BCEMP Emergency Medicine Pharmacy Certification Exam 2026:
Advanced Professional Practice Test — Emergency
Pharmacotherapy, Resuscitation, Toxicology, Critical Care, Trauma
& Medication Safety — 190 Multiple-Choice Questions with Answers
& Detailed Rationales
Domain 1: Patient Care/Management — Cardiovascular Emergencies
Question 1
A 62-year-old male presents with crushing substernal chest pain radiating to the left arm.
ECG reveals ST-elevation in leads II, III, and aVF. Vitals: BP 88/54 mm Hg, HR 48 bpm, RR 18
rpm, SpO₂ 96%. The patient is diaphoretic and nauseated. Which medication is
contraindicated in this patient?
A. Aspirin 324 mg chewed
B. Nitroglycerin sublingual
C. Heparin bolus
D. Clopidogrel loading dose
Correct Answer: B
Explanation: Inferior STEMI with bradycardia and hypotension suggests right ventricular
involvement; nitrates reduce preload and can precipitate severe hypotension. Aspirin,
heparin, and clopidogrel remain indicated.
Question 2
,A 55-year-old female with atrial fibrillation presents with palpitations and dyspnea. HR 148
bpm, BP 128/76 mm Hg. ECG confirms atrial fibrillation with rapid ventricular response.
Which agent is most appropriate for rate control in this hemodynamically stable patient?
A. Adenosine 6 mg IV push
B. Diltiazem 0.25 mg/kg IV
C. Amiodarone 150 mg IV
D. Digoxin 0.5 mg IV load
Correct Answer: B
Explanation: IV diltiazem is first-line for acute rate control in stable atrial fibrillation.
Adenosine is for SVT, amiodarone for rhythm conversion, and digoxin has delayed onset.
Question 3
A 70-year-old male with acute decompensated heart failure presents with severe dyspnea,
orthopnea, and bilateral rales. BP 168/92 mm Hg, HR 112 bpm, SpO₂ 88% on room air.
Which medication should be administered first?
A. Furosemide 40 mg IV
B. Nitroglycerin infusion
C. Morphine sulfate 4 mg IV
D. Enalaprilat 1.25 mg IV
Correct Answer: B
Explanation: In hypertensive acute pulmonary edema, nitroglycerin reduces preload and
afterload rapidly. Furosemide follows but diuresis takes time. Morphine is no longer
routinely recommended.
,Question 4
A 58-year-old male receiving amiodarone for atrial fibrillation develops thyroid storm. Which
medication is contraindicated?
A. Propylthiouracil
B. Methimazole
C. Amiodarone
D. Propranolol
Correct Answer: C
Explanation: Amiodarone contains iodine and can precipitate or worsen thyroid storm.
Propylthiouracil, methimazole, and propranolol are appropriate treatments.
Question 5
A 45-year-old male presents with sustained ventricular tachycardia and a pulse. BP 92/60
mm Hg. Which antiarrhythmic is most appropriate?
A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV over 10 minutes
C. Diltiazem 20 mg IV
D. Digoxin 0.25 mg IV
Correct Answer: B
, Explanation: Amiodarone is first-line for stable ventricular tachycardia. Adenosine is for SVT,
diltiazem contraindicated in VT, and digoxin not indicated.
Question 6
A 68-year-old female on warfarin presents with epistaxis. INR is 8.2. She is hemodynamically
stable without active bleeding. Which intervention is most appropriate?
A. Vitamin K 10 mg IV
B. Fresh frozen plasma 2 units
C. Hold warfarin and give vitamin K 2.5 mg PO
D. Prothrombin complex concentrate
Correct Answer: C
Explanation: For asymptomatic INR elevation without bleeding, low-dose oral vitamin K and
holding warfarin suffice. IV vitamin K risks anaphylaxis; FFP and PCC are for active bleeding.
Question 7
A 78-year-old male with known aortic stenosis presents with syncope. Echocardiogram
shows severe aortic stenosis. Which medication class is contraindicated?
