therapy (CBT), particularly exposure-based interventions, is
considered first-line psychotherapy for panic disorder. Abruptly switching
medications is not indicated when a partial response is occurring. Benzodiazepines
should be used cautiously and briefly, not as monotherapy. SSRIs remain first-line
pharmacologic treatment.
3. A 45-year-old woman presents with grandiose delusions, decreased need
for sleep (3-4 hours without fatigue), racing thoughts, and pressured speech
lasting 10 days. She has no psychiatric history. What is the priority diagnostic
consideration?
A) Bipolar I Disorder, Current Episode Manic
B) Bipolar II Disorder with hypomanic episode
,C) Primary psychotic disorder
D) Rule out secondary causes before diagnosing a primary mood disorder
E) Major Depressive Disorder with psychotic features
D) Rule out secondary causes before diagnosing a primary mood disorder
Rationale: When evaluating a first episode of manic symptoms in a patient with no
psychiatric history, medical etiologies must be systematically excluded first.
Secondary mania can result from thyroid dysfunction, drug effects (stimulants,
corticosteroids), infections, neurologic conditions (MS, epilepsy), sleep deprivation,
or metabolic abnormalities. A comprehensive medical workup including labs (CBC,
CMP, TSH, vitamin B12), neuroimaging if indicated, substance screening, and
medication review should precede psychiatric diagnosis. Only after medical causes
are ruled out should primary Bipolar Disorder be diagnosed.
4. A 19-year-old college student has experienced social withdrawal, bizarre
behaviors, disorganized speech, and responding to internal stimuli for 3
months. He denies substance use. Which first-generation antipsychotic
carries the LOWEST risk of extrapyramidal side effects?
A) Haloperidol
B) Perphenazine
C) Chlorpromazine
D) Fluphenazine
E) Thiothixene
C) Chlorpromazine
Rationale: Among first-generation (typical) antipsychotics, chlorpromazine has the
lowest potency and thus carries the lowest risk of extrapyramidal side effects (EPS).
However, it carries the highest risk of sedation and anticholinergic effects. High-
potency typical antipsychotics (haloperidol, fluphenazine, perphenazine) are more
likely to cause acute dystonia, akathisia, parkinsonism, and tardive dyskinesia.
, Second-generation antipsychotics are generally preferred for first-episode
psychosis due to lower EPS risk, but if using first-generation agents, chlorpromazine
would be the choice to minimize movement disorders.
5. A 52-year-old male with Generalized Anxiety Disorder has been on
lorazepam 2mg three times daily for 18 months. He now reports tolerance
and requests dose increase. What is the most appropriate response?
A) Increase lorazepam to 4mg three times daily
B) Initiate buspirone 15mg daily and slowly taper lorazepam
C) Switch to alprazolam for better efficacy
D) Continue same dose and add another benzodiazepine for synergy
E) Abruptly discontinue and start cognitive behavioral therapy only
B) Initiate buspiron 15mg daily and slowly taper lorazepam
Rationale: Long-term benzodiazepine use is associated with tolerance,
dependence, and cognitive impairment. When tolerance develops, increasing the
dose perpetuates the problem rather than solving it. Buspirone is an azapirone
anxiolytic that is not habit-forming and does not interact with benzodiazepines,
making it ideal for transitioning away from chronic benzodiazepine use. A slow
taper of lorazepam (typically reducing by 10-25% every 1-2 weeks) prevents
withdrawal symptoms including seizures. CBT should also be added. Switching
between benzodiazepines or adding multiple agents worsens dependence risk.
6. A 31-year-old woman with Posttraumatic Stress Disorder reports intrusive
memories of a motor vehicle accident, hypervigilance, and avoidance of
driving for 14 months. She was prescribed paroxetine 3 months ago. Which
additional evidence-based intervention should be recommended?
A) Increase paroxetine dose until symptoms fully resolve
B) Prolonged Exposure Therapy or Cognitive Processing Therapy
