BARKLEY ENP REVIEW EMERGENCY NURSE PRACTITIONER QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Medical Screening & Patient Acuity
2. Medical Decision Making & Differential Diagnosis
3. Patient Management & Resuscitation
4. Transitions of Care & Disposition
5. Professional Practices & Regulatory Compliance
6. Thoracic-Respiratory & Cardiovascular Disorders
7. Abdominal & Gastrointestinal Disorders
8. Traumatic Disorders & Musculoskeletal Injuries
9. Neurological & Psychobehavioral Disorders
10. Environmental, Toxicological, & Infectious Emergencies
Introduction
,This comprehensive examination is designed to assess the advanced clinical knowledge, critical thinking, and
evidence-based decision-making skills required for the Emergency Nurse Practitioner (ENP) certification. The exam
evaluates competency across the full spectrum of emergency care, including medical screening, differential
diagnosis, acute patient management, resuscitation, and disposition planning. Each question reflects real-world
clinical scenarios that demand integration of pathophysiology, pharmacology, diagnostic reasoning, and
professional standards. The multiple-choice format, coupled with detailed rationales, reinforces key concepts and
prepares the candidate for the rigor of the national certification examination. Mastery of this content ensures the
ENP is equipped to deliver safe, effective, and equitable emergency care across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male with a history of hypertension and type 2 diabetes presents with sudden-onset, severe
substernal chest pressure radiating to the jaw and left arm, accompanied by diaphoresis and nausea. His vital
signs are BP 158/92, HR 102, RR 22, SpO2 96% on room air. An electrocardiogram reveals ST-segment elevation
of 3 mm in leads V2–V4. Which of the following is the most appropriate immediate intervention?
A. Administer sublingual nitroglycerin 0.4 mg and obtain a chest X-ray
B. Initiate supplemental oxygen at 15 L/min via non-rebreather mask and obtain cardiac enzymes
C. Administer aspirin 324 mg chewed, obtain IV access, and prepare for emergent percutaneous coronary
,intervention
D. Administer morphine sulfate 4 mg IV and schedule for stress testing
🟢 C. Administer aspirin 324 mg chewed, obtain IV access, and prepare for emergent percutaneous coronary
intervention
🔴 RATIONALE: This patient presents with classic symptoms and ECG findings of an ST-segment elevation
myocardial infarction (STEMI). The standard of care includes immediate administration of aspirin (324 mg
chewed for rapid absorption), establishing IV access, and activating the catheterization lab for emergent PCI.
This is the evidence-based approach to restore coronary perfusion and reduce mortality. Nitroglycerin may be
considered but is not the immediate priority over antiplatelet therapy and reperfusion. High-flow oxygen is not
routinely indicated unless SpO2 is below 90%. Morphine should be used cautiously and is not the first-line
intervention.
Question 2
A 72-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents with worsening
dyspnea, productive cough with purulent sputum, and fever. She is tachypneic with accessory muscle use.
Arterial blood gas on room air shows pH 7.28, PaCO2 62 mmHg, PaO2 58 mmHg, HCO3 26 mEq/L. Which of the
following is the most appropriate initial management?
A. Initiate non-invasive positive pressure ventilation (NIPPV) with bilevel positive airway pressure (BiPAP)
B. Administer high-flow oxygen via non-rebreather mask at 15 L/min
C. Intubate and initiate mechanical ventilation immediately
D. Administer nebulized albuterol and ipratropium and discharge home with oral corticosteroids
, 🟢 A. Initiate non-invasive positive pressure ventilation (NIPPV) with bilevel positive airway pressure (BiPAP)
🔴 RATIONALE: This patient is in acute hypercapnic respiratory failure due to a COPD exacerbation, evidenced
by an elevated PaCO2 and respiratory acidosis. NIPPV with BiPAP is the first-line intervention for acute
hypercapnic respiratory failure in COPD, as it reduces the work of breathing, improves ventilation, and decreases
the need for intubation. High-flow oxygen without ventilatory support may worsen hypercapnia. Intubation is
reserved for patients who fail NIPPV or are unable to protect their airway. Outpatient management is
inappropriate given the severity of respiratory failure.
Question 3
A 34-year-old male is brought to the emergency department after a motor vehicle collision. He is confused, has
a Glasgow Coma Scale (GCS) score of 12, and exhibits a left-sided hemiparesis. His blood pressure is 145/90
mmHg, heart rate 88 bpm, and respiratory rate 18. A non-contrast head CT shows no acute intracranial
hemorrhage. Which of the following is the most appropriate next step in management?
