PMHNP Practicum 1: Barkley
PMHNP Practicum I Barkley 2026
Comprehensive Clinical Resource with
Questions, Verified Answers, and
Evidence-Based Applications
Although the patient may be rationalizing her behavior as Harriet is a well-established business woman who provides for her family. She was
a righteous act, patients with kleptomania do not commit recently arrested for stealing over $10,000 worth of merchandise from the mall.
theft to express anger or vengeance. Kleptomania is When Harriet is asked to describe her behavior, she says: "It just comes on me
characterized as failing to resist the impulse to steal, and quickly, and when it's done, I feel really good." She also describes how she grew
the stolen objects are typically not needed. The act of up poor and sees the theft as a way to "even the score" against those with "empty
stealing, which usually is performed alone, gives the wealth." Which of the following does not meet the diagnostic criteria for
person gratification. 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.
Borderline personality disorder is not considered a Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a
differential diagnosis for conduct disorder, as indicated long record of skipping school, talking back to his teachers, and getting poor
by the patient's truancy, defiance of authority figures, grades. His parents say he has often gotten in fights with them, has frequently
fights with family members, poor academic performance, been caught sneaking girls into his room, and has run away from home on two
sexual promiscuity, running away from home, and "tough occasions. During the session, you notice Tony acts tough and aloof, not deigning
guy" demeanor. Oppositional defiant disorder, bipolar to speak much. If you suspect conduct disorder, which of the following conditions
disorders, and adjustment disorders are all considered would you be least likely to include in your differential diagnosis?
potential differential diagnoses for conduct disorder, as 1. Borderline personality disorder
are depressive disorders, attention-deficit/hyperactivity 2. Oppositional defiant disorder
disorder, and intermittent explosive disorder. 3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
,Depressive symptoms are associated with decreased, not Which of these lab findings would be least expected in a patient with depression?
increased, levels of somatostatin in cerebrospinal fluid. 1. Decreased nocturnal growth hormone secretion
Patients with depression may exhibit a decreased thyroid- 2. Decreased thyroid-stimulating hormone response
stimulating hormone response to thyrotropin-releasing 3. Increased somatostatin in cerebrospinal fluid
hormone, as well as hypersecretion of cortisol. 4. Increased secretion of cortisol
Depressive symptoms are also associated with
irregularities in growth hormone release, such as reduced
nocturnal secretion and diurnal hypersecretion.
Although ambivalence regarding suicidal intent should Jeremy, a suicidal inpatient, is under close observation. He is able to be observed
be taken into account when considering level of at all times by hospital staff during waking hours and when he sleeps, and is
observation in a patient, it indicates a moderate risk, not a checked on every 15-30 minutes. Which of these reasons would least indicate the
severe risk. Close observation should be employed with need for this level of supervision?
patients who profess suicidal thoughts, are unable to 1. Jeremy has expressed suicidal thoughts.
commit to a "No Harm" contract, or experience 2. Jeremy experiences withdrawal from alcohol and cocaine.
withdrawal. 3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
The patient's recent involvement in risky pleasurable Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask
activity (e.g., unprotected sex), increase in goal-driven him why he is here, he says, "I'm here because I've had this increased craving for
activity at work, decreased need for sleep, and subjective sex. I've been picking up strangers in bars, not caring about using protection ... I
experience of racing thoughts all suggest a manic don't know what it is. For the last week, I've just felt really driven. Keep throwing
episode; as such, bupropion, an antidepressant, would myself into my work, don't feel much need for sleep, feel like my thoughts are
not be considered because the patient has not displayed running a marathon in my head." The patient lives a "clean life," clarifying that he
the diagnostic criteria for a major depressive episode. does not abuse any substance, "not even coffee or cigarettes." He also does not
Pharmacologic options for the treatment of manic have a history of mental disorders. Given the most likely diagnosis, which of these
episodes include anticonvulsants (carbamazepine), medications would you least likely recommend for Adam?
antipsychotics (haloperidol), and benzodiazepines Lorazepam
(lorazepam). Haloperidol
Carbamazepine
Bupropion
Lorazepam would not be the first choice to treat delirium You have determined that a patient's delirium stems from dehydration. As you
in a dehydrated patient because benzodiazepines may begin treatment, you realize the patient will require pharmacologic management
cause respiratory depression, especially in debilitated for his agitation. Which of these agents would be least appropriate in this
patients. Antipsychotics such as haloperidol, quetiapine, situation?
and risperidone are considered the mainstay in managing Risperidone
agitation in delirium patients; haloperidol is considered Haloperidol
the standard of care, but newer agents such as Quetiapine
quetiapine and risperidone may be preferred due to Lorazepam
reduced chance of side effects.
