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BARKLEY EMERGENCY/CRITICAL CARE PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
EMERGENCY/CRITICAL
Prepare for the Barkley Emergency/Critical Care Practice Exam with a focused study
resource covering essential concepts in emergency and critical care management. It
supports review of acute patient assessment, life-threatening conditions,
stabilization, prioritization, emergency interventions, critical care principles, and
patient safety. Use the material to reinforce clinical knowledge, strengthen rapid
decision-making, and identify areas that may require additional study. This resource is
best suited for nurse practitioner students and certification candidates preparing for
emergency, critical care, and board-style assessments.
MULTIPLE CHOICE.
1. A 68-year-old male presents to the emergency department with sudden
onset of chest pain, diaphoresis, and shortness of breath. His ECG shows
ST-segment elevation in leads V1–V4. Which of the following is the priority
intervention?
A) Aspirin and sublingual nitroglycerin
B) Immediate percutaneous coronary intervention (PCI) or thrombolytic
therapy
C) Oxygen at 4 L/min via nasal cannula
D) Morphine sulfate for pain
Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior ST-
elevation myocardial infarction (STEMI). The priority is reperfusion therapy
with PCI (preferred) or thrombolytics. Aspirin and nitroglycerin are
important but do not provide reperfusion; oxygen and morphine are
adjuncts.
, Page 2 of 49
2. A 55-year-old female with a history of asthma presents with respiratory
distress, audible wheezing, and use of accessory muscles. Her peak
expiratory flow rate is 40% of predicted. What is the most appropriate
initial treatment?
A) Nebulized albuterol and ipratropium
B) Systemic corticosteroids
C) Nebulized albuterol, ipratropium, and systemic corticosteroids
D) Intubation and mechanical ventilation
Answer: C
Rationale: This patient has a severe asthma exacerbation (PEFR < 50%
predicted). Treatment includes continuous or frequent nebulized
albuterol, ipratropium, and systemic corticosteroids. Intubation is
reserved for impending respiratory failure with altered mental status,
exhaustion, or worsening despite treatment.
3. A 72-year-old male presents with hypotension, tachycardia, and jugular
venous distension. His chest X-ray shows a widened mediastinum. Which
diagnosis is most likely?
A) Cardiac tamponade
B) Aortic dissection
C) Pulmonary embolism
D) Myocardial infarction
Answer: B
Rationale: Aortic dissection presents with sudden severe chest pain,
hypotension, tachycardia, and a widened mediastinum on chest X-ray.
Cardiac tamponade would show muffled heart sounds and may be a
complication; pulmonary embolism would show clear lungs; myocardial
infarction would show ECG changes.
, Page 3 of 49
4. A 45-year-old male is brought to the emergency department after a
motor vehicle accident. He is lethargic and responds to painful stimuli.
His Glasgow Coma Scale (GCS) score is 8. What is the priority
intervention?
A) Obtain a CT scan of the head
B) Secure the airway
C) Administer IV fluids
D) Perform a focused assessment with sonography for trauma (FAST)
Answer: B
Rationale: A GCS of 8 indicates a severe brain injury. The priority is to
secure the airway to prevent hypoxia and aspiration. Airway management
always takes precedence over imaging, IV fluids, or FAST exam in a
trauma patient.
5. A 60-year-old female with a history of heart failure presents with acute
respiratory distress, crackles, and frothy sputum. Her blood pressure is
160/95 mmHg and heart rate is 110 bpm. What is the most appropriate
treatment?
A) Nitroglycerin and furosemide
B) Morphine and oxygen
C) Dobutamine and dopamine
D) IV fluids and antibiotics
Answer: A
Rationale: This patient has acute pulmonary edema from heart failure.
Treatment includes preload reduction (nitroglycerin) and diuresis
(furosemide). Morphine and oxygen are adjuncts but not primary;
dobutamine and dopamine are used in cardiogenic shock; IV fluids would
worsen pulmonary edema.
, Page 4 of 49
6. A 25-year-old male presents with a stab wound to the chest. He is
tachypneic, tachycardic, and has diminished breath sounds on the left
side. Which intervention is most appropriate?
A) Needle decompression
B) Chest tube insertion
C) Oxygen therapy
D) IV fluids
Answer: B
Rationale: This patient has a pneumothorax. A chest tube is the definitive
treatment for a traumatic pneumothorax. Needle decompression is a
temporary measure for tension pneumothorax; oxygen and fluids are
supportive but not definitive.
7. A 65-year-old male with a history of chronic obstructive pulmonary
disease (COPD) presents with acute respiratory failure. His arterial blood
gas shows pH 7.25, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L.
What is the most appropriate intervention?
A) Non-invasive positive pressure ventilation (NIPPV)
B) Intubation and mechanical ventilation
C) Oxygen at 2 L/min via nasal cannula
D) Nebulized bronchodilators
Answer: A
Rationale: This patient has acute-on-chronic respiratory acidosis. Non-
invasive ventilation (BiPAP) is first-line for COPD exacerbations with
respiratory acidosis, provided the patient is awake and able to protect the
airway. Intubation is reserved for failure of NIPPV or decreased
consciousness.
