BARKLEY EMERGENCY NURSE
PRACTITIONER (ENP-C)
COMPREHENSIVE REVIEW 2026/2027
1. A 45-year-old male presents with sudden onset of ‘the worst headache of my life.’ The
initial non-contrast CT head is negative. What is the most appropriate next step in the
workup for suspected subarachnoid hemorrhage (SAH)?
A. Repeat CT head in 6 hours
B. Order an MRI of the brain
C. Perform a lumbar puncture (LP)
D. Discharge with instructions for migraine follow-up
Answer: C
Conceptual Explanation: For suspected SAH, if the initial non-contrast CT is negative and
the clinical suspicion remains high, a lumbar puncture is the gold standard to look for
xanthochromia or red blood cells. CT sensitivity decreases after the first 6-12 hours.
2. Which of the following Salter-Harris fractures involves a fracture through the growth plate
(physis) and the metaphysis?
A. Type I
,B. Type II
C. Type III
D. Type IV
Answer: B
Conceptual Explanation: Salter-Harris Type II fractures pass through the growth plate
and the metaphysis. Type I is through the physis only; Type III is through the physis and
epiphysis; Type IV is through all three; Type V is a crush injury.
3. A patient presents with a ‘tearing’ chest pain radiating to the back. Blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the gold standard
diagnostic imaging for this condition?
A. CT Angiography (CTA)
B. Transthoracic Echocardiogram (TTE)
C. Chest X-ray
D. 12-Lead EKG
Answer: A
Conceptual Explanation: CT Angiography (CTA) of the chest and abdomen is the gold
standard for diagnosing aortic dissection due to its high sensitivity and specificity and
ability to delineate the extent of the flap.
, 4. In the management of an acute asthma exacerbation, which of the following is an absolute
indication for intubation?
A. Silent chest on auscultation
B. Respiratory rate of 28 breaths/min
C. Use of accessory muscles
D. Oxygen saturation of 92% on room air
Answer: A
Conceptual Explanation: A ‘silent chest’ indicates minimal air movement and impending
respiratory failure. Other indications include altered mental status and paradoxical
thoracoabdominal breathing. RR and accessory muscle use are signs of distress but not
absolute indications for intubation on their own.
5. Which criteria are used to clinically clear a patient’s cervical spine without imaging?
A. Wells Criteria
B. NEXUS Criteria
C. CHADS2 Vasc Score
D. CURB-65
Answer: B
PRACTITIONER (ENP-C)
COMPREHENSIVE REVIEW 2026/2027
1. A 45-year-old male presents with sudden onset of ‘the worst headache of my life.’ The
initial non-contrast CT head is negative. What is the most appropriate next step in the
workup for suspected subarachnoid hemorrhage (SAH)?
A. Repeat CT head in 6 hours
B. Order an MRI of the brain
C. Perform a lumbar puncture (LP)
D. Discharge with instructions for migraine follow-up
Answer: C
Conceptual Explanation: For suspected SAH, if the initial non-contrast CT is negative and
the clinical suspicion remains high, a lumbar puncture is the gold standard to look for
xanthochromia or red blood cells. CT sensitivity decreases after the first 6-12 hours.
2. Which of the following Salter-Harris fractures involves a fracture through the growth plate
(physis) and the metaphysis?
A. Type I
,B. Type II
C. Type III
D. Type IV
Answer: B
Conceptual Explanation: Salter-Harris Type II fractures pass through the growth plate
and the metaphysis. Type I is through the physis only; Type III is through the physis and
epiphysis; Type IV is through all three; Type V is a crush injury.
3. A patient presents with a ‘tearing’ chest pain radiating to the back. Blood pressure is
180/100 mmHg in the right arm and 140/90 mmHg in the left arm. What is the gold standard
diagnostic imaging for this condition?
A. CT Angiography (CTA)
B. Transthoracic Echocardiogram (TTE)
C. Chest X-ray
D. 12-Lead EKG
Answer: A
Conceptual Explanation: CT Angiography (CTA) of the chest and abdomen is the gold
standard for diagnosing aortic dissection due to its high sensitivity and specificity and
ability to delineate the extent of the flap.
, 4. In the management of an acute asthma exacerbation, which of the following is an absolute
indication for intubation?
A. Silent chest on auscultation
B. Respiratory rate of 28 breaths/min
C. Use of accessory muscles
D. Oxygen saturation of 92% on room air
Answer: A
Conceptual Explanation: A ‘silent chest’ indicates minimal air movement and impending
respiratory failure. Other indications include altered mental status and paradoxical
thoracoabdominal breathing. RR and accessory muscle use are signs of distress but not
absolute indications for intubation on their own.
5. Which criteria are used to clinically clear a patient’s cervical spine without imaging?
A. Wells Criteria
B. NEXUS Criteria
C. CHADS2 Vasc Score
D. CURB-65
Answer: B
