1
Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review 150 Actual Exam Questions &
Answers with Detailed Rationales
The following 150-question test bank is designed for the Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review. It aligns with the American Academy of Nurse Practitioners (AANP) ENP-C exam blueprint
and reflects current emergency medicine guidelines. Questions cover all major domains: cardiovascular,
respiratory, neurology, gastrointestinal, infectious disease, trauma, toxicology, environmental emergencies,
ENT, ophthalmology, obstetrics/gynecology, pediatrics, psychiatric emergencies, and professional issues.
CARDIOVASCULAR EMERGENCIES (Questions 1–25)
Q1. A 65-year-old male presents with acute substernal chest pressure radiating to
his left arm, diaphoresis, and nausea. ECG shows 2 mm ST elevation in leads V2–
V4. What is the most appropriate initial reperfusion strategy if a PCI-capable
hospital is 20 minutes away?
A) Tenecteplase (TNK) in the emergency department
B) Transfer to the PCI hospital for primary PCI
C) Primary PCI at the current hospital
D) Emergent coronary artery bypass grafting (CABG)
: Answer : C – Primary PCI at the current hospital
Rationale: For a patient presenting to a PCI-capable hospital, primary PCI is the
preferred reperfusion strategy if door-to-balloon time is ≤90 minutes. The patient
is at a PCI-capable hospital, so immediate PCI is indicated.
Q2. A 72-year-old female presents with sudden onset of severe tearing chest pain
radiating to the back. Blood pressure is 160/90 mmHg in the right arm and 110/70
mmHg in the left arm. What is the most appropriate next diagnostic test?
A) ECG
B) CT angiography of the chest
C) Transthoracic echocardiogram
D) Chest X-ray
pg. 1
,2
: Answer : B – CT angiography of the chest
Rationale: The presentation is classic for acute aortic dissection. CT angiography is
the gold standard for diagnosis and should be obtained emergently.
Q3. A patient presents with acute onset of dyspnea, pleuritic chest pain, and
hypoxia after a long flight. Which of the following is the most appropriate initial
diagnostic test?
A) CT pulmonary angiography (CTPA)
B) D-dimer
C) Chest X-ray
D) Ventilation-perfusion (V/Q) scan
: Answer : A – CT pulmonary angiography (CTPA)
Rationale: In a patient with high clinical probability for pulmonary embolism,
CTPA is the test of choice. D-dimer is for low-to-moderate probability.
Q4. A 55-year-old male with a history of hypertension presents with acute
pulmonary edema. His blood pressure is 160/100 mmHg. Which of the following
is the most appropriate first-line medication to reduce preload?
A) Metoprolol
B) Digoxin
C) Nitroglycerin
D) Dobutamine
: Answer : C – Nitroglycerin
Rationale: Nitroglycerin is a venodilator that reduces preload and is first-line for
acute pulmonary edema with hypertension. It also dilates coronary arteries.
Q5. A patient with atrial fibrillation presents with a ventricular rate of 150 bpm,
hypotension, and chest pain. What is the most appropriate next step?
A) Synchronized cardioversion
B) IV metoprolol
pg. 2
,3
C) IV diltiazem
D) IV amiodarone
: Answer : A – Synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension, chest pain, or altered
mental status requires immediate synchronized cardioversion (starting at 100-200
J biphasic).
Q6. A 68-year-old male with a history of heart failure presents with worsening
dyspnea, crackles in both lung bases, and a new S3 gallop. His ejection fraction is
30%. Which medication should be added to his regimen of furosemide and
lisinopril to reduce mortality?
A) Digoxin
B) Metoprolol succinate
C) Hydralazine
D) Amiodarone
: Answer : B – Metoprolol succinate
Rationale: Beta-blockers (metoprolol succinate, carvedilol, bisoprolol) reduce
mortality in heart failure with reduced ejection fraction.
Q7. A 50-year-old male presents with palpitations. ECG shows a narrow-complex
tachycardia at 180 bpm. The patient is hemodynamically stable. What is the first
intervention?
A) Vagal maneuvers
B) IV adenosine
C) Synchronized cardioversion
D) IV metoprolol
: Answer : A – Vagal maneuvers
Rationale: For stable supraventricular tachycardia (SVT), vagal maneuvers are
first-line. If ineffective, IV adenosine may be given.
pg. 3
, 4
Q8. A patient with a known abdominal aortic aneurysm (AAA) presents with
sudden onset of severe back pain and hypotension. What is the most likely
diagnosis?
A) Myocardial infarction
B) Renal colic
C) Musculoskeletal back pain
D) Ruptured AAA
: Answer : D – Ruptured AAA
Rationale: Sudden back pain with hypotension in a patient with a known AAA is
highly concerning for rupture and requires immediate surgical consultation.
Q9. A 45-year-old male presents with substernal chest pain that occurs with
exertion and is relieved by rest. He has no ECG changes. Troponin is normal. What
is the most appropriate initial diagnostic test?
A) Exercise stress test
B) Coronary angiography
C) CT coronary angiography
D) Resting echocardiogram
: Answer : A – Exercise stress test
Rationale: Stable angina with normal ECG and troponin should be evaluated with
an exercise stress test to assess for inducible ischemia.
Q10. A 30-year-old female presents with palpitations. ECG shows a wide QRS
complex tachycardia. She is hemodynamically stable. What is the most
appropriate next step?
