Barkley PMHNP 2026 Ultimate Exam
Review 350 High-Yield Exam Questions
with Correct Answers & Detailed
Rationales
EXAM INFORMATION
| Item | Details |
|||
| Review Source | Barkley & Associates PMHNP Certification Review |
| Target Exam | ANCC Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC®) |
| Latest Update | 2026 |
| Question Format | Multiple choice, select all that apply, clinical scenarios |
| Content Areas | Psychopharmacology, DSM-5-TR Diagnostics, Psychotherapy, Ethics,
Neuroscience |
TABLE OF CONTENTS
1. Neurotransmitters & Psychopharmacology – Questions 1-50
2. Mood Disorders – Questions 51-80
3. Psychotic Disorders – Questions 81-110
4. Anxiety & Trauma-Related Disorders – Questions 111-140
5. Personality Disorders – Questions 141-155
6. Substance Use Disorders – Questions 156-170
7. Child & Adolescent Psychiatry – Questions 171-185
8. Geriatric Psychiatry – Questions 186-200
9. Ethics, Law & Professional Issues – Questions 201-220
10. Psychotherapy & Therapeutic Modalities – Questions 221-240
11. SATA & Clinical Judgment Questions – Questions 241-280
12. High-Yield Rapid Review – Questions 281-350
SECTION 1: NEUROTRANSMITTERS & PSYCHOPHARMACOLOGY (Questions 1-50)
,Question 1
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Answer: C) Serotonin
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition .
Question 2
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Answer: B) Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs .
Question 3
A patient with schizophrenia reports improved hallucinations but experiences severe
restlessness. What is the most likely adverse effect?
A) Dystonia
B) Akathisia
,C) Parkinsonism
D) Tardive dyskinesia
Answer: B) Akathisia
Rationale: Akathisia is an inner sense of restlessness, often seen early in antipsychotic
treatment. It may be mistaken for agitation or worsening disease. Unlike dystonia (muscle
spasms), Parkinsonism (rigidity/bradykinesia), or tardive dyskinesia (late-onset involuntary
movements), akathisia presents as a subjective feeling of needing to move .
Question 4
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A) CBC, liver panel, and lipid profile
B) TSH, renal function (BUN/creatinine), and electrolyte panel
C) Blood glucose, ECG, and vitamin D
D) Urinalysis and C-reactive protein
Answer: B) TSH, renal function (BUN/creatinine), and electrolyte panel
Rationale: Lithium affects renal and thyroid function. Baseline kidney (BUN/creatinine) and
thyroid (TSH) studies ensure safe initiation. CBC or liver tests are important for other
medications like valproate, carbamazepine, or clozapine .
Question 5
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A) Continue lithium at the same dose
B) Add propranolol to control tremors
C) Hold lithium and monitor hydration status
D) Decrease lithium by 50%
Answer: C) Hold lithium and monitor hydration status
Rationale: A level of 1.8 mEq/L is above the therapeutic range (0.6-1.2 mEq/L) and indicates
toxicity. The drug should be held, and hydration maintained to promote excretion. Once the
, patient stabilizes, a lower dose may be restarted. Levels above 2.0 mEq/L can cause seizures,
coma, and permanent neurological damage .
Question 6
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain and dyslipidemia?
A) Ziprasidone
B) Aripiprazole
C) Clozapine
D) Lurasidone
Answer: C) Clozapine
Rationale: Clozapine is associated with the highest risk of metabolic syndrome among
antipsychotics, including significant weight gain, diabetes, and dyslipidemia. Olanzapine carries
similar risk. Ziprasidone, aripiprazole, and lurasidone have lower metabolic risk but may have
other side effects .
Question 7
Which benzodiazepine has the longest half-life and is suitable for tapering protocols?
A) Alprazolam
B) Lorazepam
C) Diazepam
D) Clonazepam
Answer: C) Diazepam
Rationale: Diazepam has an extended half-life (20-100 hours) and active metabolites, providing
smoother withdrawal transition during tapering protocols. Alprazolam and lorazepam have
shorter half-lives, leading to more severe rebound anxiety and withdrawal symptoms.
Clonazepam has an intermediate half-life .