Most inpatients who develop a suicide plan and follow it Which of the following is true about suicide among inpatients?
have agreed to a "No Harm" contract. The most common Most patients who develop a suicide plan and follow it have agreed to a "No
method of suicide among inpatients is hanging, not self- Harm" contract.
inflicted wounds. When "unsolvable" problems at work, Self-inflicted wounds are the most common means of suicide.
school, or home motivate the ideation, inpatients are Inpatients with bipolar disorder are most likely to commit suicide.
most likely to attempt suicide either within the first 5 days Patients who attempt suicide due to "unsolvable" problems usually do so after a
at the hospital or shortly after discharge, not after a month in care.
month. The rate of suicide among bipolar patients is
relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety
disorder.
, Auditory hallucinations, loss of memory, and lack of Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states
personal hygiene are all markers of the acute phase of that she has been hearing voices, cannot remember anything, and refuses to take
schizophrenia. Other signs and symptoms of this stage a shower or change her clothes. He adds, "She used to be a very clean person
include illogical thinking, inappropriate social behavior, and had a really good memory." Which phase of schizophrenia is Cam most likely
catatonic excitement, and poor concentration. The experiencing?
premorbid phase is indicated by depression, sleep Premorbid phase
disturbance, and bedwetting. The prodromal phase is Prodromal phase
characterized by suspiciousness, inappropriate Stable phase
expression of feeling, and feelings of unreality. Lastly, the Acute phase
stable phase is symptomatically similar to the prodromal
phase.
Although many patients have a demographic preference Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is
for their primary care provider, merely asking if the a recent immigrant from Haiti, you begin by giving him a cultural assessment.
patient believes that you "will help him" would not Which of the following questions would be least helpful in gaining information
provide information regarding his general health beliefs. about Leon's health beliefs and practices?
The statement would more likely provide an opinion "How do you generally try to stay healthy?"
based solely on the patient's perception of the nurse "Do you believe that I will help you feel better?"
practitioner (NP). Asking about the patient's attitude "What do you think a mental disorder says about a person?"
regarding disability and illness, preventative health "Do you have any issues with undressing for an assessment?"
practices, and taboos and cultural attitudes with regards
to modesty and special procedures would all yield
beneficial information to help the NP understand the
patient's beliefs about health and healthcare.
Multisystemic therapy is a rehabilitation model aimed at Which of these patients would most likely receive rehabilitation under the
treating children and adolescents with serious mental multisystemic therapy model?
illness; under this model, parents and teachers are taught A 32-year-old female who has completed inpatient treatment for schizophrenia
skills to manage mental disorders so that the patient does A 16-year-old male undergoing treatment for bipolar disorder
not need to be removed from the community for A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
hospitalization. Multisystemic therapy is not aimed at A 27-year-old male with major depressive disorder seeking employment
adults and does not directly focus on community
reintegration or finding employment.
When initiating a schizophrenia patient on clozapine, the Clozapine use requires rigorous dosing and monitoring in patients. Which of the
patient should be instructed to titrate daily dosage by 25- following is the proper instruction for a patient being initiated on clozapine
50 mg to a target dosage of 300-450 mg/day, rather than therapy for schizophrenia?
600-900 mg/day, and a single dose should never exceed Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
450 mg. The maximum allowable daily dose is 900 Instruct the patient to return weekly for a complete blood count to monitor red
mg/day, but this dosage should not be targeted until the blood cell levels
patient has reached a targeted daily dose of 300-450 Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900
mg/day. The patient should also be instructed to return mg/day
for weekly complete blood count to monitor white blood Dosage should never exceed 450 mg at one time
count in order to prevent agranulocytosis.
Although a fine hand tremor is a potential side effect of Which of these side effects would be of greatest concern for a patient taking
therapeutic use of lithium, a coarse hand tremor is lithium?
suggestive of lithium toxicity. Diarrhea and other Skin rash
gastrointestinal complications may occur with toxicity but Coarse hand tremor
are expected with normal doses of lithium. Other side Polyuria
effects associated with therapeutic use of lithium include Diarrhea
polyuria, dermatologic disturbances, polydipsia, and
weight gain.
