Barkley ENP-C Diagnostic Readiness
Test (DRT) | 100 Emergency NP
Practice Questions and Answers
Question 1
A 45-year-old male presents to the emergency department with a deep laceration
to the palmar surface of the hand. During the physical exam, the patient is unable to
oppose the thumb to the little finger. Which nerve is likely injured?
A) Radial nerve
B) Ulnar nerve
C) Median nerve
D) Musculocutaneous nerve
,,,answer,,,,: C) Median nerve
Rationale: The "recurrent branch" of the median nerve innervates the thenar
muscles, which are responsible for thumb opposition. Damage to this nerve in
palmar lacerations results in the inability to perform this movement. The radial
nerve controls wrist extension, the ulnar nerve controls finger abduction/adduction,
and the musculocutaneous nerve controls elbow flexion.
,Question 2
Which of the following EKG findings is most suggestive of an acute posterior
myocardial infarction?
A) ST-segment elevation in leads V1 through V3
B) Tall R waves and ST-segment depression in V1 and V2
C) Pathologic Q waves in leads II, III, and aVF
D) Horizontal ST-segment depression with upright T waves in V1-V3
,,,answer,,,,: B) Tall R waves and ST-segment depression in V1 and V2
Rationale: Because the standard 12-lead EKG does not directly view the posterior
wall, reciprocal changes are seen in the anterior leads (V1-V3). Tall R waves and
ST-segment depression in V1-V2 are indicative of a posterior MI. ST elevation in V1-
V3 suggests an anterior or septal MI. Pathologic Q waves in II, III, and aVF indicate
an inferior MI.
Question 3
A 62-year-old male with a history of hypertension and smoking presents with acute
substernal chest pressure radiating to his left arm. He is diaphoretic and nauseous.
ECG shows ST-segment elevation in leads V1-V4. His blood pressure is 148/92
mmHg. What is the most appropriate initial management?
A) Aspirin 324 mg chewed and sublingual nitroglycerin
B) Immediate cardiac catheterization
C) IV heparin and clopidogrel
D) Thrombolytic therapy
,,,answer,,,,: A) Aspirin 324 mg chewed and sublingual nitroglycerin
,Rationale: This patient is presenting with an acute STEMI (ST elevation in V1-V4
indicates anterior wall MI). The initial management includes aspirin 324 mg chewed
for its rapid antiplatelet effect and sublingual nitroglycerin for vasodilation and pain
relief, provided there are no contraindications. Immediate cardiac catheterization is
indicated but follows initial stabilization and activation of the cath lab.
Question 4
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 185 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
A) Synchronized cardioversion
B) Vagal maneuvers
C) IV amiodarone
D) IV adenosine
,,,answer,,,,: B) Vagal maneuvers
Rationale: In a hemodynamically stable patient with regular narrow-complex
tachycardia (likely supraventricular tachycardia), vagal maneuvers (e.g., Valsalva
maneuver, carotid sinus massage) are the first-line intervention. If unsuccessful, IV
adenosine (6 mg rapid IV push followed by 12 mg if needed) is the next step.
Synchronized cardioversion is reserved for unstable patients.
Question 5
A patient presents with bradycardia (heart rate 38 bpm), hypotension, and altered
, mental status. Atropine 0.5 mg IV is administered without improvement. What is
the next most appropriate intervention?
A) Transcutaneous pacing
B) IV dopamine infusion
C) IV epinephrine infusion
D) Repeat atropine
,,,answer,,,,: A) Transcutaneous pacing
Rationale: For symptomatic bradycardia unresponsive to atropine (0.5 mg IV, up to
3 mg total), transcutaneous pacing is the next intervention. Dopamine or
epinephrine infusions are alternatives if pacing is not available, but pacing is
preferred for hemodynamically significant bradycardia with signs of shock.
Question 6
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
A) Amiodarone
B) Lidocaine
C) Epinephrine
D) Atropine
,,,answer,,,,: C) Epinephrine
Rationale: Epinephrine is the first medication administered in pulseless VT and VF,
given as 1 mg IV/IO every 3-5 minutes. Amiodarone (300 mg IV/IO) is the first
antiarrhythmic agent recommended for shock-refractory VF/pulseless VT after the
third shock. Lidocaine is an alternative antiarrhythmic agent. Atropine is not
indicated in cardiac arrest from VF/VT.
