BARKLEY PMHNP NEWEST EXAM
PREPARATION 2026/2027 NEWEST WITH
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS
Psychiatric Assessment & Diagnosis (Questions 1-20)
1. A 32-year-old patient presents with anhedonia, fatigue, and sleep disturbances
for the past 3 weeks following a job loss. What is the most likely diagnosis?
• A. Major Depressive Disorder
• B. Persistent Depressive Disorder (Dysthymia)
• C. Adjustment Disorder with Depressed Mood
• D. Bereavement
Correct ,,,,ANSWER,,,: C
Rationale: Adjustment Disorder involves emotional or behavioral symptoms in
response to an identifiable stressor (job loss), lasting less than 6 months. MDD
requires symptoms for at least 2 weeks but is not triggered by a stressor.
Dysthymia lasts at least 2 years .
2. A patient reports recurrent, intrusive thoughts of contamination followed by
repetitive hand washing that takes 2 hours daily. These symptoms cause significant
distress and interfere with work. What is the most likely diagnosis?
• A. Generalized Anxiety Disorder
• B. Obsessive-Compulsive Disorder
, • C. Specific Phobia
• D. Illness Anxiety Disorder
Correct ,,,,ANSWER,,,: B
Rationale: OCD is characterized by obsessions (intrusive thoughts) and
compulsions (hand washing) that are time-consuming (>1 hour/day) and cause
functional impairment. GAD involves worry without compulsions .
3. A 45-year-old patient presents with depressed mood, loss of interest, poor
concentration, and weight loss over the past 6 months. These symptoms are
present most of the day, nearly every day. What is the most likely diagnosis?
• A. Persistent Depressive Disorder
• B. Major Depressive Disorder, single episode
• C. Bipolar II Disorder
• D. Cyclothymic Disorder
Correct ,,,,ANSWER,,,: B
Rationale: MDD requires ≥5 symptoms (including depressed mood or anhedonia)
present for ≥2 weeks. The duration of 6 months is within MDD range. Persistent
depressive disorder requires symptoms for ≥2 years .
4. A 28-year-old patient presents with a 1-week history of elevated mood,
grandiosity, decreased need for sleep, pressured speech, and reckless spending.
The patient has no prior mood episodes. What is the most likely diagnosis?
• A. Hypomanic Episode
• B. Manic Episode
• C. Cyclothymic Disorder
• D. Major Depressive Episode
Correct ,,,,ANSWER,,,: B
Rationale: The symptoms (elevated mood, grandiosity, decreased sleep, reckless
,behavior) lasting ≥1 week with functional impairment meet criteria for a manic
episode. Hypomanic episodes last 4 days and do not cause marked impairment .
5. A patient with a history of major depressive episodes presents with a 4-day
history of elevated mood, increased energy, and decreased need for sleep. The
patient is functioning well at work. What is the most likely diagnosis?
• A. Manic Episode
• B. Hypomanic Episode
• C. Mixed Episode
• D. Cyclothymic Disorder
Correct ,,,,ANSWER,,,: B
Rationale: Hypomanic episodes last at least 4 days, do not cause marked
functional impairment, and do not include psychotic features. Manic episodes last
≥1 week and cause severe impairment .
6. A patient presents with recurrent panic attacks characterized by palpitations,
sweating, trembling, shortness of breath, and fear of dying. The patient has worried
about having additional attacks for 2 months and has avoided driving. What is the
most likely diagnosis?
• A. Panic Disorder
• B. Agoraphobia
• C. Generalized Anxiety Disorder
• D. Specific Phobia
Correct ,,,,ANSWER,,,: A
Rationale: Panic Disorder requires recurrent unexpected panic attacks followed by
≥1 month of persistent concern about additional attacks or maladaptive behavior
changes. Agoraphobia may co-occur but is not the primary diagnosis here .
, 7. A patient reports excessive anxiety and worry about work, finances, and health
for the past 8 months. The patient reports restlessness, fatigue, muscle tension,
and difficulty sleeping. What is the most likely diagnosis?
• A. Panic Disorder
• B. Generalized Anxiety Disorder
• C. Social Anxiety Disorder
• D. Obsessive-Compulsive Disorder
Correct ,,,,ANSWER,,,: B
Rationale: GAD involves excessive worry for ≥6 months about multiple domains,
associated with ≥3 symptoms (restlessness, fatigue, muscle tension, sleep
disturbance). Panic disorder involves discrete panic attacks .
8. A 22-year-old patient reports intense fear of public speaking, avoiding work
presentations. The patient recognizes the fear is excessive. Symptoms began at age
15. What is the most likely diagnosis?
• A. Panic Disorder
• B. Social Anxiety Disorder (Social Phobia)
• C. Agoraphobia
• D. Specific Phobia
Correct ,,,,ANSWER,,,: B
Rationale: Social Anxiety Disorder involves marked fear of social situations where
the individual may be scrutinized, with avoidance. Symptoms typically begin in
adolescence. Specific phobia is limited to a specific object or situation .
9. A patient reports hearing voices commenting on her behavior. She believes the
FBI is monitoring her through her television. She has poor self-care and has been
withdrawn for 6 months. What is the most likely diagnosis?
