Level 3 Barkley PMHNP Ultimate Exam
Review 2026 – 300 Questions with Answers &
Rationales
Section 1: Foundations of Psychiatric-Mental Health NP Practice (Questions
1–40)
1. A 45-year-old patient is brought to the emergency department by police
after being found wandering in traffic. The patient is disoriented, agitated,
and unable to provide a coherent history. What is the PMHNP's priority
action?
A) Obtain a detailed psychiatric history from the patient
B) Order a comprehensive metabolic panel and urine toxicology screen
C) Administer haloperidol 5 mg IM for immediate sedation
D) Place the patient in seclusion until calm
✅ Correct Answer: B
Rationale: In an undifferentiated agitated patient, medical causes (e.g.,
hypoglycemia, infection, electrolyte disturbance, intoxication) must be ruled
out before attributing symptoms to a primary psychiatric condition. Safety is
the priority, but ruling out medical emergencies comes before psychotropic
administration .
2. The PMHNP is establishing a therapeutic alliance with a new patient.
Which statement best promotes rapport?
A) "I need you to tell me everything about your symptoms today."
B) "You seem upset. Would you like to talk about what's bothering you?"
C) "Your family says you haven't been taking your medications."
D) "Let's focus on your history of hospitalization first."
,✅ Correct Answer: B
Rationale: Open-ended, empathetic statements that validate the patient's
emotional state promote trust and rapport. Focus on the patient's immediate
concerns rather than imposing an agenda .
3. Which of the following is an essential component of informed consent for
psychiatric treatment?
A) Guarantee of treatment success
B) Disclosure of potential risks and benefits of the proposed treatment
C) Agreement from the patient's family to support the decision
D) Waiver of the right to refuse treatment
✅ Correct Answer: B
Rationale: Informed consent requires disclosure of the nature of the
treatment, potential risks and benefits, reasonable alternatives, and the right
to refuse. No guarantees of outcome are ethically permissible .
4. A patient with a history of schizophrenia is deemed incompetent to make
treatment decisions. Who is legally authorized to consent to treatment on
the patient's behalf?
A) The attending psychiatrist
B) A court-appointed guardian or healthcare proxy
C) The patient's nearest relative
D) The hospital ethics committee
✅ Correct Answer: B
Rationale: When a patient lacks decision-making capacity, a court-appointed
guardian or durable power of attorney for healthcare (healthcare proxy) is
legally authorized to provide substituted consent. Family members do not
have automatic authority .
,5. The PMHNP is evaluating a patient who has been involuntarily
committed. Which patient right is NOT suspended by involuntary
commitment?
A) The right to refuse medication
B) The right to communicate with an attorney
C) The right to leave the facility
D) The right to privacy
✅ Correct Answer: B
Rationale: Involuntarily committed patients retain all rights except the right
to leave the facility and (in some jurisdictions) the right to refuse emergency
treatment. Right to legal counsel, privacy, and humane treatment remain
intact .
6. A patient threatens to sue the PMHNP for abandonment after the NP
terminates the therapeutic relationship. Which action would best protect
against a successful malpractice claim?
A) Discontinuing care immediately upon the patient's threat
B) Providing appropriate notice of termination and referral for continued
care
C) Continuing treatment indefinitely to avoid legal action
D) Transferring the patient's records to the patient directly
✅ Correct Answer: B
Rationale: To avoid patient abandonment claims, the NP must provide
reasonable notice (typically 30 days), assist in finding alternative care, and
ensure continuity during transition. Immediate discontinuation constitutes
abandonment .
, 7. The PMHNP is calculating controlled substance prescription quantities.
According to DEA regulations, a Schedule II prescription may be written for
a maximum of:
A) 30-day supply, no refills
B) 90-day supply, with one refill
C) 30-day supply, with up to 5 refills
D) Unlimited supply with prior approval
✅ Correct Answer: A
*Rationale: Schedule II controlled substances have no refills and are limited
to a 30-day supply in most states. Electronic prescribing is required in many
jurisdictions for Schedule II medications .*
8. The PMHNP suspects that a patient is malingering. Which finding is most
consistent with malingering?
A) Symptom onset following a traumatic event
B) Inconsistency between reported symptoms and objective findings with
clear secondary gain
C) Long-standing pattern of attention-seeking behavior
D) Lack of insight into the illness
✅ Correct Answer: B
Rationale: Malingering involves intentional fabrication of symptoms for
external incentives (e.g., financial compensation, avoiding legal
consequences, obtaining drugs). It differs from factitious disorder where
motivation is to assume the sick role .
9. During a telehealth session, the patient reveals active suicidal ideation
with a plan. What is the PMHNP's most appropriate action?