Test (DRT) | 100 Emergency NP
Practice Questions and Answers
Question 1
A 45-year-old male presents to the emergency department with a deep laceration
to the palmar surface of the hand. During the physical exam, the patient is unable to
oppose the thumb to the little finger. Which nerve is likely injured?
A) Radial nerve
B) Ulnar nerve
C) Median nerve
D) Musculocutaneous nerve
,,,answer,,,,: C) Median nerve
Rationale: The "recurrent branch" of the median nerve innervates the thenar
muscles, which are responsible for thumb opposition. Damage to this nerve in
palmar lacerations results in the inability to perform this movement. The radial
nerve controls wrist extension, the ulnar nerve controls finger abduction/adduction,
and the musculocutaneous nerve controls elbow flexion.
,Question 2
Which of the following EKG findings is most suggestive of an acute posterior
myocardial infarction?
A) ST-segment elevation in leads V1 through V3
B) Tall R waves and ST-segment depression in V1 and V2
C) Pathologic Q waves in leads II, III, and aVF
D) Horizontal ST-segment depression with upright T waves in V1-V3
,,,answer,,,,: B) Tall R waves and ST-segment depression in V1 and V2
Rationale: Because the standard 12-lead EKG does not directly view the posterior
wall, reciprocal changes are seen in the anterior leads (V1-V3). Tall R waves and
ST-segment depression in V1-V2 are indicative of a posterior MI. ST elevation in V1-
V3 suggests an anterior or septal MI. Pathologic Q waves in II, III, and aVF indicate
an inferior MI.
Question 3
A 62-year-old male with a history of hypertension and smoking presents with acute
substernal chest pressure radiating to his left arm. He is diaphoretic and nauseous.
ECG shows ST-segment elevation in leads V1-V4. His blood pressure is 148/92
mmHg. What is the most appropriate initial management?
A) Aspirin 324 mg chewed and sublingual nitroglycerin
B) Immediate cardiac catheterization
C) IV heparin and clopidogrel
D) Thrombolytic therapy
,,,answer,,,,: A) Aspirin 324 mg chewed and sublingual nitroglycerin
,Rationale: This patient is presenting with an acute STEMI (ST elevation in V1-V4
indicates anterior wall MI). The initial management includes aspirin 324 mg chewed
for its rapid antiplatelet effect and sublingual nitroglycerin for vasodilation and pain
relief, provided there are no contraindications. Immediate cardiac catheterization is
indicated but follows initial stabilization and activation of the cath lab.
Question 4
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 185 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
A) Synchronized cardioversion
B) Vagal maneuvers
C) IV amiodarone
D) IV adenosine
,,,answer,,,,: B) Vagal maneuvers
Rationale: In a hemodynamically stable patient with regular narrow-complex
tachycardia (likely supraventricular tachycardia), vagal maneuvers (e.g., Valsalva
maneuver, carotid sinus massage) are the first-line intervention. If unsuccessful, IV
adenosine (6 mg rapid IV push followed by 12 mg if needed) is the next step.
Synchronized cardioversion is reserved for unstable patients.
Question 5
A patient presents with bradycardia (heart rate 38 bpm), hypotension, and altered
, mental status. Atropine 0.5 mg IV is administered without improvement. What is
the next most appropriate intervention?
A) Transcutaneous pacing
B) IV dopamine infusion
C) IV epinephrine infusion
D) Repeat atropine
,,,answer,,,,: A) Transcutaneous pacing
Rationale: For symptomatic bradycardia unresponsive to atropine (0.5 mg IV, up to
3 mg total), transcutaneous pacing is the next intervention. Dopamine or
epinephrine infusions are alternatives if pacing is not available, but pacing is
preferred for hemodynamically significant bradycardia with signs of shock.
Question 6
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
A) Amiodarone
B) Lidocaine
C) Epinephrine
D) Atropine
,,,answer,,,,: C) Epinephrine
Rationale: Epinephrine is the first medication administered in pulseless VT and VF,
given as 1 mg IV/IO every 3-5 minutes. Amiodarone (300 mg IV/IO) is the first
antiarrhythmic agent recommended for shock-refractory VF/pulseless VT after the
third shock. Lidocaine is an alternative antiarrhythmic agent. Atropine is not
indicated in cardiac arrest from VF/VT.