PMHNP Practicum I Barkley 2026
Comprehensive Clinical Resource with
Questions, Verified Answers, and
Evidence-Based Applications
Although the patient may be rationalizing her behavior as Harriet is a well-established business woman who provides for her family. She was
a righteous act, patients with kleptomania do not commit recently arrested for stealing over $10,000 worth of merchandise from the mall.
theft to express anger or vengeance. Kleptomania is When Harriet is asked to describe her behavior, she says: "It just comes on me
characterized as failing to resist the impulse to steal, and quickly, and when it's done, I feel really good." She also describes how she grew
the stolen objects are typically not needed. The act of up poor and sees the theft as a way to "even the score" against those with "empty
stealing, which usually is performed alone, gives the wealth." Which of the following does not meet the diagnostic criteria for
person gratification. 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.
Borderline personality disorder is not considered a Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a
differential diagnosis for conduct disorder, as indicated long record of skipping school, talking back to his teachers, and getting poor
by the patient's truancy, defiance of authority figures, grades. His parents say he has often gotten in fights with them, has frequently
fights with family members, poor academic performance, been caught sneaking girls into his room, and has run away from home on two
sexual promiscuity, running away from home, and "tough occasions. During the session, you notice Tony acts tough and aloof, not deigning
guy" demeanor. Oppositional defiant disorder, bipolar to speak much. If you suspect conduct disorder, which of the following conditions
disorders, and adjustment disorders are all considered would you be least likely to include in your differential diagnosis?
potential differential diagnoses for conduct disorder, as 1. Borderline personality disorder
are depressive disorders, attention-deficit/hyperactivity 2. Oppositional defiant disorder
disorder, and intermittent explosive disorder. 3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
,Depressive symptoms are associated with decreased, not Which of these lab findings would be least expected in a patient with depression?
increased, levels of somatostatin in cerebrospinal fluid. 1. Decreased nocturnal growth hormone secretion
Patients with depression may exhibit a decreased thyroid- 2. Decreased thyroid-stimulating hormone response
stimulating hormone response to thyrotropin-releasing 3. Increased somatostatin in cerebrospinal fluid
hormone, as well as hypersecretion of cortisol. 4. Increased secretion of cortisol
Depressive symptoms are also associated with
irregularities in growth hormone release, such as reduced
nocturnal secretion and diurnal hypersecretion.
Although ambivalence regarding suicidal intent should Jeremy, a suicidal inpatient, is under close observation. He is able to be observed
be taken into account when considering level of at all times by hospital staff during waking hours and when he sleeps, and is
observation in a patient, it indicates a moderate risk, not a checked on every 15-30 minutes. Which of these reasons would least indicate the
severe risk. Close observation should be employed with need for this level of supervision?
patients who profess suicidal thoughts, are unable to 1. Jeremy has expressed suicidal thoughts.
commit to a "No Harm" contract, or experience 2. Jeremy experiences withdrawal from alcohol and cocaine.
withdrawal. 3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
The patient's recent involvement in risky pleasurable Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask
activity (e.g., unprotected sex), increase in goal-driven him why he is here, he says, "I'm here because I've had this increased craving for
activity at work, decreased need for sleep, and subjective sex. I've been picking up strangers in bars, not caring about using protection ... I
experience of racing thoughts all suggest a manic don't know what it is. For the last week, I've just felt really driven. Keep throwing
episode; as such, bupropion, an antidepressant, would myself into my work, don't feel much need for sleep, feel like my thoughts are
not be considered because the patient has not displayed running a marathon in my head." The patient lives a "clean life," clarifying that he
the diagnostic criteria for a major depressive episode. does not abuse any substance, "not even coffee or cigarettes." He also does not
Pharmacologic options for the treatment of manic have a history of mental disorders. Given the most likely diagnosis, which of these
episodes include anticonvulsants (carbamazepine), medications would you least likely recommend for Adam?
antipsychotics (haloperidol), and benzodiazepines Lorazepam
(lorazepam). Haloperidol
Carbamazepine
Bupropion
Lorazepam would not be the first choice to treat delirium You have determined that a patient's delirium stems from dehydration. As you
in a dehydrated patient because benzodiazepines may begin treatment, you realize the patient will require pharmacologic management
cause respiratory depression, especially in debilitated for his agitation. Which of these agents would be least appropriate in this
patients. Antipsychotics such as haloperidol, quetiapine, situation?
and risperidone are considered the mainstay in managing Risperidone
agitation in delirium patients; haloperidol is considered Haloperidol
the standard of care, but newer agents such as Quetiapine
quetiapine and risperidone may be preferred due to Lorazepam
reduced chance of side effects.
