ENP-C Emergency Nurse Practitioner Certification Exam 2026:
Comprehensive Professional Practice Test — Medical Screening,
Differential Diagnosis, Patient Management, Transitions of Care &
Professional Practice — 192 Multiple-Choice Questions with
Answers & Detailed Rationales
SECTION 1: MEDICAL SCREENING
Question 1
A 45-year-old male presents to the emergency department with a chief complaint of chest
pain. He describes the pain as a squeezing sensation that radiates to his left arm. He is
diaphoretic and short of breath. What is the most appropriate initial action?
A. Administer nitroglycerin
B. Obtain a 12-lead ECG
C. Draw blood for cardiac enzymes
D. Administer aspirin
Correct Answer: B
Explanation: The 12-lead ECG is the most time-sensitive initial action to identify ST-elevation
myocardial infarction requiring immediate reperfusion therapy.
Question 2
A 6-year-old child is brought to the emergency department with a 2-day history of fever,
cough, and runny nose. The child is alert and playful, with a respiratory rate of 24
breaths/minute and an oxygen saturation of 98% on room air. According to the Emergency
Severity Index (ESI), what is the most appropriate triage level for this child?
A. Level 1
B. Level 2
,C. Level 3
D. Level 4
Correct Answer: D
Explanation: A stable child with a simple viral illness requires minimal resources, making ESI
level 4 the appropriate triage designation.
Question 3
A 65-year-old female with a history of hypertension presents with sudden onset of tearing
chest pain that radiates to her back. Her blood pressure is 220/120 mmHg in the right arm
and 180/100 mmHg in the left arm. A chest X-ray reveals a widened mediastinum. What is
the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Explanation: Tearing chest pain radiating to the back with interarm blood pressure
differential and widened mediastinum is the classic presentation of aortic dissection.
Question 4
A 2-year-old child is brought to the emergency department after ingesting an unknown
amount of their grandmother's diltiazem. The child is lethargic, with a heart rate of 50
beats/minute and a blood pressure of 70/40 mmHg. What is the most appropriate initial
treatment?
,A. Atropine
B. Glucagon
C. Calcium gluconate
D. Naloxone
Correct Answer: C
Explanation: Calcium gluconate is first-line for calcium channel blocker toxicity, directly
antagonizing the drug's effects at the cellular level.
Question 5
A 16-year-old female presents to the emergency department requesting treatment for a
sexually transmitted infection. She asks that her parents not be informed. What is the most
appropriate action for the nurse practitioner?
A. Refuse to treat the patient without parental consent.
B. Inform the parents of the patient's request.
C. Treat the patient without parental consent.
D. Contact child protective services.
Correct Answer: C
Explanation: In most jurisdictions, minors may consent to STI testing and treatment without
parental notification, preserving confidentiality to encourage care-seeking.
Question 6
A 70-year-old male with a history of atrial fibrillation presents with the sudden onset of
right-sided weakness and aphasia. His symptoms began 2 hours ago. A non-contrast head CT
is negative for hemorrhage. What is the most appropriate next step in management?
, A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer aspirin 325 mg orally
C. Obtain an MRI of the brain
D. Initiate therapeutic heparin infusion
Correct Answer: A
Explanation: With symptom onset within 4.5 hours and hemorrhage excluded, IV tPA is
indicated for acute ischemic stroke to restore perfusion.
Question 7
A 28-year-old female presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She is afebrile with stable vital signs. What is the most appropriate
diagnostic test?
A. CT abdomen/pelvis with contrast
B. Urinalysis with microscopy
C. Blood cultures
D. Renal ultrasound
Correct Answer: B
Explanation: Uncomplicated cystitis is diagnosed by urinalysis showing pyuria and
bacteriuria; imaging is unnecessary for typical presentations.
Question 8
A 55-year-old male with a history of alcohol use disorder presents with confusion, ataxia,
and bilateral ophthalmoplegia. What is the most appropriate initial treatment?
