EMERGENCY NURSE PRACTITIONER (ENP)
EXAMINATION
1. Emergency Assessment, Triage, and Clinical Decision-Making
Question 1
Which assessment finding in an adult patient with acute illness requires the emergency nurse practitioner
to intervene most immediately because it indicates impending airway compromise?
A. Respiratory rate of 24 breaths per minute
B. Hoarse voice with inspiratory stridor
C. Oxygen saturation of 94% on room air
D. Mild anxiety with diaphoresis
Correct Answer: B
Rationale:
B is correct because inspiratory stridor and a changing or hoarse voice suggest significant upper-airway
narrowing that can rapidly progress to complete obstruction.
A is incorrect because a respiratory rate of 24 is elevated but does not by itself indicate immediate airway
obstruction.
C is incorrect because an oxygen saturation of 94% is not, by itself, evidence of impending airway collapse.
D is incorrect because anxiety and diaphoresis are nonspecific findings and do not establish airway
compromise.
Question 2
A patient arrives after a motor-vehicle collision with severe respiratory distress, hypotension, and absent
breath sounds on the right side; what action should occur first?
A. Obtain a portable chest radiograph
B. Administer intravenous morphine for pain
C. Prepare for immediate needle or finger thoracostomy
D. Obtain a computed tomography scan of the chest
Correct Answer: C
Rationale:
C is correct because severe respiratory distress, hypotension, and unilateral absent breath sounds strongly
suggest tension pneumothorax, which requires immediate decompression without waiting for imaging.
A is incorrect because radiography should not delay lifesaving treatment in a clinically obvious tension
pneumothorax.
B is incorrect because opioid administration does not treat the obstructive physiology and may worsen
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,respiratory depression.
D is incorrect because CT imaging is inappropriate when immediate decompression is required.
Question 3
What clinical feature most strongly indicates that a patient with chest pain may be experiencing an acute
coronary syndrome rather than uncomplicated gastroesophageal reflux?
A. Burning discomfort occurring after a large meal
B. Pain reproducible with direct chest-wall palpation
C. Substernal pressure associated with diaphoresis and nausea
D. Symptoms improving after drinking an antacid
Correct Answer: C
Rationale:
C is correct because substernal pressure accompanied by autonomic symptoms such as diaphoresis and
nausea is highly concerning for myocardial ischemia.
A is incorrect because postprandial burning can occur with reflux, although meal association alone cannot
exclude ACS.
B is incorrect because reproducible chest-wall tenderness makes a musculoskeletal cause more likely,
although it does not absolutely exclude ACS.
D is incorrect because improvement with an antacid does not reliably distinguish reflux from cardiac
ischemia.
Question 4
Which electrocardiographic finding in a patient with crushing substernal chest pain most strongly supports
an acute ST-elevation myocardial infarction requiring immediate reperfusion evaluation?
A. Diffuse PR-segment shortening
B. New localized ST-segment elevation in anatomically contiguous leads
C. Isolated premature ventricular contractions
D. Sinus tachycardia without ischemic changes
Correct Answer: B
Rationale:
B is correct because new ST-segment elevation in contiguous leads can indicate acute coronary occlusion
and requires immediate reperfusion assessment.
A is incorrect because PR-segment shortening is not the characteristic finding of acute STEMI.
C is incorrect because isolated PVCs may occur with many conditions and do not establish acute coronary
occlusion.
D is incorrect because sinus tachycardia is nonspecific and does not demonstrate STEMI.
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, Question 5
A hypotensive patient has cool extremities, altered mental status, delayed capillary refill, and tachycardia
after a large gastrointestinal hemorrhage; which shock category is most likely?
A. Hypovolemic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Distributive shock
Correct Answer: A
Rationale:
A is correct because substantial blood loss reduces circulating intravascular volume and produces
compensatory tachycardia followed by inadequate tissue perfusion.
B is incorrect because neurogenic shock classically produces vasodilation and may cause relative
bradycardia rather than the typical compensatory tachycardia seen here.
C is incorrect because the clinical history identifies major blood loss rather than primary pump failure.
D is incorrect because distributive shock involves abnormal vascular tone and is not the most likely
explanation after significant hemorrhage.
Question 6
Which intervention is most appropriate when an adult patient presents with severe hypoglycemia, altered
consciousness, and no reliable intravenous access?
A. Administer oral glucose immediately
B. Administer intramuscular glucagon
C. Give subcutaneous insulin
D. Encourage the patient to drink water
Correct Answer: B
Rationale:
B is correct because intramuscular glucagon can rapidly raise blood glucose when a severely altered
patient cannot safely receive oral glucose and IV access is unavailable.
A is incorrect because oral administration creates an aspiration risk in a patient with impaired
consciousness.
C is incorrect because insulin would further lower blood glucose.
D is incorrect because water does not correct hypoglycemia.
Question 7
Why should an emergency nurse practitioner reassess a patient repeatedly after an initially reassuring
evaluation for potentially serious illness?
