BARKLEY PMHNP PRACTICE EXAM
2026/2027 | VERIFIED QUESTIONS WITH
DETAILED ANSWERS | BOARD PREP GUIDE
BARKLEY PMHNP PRACTICE EXAM 2026/2027 | VERIFIED QUESTIONS WITH
DETAILED ANSWERS | BOARD PREP GUIDE
DOCUMENT OVERVIEW:
• This comprehensive practice exam contains 200 verified board-prep questions
covering all major PMHNP examination domains including pharmacotherapy,
psychiatric disorders, assessment and diagnosis, treatment modalities, ethical-legal
frameworks, and specialized populations
• Designed for self-directed study with detailed rationales for every answer; use this
material to identify knowledge gaps, reinforce clinical decision-making, and build
confidence for your certification exam
QUESTION 1
A 45-year-old male with major depressive disorder has been on sertraline 100
mg daily for 8 weeks with minimal response. The patient denies suicidal
ideation and has good medication adherence. Which of the following is the
most appropriate next step?
A) Discontinue sertraline immediately and switch to a tricyclic antidepressant
B) Increase sertraline to 200 mg daily
C) Add bupropion 150 mg daily to the current sertraline regimen
D) Switch to a monoamine oxidase inhibitor due to treatment resistance
E) Recommend psychotherapy alone and discontinue all medications
✓ CORRECT ANSWER: C) Add bupropion 150 mg daily to the current sertraline
regimen
RATIONALE: After 8 weeks of monotherapy at therapeutic dose with inadequate
response, augmentation is an evidence-based strategy before switching agents.
,Bupropion addition to an SSRI is a well-supported augmentation strategy that
targets different neurotransmitter systems (dopamine/norepinephrine). Option A is
incorrect as abrupt discontinuation risks withdrawal symptoms and is not standard
practice. Option B represents only a modest dose increase; 8 weeks is adequate
time for assessment. Option D (MAOI) would require washout of sertraline due to
serotonin syndrome risk. Option E ignores the established efficacy of
pharmacotherapy for MDD.
QUESTION 2
Which of the following antipsychotics carries the highest risk for metabolic
syndrome and weight gain?
A) Aripiprazole
B) Quetiapine
C) Risperidone
D) Haloperidol
E) Ziprasidone
✓ CORRECT ANSWER: B) Quetiapine
RATIONALE: Quetiapine is among the atypical antipsychotics with the highest
propensity for weight gain and metabolic disturbance, often gaining 10+ pounds in
the first few weeks. While risperidone also carries moderate metabolic risk,
quetiapine is consistently documented as having greater weight gain liability.
Aripiprazole and ziprasidone have lower metabolic profiles. Haloperidol, a typical
antipsychotic, carries less metabolic risk but has higher extrapyramidal side effect
burden. Regular monitoring of weight, glucose, and lipids is essential with
quetiapine therapy.
QUESTION 3
,A 38-year-old female with bipolar I disorder is currently stable on lithium
carbonate 900 mg daily. She presents to clinic requesting pregnancy planning.
What is the most critical action?
A) Immediately discontinue lithium due to teratogenic risk and switch to valproate
B) Continue lithium throughout pregnancy as benefits outweigh risks
C) Transition to lamotrigine prior to conception and discuss risks/benefits
thoroughly
D) Discontinue all mood stabilizers during pregnancy to protect the fetus
E) Increase lithium dose to maintain therapeutic levels during pregnancy
✓ CORRECT ANSWER: C) Transition to lamotrigine prior to conception and
discuss risks/benefits thoroughly
RATIONALE: While lithium carries increased risk of cardiac anomalies (especially
Ebstein's anomaly) and carries FDA pregnancy category D designation, abrupt
discontinuation risks severe mood episode relapse. The optimal approach involves
preconception counseling with discussion of risks and benefits, consideration of
alternatives like lamotrigine (FDA category C), and close monitoring if mood
stabilizer continuation is necessary. Valproate (option A) is teratogenic and
contraindicated in pregnancy. Discontinuing all medications (option D) significantly
increases relapse risk, particularly in bipolar I disorder. Increasing lithium (option E)
worsens fetal exposure.