A. Administer tissue plasminogen activator (tPA) immediately
B. Obtain a CT angiogram of the head and neck to evaluate for large vessel occlusion
C. Admit to the observation unit for serial neurological checks
D. Administer aspirin 325 mg and discharge with neurology follow-up
🟢 B. Obtain a CT angiogram of the head and neck to evaluate for large vessel occlusion
🔴 RATIONALE: This patient presents with an acute ischemic stroke with a GCS of 12 and focal neurological
deficits (left hemiparesis). While tPA is a consideration, it is critical to first rule out a large vessel occlusion (LVO)
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Medical Screening & Patient Acuity
2. Medical Decision Making & Differential Diagnosis
3. Patient Management & Resuscitation
4. Transitions of Care & Disposition
5. Professional Practices & Regulatory Compliance
6. Thoracic-Respiratory & Cardiovascular Disorders
7. Abdominal & Gastrointestinal Disorders
8. Traumatic Disorders & Musculoskeletal Injuries
9. Neurological & Psychobehavioral Disorders
10. Environmental, Toxicological, & Infectious Emergencies
Introduction
,This comprehensive examination is designed to assess the advanced clinical knowledge, critical thinking, and
evidence-based decision-making skills required for the Emergency Nurse Practitioner (ENP) certification. The exam
evaluates competency across the full spectrum of emergency care, including medical screening, differential
diagnosis, acute patient management, resuscitation, and disposition planning. Each question reflects real-world
clinical scenarios that demand integration of pathophysiology, pharmacology, diagnostic reasoning, and
professional standards. The multiple-choice format, coupled with detailed rationales, reinforces key concepts and
prepares the candidate for the rigor of the national certification examination. Mastery of this content ensures the
ENP is equipped to deliver safe, effective, and equitable emergency care across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male with a history of hypertension and type 2 diabetes presents with sudden-onset, severe
substernal chest pressure radiating to the jaw and left arm, accompanied by diaphoresis and nausea. His vital
signs are BP 158/92, HR 102, RR 22, SpO2 96% on room air. An electrocardiogram reveals ST-segment elevation
of 3 mm in leads V2–V4. Which of the following is the most appropriate immediate intervention?
A. Administer sublingual nitroglycerin 0.4 mg and obtain a chest X-ray
B. Initiate supplemental oxygen at 15 L/min via non-rebreather mask and obtain cardiac enzymes
C. Administer aspirin 324 mg chewed, obtain IV access, and prepare for emergent percutaneous coronary
,intervention
D. Administer morphine sulfate 4 mg IV and schedule for stress testing
🟢 C. Administer aspirin 324 mg chewed, obtain IV access, and prepare for emergent percutaneous coronary
intervention
🔴 RATIONALE: This patient presents with classic symptoms and ECG findings of an ST-segment elevation
myocardial infarction (STEMI). The standard of care includes immediate administration of aspirin (324 mg
chewed for rapid absorption), establishing IV access, and activating the catheterization lab for emergent PCI.
This is the evidence-based approach to restore coronary perfusion and reduce mortality. Nitroglycerin may be
considered but is not the immediate priority over antiplatelet therapy and reperfusion. High-flow oxygen is not
routinely indicated unless SpO2 is below 90%. Morphine should be used cautiously and is not the first-line
intervention.
Question 2
A 72-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents with worsening
dyspnea, productive cough with purulent sputum, and fever. She is tachypneic with accessory muscle use.
Arterial blood gas on room air shows pH 7.28, PaCO2 62 mmHg, PaO2 58 mmHg, HCO3 26 mEq/L. Which of the
following is the most appropriate initial management?
A. Initiate non-invasive positive pressure ventilation (NIPPV) with bilevel positive airway pressure (BiPAP)
B. Administer high-flow oxygen via non-rebreather mask at 15 L/min
C. Intubate and initiate mechanical ventilation immediately
D. Administer nebulized albuterol and ipratropium and discharge home with oral corticosteroids
, 🟢 A. Initiate non-invasive positive pressure ventilation (NIPPV) with bilevel positive airway pressure (BiPAP)
🔴 RATIONALE: This patient is in acute hypercapnic respiratory failure due to a COPD exacerbation, evidenced
by an elevated PaCO2 and respiratory acidosis. NIPPV with BiPAP is the first-line intervention for acute
hypercapnic respiratory failure in COPD, as it reduces the work of breathing, improves ventilation, and decreases
the need for intubation. High-flow oxygen without ventilatory support may worsen hypercapnia. Intubation is
reserved for patients who fail NIPPV or are unable to protect their airway. Outpatient management is
inappropriate given the severity of respiratory failure.
Question 3
A 34-year-old male is brought to the emergency department after a motor vehicle collision. He is confused, has
a Glasgow Coma Scale (GCS) score of 12, and exhibits a left-sided hemiparesis. His blood pressure is 145/90
mmHg, heart rate 88 bpm, and respiratory rate 18. A non-contrast head CT shows no acute intracranial
hemorrhage. Which of the following is the most appropriate next step in management?
A. Administer tissue plasminogen activator (tPA) immediately
B. Obtain a CT angiogram of the head and neck to evaluate for large vessel occlusion
C. Admit to the observation unit for serial neurological checks
D. Administer aspirin 325 mg and discharge with neurology follow-up
🟢 B. Obtain a CT angiogram of the head and neck to evaluate for large vessel occlusion
🔴 RATIONALE: This patient presents with an acute ischemic stroke with a GCS of 12 and focal neurological
deficits (left hemiparesis). While tPA is a consideration, it is critical to first rule out a large vessel occlusion (LVO)
