Emergency Nurse Practitioner ENP Ultimate Exam
**Question 1.** A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm. ECG shows ST-segment elevation in leads II, III, aVF. Which immediate medication is indicated?
A) Metoprolol 5 mg IV
B) Nitroglycerin 0.4 mg SL
C) Alteplase 100 mg IV infusion
D) Aspirin 325 mg PO
Answer: **C**
Explanation: ST-segment elevation myocardial infarction (STEMI) in the inferior leads requires rapid
reperfusion; alteplase (or another fibrinolytic) is given when PCI is not immediately available.
**Question 2.** A patient arrives with a Glasgow Coma Scale of 6, unequal pupils, and a CT scan
showing a crescent-shaped hyperdensity crossing the midline. What is the most likely diagnosis?
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Intracerebral hemorrhage
Answer: **B**
Explanation: Subdural hematomas appear crescent-shaped and can cross suture lines, causing mass
effect and herniation.
**Question 3.** According to the Emergency Severity Index (ESI), which of the following patients should
be classified as level 1?
A) A 30-year-old with a simple laceration requiring sutures
B) A 72-year-old with acute shortness of breath, hypotension, and altered mental status
C) A child with otitis media and fever of 38.5 °C
D) An adult with abdominal pain, stable vitals, and no comorbidities
, Emergency Nurse Practitioner ENP Ultimate Exam
Answer: **B**
Explanation: ESI level 1 denotes patients requiring immediate life-saving intervention; the hypotensive,
hypoxic, altered patient meets this criterion.
**Question 4.** Which of the following is a “can’t-miss” diagnosis in a patient with sudden onset severe
unilateral leg pain, swelling, and a positive Homan’s sign?
A) Cellulitis
B) Deep vein thrombosis (DVT)
C) Muscle strain
D) Peripheral neuropathy
Answer: **B**
Explanation: DVT can progress to pulmonary embolism; rapid identification and anticoagulation are
essential.
**Question 5.** A 45-year-old female presents with a fever, neck stiffness, and a CSF analysis showing
low glucose, high protein, and neutrophilic predominance. Which organism is most likely?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Herpes simplex virus
Answer: **B**
Explanation: Bacterial meningitis in adults is most commonly caused by Streptococcus pneumoniae,
producing the classic CSF pattern.
**Question 6.** In a patient with suspected pulmonary embolism, which clinical decision rule helps to
safely rule out PE without imaging?
A) Ottawa Ankle Rules
B) PERC Rule
C) Wells Score for DVT
, Emergency Nurse Practitioner ENP Ultimate Exam
D) NEXUS Cervical Spine Rule
Answer: **B**
Explanation: The Pulmonary Embolism Rule-out Criteria (PERC) identifies low-risk patients who can
forego further testing.
**Question 7.** Which medication is the antidote for severe acetaminophen toxicity when
administered within 8 hours of ingestion?
A) N-acetylcysteine
B) Fomepizole
C) Flumazenil
D) Sodium bicarbonate
Answer: **A**
Explanation: N-acetylcysteine replenishes glutathione and prevents hepatic injury if given early.
**Question 8.** A 22-year-old male is brought after a motor vehicle collision. FAST exam shows free
fluid in Morison’s pouch. What is the next best step?
A) Obtain a CT abdomen with contrast
B) Immediate exploratory laparotomy
C) Observation in the trauma bay
D) Administer IV antibiotics only
Answer: **A**
Explanation: Positive FAST in a hemodynamically stable trauma patient warrants CT imaging to delineate
injuries before operative decision.
**Question 9.** Which ECG finding is diagnostic of a Brugada pattern?
A) ST-segment elevation in V1-V3 with a coved morphology
B) Diffuse T-wave inversions in leads II, III, aVF
, Emergency Nurse Practitioner ENP Ultimate Exam
C) Prolonged PR interval >200 ms
D) Widespread QRS fragmentation
Answer: **A**
Explanation: Brugada syndrome presents with coved ST elevation in the right precordial leads (V1-V3).
**Question 10.** A patient with a known asthma exacerbation fails to improve after three doses of
nebulized albuterol, systemic steroids, and magnesium sulfate. What is the next recommended
intervention?
A) Initiate high-flow nasal cannula oxygen
B) Perform endotracheal intubation with rapid sequence induction
C) Administer a second dose of systemic steroids
D) Start a trial of non-invasive positive pressure ventilation
Answer: **B**
Explanation: Status asthmaticus unresponsive to maximal medical therapy requires airway protection via
intubation.
**Question 11.** Which of the following is a sign of impending airway compromise in a patient with a
severe epiglottitis?
A) Stridor at rest
B) Mild hoarseness
C) Intermittent cough
D) Normal oxygen saturation
Answer: **A**
Explanation: Stridor at rest indicates significant upper airway obstruction, necessitating immediate
airway management.
