EMERGENCY NURSE PRACTITIONER
(ENP-C) ADVANCED PRACTICE
EXAMINATION QUESTIONS AND
ANSWERS
1. A 62-year-old male presents with severe chest pain and an ECG showing a Left Bundle
Branch Block (LBBB). Which of the following findings, based on the Modified Sgarbossa
Criteria, is most predictive of an acute ST-elevation myocardial infarction (STEMI)?
A. ST-segment depression ≥ 1 mm in lead V1, V2, or V3
B. ST-segment elevation ≥ 0.5 mm in lead V5 or V6
C. Excessive discordant ST-segment elevation ≥ 5 mm in leads with a negative QRS complex
D. Concordant ST-segment elevation ≥ 1 mm in any lead with a positive QRS complex
Answer: D
Conceptual Explanation: The Modified Sgarbossa Criteria are used to identify STEMI in
the presence of LBBB. Concordant ST-elevation ≥ 1 mm in any lead is the most specific
finding (Score 5 in original criteria).
,2. A 45-year-old female presents with a ‘thunderclap’ headache and a normal non-contrast CT
head performed 4 hours after symptom onset. What is the most appropriate next step for an
ENP to rule out subarachnoid hemorrhage (SAH)?
A. Perform a CT Angiogram (CTA) of the head
B. Order a repeat CT head in 24 hours
C. Discharge with instructions for migraine management
D. Perform a Lumbar Puncture (LP) to check for xanthochromia
Answer: D
Conceptual Explanation: While modern CT scans are highly sensitive for SAH within 6
hours, the gold standard for ruling out SAH following a negative CT in a high-risk patient
remains a lumbar puncture to assess for xanthochromia or red blood cells.
3. Which of the following findings is most characteristic of Brown-Séquard Syndrome
following a penetrating spinal cord injury?
A. Ipsilateral loss of motor function and contralateral loss of pain and temperature
sensation
B. Bilateral loss of motor function with preserved proprioception
C. Contralateral loss of motor function and ipsilateral loss of pain sensation
D. Total loss of all sensation and motor function below the level of the lesion
Answer: A
, Conceptual Explanation: Brown-Séquard Syndrome involves hemisection of the spinal
cord, resulting in ipsilateral loss of motor function (corticospinal tract) and proprioception
(dorsal columns), with contralateral loss of pain and temperature (spinothalamic tract).
4. A 4-year-old child presents in respiratory distress with drooling, muffled voice, and a high
fever. Stridor is noted. What is the immediate priority for the ENP?
A. Obtain a lateral neck X-ray to look for a ‘thumbprint’ sign
B. Attempt a bedside visual examination of the oropharynx with a tongue blade
C. Administer nebulized racemic epinephrine and IV dexamethasone
D. Keep the child calm and prepare for controlled airway management in the OR
Answer: D
Conceptual Explanation: These symptoms suggest Epiglottitis. The priority is maintaining
the airway while avoiding agitation, as attempts to visualize the throat or perform painful
procedures can trigger laryngospasm. Airway management should be done by experts in a
controlled environment.
5. In the management of Hyperosmolar Hyperglycemic State (HHS), what is the primary
physiological goal that differs significantly from the management of Diabetic Ketoacidosis
(DKA)?
A. Aggressive fluid resuscitation to correct the profound free water deficit
B. Rapid reduction of blood glucose levels to under 200 mg/dL
C. Correction of metabolic acidosis via bicarbonate administration
(ENP-C) ADVANCED PRACTICE
EXAMINATION QUESTIONS AND
ANSWERS
1. A 62-year-old male presents with severe chest pain and an ECG showing a Left Bundle
Branch Block (LBBB). Which of the following findings, based on the Modified Sgarbossa
Criteria, is most predictive of an acute ST-elevation myocardial infarction (STEMI)?
A. ST-segment depression ≥ 1 mm in lead V1, V2, or V3
B. ST-segment elevation ≥ 0.5 mm in lead V5 or V6
C. Excessive discordant ST-segment elevation ≥ 5 mm in leads with a negative QRS complex
D. Concordant ST-segment elevation ≥ 1 mm in any lead with a positive QRS complex
Answer: D
Conceptual Explanation: The Modified Sgarbossa Criteria are used to identify STEMI in
the presence of LBBB. Concordant ST-elevation ≥ 1 mm in any lead is the most specific
finding (Score 5 in original criteria).
,2. A 45-year-old female presents with a ‘thunderclap’ headache and a normal non-contrast CT
head performed 4 hours after symptom onset. What is the most appropriate next step for an
ENP to rule out subarachnoid hemorrhage (SAH)?
A. Perform a CT Angiogram (CTA) of the head
B. Order a repeat CT head in 24 hours
C. Discharge with instructions for migraine management
D. Perform a Lumbar Puncture (LP) to check for xanthochromia
Answer: D
Conceptual Explanation: While modern CT scans are highly sensitive for SAH within 6
hours, the gold standard for ruling out SAH following a negative CT in a high-risk patient
remains a lumbar puncture to assess for xanthochromia or red blood cells.
3. Which of the following findings is most characteristic of Brown-Séquard Syndrome
following a penetrating spinal cord injury?
A. Ipsilateral loss of motor function and contralateral loss of pain and temperature
sensation
B. Bilateral loss of motor function with preserved proprioception
C. Contralateral loss of motor function and ipsilateral loss of pain sensation
D. Total loss of all sensation and motor function below the level of the lesion
Answer: A
, Conceptual Explanation: Brown-Séquard Syndrome involves hemisection of the spinal
cord, resulting in ipsilateral loss of motor function (corticospinal tract) and proprioception
(dorsal columns), with contralateral loss of pain and temperature (spinothalamic tract).
4. A 4-year-old child presents in respiratory distress with drooling, muffled voice, and a high
fever. Stridor is noted. What is the immediate priority for the ENP?
A. Obtain a lateral neck X-ray to look for a ‘thumbprint’ sign
B. Attempt a bedside visual examination of the oropharynx with a tongue blade
C. Administer nebulized racemic epinephrine and IV dexamethasone
D. Keep the child calm and prepare for controlled airway management in the OR
Answer: D
Conceptual Explanation: These symptoms suggest Epiglottitis. The priority is maintaining
the airway while avoiding agitation, as attempts to visualize the throat or perform painful
procedures can trigger laryngospasm. Airway management should be done by experts in a
controlled environment.
5. In the management of Hyperosmolar Hyperglycemic State (HHS), what is the primary
physiological goal that differs significantly from the management of Diabetic Ketoacidosis
(DKA)?
A. Aggressive fluid resuscitation to correct the profound free water deficit
B. Rapid reduction of blood glucose levels to under 200 mg/dL
C. Correction of metabolic acidosis via bicarbonate administration
