BARKLEY DRT PMHNP Practicum 1 Pre-
Test (UPDATED 2026) (A+ Graded)
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?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. -CORRECTANSWER 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?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder -CORRECTANSWER 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?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol -CORRECTANSWER 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?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. -CORRECTANSWER
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?
, Lorazepam
Haloperidol
Carbamazepine
Bupropion -CORRECTANSWER 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?
Risperidone
Haloperidol
Quetiapine
Lorazepam -CORRECTANSWER Lorazepam would not be the first choice to treat
delirium in a dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as haloperidol,
quetiapine, and risperidone are considered the mainstay in managing agitation in
delirium patients; haloperidol is considered the standard of care, but newer agents such
as quetiapine and risperidone may be preferred due to reduced chance of side effects.
Test (UPDATED 2026) (A+ Graded)
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?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive. -CORRECTANSWER 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?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder -CORRECTANSWER 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?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol -CORRECTANSWER 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?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract. -CORRECTANSWER
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?
, Lorazepam
Haloperidol
Carbamazepine
Bupropion -CORRECTANSWER 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?
Risperidone
Haloperidol
Quetiapine
Lorazepam -CORRECTANSWER Lorazepam would not be the first choice to treat
delirium in a dehydrated patient because benzodiazepines may cause respiratory
depression, especially in debilitated patients. Antipsychotics such as haloperidol,
quetiapine, and risperidone are considered the mainstay in managing agitation in
delirium patients; haloperidol is considered the standard of care, but newer agents such
as quetiapine and risperidone may be preferred due to reduced chance of side effects.