Most inpatients who develop a suicide plan and follow it Which of the following is true about suicide among inpatients?
have agreed to a "No Harm" contract. The most common Most patients who develop a suicide plan and follow it have agreed to a "No
method of suicide among inpatients is hanging, not self- Harm" contract.
inflicted wounds. When "unsolvable" problems at work, Self-inflicted wounds are the most common means of suicide.
school, or home motivate the ideation, inpatients are Inpatients with bipolar disorder are most likely to commit suicide.
most likely to attempt suicide either within the first 5 days Patients who attempt suicide due to "unsolvable" problems usually do so after a
at the hospital or shortly after discharge, not after a month in care.
month. The rate of suicide among bipolar patients is
relatively low, about 10%-15%, and risk would be higher in
patients with schizophrenia or an untreated anxiety
disorder.
, Auditory hallucinations, loss of memory, and lack of Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states
personal hygiene are all markers of the acute phase of that she has been hearing voices, cannot remember anything, and refuses to take
schizophrenia. Other signs and symptoms of this stage a shower or change her clothes. He adds, "She used to be a very clean person
include illogical thinking, inappropriate social behavior, and had a really good memory." Which phase of schizophrenia is Cam most likely
catatonic excitement, and poor concentration. The experiencing?
premorbid phase is indicated by depression, sleep Premorbid phase
disturbance, and bedwetting. The prodromal phase is Prodromal phase
characterized by suspiciousness, inappropriate Stable phase
expression of feeling, and feelings of unreality. Lastly, the Acute phase
stable phase is symptomatically similar to the prodromal
phase.
Although many patients have a demographic preference Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is
for their primary care provider, merely asking if the a recent immigrant from Haiti, you begin by giving him a cultural assessment.
patient believes that you "will help him" would not Which of the following questions would be least helpful in gaining information
provide information regarding his general health beliefs. about Leon's health beliefs and practices?
The statement would more likely provide an opinion "How do you generally try to stay healthy?"
based solely on the patient's perception of the nurse "Do you believe that I will help you feel better?"
practitioner (NP). Asking about the patient's attitude "What do you think a mental disorder says about a person?"
regarding disability and illness, preventative health "Do you have any issues with undressing for an assessment?"
practices, and taboos and cultural attitudes with regards
to modesty and special procedures would all yield
beneficial information to help the NP understand the
patient's beliefs about health and healthcare.
Multisystemic therapy is a rehabilitation model aimed at Which of these patients would most likely receive rehabilitation under the
treating children and adolescents with serious mental multisystemic therapy model?
illness; under this model, parents and teachers are taught A 32-year-old female who has completed inpatient treatment for schizophrenia
skills to manage mental disorders so that the patient does A 16-year-old male undergoing treatment for bipolar disorder
not need to be removed from the community for A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
hospitalization. Multisystemic therapy is not aimed at A 27-year-old male with major depressive disorder seeking employment
adults and does not directly focus on community
reintegration or finding employment.
When initiating a schizophrenia patient on clozapine, the Clozapine use requires rigorous dosing and monitoring in patients. Which of the
patient should be instructed to titrate daily dosage by 25- following is the proper instruction for a patient being initiated on clozapine
50 mg to a target dosage of 300-450 mg/day, rather than therapy for schizophrenia?
600-900 mg/day, and a single dose should never exceed Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
450 mg. The maximum allowable daily dose is 900 Instruct the patient to return weekly for a complete blood count to monitor red
mg/day, but this dosage should not be targeted until the blood cell levels
patient has reached a targeted daily dose of 300-450 Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900
mg/day. The patient should also be instructed to return mg/day
for weekly complete blood count to monitor white blood Dosage should never exceed 450 mg at one time
count in order to prevent agranulocytosis.
Although a fine hand tremor is a potential side effect of Which of these side effects would be of greatest concern for a patient taking
therapeutic use of lithium, a coarse hand tremor is lithium?
suggestive of lithium toxicity. Diarrhea and other Skin rash
gastrointestinal complications may occur with toxicity but Coarse hand tremor
are expected with normal doses of lithium. Other side Polyuria
effects associated with therapeutic use of lithium include Diarrhea
polyuria, dermatologic disturbances, polydipsia, and
weight gain.
