Barkley Emergency Nurse Practitioner
(ENP-C) Certification Review 150 Actual
Exam Questions & Answers with Detailed
Rationales
Summary
This comprehensive review covers 150 practice questions across all major ENP-C
exam domains, including:
• Cardiovascular emergencies
• Respiratory emergencies
• Neurological emergencies
• Gastrointestinal emergencies
• Trauma and orthopedic emergencies
• Infectious disease emergencies
• Renal and genitourinary emergencies
• Endocrine emergencies
• Obstetric and gynecologic emergencies
• Psychiatric and behavioral emergencies
• Pediatric emergencies
• Pharmacology and toxicology
• Environmental and toxicologic emergencies
• Professional role and emergency preparedness
,Cardiovascular Emergencies
Question 1
A 45-year-old male presents with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 160/90 mmHg in the right arm and
110/70 mmHg in the left arm. What is the most appropriate initial diagnostic study?
A) 12-lead ECG
B) Chest X-ray
C) Bedside echocardiogram
D) CT angiogram of the chest
Answer: D) CT angiogram of the chest
Rationale: This presentation—sudden, tearing chest pain radiating to the back with
a significant blood pressure differential between arms—is classic for aortic
dissection. CT angiography (CTA) of the chest is the initial diagnostic test of choice,
as it can rapidly and accurately identify the presence and extent of a dissection.
While a chest X-ray may show a widened mediastinum, it is not sensitive or
specific. A bedside echo can identify an aortic root dissection but is operator-
dependent and less comprehensive than CTA. An ECG is important to rule out MI
but does not rule out dissection.
Question 2
Which of the following EKG findings is most suggestive of an acute posterior
myocardial infarction?
A) ST-segment elevation in leads V1 through V3
B) Tall R waves and ST-segment depression in V1 and V2
,C) Pathologic Q waves in leads II, III, and aVF
D) Horizontal ST-segment depression with upright T waves in V1-V3
Answer: B) Tall R waves and ST-segment depression in V1 and V2
Rationale: Because the standard 12-lead EKG does not directly view the posterior
wall, reciprocal changes are seen in the anterior leads (V1-V3). Tall R waves and
ST-segment depression in V1-V2 are indicative of a posterior MI. ST elevation in V1-
V3 suggests an anterior or septal MI. Pathologic Q waves in II, III, and aVF indicate
an inferior MI.
Question 3
A 62-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure, diaphoresis, and nausea. An ECG shows ST-segment
elevation in leads V1-V4. Which of the following is the most appropriate initial
management?
A) Aspirin 324 mg chewed and sublingual nitroglycerin
B) Immediate cardiac catheterization
C) IV heparin and clopidogrel
D) Thrombolytic therapy
Answer: A) Aspirin 324 mg chewed and sublingual nitroglycerin
Rationale: For a patient with suspected STEMI, initial management includes aspirin
(324 mg chewed) for its antiplatelet effects and sublingual nitroglycerin for
vasodilation and pain relief, provided there are no contraindications (e.g.,
hypotension, recent phosphodiesterase inhibitor use). Immediate cardiac
catheterization is indicated but typically follows initial stabilization. IV heparin and
, clopidogrel are important adjuncts but not the first step. Thrombolytics are an
alternative if PCI is not available within 90-120 minutes.
Question 4
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 180 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. What is the most appropriate initial intervention for a hemodynamically
stable patient?
A) Synchronized cardioversion
B) Vagal maneuvers
C) IV amiodarone
D) IV adenosine
Answer: B) Vagal maneuvers
Rationale: In a hemodynamically stable patient with regular narrow-complex
tachycardia (likely supraventricular tachycardia), vagal maneuvers (e.g., Valsalva
maneuver, carotid sinus massage) are the first-line intervention. If unsuccessful, IV
adenosine is the next step. Synchronized cardioversion is reserved for unstable
patients. Amiodarone is used for stable wide-complex tachycardia or as a second-
line agent.