A) Schedule a follow-up appointment for the next day
B) Contract for safety and continue the telehealth session
Review 2026 – 300 Questions with Answers &
Rationales
Section 1: Foundations of Psychiatric-Mental Health NP Practice (Questions
1–40)
1. A 45-year-old patient is brought to the emergency department by police
after being found wandering in traffic. The patient is disoriented, agitated,
and unable to provide a coherent history. What is the PMHNP's priority
action?
A) Obtain a detailed psychiatric history from the patient
B) Order a comprehensive metabolic panel and urine toxicology screen
C) Administer haloperidol 5 mg IM for immediate sedation
D) Place the patient in seclusion until calm
✅ Correct Answer: B
Rationale: In an undifferentiated agitated patient, medical causes (e.g.,
hypoglycemia, infection, electrolyte disturbance, intoxication) must be ruled
out before attributing symptoms to a primary psychiatric condition. Safety is
the priority, but ruling out medical emergencies comes before psychotropic
administration .
2. The PMHNP is establishing a therapeutic alliance with a new patient.
Which statement best promotes rapport?
A) "I need you to tell me everything about your symptoms today."
B) "You seem upset. Would you like to talk about what's bothering you?"
C) "Your family says you haven't been taking your medications."
D) "Let's focus on your history of hospitalization first."
,✅ Correct Answer: B
Rationale: Open-ended, empathetic statements that validate the patient's
emotional state promote trust and rapport. Focus on the patient's immediate
concerns rather than imposing an agenda .
3. Which of the following is an essential component of informed consent for
psychiatric treatment?
A) Guarantee of treatment success
B) Disclosure of potential risks and benefits of the proposed treatment
C) Agreement from the patient's family to support the decision
D) Waiver of the right to refuse treatment
✅ Correct Answer: B
Rationale: Informed consent requires disclosure of the nature of the
treatment, potential risks and benefits, reasonable alternatives, and the right
to refuse. No guarantees of outcome are ethically permissible .
4. A patient with a history of schizophrenia is deemed incompetent to make
treatment decisions. Who is legally authorized to consent to treatment on
the patient's behalf?
A) The attending psychiatrist
B) A court-appointed guardian or healthcare proxy
C) The patient's nearest relative
D) The hospital ethics committee
✅ Correct Answer: B
Rationale: When a patient lacks decision-making capacity, a court-appointed
guardian or durable power of attorney for healthcare (healthcare proxy) is
legally authorized to provide substituted consent. Family members do not
have automatic authority .
,5. The PMHNP is evaluating a patient who has been involuntarily
committed. Which patient right is NOT suspended by involuntary
commitment?
A) The right to refuse medication
B) The right to communicate with an attorney
C) The right to leave the facility
D) The right to privacy
✅ Correct Answer: B
Rationale: Involuntarily committed patients retain all rights except the right
to leave the facility and (in some jurisdictions) the right to refuse emergency
treatment. Right to legal counsel, privacy, and humane treatment remain
intact .
6. A patient threatens to sue the PMHNP for abandonment after the NP
terminates the therapeutic relationship. Which action would best protect
against a successful malpractice claim?
A) Discontinuing care immediately upon the patient's threat
B) Providing appropriate notice of termination and referral for continued
care
C) Continuing treatment indefinitely to avoid legal action
D) Transferring the patient's records to the patient directly
✅ Correct Answer: B
Rationale: To avoid patient abandonment claims, the NP must provide
reasonable notice (typically 30 days), assist in finding alternative care, and
ensure continuity during transition. Immediate discontinuation constitutes
abandonment .
, 7. The PMHNP is calculating controlled substance prescription quantities.
According to DEA regulations, a Schedule II prescription may be written for
a maximum of:
A) 30-day supply, no refills
B) 90-day supply, with one refill
C) 30-day supply, with up to 5 refills
D) Unlimited supply with prior approval
✅ Correct Answer: A
*Rationale: Schedule II controlled substances have no refills and are limited
to a 30-day supply in most states. Electronic prescribing is required in many
jurisdictions for Schedule II medications .*
8. The PMHNP suspects that a patient is malingering. Which finding is most
consistent with malingering?
A) Symptom onset following a traumatic event
B) Inconsistency between reported symptoms and objective findings with
clear secondary gain
C) Long-standing pattern of attention-seeking behavior
D) Lack of insight into the illness
✅ Correct Answer: B
Rationale: Malingering involves intentional fabrication of symptoms for
external incentives (e.g., financial compensation, avoiding legal
consequences, obtaining drugs). It differs from factitious disorder where
motivation is to assume the sick role .
9. During a telehealth session, the patient reveals active suicidal ideation
with a plan. What is the PMHNP's most appropriate action?
A) Schedule a follow-up appointment for the next day
B) Contract for safety and continue the telehealth session