QUESTION 4
A 52-year-old male with schizophrenia presents with akathisia after initiation
of risperidone. Which medication would be most effective for managing this
side effect?
A) Benztropine 1 mg twice daily
B) Propranolol 10-20 mg three times daily
C) Lorazepam 0.5 mg three times daily
, D) Diphenhydramine 25-50 mg at bedtime
E) Methylphenidate 5 mg twice daily
✓ CORRECT ANSWER: B) Propranolol 10-20 mg three times daily
RATIONALE: Akathisia, characterized by subjective restlessness and inability to
remain still, responds best to beta-blockers, particularly propranolol. Propranolol
crosses the blood-brain barrier effectively and provides symptomatic relief in 60-
80% of cases. Benztropine (anticholinergic) is more effective for dystonia and
parkinsonism. While benzodiazepines may provide short-term relief, propranolol is
first-line. Diphenhydramine has anticholinergic effects and is not optimal for
akathisia. Methylphenidate would likely worsen the condition.
QUESTION 5
A 28-year-old female with panic disorder is prescribed sertraline but
expresses concern about sexual side effects. Which alternative SSRI carries
the lowest risk for sexual dysfunction?
A) Citalopram
B) Fluoxetine
C) Paroxetine
D) Fluvoxamine
E) Escitalopram
✓ CORRECT ANSWER: B) Fluoxetine
RATIONALE: Among SSRIs, fluoxetine demonstrates the lowest incidence of sexual
dysfunction, occurring in approximately 10-20% of patients compared to 40-60%
with paroxetine. Sertraline, citalopram, and escitalopram show intermediate rates.
Fluvoxamine shows higher rates. Fluoxetine's longer half-life and potential effects
on dopamine may contribute to lower sexual side effect burden. If sexual
dysfunction develops on any SSRI, switching to fluoxetine or adding bupropion
augmentation are evidence-based strategies.
2026/2027 | VERIFIED QUESTIONS WITH
DETAILED ANSWERS | BOARD PREP GUIDE
BARKLEY PMHNP PRACTICE EXAM 2026/2027 | VERIFIED QUESTIONS WITH
DETAILED ANSWERS | BOARD PREP GUIDE
DOCUMENT OVERVIEW:
• This comprehensive practice exam contains 200 verified board-prep questions
covering all major PMHNP examination domains including pharmacotherapy,
psychiatric disorders, assessment and diagnosis, treatment modalities, ethical-legal
frameworks, and specialized populations
• Designed for self-directed study with detailed rationales for every answer; use this
material to identify knowledge gaps, reinforce clinical decision-making, and build
confidence for your certification exam
QUESTION 1
A 45-year-old male with major depressive disorder has been on sertraline 100
mg daily for 8 weeks with minimal response. The patient denies suicidal
ideation and has good medication adherence. Which of the following is the
most appropriate next step?
A) Discontinue sertraline immediately and switch to a tricyclic antidepressant
B) Increase sertraline to 200 mg daily
C) Add bupropion 150 mg daily to the current sertraline regimen
D) Switch to a monoamine oxidase inhibitor due to treatment resistance
E) Recommend psychotherapy alone and discontinue all medications
✓ CORRECT ANSWER: C) Add bupropion 150 mg daily to the current sertraline
regimen
RATIONALE: After 8 weeks of monotherapy at therapeutic dose with inadequate
response, augmentation is an evidence-based strategy before switching agents.
,Bupropion addition to an SSRI is a well-supported augmentation strategy that
targets different neurotransmitter systems (dopamine/norepinephrine). Option A is
incorrect as abrupt discontinuation risks withdrawal symptoms and is not standard
practice. Option B represents only a modest dose increase; 8 weeks is adequate
time for assessment. Option D (MAOI) would require washout of sertraline due to
serotonin syndrome risk. Option E ignores the established efficacy of
pharmacotherapy for MDD.