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EXAMINATION
1. Emergency Assessment, Triage, and Clinical Decision-Making
Question 1
Which assessment finding in an adult patient with acute illness requires the emergency nurse practitioner
to intervene most immediately because it indicates impending airway compromise?
A. Respiratory rate of 24 breaths per minute
B. Hoarse voice with inspiratory stridor
C. Oxygen saturation of 94% on room air
D. Mild anxiety with diaphoresis
Correct Answer: B
Rationale:
B is correct because inspiratory stridor and a changing or hoarse voice suggest significant upper-airway
narrowing that can rapidly progress to complete obstruction.
A is incorrect because a respiratory rate of 24 is elevated but does not by itself indicate immediate airway
obstruction.
C is incorrect because an oxygen saturation of 94% is not, by itself, evidence of impending airway collapse.
D is incorrect because anxiety and diaphoresis are nonspecific findings and do not establish airway
compromise.
Question 2
A patient arrives after a motor-vehicle collision with severe respiratory distress, hypotension, and absent
breath sounds on the right side; what action should occur first?
A. Obtain a portable chest radiograph
B. Administer intravenous morphine for pain
C. Prepare for immediate needle or finger thoracostomy
D. Obtain a computed tomography scan of the chest
Correct Answer: C
Rationale:
C is correct because severe respiratory distress, hypotension, and unilateral absent breath sounds strongly
suggest tension pneumothorax, which requires immediate decompression without waiting for imaging.
A is incorrect because radiography should not delay lifesaving treatment in a clinically obvious tension
pneumothorax.
B is incorrect because opioid administration does not treat the obstructive physiology and may worsen
1
,respiratory depression.
D is incorrect because CT imaging is inappropriate when immediate decompression is required.
Question 3
What clinical feature most strongly indicates that a patient with chest pain may be experiencing an acute
coronary syndrome rather than uncomplicated gastroesophageal reflux?
A. Burning discomfort occurring after a large meal
B. Pain reproducible with direct chest-wall palpation
C. Substernal pressure associated with diaphoresis and nausea
D. Symptoms improving after drinking an antacid
Correct Answer: C
Rationale:
C is correct because substernal pressure accompanied by autonomic symptoms such as diaphoresis and
nausea is highly concerning for myocardial ischemia.
A is incorrect because postprandial burning can occur with reflux, although meal association alone cannot
exclude ACS.
B is incorrect because reproducible chest-wall tenderness makes a musculoskeletal cause more likely,
although it does not absolutely exclude ACS.
D is incorrect because improvement with an antacid does not reliably distinguish reflux from cardiac
ischemia.
Question 4
Which electrocardiographic finding in a patient with crushing substernal chest pain most strongly supports
an acute ST-elevation myocardial infarction requiring immediate reperfusion evaluation?
A. Diffuse PR-segment shortening
B. New localized ST-segment elevation in anatomically contiguous leads
C. Isolated premature ventricular contractions
D. Sinus tachycardia without ischemic changes
Correct Answer: B
Rationale:
B is correct because new ST-segment elevation in contiguous leads can indicate acute coronary occlusion
and requires immediate reperfusion assessment.
A is incorrect because PR-segment shortening is not the characteristic finding of acute STEMI.
C is incorrect because isolated PVCs may occur with many conditions and do not establish acute coronary
occlusion.
D is incorrect because sinus tachycardia is nonspecific and does not demonstrate STEMI.
2
, Question 5
A hypotensive patient has cool extremities, altered mental status, delayed capillary refill, and tachycardia
after a large gastrointestinal hemorrhage; which shock category is most likely?
A. Hypovolemic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Distributive shock
Correct Answer: A
Rationale:
A is correct because substantial blood loss reduces circulating intravascular volume and produces
compensatory tachycardia followed by inadequate tissue perfusion.
B is incorrect because neurogenic shock classically produces vasodilation and may cause relative
bradycardia rather than the typical compensatory tachycardia seen here.
C is incorrect because the clinical history identifies major blood loss rather than primary pump failure.
D is incorrect because distributive shock involves abnormal vascular tone and is not the most likely
explanation after significant hemorrhage.
Question 6
Which intervention is most appropriate when an adult patient presents with severe hypoglycemia, altered
consciousness, and no reliable intravenous access?
A. Administer oral glucose immediately
B. Administer intramuscular glucagon
C. Give subcutaneous insulin
D. Encourage the patient to drink water
Correct Answer: B
Rationale:
B is correct because intramuscular glucagon can rapidly raise blood glucose when a severely altered
patient cannot safely receive oral glucose and IV access is unavailable.
A is incorrect because oral administration creates an aspiration risk in a patient with impaired
consciousness.
C is incorrect because insulin would further lower blood glucose.
D is incorrect because water does not correct hypoglycemia.
Question 7
Why should an emergency nurse practitioner reassess a patient repeatedly after an initially reassuring
evaluation for potentially serious illness?
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