**Question 1.** A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm. ECG shows ST-segment elevation in leads II, III, aVF. Which immediate medication is indicated?
A) Metoprolol 5 mg IV
B) Nitroglycerin 0.4 mg SL
C) Alteplase 100 mg IV infusion
D) Aspirin 325 mg PO
Answer: **C**
Explanation: ST-segment elevation myocardial infarction (STEMI) in the inferior leads requires rapid
reperfusion; alteplase (or another fibrinolytic) is given when PCI is not immediately available.
**Question 2.** A patient arrives with a Glasgow Coma Scale of 6, unequal pupils, and a CT scan
showing a crescent-shaped hyperdensity crossing the midline. What is the most likely diagnosis?
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Intracerebral hemorrhage
Answer: **B**
Explanation: Subdural hematomas appear crescent-shaped and can cross suture lines, causing mass
effect and herniation.
**Question 3.** According to the Emergency Severity Index (ESI), which of the following patients should
be classified as level 1?
A) A 30-year-old with a simple laceration requiring sutures
B) A 72-year-old with acute shortness of breath, hypotension, and altered mental status
C) A child with otitis media and fever of 38.5 °C
D) An adult with abdominal pain, stable vitals, and no comorbidities
, Emergency Nurse Practitioner ENP Ultimate Exam
Answer: **B**
Explanation: ESI level 1 denotes patients requiring immediate life-saving intervention; the hypotensive,
hypoxic, altered patient meets this criterion.
**Question 4.** Which of the following is a “can’t-miss” diagnosis in a patient with sudden onset severe
unilateral leg pain, swelling, and a positive Homan’s sign?
A) Cellulitis
B) Deep vein thrombosis (DVT)
C) Muscle strain
D) Peripheral neuropathy
Answer: **B**
Explanation: DVT can progress to pulmonary embolism; rapid identification and anticoagulation are
essential.
**Question 5.** A 45-year-old female presents with a fever, neck stiffness, and a CSF analysis showing
low glucose, high protein, and neutrophilic predominance. Which organism is most likely?
A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Listeria monocytogenes
D) Herpes simplex virus
Answer: **B**
Explanation: Bacterial meningitis in adults is most commonly caused by Streptococcus pneumoniae,
producing the classic CSF pattern.
**Question 6.** In a patient with suspected pulmonary embolism, which clinical decision rule helps to
safely rule out PE without imaging?
A) Ottawa Ankle Rules
B) PERC Rule
C) Wells Score for DVT
, Emergency Nurse Practitioner ENP Ultimate Exam
D) NEXUS Cervical Spine Rule
Answer: **B**
Explanation: The Pulmonary Embolism Rule-out Criteria (PERC) identifies low-risk patients who can
forego further testing.
**Question 7.** Which medication is the antidote for severe acetaminophen toxicity when
administered within 8 hours of ingestion?
A) N-acetylcysteine
B) Fomepizole
C) Flumazenil
D) Sodium bicarbonate
Answer: **A**
Explanation: N-acetylcysteine replenishes glutathione and prevents hepatic injury if given early.
**Question 8.** A 22-year-old male is brought after a motor vehicle collision. FAST exam shows free
fluid in Morison’s pouch. What is the next best step?
A) Obtain a CT abdomen with contrast
B) Immediate exploratory laparotomy
C) Observation in the trauma bay
D) Administer IV antibiotics only
Answer: **A**
Explanation: Positive FAST in a hemodynamically stable trauma patient warrants CT imaging to delineate
injuries before operative decision.
**Question 9.** Which ECG finding is diagnostic of a Brugada pattern?
A) ST-segment elevation in V1-V3 with a coved morphology
B) Diffuse T-wave inversions in leads II, III, aVF
, Emergency Nurse Practitioner ENP Ultimate Exam
C) Prolonged PR interval >200 ms
D) Widespread QRS fragmentation
Answer: **A**
Explanation: Brugada syndrome presents with coved ST elevation in the right precordial leads (V1-V3).
**Question 10.** A patient with a known asthma exacerbation fails to improve after three doses of
nebulized albuterol, systemic steroids, and magnesium sulfate. What is the next recommended
intervention?
A) Initiate high-flow nasal cannula oxygen
B) Perform endotracheal intubation with rapid sequence induction
C) Administer a second dose of systemic steroids
D) Start a trial of non-invasive positive pressure ventilation
Answer: **B**
Explanation: Status asthmaticus unresponsive to maximal medical therapy requires airway protection via
intubation.
**Question 11.** Which of the following is a sign of impending airway compromise in a patient with a
severe epiglottitis?
A) Stridor at rest
B) Mild hoarseness
C) Intermittent cough
D) Normal oxygen saturation
Answer: **A**
Explanation: Stridor at rest indicates significant upper airway obstruction, necessitating immediate
airway management.
