Emergency Nurse Practitioner (ENP) Ultimate Exam 2026/2027 –
Practice Test Bank
Verified Questions with Answers & Detailed Rationales
Section 1: Cardiovascular Emergencies (Questions 1–20)
1. A 45-year-old male presents to the ED with sudden onset of
severe retrosternal chest pain radiating to his back. He is
hypertensive and diaphoretic. On examination, you note a blood
pressure differential of 25 mmHg between his right and left arms.
What is the most likely diagnosis?
A) Acute myocardial infarction with cardiogenic shock
B) Tension pneumothorax
C) Acute aortic dissection
D) Pulmonary embolism with acute right heart strain
,Answer C: — Acute aortic dissection
Rationale: The clinical presentation of sudden onset severe
retrosternal chest pain radiating to the back, hypertension,
diaphoresis, and most critically, the blood pressure differential
between arms (>20 mmHg) is classic for acute aortic dissection. This
blood pressure differential occurs due to involvement of the
subclavian arteries. Acute MI typically does not present with inter-
arm blood pressure differentials. Tension pneumothorax would
present with acute respiratory distress and hypotension. Pulmonary
embolism typically presents with pleuritic chest pain and dyspnea
rather than retrosternal tearing pain. ---
2. A 62-year-old male presents with chest pressure radiating to the
left arm, diaphoresis, and nausea. BP 148/92, HR 104, SpO₂ 95%.
What is the most appropriate INITIAL intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Start IV antibiotics
D) Obtain a chest X-ray
Answer B: — Obtain a 12-lead EKG
,Rationale: The priority is to obtain a 12-lead EKG to confirm or rule
out STEMI, as time-to-diagnosis and reperfusion are critical for
myocardial salvage. While nitroglycerin may be indicated for ongoing
chest pain, diagnosis must precede treatment. ---
3. A patient with suspected STEMI develops pulseless ventricular
tachycardia. What is the IMMEDIATE treatment?
A) Amiodarone 300 mg IV push
B) Defibrillation at 200 J biphasic
C) Epinephrine 1 mg IV push
D) Synchronized cardioversion
Answer B: — Defibrillation at 200 J biphasic
Rationale: Pulseless ventricular tachycardia is a shockable rhythm
requiring immediate defibrillation. Unsynchronized defibrillation at
200 J biphasic is the priority treatment. Amiodarone and epinephrine
are given after defibrillation if the rhythm persists. ---
4. A 55-year-old with hypertension and diabetes presents with
dyspnea, orthopnea, and bilateral crackles. What is the most
, appropriate initial pharmacologic intervention for acute pulmonary
edema?
A) IV furosemide
B) Sublingual nitroglycerin
C) IV morphine
D) IV digoxin
Answer A: — IV furosemide
Rationale: IV furosemide is the initial pharmacologic intervention for
acute pulmonary edema to reduce preload through diuresis.
Nitroglycerin may be used for afterload reduction, and morphine may
help with anxiety and preload reduction, but furosemide is the first-
line agent. ---
5. A patient presents with bilateral lower extremity edema, jugular
venous distention, and a pulsatile liver. These findings suggest:
A) Left-sided heart failure
B) Right-sided heart failure
C) Pericarditis
D) Cor pulmonale
Answer B: — Right-sided heart failure
Practice Test Bank
Verified Questions with Answers & Detailed Rationales
Section 1: Cardiovascular Emergencies (Questions 1–20)
1. A 45-year-old male presents to the ED with sudden onset of
severe retrosternal chest pain radiating to his back. He is
hypertensive and diaphoretic. On examination, you note a blood
pressure differential of 25 mmHg between his right and left arms.
What is the most likely diagnosis?
A) Acute myocardial infarction with cardiogenic shock
B) Tension pneumothorax
C) Acute aortic dissection
D) Pulmonary embolism with acute right heart strain
,Answer C: — Acute aortic dissection
Rationale: The clinical presentation of sudden onset severe
retrosternal chest pain radiating to the back, hypertension,
diaphoresis, and most critically, the blood pressure differential
between arms (>20 mmHg) is classic for acute aortic dissection. This
blood pressure differential occurs due to involvement of the
subclavian arteries. Acute MI typically does not present with inter-
arm blood pressure differentials. Tension pneumothorax would
present with acute respiratory distress and hypotension. Pulmonary
embolism typically presents with pleuritic chest pain and dyspnea
rather than retrosternal tearing pain. ---
2. A 62-year-old male presents with chest pressure radiating to the
left arm, diaphoresis, and nausea. BP 148/92, HR 104, SpO₂ 95%.
What is the most appropriate INITIAL intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Start IV antibiotics
D) Obtain a chest X-ray
Answer B: — Obtain a 12-lead EKG
,Rationale: The priority is to obtain a 12-lead EKG to confirm or rule
out STEMI, as time-to-diagnosis and reperfusion are critical for
myocardial salvage. While nitroglycerin may be indicated for ongoing
chest pain, diagnosis must precede treatment. ---
3. A patient with suspected STEMI develops pulseless ventricular
tachycardia. What is the IMMEDIATE treatment?
A) Amiodarone 300 mg IV push
B) Defibrillation at 200 J biphasic
C) Epinephrine 1 mg IV push
D) Synchronized cardioversion
Answer B: — Defibrillation at 200 J biphasic
Rationale: Pulseless ventricular tachycardia is a shockable rhythm
requiring immediate defibrillation. Unsynchronized defibrillation at
200 J biphasic is the priority treatment. Amiodarone and epinephrine
are given after defibrillation if the rhythm persists. ---
4. A 55-year-old with hypertension and diabetes presents with
dyspnea, orthopnea, and bilateral crackles. What is the most
, appropriate initial pharmacologic intervention for acute pulmonary
edema?
A) IV furosemide
B) Sublingual nitroglycerin
C) IV morphine
D) IV digoxin
Answer A: — IV furosemide
Rationale: IV furosemide is the initial pharmacologic intervention for
acute pulmonary edema to reduce preload through diuresis.
Nitroglycerin may be used for afterload reduction, and morphine may
help with anxiety and preload reduction, but furosemide is the first-
line agent. ---
5. A patient presents with bilateral lower extremity edema, jugular
venous distention, and a pulsatile liver. These findings suggest:
A) Left-sided heart failure
B) Right-sided heart failure
C) Pericarditis
D) Cor pulmonale
Answer B: — Right-sided heart failure