A. Beta-blockers
B. ACE inhibitors
C. Vasodilators
D. Statins
Correct Answer: C
Advanced Professional Practice Test — Emergency
Pharmacotherapy, Resuscitation, Toxicology, Critical Care, Trauma
& Medication Safety — 190 Multiple-Choice Questions with Answers
& Detailed Rationales
Domain 1: Patient Care/Management — Cardiovascular Emergencies
Question 1
A 62-year-old male presents with crushing substernal chest pain radiating to the left arm.
ECG reveals ST-elevation in leads II, III, and aVF. Vitals: BP 88/54 mm Hg, HR 48 bpm, RR 18
rpm, SpO₂ 96%. The patient is diaphoretic and nauseated. Which medication is
contraindicated in this patient?
A. Aspirin 324 mg chewed
B. Nitroglycerin sublingual
C. Heparin bolus
D. Clopidogrel loading dose
Correct Answer: B
Explanation: Inferior STEMI with bradycardia and hypotension suggests right ventricular
involvement; nitrates reduce preload and can precipitate severe hypotension. Aspirin,
heparin, and clopidogrel remain indicated.
Question 2
,A 55-year-old female with atrial fibrillation presents with palpitations and dyspnea. HR 148
bpm, BP 128/76 mm Hg. ECG confirms atrial fibrillation with rapid ventricular response.
Which agent is most appropriate for rate control in this hemodynamically stable patient?
A. Adenosine 6 mg IV push
B. Diltiazem 0.25 mg/kg IV
C. Amiodarone 150 mg IV
D. Digoxin 0.5 mg IV load
Correct Answer: B
Explanation: IV diltiazem is first-line for acute rate control in stable atrial fibrillation.
Adenosine is for SVT, amiodarone for rhythm conversion, and digoxin has delayed onset.
Question 3
A 70-year-old male with acute decompensated heart failure presents with severe dyspnea,
orthopnea, and bilateral rales. BP 168/92 mm Hg, HR 112 bpm, SpO₂ 88% on room air.
Which medication should be administered first?
A. Furosemide 40 mg IV
B. Nitroglycerin infusion
C. Morphine sulfate 4 mg IV
D. Enalaprilat 1.25 mg IV
Correct Answer: B
Explanation: In hypertensive acute pulmonary edema, nitroglycerin reduces preload and
afterload rapidly. Furosemide follows but diuresis takes time. Morphine is no longer
routinely recommended.
,Question 4
A 58-year-old male receiving amiodarone for atrial fibrillation develops thyroid storm. Which
medication is contraindicated?
A. Propylthiouracil
B. Methimazole
C. Amiodarone
D. Propranolol
Correct Answer: C
Explanation: Amiodarone contains iodine and can precipitate or worsen thyroid storm.
Propylthiouracil, methimazole, and propranolol are appropriate treatments.
Question 5
A 45-year-old male presents with sustained ventricular tachycardia and a pulse. BP 92/60
mm Hg. Which antiarrhythmic is most appropriate?
A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV over 10 minutes
C. Diltiazem 20 mg IV
D. Digoxin 0.25 mg IV
Correct Answer: B
, Explanation: Amiodarone is first-line for stable ventricular tachycardia. Adenosine is for SVT,
diltiazem contraindicated in VT, and digoxin not indicated.
Question 6
A 68-year-old female on warfarin presents with epistaxis. INR is 8.2. She is hemodynamically
stable without active bleeding. Which intervention is most appropriate?
A. Vitamin K 10 mg IV
B. Fresh frozen plasma 2 units
C. Hold warfarin and give vitamin K 2.5 mg PO
D. Prothrombin complex concentrate
Correct Answer: C
Explanation: For asymptomatic INR elevation without bleeding, low-dose oral vitamin K and
holding warfarin suffice. IV vitamin K risks anaphylaxis; FFP and PCC are for active bleeding.
Question 7
A 78-year-old male with known aortic stenosis presents with syncope. Echocardiogram
shows severe aortic stenosis. Which medication class is contraindicated?
A. Beta-blockers
B. ACE inhibitors
C. Vasodilators
D. Statins
Correct Answer: C
