BARKLEY EMERGENCY NURSE
PRACTITIONER (ENP-C)
CERTIFICATION COMPREHENSIVE
PREP 2026/2027
1. A 62-year-old male presents with acute onset substernal chest pain. The ECG reveals ST-
segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Answer: C
Conceptual Explanation: ST elevation in leads V1-V4 typically indicates an anterior wall
myocardial infarction, which is most often caused by occlusion of the Left Anterior
Descending (LAD) artery.
,2. According to the NEXUS criteria, which of the following patients requires cervical spine
imaging?
A. A 25-year-old with no midline cervical tenderness and normal alertness.
B. A 40-year-old with a distracting painful injury (femur fracture) but no neck pain.
C. A 30-year-old with no focal neurologic deficits and no intoxication.
D. A 50-year-old who states their neck does not hurt during range of motion testing.
Answer: B
Conceptual Explanation: The NEXUS criteria specify that imaging is required if a
distracting painful injury is present, even if neck pain is absent, as it may mask cervical
spine symptoms.
3. A 4-year-old child presents with a high fever, drooling, and a ‘tripod’ position. What is the
most likely diagnosis?
A. Croup
B. Foreign body aspiration
C. Epiglottitis
D. Bacterial tracheitis
Answer: C
, Conceptual Explanation: Epiglottitis classically presents with the ‘4 Ds’: Drooling,
Dysphagia, Dysphonia, and Distressed inspiratory efforts, often in a tripod position to
maintain airway patency.
4. What is the initial management for a patient presenting with suspected tension
pneumothorax and hemodynamic instability?
A. Immediate chest X-ray
B. Needle decompression
C. Endotracheal intubation
D. Focused Assessment with Sonography for Trauma (FAST)
Answer: B
Conceptual Explanation: Tension pneumothorax is a clinical diagnosis requiring
immediate needle decompression to relieve intrapleural pressure before definitive chest
tube thoracostomy.
5. In the management of an acute asthma exacerbation, which medication is most
appropriate for a patient who does not respond to initial beta-agonist therapy?
A. Inhaled Ipratropium bromide
B. Oral Theophylline
C. Both A and C
D. Intravenous Magnesium Sulfate
PRACTITIONER (ENP-C)
CERTIFICATION COMPREHENSIVE
PREP 2026/2027
1. A 62-year-old male presents with acute onset substernal chest pain. The ECG reveals ST-
segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Answer: C
Conceptual Explanation: ST elevation in leads V1-V4 typically indicates an anterior wall
myocardial infarction, which is most often caused by occlusion of the Left Anterior
Descending (LAD) artery.
,2. According to the NEXUS criteria, which of the following patients requires cervical spine
imaging?
A. A 25-year-old with no midline cervical tenderness and normal alertness.
B. A 40-year-old with a distracting painful injury (femur fracture) but no neck pain.
C. A 30-year-old with no focal neurologic deficits and no intoxication.
D. A 50-year-old who states their neck does not hurt during range of motion testing.
Answer: B
Conceptual Explanation: The NEXUS criteria specify that imaging is required if a
distracting painful injury is present, even if neck pain is absent, as it may mask cervical
spine symptoms.
3. A 4-year-old child presents with a high fever, drooling, and a ‘tripod’ position. What is the
most likely diagnosis?
A. Croup
B. Foreign body aspiration
C. Epiglottitis
D. Bacterial tracheitis
Answer: C
, Conceptual Explanation: Epiglottitis classically presents with the ‘4 Ds’: Drooling,
Dysphagia, Dysphonia, and Distressed inspiratory efforts, often in a tripod position to
maintain airway patency.
4. What is the initial management for a patient presenting with suspected tension
pneumothorax and hemodynamic instability?
A. Immediate chest X-ray
B. Needle decompression
C. Endotracheal intubation
D. Focused Assessment with Sonography for Trauma (FAST)
Answer: B
Conceptual Explanation: Tension pneumothorax is a clinical diagnosis requiring
immediate needle decompression to relieve intrapleural pressure before definitive chest
tube thoracostomy.
5. In the management of an acute asthma exacerbation, which medication is most
appropriate for a patient who does not respond to initial beta-agonist therapy?
A. Inhaled Ipratropium bromide
B. Oral Theophylline
C. Both A and C
D. Intravenous Magnesium Sulfate