A) Immediate cardioversion
B) IV amiodarone
C) IV adenosine
D) IV lidocaine
: Answer : B – IV amiodarone
Rationale: For stable monomorphic ventricular tachycardia, IV amiodarone is
first-line. Unstable VT requires immediate cardioversion.
pg. 4
Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review 150 Actual Exam Questions &
Answers with Detailed Rationales
The following 150-question test bank is designed for the Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review. It aligns with the American Academy of Nurse Practitioners (AANP) ENP-C exam blueprint
and reflects current emergency medicine guidelines. Questions cover all major domains: cardiovascular,
respiratory, neurology, gastrointestinal, infectious disease, trauma, toxicology, environmental emergencies,
ENT, ophthalmology, obstetrics/gynecology, pediatrics, psychiatric emergencies, and professional issues.
CARDIOVASCULAR EMERGENCIES (Questions 1–25)
Q1. A 65-year-old male presents with acute substernal chest pressure radiating to
his left arm, diaphoresis, and nausea. ECG shows 2 mm ST elevation in leads V2–
V4. What is the most appropriate initial reperfusion strategy if a PCI-capable
hospital is 20 minutes away?
A) Tenecteplase (TNK) in the emergency department
B) Transfer to the PCI hospital for primary PCI
C) Primary PCI at the current hospital
D) Emergent coronary artery bypass grafting (CABG)
: Answer : C – Primary PCI at the current hospital
Rationale: For a patient presenting to a PCI-capable hospital, primary PCI is the
preferred reperfusion strategy if door-to-balloon time is ≤90 minutes. The patient
is at a PCI-capable hospital, so immediate PCI is indicated.
Q2. A 72-year-old female presents with sudden onset of severe tearing chest pain
radiating to the back. Blood pressure is 160/90 mmHg in the right arm and 110/70
mmHg in the left arm. What is the most appropriate next diagnostic test?
A) ECG
B) CT angiography of the chest
C) Transthoracic echocardiogram
D) Chest X-ray
pg. 1
,2
: Answer : B – CT angiography of the chest
Rationale: The presentation is classic for acute aortic dissection. CT angiography is
the gold standard for diagnosis and should be obtained emergently.
Q3. A patient presents with acute onset of dyspnea, pleuritic chest pain, and
hypoxia after a long flight. Which of the following is the most appropriate initial
diagnostic test?
A) CT pulmonary angiography (CTPA)
B) D-dimer
C) Chest X-ray
D) Ventilation-perfusion (V/Q) scan
: Answer : A – CT pulmonary angiography (CTPA)
Rationale: In a patient with high clinical probability for pulmonary embolism,
CTPA is the test of choice. D-dimer is for low-to-moderate probability.
Q4. A 55-year-old male with a history of hypertension presents with acute
pulmonary edema. His blood pressure is 160/100 mmHg. Which of the following
is the most appropriate first-line medication to reduce preload?
A) Metoprolol
B) Digoxin
C) Nitroglycerin
D) Dobutamine
: Answer : C – Nitroglycerin
Rationale: Nitroglycerin is a venodilator that reduces preload and is first-line for
acute pulmonary edema with hypertension. It also dilates coronary arteries.
Q5. A patient with atrial fibrillation presents with a ventricular rate of 150 bpm,
hypotension, and chest pain. What is the most appropriate next step?
A) Synchronized cardioversion
B) IV metoprolol
pg. 2
,3
C) IV diltiazem
D) IV amiodarone
: Answer : A – Synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension, chest pain, or altered
mental status requires immediate synchronized cardioversion (starting at 100-200
J biphasic).
Q6. A 68-year-old male with a history of heart failure presents with worsening
dyspnea, crackles in both lung bases, and a new S3 gallop. His ejection fraction is
30%. Which medication should be added to his regimen of furosemide and
lisinopril to reduce mortality?
A) Digoxin
B) Metoprolol succinate
C) Hydralazine
D) Amiodarone
: Answer : B – Metoprolol succinate
Rationale: Beta-blockers (metoprolol succinate, carvedilol, bisoprolol) reduce
mortality in heart failure with reduced ejection fraction.
Q7. A 50-year-old male presents with palpitations. ECG shows a narrow-complex
tachycardia at 180 bpm. The patient is hemodynamically stable. What is the first
intervention?
A) Vagal maneuvers
B) IV adenosine
C) Synchronized cardioversion
D) IV metoprolol
: Answer : A – Vagal maneuvers
Rationale: For stable supraventricular tachycardia (SVT), vagal maneuvers are
first-line. If ineffective, IV adenosine may be given.
pg. 3
, 4
Q8. A patient with a known abdominal aortic aneurysm (AAA) presents with
sudden onset of severe back pain and hypotension. What is the most likely
diagnosis?
A) Myocardial infarction
B) Renal colic
C) Musculoskeletal back pain
D) Ruptured AAA
: Answer : D – Ruptured AAA
Rationale: Sudden back pain with hypotension in a patient with a known AAA is
highly concerning for rupture and requires immediate surgical consultation.
Q9. A 45-year-old male presents with substernal chest pain that occurs with
exertion and is relieved by rest. He has no ECG changes. Troponin is normal. What
is the most appropriate initial diagnostic test?
A) Exercise stress test
B) Coronary angiography
C) CT coronary angiography
D) Resting echocardiogram
: Answer : A – Exercise stress test
Rationale: Stable angina with normal ECG and troponin should be evaluated with
an exercise stress test to assess for inducible ischemia.
Q10. A 30-year-old female presents with palpitations. ECG shows a wide QRS
complex tachycardia. She is hemodynamically stable. What is the most
appropriate next step?
A) Immediate cardioversion
B) IV amiodarone
C) IV adenosine
D) IV lidocaine
: Answer : B – IV amiodarone
Rationale: For stable monomorphic ventricular tachycardia, IV amiodarone is
first-line. Unstable VT requires immediate cardioversion.
pg. 4