Comprehensive Professional Practice Test — Medical Screening,
Differential Diagnosis, Patient Management, Transitions of Care &
Professional Practice — 192 Multiple-Choice Questions with
Answers & Detailed Rationales
SECTION 1: MEDICAL SCREENING
Question 1
A 45-year-old male presents to the emergency department with a chief complaint of chest
pain. He describes the pain as a squeezing sensation that radiates to his left arm. He is
diaphoretic and short of breath. What is the most appropriate initial action?
A. Administer nitroglycerin
B. Obtain a 12-lead ECG
C. Draw blood for cardiac enzymes
D. Administer aspirin
Correct Answer: B
Explanation: The 12-lead ECG is the most time-sensitive initial action to identify ST-elevation
myocardial infarction requiring immediate reperfusion therapy.
Question 2
A 6-year-old child is brought to the emergency department with a 2-day history of fever,
cough, and runny nose. The child is alert and playful, with a respiratory rate of 24
breaths/minute and an oxygen saturation of 98% on room air. According to the Emergency
Severity Index (ESI), what is the most appropriate triage level for this child?
A. Level 1
B. Level 2
,C. Level 3
D. Level 4
Correct Answer: D
Explanation: A stable child with a simple viral illness requires minimal resources, making ESI
level 4 the appropriate triage designation.
Question 3
A 65-year-old female with a history of hypertension presents with sudden onset of tearing
chest pain that radiates to her back. Her blood pressure is 220/120 mmHg in the right arm
and 180/100 mmHg in the left arm. A chest X-ray reveals a widened mediastinum. What is
the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Explanation: Tearing chest pain radiating to the back with interarm blood pressure
differential and widened mediastinum is the classic presentation of aortic dissection.
Question 4
A 2-year-old child is brought to the emergency department after ingesting an unknown
amount of their grandmother's diltiazem. The child is lethargic, with a heart rate of 50
beats/minute and a blood pressure of 70/40 mmHg. What is the most appropriate initial
treatment?
,A. Atropine
B. Glucagon
C. Calcium gluconate
D. Naloxone
Correct Answer: C
Explanation: Calcium gluconate is first-line for calcium channel blocker toxicity, directly
antagonizing the drug's effects at the cellular level.
Question 5
A 16-year-old female presents to the emergency department requesting treatment for a
sexually transmitted infection. She asks that her parents not be informed. What is the most
appropriate action for the nurse practitioner?
A. Refuse to treat the patient without parental consent.
B. Inform the parents of the patient's request.
C. Treat the patient without parental consent.
D. Contact child protective services.
Correct Answer: C
Explanation: In most jurisdictions, minors may consent to STI testing and treatment without
parental notification, preserving confidentiality to encourage care-seeking.
Question 6
A 70-year-old male with a history of atrial fibrillation presents with the sudden onset of
right-sided weakness and aphasia. His symptoms began 2 hours ago. A non-contrast head CT
is negative for hemorrhage. What is the most appropriate next step in management?
, A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer aspirin 325 mg orally
C. Obtain an MRI of the brain
D. Initiate therapeutic heparin infusion
Correct Answer: A
Explanation: With symptom onset within 4.5 hours and hemorrhage excluded, IV tPA is
indicated for acute ischemic stroke to restore perfusion.
Question 7
A 28-year-old female presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She is afebrile with stable vital signs. What is the most appropriate
diagnostic test?
A. CT abdomen/pelvis with contrast
B. Urinalysis with microscopy
C. Blood cultures
D. Renal ultrasound
Correct Answer: B
Explanation: Uncomplicated cystitis is diagnosed by urinalysis showing pyuria and
bacteriuria; imaging is unnecessary for typical presentations.
Question 8
A 55-year-old male with a history of alcohol use disorder presents with confusion, ataxia,
and bilateral ophthalmoplegia. What is the most appropriate initial treatment?
