The Ultimate ENP-C Exam Cram:
Practice Questions with Correct
Answers & Detailed Rationales
Cardiovascular Emergencies
A 62-year-old male presents with chest pressure radiating to the left arm,
diaphoresis, and nausea. BP 148/92, HR 104, SpO2 95%. What is the most
appropriate initial intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Start IV antibiotics
D) Obtain a chest X-ray
Answer: B – The priority is to obtain a 12-lead EKG to confirm or rule out
STEMI, as time-to-diagnosis and reperfusion are critical for myocardial
salvage. While nitroglycerin may be indicated, diagnosis must precede
treatment.
Which EKG finding 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 – 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 these leads suggest posterior MI.
A patient with suspected STEMI develops pulseless ventricular tachycardia.
What is the immediate treatment?
A) Amiodarone 300 mg IV push
B) Defibrillation at 200 J biphasic
C) Epinephrine 1 mg IV push
D) Synchronized cardioversion
Answer: B – Pulseless ventricular tachycardia is a shockable rhythm
requiring immediate defibrillation. Unsynchronized defibrillation at 200 J
biphasic is the priority. Amiodarone and epinephrine are given after
defibrillation if the rhythm persists.
A 55-year-old with hypertension and diabetes presents with dyspnea,
orthopnea, and bilateral crackles. What is the most appropriate initial
pharmacologic intervention for acute pulmonary edema?
A) IV furosemide
B) Sublingual nitroglycerin
,C) IV morphine
D) IV digoxin
Answer: A – IV furosemide is the first-line diuretic for acute pulmonary
edema to reduce preload. Nitroglycerin and morphine are adjunctive
therapies. Digoxin has no role in acute management.
A 72-year-old male with heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. BP 165/98, HR 118, RR 32, SpO2 88%
on 4L NC. Lung auscultation reveals bilateral crackles. What is the most
appropriate initial intervention?
A) IV furosemide 40 mg
B) IV nitroglycerin infusion
C) Non-invasive positive pressure ventilation (BiPAP)
D) IV morphine sulfate
Answer: C – BiPAP is indicated for severe respiratory distress with hypoxia
and signs of pulmonary edema. It reduces preload and afterload while
improving oxygenation. Diuretics and nitroglycerin are important but do
not address immediate respiratory failure.
A 48-year-old male presents with acute right leg swelling, pain, and warmth
after a long flight. He has no chest pain or dyspnea. What is the most
appropriate initial diagnostic approach?
A) D-dimer
B) Venous duplex ultrasound of the right leg
, C) CT pulmonary angiography
D) Wells criteria assessment followed by D-dimer
Answer: D – Using a clinical prediction rule such as the Wells criteria to
stratify risk is the recommended first step. If low pretest probability, a D-
dimer can rule out DVT. If moderate to high probability, duplex ultrasound
is indicated.
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 5 presents
with sudden left-sided weakness and facial droop. What is the most
appropriate next step?
A) Administer IV heparin
B) Obtain a non-contrast CT head
C) Start aspirin 325 mg
D) Administer IV tPA immediately
Answer: B – A non-contrast CT head must be obtained emergently to rule
out intracranial hemorrhage before any anticoagulation or thrombolytic
therapy is considered. Time from symptom onset determines tPA eligibility.
A 68-year-old male with sudden severe chest pain and a blood pressure of
80/50 mmHg has jugular venous distention and muffled heart sounds.
What is the most likely diagnosis?
A) Acute myocardial infarction
B) Cardiac tamponade
Practice Questions with Correct
Answers & Detailed Rationales
Cardiovascular Emergencies
A 62-year-old male presents with chest pressure radiating to the left arm,
diaphoresis, and nausea. BP 148/92, HR 104, SpO2 95%. What is the most
appropriate initial intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Start IV antibiotics
D) Obtain a chest X-ray
Answer: B – The priority is to obtain a 12-lead EKG to confirm or rule out
STEMI, as time-to-diagnosis and reperfusion are critical for myocardial
salvage. While nitroglycerin may be indicated, diagnosis must precede
treatment.
Which EKG finding 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 – 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 these leads suggest posterior MI.
A patient with suspected STEMI develops pulseless ventricular tachycardia.
What is the immediate treatment?
A) Amiodarone 300 mg IV push
B) Defibrillation at 200 J biphasic
C) Epinephrine 1 mg IV push
D) Synchronized cardioversion
Answer: B – Pulseless ventricular tachycardia is a shockable rhythm
requiring immediate defibrillation. Unsynchronized defibrillation at 200 J
biphasic is the priority. Amiodarone and epinephrine are given after
defibrillation if the rhythm persists.
A 55-year-old with hypertension and diabetes presents with dyspnea,
orthopnea, and bilateral crackles. What is the most appropriate initial
pharmacologic intervention for acute pulmonary edema?
A) IV furosemide
B) Sublingual nitroglycerin
,C) IV morphine
D) IV digoxin
Answer: A – IV furosemide is the first-line diuretic for acute pulmonary
edema to reduce preload. Nitroglycerin and morphine are adjunctive
therapies. Digoxin has no role in acute management.
A 72-year-old male with heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. BP 165/98, HR 118, RR 32, SpO2 88%
on 4L NC. Lung auscultation reveals bilateral crackles. What is the most
appropriate initial intervention?
A) IV furosemide 40 mg
B) IV nitroglycerin infusion
C) Non-invasive positive pressure ventilation (BiPAP)
D) IV morphine sulfate
Answer: C – BiPAP is indicated for severe respiratory distress with hypoxia
and signs of pulmonary edema. It reduces preload and afterload while
improving oxygenation. Diuretics and nitroglycerin are important but do
not address immediate respiratory failure.
A 48-year-old male presents with acute right leg swelling, pain, and warmth
after a long flight. He has no chest pain or dyspnea. What is the most
appropriate initial diagnostic approach?
A) D-dimer
B) Venous duplex ultrasound of the right leg
, C) CT pulmonary angiography
D) Wells criteria assessment followed by D-dimer
Answer: D – Using a clinical prediction rule such as the Wells criteria to
stratify risk is the recommended first step. If low pretest probability, a D-
dimer can rule out DVT. If moderate to high probability, duplex ultrasound
is indicated.
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 5 presents
with sudden left-sided weakness and facial droop. What is the most
appropriate next step?
A) Administer IV heparin
B) Obtain a non-contrast CT head
C) Start aspirin 325 mg
D) Administer IV tPA immediately
Answer: B – A non-contrast CT head must be obtained emergently to rule
out intracranial hemorrhage before any anticoagulation or thrombolytic
therapy is considered. Time from symptom onset determines tPA eligibility.
A 68-year-old male with sudden severe chest pain and a blood pressure of
80/50 mmHg has jugular venous distention and muffled heart sounds.
What is the most likely diagnosis?
A) Acute myocardial infarction
B) Cardiac tamponade