Question 5
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
(ENP-C) Certification Review 150 Actual
Exam Questions & Answers with Detailed
Rationales
Summary
This comprehensive review covers 150 practice questions across all major ENP-C
exam domains, including:
• Cardiovascular emergencies
• Respiratory emergencies
• Neurological emergencies
• Gastrointestinal emergencies
• Trauma and orthopedic emergencies
• Infectious disease emergencies
• Renal and genitourinary emergencies
• Endocrine emergencies
• Obstetric and gynecologic emergencies
• Psychiatric and behavioral emergencies
• Pediatric emergencies
• Pharmacology and toxicology
• Environmental and toxicologic emergencies
• Professional role and emergency preparedness
,Cardiovascular Emergencies
Question 1
A 45-year-old male presents with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 160/90 mmHg in the right arm and
110/70 mmHg in the left arm. What is the most appropriate initial diagnostic study?
A) 12-lead ECG
B) Chest X-ray
C) Bedside echocardiogram
D) CT angiogram of the chest
Answer: D) CT angiogram of the chest
Rationale: This presentation—sudden, tearing chest pain radiating to the back with
a significant blood pressure differential between arms—is classic for aortic
dissection. CT angiography (CTA) of the chest is the initial diagnostic test of choice,
as it can rapidly and accurately identify the presence and extent of a dissection.
While a chest X-ray may show a widened mediastinum, it is not sensitive or
specific. A bedside echo can identify an aortic root dissection but is operator-
dependent and less comprehensive than CTA. An ECG is important to rule out MI
but does not rule out dissection.
Question 2
Which of the following EKG findings is most suggestive of an acute posterior
myocardial infarction?
A) ST-segment elevation in leads V1 through V3
B) Tall R waves and ST-segment depression in V1 and V2
,C) Pathologic Q waves in leads II, III, and aVF
D) Horizontal ST-segment depression with upright T waves in V1-V3
Answer: B) Tall R waves and ST-segment depression in V1 and V2
Rationale: Because the standard 12-lead EKG does not directly view the posterior
wall, reciprocal changes are seen in the anterior leads (V1-V3). Tall R waves and
ST-segment depression in V1-V2 are indicative of a posterior MI. ST elevation in V1-
V3 suggests an anterior or septal MI. Pathologic Q waves in II, III, and aVF indicate
an inferior MI.
Question 3
A 62-year-old male with a history of hypertension and diabetes presents with
substernal chest pressure, diaphoresis, and nausea. An ECG shows ST-segment
elevation in leads V1-V4. Which of the following is the most appropriate initial
management?
A) Aspirin 324 mg chewed and sublingual nitroglycerin
B) Immediate cardiac catheterization
C) IV heparin and clopidogrel
D) Thrombolytic therapy
Answer: A) Aspirin 324 mg chewed and sublingual nitroglycerin
Rationale: For a patient with suspected STEMI, initial management includes aspirin
(324 mg chewed) for its antiplatelet effects and sublingual nitroglycerin for
vasodilation and pain relief, provided there are no contraindications (e.g.,
hypotension, recent phosphodiesterase inhibitor use). Immediate cardiac
catheterization is indicated but typically follows initial stabilization. IV heparin and
, clopidogrel are important adjuncts but not the first step. Thrombolytics are an
alternative if PCI is not available within 90-120 minutes.
Question 4
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 180 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. What is the most appropriate initial intervention for a hemodynamically
stable patient?
A) Synchronized cardioversion
B) Vagal maneuvers
C) IV amiodarone
D) IV adenosine
Answer: B) Vagal maneuvers
Rationale: In a hemodynamically stable patient with regular narrow-complex
tachycardia (likely supraventricular tachycardia), vagal maneuvers (e.g., Valsalva
maneuver, carotid sinus massage) are the first-line intervention. If unsuccessful, IV
adenosine is the next step. Synchronized cardioversion is reserved for unstable
patients. Amiodarone is used for stable wide-complex tachycardia or as a second-
line agent.
Question 5
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