• A. Major Depressive Disorder with Psychotic Features
PREPARATION 2026/2027 NEWEST WITH
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS
Psychiatric Assessment & Diagnosis (Questions 1-20)
1. A 32-year-old patient presents with anhedonia, fatigue, and sleep disturbances
for the past 3 weeks following a job loss. What is the most likely diagnosis?
• A. Major Depressive Disorder
• B. Persistent Depressive Disorder (Dysthymia)
• C. Adjustment Disorder with Depressed Mood
• D. Bereavement
Correct ,,,,ANSWER,,,: C
Rationale: Adjustment Disorder involves emotional or behavioral symptoms in
response to an identifiable stressor (job loss), lasting less than 6 months. MDD
requires symptoms for at least 2 weeks but is not triggered by a stressor.
Dysthymia lasts at least 2 years .
2. A patient reports recurrent, intrusive thoughts of contamination followed by
repetitive hand washing that takes 2 hours daily. These symptoms cause significant
distress and interfere with work. What is the most likely diagnosis?
• A. Generalized Anxiety Disorder
• B. Obsessive-Compulsive Disorder
, • C. Specific Phobia
• D. Illness Anxiety Disorder
Correct ,,,,ANSWER,,,: B
Rationale: OCD is characterized by obsessions (intrusive thoughts) and
compulsions (hand washing) that are time-consuming (>1 hour/day) and cause
functional impairment. GAD involves worry without compulsions .
3. A 45-year-old patient presents with depressed mood, loss of interest, poor
concentration, and weight loss over the past 6 months. These symptoms are
present most of the day, nearly every day. What is the most likely diagnosis?
• A. Persistent Depressive Disorder
• B. Major Depressive Disorder, single episode
• C. Bipolar II Disorder
• D. Cyclothymic Disorder
Correct ,,,,ANSWER,,,: B
Rationale: MDD requires ≥5 symptoms (including depressed mood or anhedonia)
present for ≥2 weeks. The duration of 6 months is within MDD range. Persistent
depressive disorder requires symptoms for ≥2 years .
4. A 28-year-old patient presents with a 1-week history of elevated mood,
grandiosity, decreased need for sleep, pressured speech, and reckless spending.
The patient has no prior mood episodes. What is the most likely diagnosis?
• A. Hypomanic Episode
• B. Manic Episode
• C. Cyclothymic Disorder
• D. Major Depressive Episode
Correct ,,,,ANSWER,,,: B
Rationale: The symptoms (elevated mood, grandiosity, decreased sleep, reckless
,behavior) lasting ≥1 week with functional impairment meet criteria for a manic
episode. Hypomanic episodes last 4 days and do not cause marked impairment .
5. A patient with a history of major depressive episodes presents with a 4-day
history of elevated mood, increased energy, and decreased need for sleep. The
patient is functioning well at work. What is the most likely diagnosis?
• A. Manic Episode
• B. Hypomanic Episode
• C. Mixed Episode
• D. Cyclothymic Disorder
Correct ,,,,ANSWER,,,: B
Rationale: Hypomanic episodes last at least 4 days, do not cause marked
functional impairment, and do not include psychotic features. Manic episodes last
≥1 week and cause severe impairment .
6. A patient presents with recurrent panic attacks characterized by palpitations,
sweating, trembling, shortness of breath, and fear of dying. The patient has worried
about having additional attacks for 2 months and has avoided driving. What is the
most likely diagnosis?
• A. Panic Disorder
• B. Agoraphobia
• C. Generalized Anxiety Disorder
• D. Specific Phobia
Correct ,,,,ANSWER,,,: A
Rationale: Panic Disorder requires recurrent unexpected panic attacks followed by
≥1 month of persistent concern about additional attacks or maladaptive behavior
changes. Agoraphobia may co-occur but is not the primary diagnosis here .
, 7. A patient reports excessive anxiety and worry about work, finances, and health
for the past 8 months. The patient reports restlessness, fatigue, muscle tension,
and difficulty sleeping. What is the most likely diagnosis?
• A. Panic Disorder
• B. Generalized Anxiety Disorder
• C. Social Anxiety Disorder
• D. Obsessive-Compulsive Disorder
Correct ,,,,ANSWER,,,: B
Rationale: GAD involves excessive worry for ≥6 months about multiple domains,
associated with ≥3 symptoms (restlessness, fatigue, muscle tension, sleep
disturbance). Panic disorder involves discrete panic attacks .
8. A 22-year-old patient reports intense fear of public speaking, avoiding work
presentations. The patient recognizes the fear is excessive. Symptoms began at age
15. What is the most likely diagnosis?
• A. Panic Disorder
• B. Social Anxiety Disorder (Social Phobia)
• C. Agoraphobia
• D. Specific Phobia
Correct ,,,,ANSWER,,,: B
Rationale: Social Anxiety Disorder involves marked fear of social situations where
the individual may be scrutinized, with avoidance. Symptoms typically begin in
adolescence. Specific phobia is limited to a specific object or situation .
9. A patient reports hearing voices commenting on her behavior. She believes the
FBI is monitoring her through her television. She has poor self-care and has been
withdrawn for 6 months. What is the most likely diagnosis?
• A. Major Depressive Disorder with Psychotic Features
