ENP - EMERGENCY NURSE PRACTITIONER ULTIMATE | EXAM
REVISION PACK 2026/2027 | QUESTIONS AND 100% VERIFIED
ANSWERS | PASS GUARANTEED
1. Q: A 55-year-old male presents with severe, tearing chest pain radiating
to his back. Blood pressure is 180/110 in the right arm and 140/80 in the
left arm. What is the most likely diagnosis?
ANSWER Acute Aortic Dissection. Rationale: Unequal pulse
pressures/BPs and tearing back pain are classic for dissection.
2. Q: A patient with a known history of ascending aortic aneurysm
presents with chest pain and syncopal episode. What is the most
appropriate initial imaging study?
ANSWER Transesophageal echocardiogram (TEE) or CT Angiography of
the chest. Rationale: TEE is highly sensitive for ascending dissections,
while CTA is the standard of care for overall aortic imaging.
3. Q: A 60-year-old female presents with chest pain. ECG shows ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
ANSWER Right Coronary Artery (RCA). Rationale: Inferior STEMI is
typically caused by RCA occlusion.
4. Q: During an inferior STEMI, the patient suddenly develops severe
hypotension and clear lungs. What complication should you suspect?
ANSWER Right Ventricular (RV) infarct. Rationale: RV infarct causes
profound hypotension due to decreased preload, but lungs remain clear.
Treat with IV fluids, not nitroglycerin.
,5. Q: A patient presents with wide-complex tachycardia at a rate of 160
bpm. He is alert and oriented with a BP of 110/70. What is the first-line
treatment?
ANSWER Procainamide or Amiodarone. Rationale: In stable wide-
complex tachycardia of unknown origin, antiarrhythmics are first-line.
Avoid Verapamil in wide-complex tachycardias.
6. Q: What is the classic ECG finding of pericarditis?
ANSWER Diffuse ST-segment elevation and PR segment depression.
Rationale: Unlike STEMI, pericarditis affects multiple coronary territories
and has reciprocal PR depression.
7. Q: A patient with end-stage renal disease presents with shortness of
breath, wide QRS complexes, and peaked T waves. What is the first-line
medication for hyperkalemia-induced cardiac toxicity?
ANSWER Calcium Gluconate (or Calcium Chloride). Rationale: Calcium
stabilizes the myocardial cell membrane but does not lower potassium
levels.
8. Q: Following calcium administration for hyperkalemia, what medication
should be given next to shift potassium intracellularly?
ANSWER Regular insulin combined with Dextrose (D50). Rationale:
Insulin drives potassium into cells, temporarily lowering serum levels.
9. Q: A patient presents with sharp chest pain that worsens with deep
inspiration and improves when leaning forward. A friction rub is heard on
auscultation. What is the diagnosis?
ANSWER Pericarditis. Rationale: Positional pain and a friction rub are
pathognomonic for pericarditis.
10. Q: A 45-year-old male presents with sudden onset palpitations. ECG
shows a narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail.
What is the next step?
, ANSWER Adenosine IV push. Rationale: Adenosine is the treatment of
choice for stable supraventricular tachycardia (SVT) after vagal
maneuvers fail.
11. Q: A patient presents with severe chest pain, diaphoresis, and
vomiting. ECG shows hyperacute T waves in the anterior leads. What is
the immediate next step in management?
ANSWER Administer Aspirin, obtain IV access, and prepare for
immediate reperfusion (Cath lab or thrombolytics). Rationale: Hyperacute
T waves are the earliest sign of STEMI.
12. Q: What is the most common cause of pulseless electrical activity
(PEA)?
ANSWER Hypovolemia. Rationale: The "H's and T's" are the causes of
PEA; Hypovolemia is the most common.
13. Q: A patient with a mechanical heart valve presents with a severe
headache and right-sided hemiparesis. INR is 1.2. What is the most
appropriate action?
ANSWER Emergent CT head to rule out hemorrhage, then IV Vitamin K
and Fresh Frozen Plasma (FFP) or Prothrombin Complex Concentrate
(PCC). Rationale: Suspected thrombotic stroke in a non-anticoagulated
mechanical valve patient requires rapid reversal and neurology consult.