BARKLEY EMERGENCY/CRITICAL CARE PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
EMERGENCY/CRITICAL
Prepare for the Barkley Emergency/Critical Care Practice Exam with a focused study
resource covering essential concepts in emergency and critical care management. It
supports review of acute patient assessment, life-threatening conditions,
stabilization, prioritization, emergency interventions, critical care principles, and
patient safety. Use the material to reinforce clinical knowledge, strengthen rapid
decision-making, and identify areas that may require additional study. This resource is
best suited for nurse practitioner students and certification candidates preparing for
emergency, critical care, and board-style assessments.
MULTIPLE CHOICE.
1. A 68-year-old male presents to the emergency department with sudden
onset of chest pain, diaphoresis, and shortness of breath. His ECG shows
ST-segment elevation in leads V1–V4. Which of the following is the priority
intervention?
A) Aspirin and sublingual nitroglycerin
B) Immediate percutaneous coronary intervention (PCI) or thrombolytic
therapy
C) Oxygen at 4 L/min via nasal cannula
D) Morphine sulfate for pain
Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior ST-
elevation myocardial infarction (STEMI). The priority is reperfusion therapy
with PCI (preferred) or thrombolytics. Aspirin and nitroglycerin are
important but do not provide reperfusion; oxygen and morphine are
adjuncts.
, Page 2 of 49
2. A 55-year-old female with a history of asthma presents with respiratory
distress, audible wheezing, and use of accessory muscles. Her peak
expiratory flow rate is 40% of predicted. What is the most appropriate
initial treatment?
A) Nebulized albuterol and ipratropium
B) Systemic corticosteroids
C) Nebulized albuterol, ipratropium, and systemic corticosteroids
D) Intubation and mechanical ventilation
Answer: C
Rationale: This patient has a severe asthma exacerbation (PEFR < 50%
predicted). Treatment includes continuous or frequent nebulized
albuterol, ipratropium, and systemic corticosteroids. Intubation is
reserved for impending respiratory failure with altered mental status,
exhaustion, or worsening despite treatment.
3. A 72-year-old male presents with hypotension, tachycardia, and jugular
venous distension. His chest X-ray shows a widened mediastinum. Which
diagnosis is most likely?
A) Cardiac tamponade
B) Aortic dissection
C) Pulmonary embolism
D) Myocardial infarction
Answer: B
Rationale: Aortic dissection presents with sudden severe chest pain,
hypotension, tachycardia, and a widened mediastinum on chest X-ray.
Cardiac tamponade would show muffled heart sounds and may be a
complication; pulmonary embolism would show clear lungs; myocardial
infarction would show ECG changes.
, Page 3 of 49
4. A 45-year-old male is brought to the emergency department after a
motor vehicle accident. He is lethargic and responds to painful stimuli.
His Glasgow Coma Scale (GCS) score is 8. What is the priority
intervention?
A) Obtain a CT scan of the head
B) Secure the airway
C) Administer IV fluids
D) Perform a focused assessment with sonography for trauma (FAST)
Answer: B
Rationale: A GCS of 8 indicates a severe brain injury. The priority is to
secure the airway to prevent hypoxia and aspiration. Airway management
always takes precedence over imaging, IV fluids, or FAST exam in a
trauma patient.
5. A 60-year-old female with a history of heart failure presents with acute
respiratory distress, crackles, and frothy sputum. Her blood pressure is
160/95 mmHg and heart rate is 110 bpm. What is the most appropriate
treatment?
A) Nitroglycerin and furosemide
B) Morphine and oxygen
C) Dobutamine and dopamine
D) IV fluids and antibiotics
Answer: A
Rationale: This patient has acute pulmonary edema from heart failure.
Treatment includes preload reduction (nitroglycerin) and diuresis
(furosemide). Morphine and oxygen are adjuncts but not primary;
dobutamine and dopamine are used in cardiogenic shock; IV fluids would
worsen pulmonary edema.
, Page 4 of 49
6. A 25-year-old male presents with a stab wound to the chest. He is
tachypneic, tachycardic, and has diminished breath sounds on the left
side. Which intervention is most appropriate?
A) Needle decompression
B) Chest tube insertion
C) Oxygen therapy
D) IV fluids
Answer: B
Rationale: This patient has a pneumothorax. A chest tube is the definitive
treatment for a traumatic pneumothorax. Needle decompression is a
temporary measure for tension pneumothorax; oxygen and fluids are
supportive but not definitive.
7. A 65-year-old male with a history of chronic obstructive pulmonary
disease (COPD) presents with acute respiratory failure. His arterial blood
gas shows pH 7.25, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L.
What is the most appropriate intervention?
A) Non-invasive positive pressure ventilation (NIPPV)
B) Intubation and mechanical ventilation
C) Oxygen at 2 L/min via nasal cannula
D) Nebulized bronchodilators
Answer: A
Rationale: This patient has acute-on-chronic respiratory acidosis. Non-
invasive ventilation (BiPAP) is first-line for COPD exacerbations with
respiratory acidosis, provided the patient is awake and able to protect the
airway. Intubation is reserved for failure of NIPPV or decreased
consciousness.
