BARKLEY EMERGENCY NURSE
PRACTITIONER (ENP-C) 2026/2027
COMPREHENSIVE EXAM
1. A 45-year-old male presents with a high-pressure injection injury to his left index finger
from a paint sprayer. There is a 2mm puncture wound but no swelling or pain. What is the
most appropriate management?
A. Immediate surgical consultation for operative debridement
B. Perform digital block and bedside irrigation
C. Apply a warm compress and discharge with oral antibiotics
D. Obtain an X-ray and observe for 4 hours for compartment syndrome
Answer: A
Conceptual Explanation: High-pressure injection injuries are surgical emergencies even
with minimal external findings. Initial benign appearance often masks deep tissue necrosis
and chemical inflammation requiring immediate operative debridement.
2. Which of the following is a criterion in the NEXUS C-spine rule that allows a clinician to
omit cervical spine imaging?
A. Absence of focal neurological deficit
,B. Age less than 65 years
C. Ability to rotate the neck 45 degrees
D. Negative distracting injury in the presence of midline tenderness
Answer: A
Conceptual Explanation: The NEXUS criteria include: No posterior midline cervical spine
tenderness, no evidence of intoxication, normal level of alertness, no focal neurological
deficit, and no painful distracting injuries.
3. A patient presents with suspected Salicylate toxicity. Which of the following acid-base
disturbances is most typically seen initially in adults?
A. Mixed respiratory alkalosis and metabolic acidosis
B. Respiratory acidosis with metabolic alkalosis
C. Pure metabolic acidosis
D. Isolated respiratory alkalosis
Answer: A
Conceptual Explanation: Salicylates stimulate the respiratory center directly causing
respiratory alkalosis, while also interfering with the Krebs cycle and oxidative
phosphorylation leading to metabolic acidosis (anion gap).
, 4. In a patient with suspected Boerhaave syndrome, which radiographic finding is most
characteristic?
A. Widened mediastinum on AP view only
B. Pneumomediastinum
C. Left-sided pleural effusion with high amylase
D. Subdiaphragmatic free air
Answer: B
Conceptual Explanation: Boerhaave syndrome (esophageal perforation) often presents
with Mackler’s triad (vomiting, chest pain, subcutaneous emphysema) and
pneumomediastinum on imaging.
5. A 28-year-old female presents with sudden onset pelvic pain and vaginal bleeding. Her HCG
is 1500 mIU/mL. Transvaginal ultrasound (TVUS) shows an empty uterus and no adnexal
masses. What is the next best step?
A. Immediate laparoscopy
B. Dilation and curettage
C. Administer Methotrexate 50mg/m2
D. Repeat HCG in 48 hours
Answer: D
PRACTITIONER (ENP-C) 2026/2027
COMPREHENSIVE EXAM
1. A 45-year-old male presents with a high-pressure injection injury to his left index finger
from a paint sprayer. There is a 2mm puncture wound but no swelling or pain. What is the
most appropriate management?
A. Immediate surgical consultation for operative debridement
B. Perform digital block and bedside irrigation
C. Apply a warm compress and discharge with oral antibiotics
D. Obtain an X-ray and observe for 4 hours for compartment syndrome
Answer: A
Conceptual Explanation: High-pressure injection injuries are surgical emergencies even
with minimal external findings. Initial benign appearance often masks deep tissue necrosis
and chemical inflammation requiring immediate operative debridement.
2. Which of the following is a criterion in the NEXUS C-spine rule that allows a clinician to
omit cervical spine imaging?
A. Absence of focal neurological deficit
,B. Age less than 65 years
C. Ability to rotate the neck 45 degrees
D. Negative distracting injury in the presence of midline tenderness
Answer: A
Conceptual Explanation: The NEXUS criteria include: No posterior midline cervical spine
tenderness, no evidence of intoxication, normal level of alertness, no focal neurological
deficit, and no painful distracting injuries.
3. A patient presents with suspected Salicylate toxicity. Which of the following acid-base
disturbances is most typically seen initially in adults?
A. Mixed respiratory alkalosis and metabolic acidosis
B. Respiratory acidosis with metabolic alkalosis
C. Pure metabolic acidosis
D. Isolated respiratory alkalosis
Answer: A
Conceptual Explanation: Salicylates stimulate the respiratory center directly causing
respiratory alkalosis, while also interfering with the Krebs cycle and oxidative
phosphorylation leading to metabolic acidosis (anion gap).
, 4. In a patient with suspected Boerhaave syndrome, which radiographic finding is most
characteristic?
A. Widened mediastinum on AP view only
B. Pneumomediastinum
C. Left-sided pleural effusion with high amylase
D. Subdiaphragmatic free air
Answer: B
Conceptual Explanation: Boerhaave syndrome (esophageal perforation) often presents
with Mackler’s triad (vomiting, chest pain, subcutaneous emphysema) and
pneumomediastinum on imaging.
5. A 28-year-old female presents with sudden onset pelvic pain and vaginal bleeding. Her HCG
is 1500 mIU/mL. Transvaginal ultrasound (TVUS) shows an empty uterus and no adnexal
masses. What is the next best step?
A. Immediate laparoscopy
B. Dilation and curettage
C. Administer Methotrexate 50mg/m2
D. Repeat HCG in 48 hours
Answer: D