14. Q: Which heart murmur is associated with hypertrophic obstructive
cardiomyopathy (HOCM) and worsens with Valsalva?
ANSWER Systolic ejection murmur that increases with Valsalva.
Rationale: Valsalva decreases preload, which increases the dynamic
outflow tract obstruction in HOCM, making the murmur louder.
15. Q: A patient in cardiac arrest has return of spontaneous circulation
(ROSC) but remains comatose. What targeted temperature management
(TTM) guideline is recommended?
, ANSWER Maintain core temperature between 32°C and 36°C for at least
24 hours. Rationale: TTM improves neurologic outcomes in comatose
post-cardiac arrest patients.
Neurology (16-30)
16. Q: A 68-year-old patient presents with sudden onset right-sided
hemiplegia and aphasia. Symptoms started 2 hours ago. CT head is
negative for hemorrhage. What is the definitive treatment?
ANSWER Alteplase (tPA) IV. Rationale: Ischemic stroke within the 3 to
4.5-hour window without contraindications warrants thrombolytics.
17. Q: What is the absolute contraindication to administering tPA in an
acute ischemic stroke?
ANSWER Active internal bleeding or intracranial hemorrhage on CT.
Rationale: Giving tPA in the setting of hemorrhage is fatal.
18. Q: A patient presents with the "worst headache of my life." What is the
initial diagnostic test of choice?
ANSWER Non-contrast CT head. Rationale: Highly sensitive for detecting
acute subarachnoid hemorrhage (SAH) in the first 24 hours.
19. Q: If the non-contrast CT head is negative for subarachnoid
hemorrhage but clinical suspicion remains high, what is the next step?
ANSWER Lumbar Puncture (LP). Rationale: LP looks for xanthochromia
(yellowish tint from bilirubin, a breakdown product of RBCs) to confirm
SAH.
20. Q: A 22-year-old female presents with a severe headache, fever, and
nuchal rigidity. What is the most appropriate empiric antibiotic to add if
Neisseria meningitidis is suspected?
REVISION PACK 2026/2027 | QUESTIONS AND 100% VERIFIED
ANSWERS | PASS GUARANTEED
1. Q: A 55-year-old male presents with severe, tearing chest pain radiating
to his back. Blood pressure is 180/110 in the right arm and 140/80 in the
left arm. What is the most likely diagnosis?
ANSWER Acute Aortic Dissection. Rationale: Unequal pulse
pressures/BPs and tearing back pain are classic for dissection.
2. Q: A patient with a known history of ascending aortic aneurysm
presents with chest pain and syncopal episode. What is the most
appropriate initial imaging study?
ANSWER Transesophageal echocardiogram (TEE) or CT Angiography of
the chest. Rationale: TEE is highly sensitive for ascending dissections,
while CTA is the standard of care for overall aortic imaging.
3. Q: A 60-year-old female presents with chest pain. ECG shows ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
ANSWER Right Coronary Artery (RCA). Rationale: Inferior STEMI is
typically caused by RCA occlusion.
4. Q: During an inferior STEMI, the patient suddenly develops severe
hypotension and clear lungs. What complication should you suspect?
ANSWER Right Ventricular (RV) infarct. Rationale: RV infarct causes
profound hypotension due to decreased preload, but lungs remain clear.
Treat with IV fluids, not nitroglycerin.
,5. Q: A patient presents with wide-complex tachycardia at a rate of 160
bpm. He is alert and oriented with a BP of 110/70. What is the first-line
treatment?
ANSWER Procainamide or Amiodarone. Rationale: In stable wide-
complex tachycardia of unknown origin, antiarrhythmics are first-line.
Avoid Verapamil in wide-complex tachycardias.
6. Q: What is the classic ECG finding of pericarditis?
ANSWER Diffuse ST-segment elevation and PR segment depression.
Rationale: Unlike STEMI, pericarditis affects multiple coronary territories
and has reciprocal PR depression.