QUESTION 2
Which of the following antipsychotics carries the highest risk for metabolic
syndrome and weight gain?
A) Aripiprazole
B) Quetiapine
C) Risperidone
D) Haloperidol
E) Ziprasidone
✓ CORRECT ANSWER: B) Quetiapine
RATIONALE: Quetiapine is among the atypical antipsychotics with the highest
propensity for weight gain and metabolic disturbance, often gaining 10+ pounds in
the first few weeks. While risperidone also carries moderate metabolic risk,
quetiapine is consistently documented as having greater weight gain liability.
Aripiprazole and ziprasidone have lower metabolic profiles. Haloperidol, a typical
antipsychotic, carries less metabolic risk but has higher extrapyramidal side effect
burden. Regular monitoring of weight, glucose, and lipids is essential with
quetiapine therapy.
QUESTION 3
,A 38-year-old female with bipolar I disorder is currently stable on lithium
carbonate 900 mg daily. She presents to clinic requesting pregnancy planning.
What is the most critical action?
A) Immediately discontinue lithium due to teratogenic risk and switch to valproate
B) Continue lithium throughout pregnancy as benefits outweigh risks
C) Transition to lamotrigine prior to conception and discuss risks/benefits
thoroughly
D) Discontinue all mood stabilizers during pregnancy to protect the fetus
E) Increase lithium dose to maintain therapeutic levels during pregnancy
✓ CORRECT ANSWER: C) Transition to lamotrigine prior to conception and
discuss risks/benefits thoroughly
RATIONALE: While lithium carries increased risk of cardiac anomalies (especially
Ebstein's anomaly) and carries FDA pregnancy category D designation, abrupt
discontinuation risks severe mood episode relapse. The optimal approach involves
preconception counseling with discussion of risks and benefits, consideration of
alternatives like lamotrigine (FDA category C), and close monitoring if mood
stabilizer continuation is necessary. Valproate (option A) is teratogenic and
contraindicated in pregnancy. Discontinuing all medications (option D) significantly
increases relapse risk, particularly in bipolar I disorder. Increasing lithium (option E)
worsens fetal exposure.
QUESTION 4
A 52-year-old male with schizophrenia presents with akathisia after initiation
of risperidone. Which medication would be most effective for managing this
side effect?
A) Benztropine 1 mg twice daily
B) Propranolol 10-20 mg three times daily
C) Lorazepam 0.5 mg three times daily
, D) Diphenhydramine 25-50 mg at bedtime
E) Methylphenidate 5 mg twice daily
✓ CORRECT ANSWER: B) Propranolol 10-20 mg three times daily
RATIONALE: Akathisia, characterized by subjective restlessness and inability to
remain still, responds best to beta-blockers, particularly propranolol. Propranolol
crosses the blood-brain barrier effectively and provides symptomatic relief in 60-
80% of cases. Benztropine (anticholinergic) is more effective for dystonia and
parkinsonism. While benzodiazepines may provide short-term relief, propranolol is
first-line. Diphenhydramine has anticholinergic effects and is not optimal for
akathisia. Methylphenidate would likely worsen the condition.
QUESTION 5
A 28-year-old female with panic disorder is prescribed sertraline but
expresses concern about sexual side effects. Which alternative SSRI carries
the lowest risk for sexual dysfunction?
A) Citalopram
B) Fluoxetine
C) Paroxetine
D) Fluvoxamine
E) Escitalopram
✓ CORRECT ANSWER: B) Fluoxetine
RATIONALE: Among SSRIs, fluoxetine demonstrates the lowest incidence of sexual
dysfunction, occurring in approximately 10-20% of patients compared to 40-60%
with paroxetine. Sertraline, citalopram, and escitalopram show intermediate rates.
Fluvoxamine shows higher rates. Fluoxetine's longer half-life and potential effects
on dopamine may contribute to lower sexual side effect burden. If sexual
dysfunction develops on any SSRI, switching to fluoxetine or adding bupropion
augmentation are evidence-based strategies.