Question 8
Review 350 High-Yield Exam Questions
with Correct Answers & Detailed
Rationales
EXAM INFORMATION
| Item | Details |
|||
| Review Source | Barkley & Associates PMHNP Certification Review |
| Target Exam | ANCC Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC®) |
| Latest Update | 2026 |
| Question Format | Multiple choice, select all that apply, clinical scenarios |
| Content Areas | Psychopharmacology, DSM-5-TR Diagnostics, Psychotherapy, Ethics,
Neuroscience |
TABLE OF CONTENTS
1. Neurotransmitters & Psychopharmacology – Questions 1-50
2. Mood Disorders – Questions 51-80
3. Psychotic Disorders – Questions 81-110
4. Anxiety & Trauma-Related Disorders – Questions 111-140
5. Personality Disorders – Questions 141-155
6. Substance Use Disorders – Questions 156-170
7. Child & Adolescent Psychiatry – Questions 171-185
8. Geriatric Psychiatry – Questions 186-200
9. Ethics, Law & Professional Issues – Questions 201-220
10. Psychotherapy & Therapeutic Modalities – Questions 221-240
11. SATA & Clinical Judgment Questions – Questions 241-280
12. High-Yield Rapid Review – Questions 281-350
SECTION 1: NEUROTRANSMITTERS & PSYCHOPHARMACOLOGY (Questions 1-50)
,Question 1
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Answer: C) Serotonin
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition .
Question 2
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Answer: B) Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs .
Question 3
A patient with schizophrenia reports improved hallucinations but experiences severe
restlessness. What is the most likely adverse effect?
A) Dystonia
B) Akathisia
,C) Parkinsonism
D) Tardive dyskinesia
Answer: B) Akathisia
Rationale: Akathisia is an inner sense of restlessness, often seen early in antipsychotic
treatment. It may be mistaken for agitation or worsening disease. Unlike dystonia (muscle
spasms), Parkinsonism (rigidity/bradykinesia), or tardive dyskinesia (late-onset involuntary
movements), akathisia presents as a subjective feeling of needing to move .
Question 4
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A) CBC, liver panel, and lipid profile
B) TSH, renal function (BUN/creatinine), and electrolyte panel
C) Blood glucose, ECG, and vitamin D
D) Urinalysis and C-reactive protein
Answer: B) TSH, renal function (BUN/creatinine), and electrolyte panel
Rationale: Lithium affects renal and thyroid function. Baseline kidney (BUN/creatinine) and
thyroid (TSH) studies ensure safe initiation. CBC or liver tests are important for other
medications like valproate, carbamazepine, or clozapine .
Question 5
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A) Continue lithium at the same dose
B) Add propranolol to control tremors
C) Hold lithium and monitor hydration status
D) Decrease lithium by 50%
Answer: C) Hold lithium and monitor hydration status
Rationale: A level of 1.8 mEq/L is above the therapeutic range (0.6-1.2 mEq/L) and indicates
toxicity. The drug should be held, and hydration maintained to promote excretion. Once the
, patient stabilizes, a lower dose may be restarted. Levels above 2.0 mEq/L can cause seizures,
coma, and permanent neurological damage .
Question 6
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain and dyslipidemia?
A) Ziprasidone
B) Aripiprazole
C) Clozapine
D) Lurasidone
Answer: C) Clozapine
Rationale: Clozapine is associated with the highest risk of metabolic syndrome among
antipsychotics, including significant weight gain, diabetes, and dyslipidemia. Olanzapine carries
similar risk. Ziprasidone, aripiprazole, and lurasidone have lower metabolic risk but may have
other side effects .
Question 7
Which benzodiazepine has the longest half-life and is suitable for tapering protocols?
A) Alprazolam
B) Lorazepam
C) Diazepam
D) Clonazepam
Answer: C) Diazepam
Rationale: Diazepam has an extended half-life (20-100 hours) and active metabolites, providing
smoother withdrawal transition during tapering protocols. Alprazolam and lorazepam have
shorter half-lives, leading to more severe rebound anxiety and withdrawal symptoms.
Clonazepam has an intermediate half-life .
Question 8