7. Q: A patient with end-stage renal disease presents with shortness of
breath, wide QRS complexes, and peaked T waves. What is the first-line
medication for hyperkalemia-induced cardiac toxicity?
ANSWER Calcium Gluconate (or Calcium Chloride). Rationale: Calcium
stabilizes the myocardial cell membrane but does not lower potassium
levels.
8. Q: Following calcium administration for hyperkalemia, what medication
should be given next to shift potassium intracellularly?
ANSWER Regular insulin combined with Dextrose (D50). Rationale:
Insulin drives potassium into cells, temporarily lowering serum levels.
9. Q: A patient presents with sharp chest pain that worsens with deep
inspiration and improves when leaning forward. A friction rub is heard on
auscultation. What is the diagnosis?
ANSWER Pericarditis. Rationale: Positional pain and a friction rub are
pathognomonic for pericarditis.
10. Q: A 45-year-old male presents with sudden onset palpitations. ECG
shows a narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail.
What is the next step?
, ANSWER Adenosine IV push. Rationale: Adenosine is the treatment of
choice for stable supraventricular tachycardia (SVT) after vagal
maneuvers fail.
11. Q: A patient presents with severe chest pain, diaphoresis, and
vomiting. ECG shows hyperacute T waves in the anterior leads. What is
the immediate next step in management?
ANSWER Administer Aspirin, obtain IV access, and prepare for
immediate reperfusion (Cath lab or thrombolytics). Rationale: Hyperacute
T waves are the earliest sign of STEMI.
12. Q: What is the most common cause of pulseless electrical activity
(PEA)?
ANSWER Hypovolemia. Rationale: The "H's and T's" are the causes of
PEA; Hypovolemia is the most common.
13. Q: A patient with a mechanical heart valve presents with a severe
headache and right-sided hemiparesis. INR is 1.2. What is the most
appropriate action?
ANSWER Emergent CT head to rule out hemorrhage, then IV Vitamin K
and Fresh Frozen Plasma (FFP) or Prothrombin Complex Concentrate
(PCC). Rationale: Suspected thrombotic stroke in a non-anticoagulated
mechanical valve patient requires rapid reversal and neurology consult.
14. Q: Which heart murmur is associated with hypertrophic obstructive
cardiomyopathy (HOCM) and worsens with Valsalva?
ANSWER Systolic ejection murmur that increases with Valsalva.
Rationale: Valsalva decreases preload, which increases the dynamic
outflow tract obstruction in HOCM, making the murmur louder.
15. Q: A patient in cardiac arrest has return of spontaneous circulation
(ROSC) but remains comatose. What targeted temperature management
(TTM) guideline is recommended?
, ANSWER Maintain core temperature between 32°C and 36°C for at least
24 hours. Rationale: TTM improves neurologic outcomes in comatose
post-cardiac arrest patients.
Neurology (16-30)
16. Q: A 68-year-old patient presents with sudden onset right-sided
hemiplegia and aphasia. Symptoms started 2 hours ago. CT head is
negative for hemorrhage. What is the definitive treatment?
ANSWER Alteplase (tPA) IV. Rationale: Ischemic stroke within the 3 to
4.5-hour window without contraindications warrants thrombolytics.
17. Q: What is the absolute contraindication to administering tPA in an
acute ischemic stroke?
ANSWER Active internal bleeding or intracranial hemorrhage on CT.
Rationale: Giving tPA in the setting of hemorrhage is fatal.
18. Q: A patient presents with the "worst headache of my life." What is the
initial diagnostic test of choice?
ANSWER Non-contrast CT head. Rationale: Highly sensitive for detecting
acute subarachnoid hemorrhage (SAH) in the first 24 hours.
19. Q: If the non-contrast CT head is negative for subarachnoid
hemorrhage but clinical suspicion remains high, what is the next step?
ANSWER Lumbar Puncture (LP). Rationale: LP looks for xanthochromia
(yellowish tint from bilirubin, a breakdown product of RBCs) to confirm
SAH.
20. Q: A 22-year-old female presents with a severe headache, fever, and
nuchal rigidity. What is the most appropriate empiric antibiotic to add if
Neisseria meningitidis is suspected?
