BARKLEY ENP-C DIAGNOSTIC READINESS
TEST (DRT) #3 100 Practice Questions with
Detailed Rationales
Question 1
A 62-year-old male with a history of hypertension and smoking presents with acute
substernal chest pressure radiating to his left arm. He is diaphoretic and nauseous.
ECG shows ST-segment elevation in leads V1-V4. His blood pressure is 148/92
mmHg. What 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: This patient is presenting with an acute STEMI (ST elevation in V1-V4
indicates anterior wall MI). The initial management includes aspirin 324 mg chewed
for its rapid antiplatelet effect and sublingual nitroglycerin for vasodilation and pain
relief, provided there are no contraindications (e.g., hypotension, recent
phosphodiesterase inhibitor use, right ventricular infarction). Immediate cardiac
catheterization is indicated but follows initial stabilization and activation of the cath
lab. 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 2
A 45-year-old male presents with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 165/95 mmHg in the right arm and
110/70 mmHg in the left arm. Which of the following 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 (≥20 mmHg)—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 3
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 185 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
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 (6 mg rapid IV push followed by 12 mg if needed) is the next step.
Synchronized cardioversion is reserved for unstable patients with signs of shock,
hypotension, or altered mental status. Amiodarone is used for stable wide-complex
tachycardia or as a second-line agent for refractory SVT.
Question 4
A patient presents with bradycardia (heart rate 38 bpm), hypotension, and altered
mental status. Atropine 0.5 mg IV is administered without improvement. What is
the next most appropriate intervention?
A) Transcutaneous pacing
B) IV dopamine infusion
C) IV epinephrine infusion
D) Repeat atropine
,,,answer,,,,: A) Transcutaneous pacing
Rationale: For symptomatic bradycardia unresponsive to atropine (0.5 mg IV, up to
3 mg total), transcutaneous pacing is the next intervention. Dopamine (2-20
mcg/kg/min) or epinephrine (2-10 mcg/min) infusions are alternatives if pacing is
not available or ineffective, but pacing is preferred for hemodynamically significant
, bradycardia with signs of shock. Repeat atropine may be considered up to the
maximum dose, but pacing is the definitive intervention.
Question 5
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
A) Amiodarone
B) Lidocaine
C) Epinephrine
D) Atropine
,,,answer,,,,: C) Epinephrine
Rationale: Epinephrine is the first medication administered in pulseless VT and VF,
given as 1 mg IV/IO every 3-5 minutes. Amiodarone (300 mg IV/IO) is the first
antiarrhythmic agent recommended for shock-refractory VF/pulseless VT after the
third shock. Lidocaine is an alternative antiarrhythmic agent (1-1.5 mg/kg). Atropine
is not indicated in cardiac arrest from VF/VT.
Question 6
A 55-year-old female presents with acute dyspnea, orthopnea, and bilateral lower
extremity edema. She has a history of heart failure with reduced ejection fraction.
Jugular venous pressure is elevated, and lung auscultation reveals crackles. Which
medication should be administered first?
A) IV furosemide
B) IV morphine
TEST (DRT) #3 100 Practice Questions with
Detailed Rationales
Question 1
A 62-year-old male with a history of hypertension and smoking presents with acute
substernal chest pressure radiating to his left arm. He is diaphoretic and nauseous.
ECG shows ST-segment elevation in leads V1-V4. His blood pressure is 148/92
mmHg. What 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: This patient is presenting with an acute STEMI (ST elevation in V1-V4
indicates anterior wall MI). The initial management includes aspirin 324 mg chewed
for its rapid antiplatelet effect and sublingual nitroglycerin for vasodilation and pain
relief, provided there are no contraindications (e.g., hypotension, recent
phosphodiesterase inhibitor use, right ventricular infarction). Immediate cardiac
catheterization is indicated but follows initial stabilization and activation of the cath
lab. 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 2
A 45-year-old male presents with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 165/95 mmHg in the right arm and
110/70 mmHg in the left arm. Which of the following 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 (≥20 mmHg)—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 3
A patient presents with acute-onset palpitations, lightheadedness, and a heart rate
of 185 bpm. ECG reveals a regular, narrow-complex tachycardia without visible P
waves. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
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 (6 mg rapid IV push followed by 12 mg if needed) is the next step.
Synchronized cardioversion is reserved for unstable patients with signs of shock,
hypotension, or altered mental status. Amiodarone is used for stable wide-complex
tachycardia or as a second-line agent for refractory SVT.
Question 4
A patient presents with bradycardia (heart rate 38 bpm), hypotension, and altered
mental status. Atropine 0.5 mg IV is administered without improvement. What is
the next most appropriate intervention?
A) Transcutaneous pacing
B) IV dopamine infusion
C) IV epinephrine infusion
D) Repeat atropine
,,,answer,,,,: A) Transcutaneous pacing
Rationale: For symptomatic bradycardia unresponsive to atropine (0.5 mg IV, up to
3 mg total), transcutaneous pacing is the next intervention. Dopamine (2-20
mcg/kg/min) or epinephrine (2-10 mcg/min) infusions are alternatives if pacing is
not available or ineffective, but pacing is preferred for hemodynamically significant
, bradycardia with signs of shock. Repeat atropine may be considered up to the
maximum dose, but pacing is the definitive intervention.
Question 5
According to ACLS guidelines, what is the first medication administered for
pulseless ventricular tachycardia or ventricular fibrillation?
A) Amiodarone
B) Lidocaine
C) Epinephrine
D) Atropine
,,,answer,,,,: C) Epinephrine
Rationale: Epinephrine is the first medication administered in pulseless VT and VF,
given as 1 mg IV/IO every 3-5 minutes. Amiodarone (300 mg IV/IO) is the first
antiarrhythmic agent recommended for shock-refractory VF/pulseless VT after the
third shock. Lidocaine is an alternative antiarrhythmic agent (1-1.5 mg/kg). Atropine
is not indicated in cardiac arrest from VF/VT.
Question 6
A 55-year-old female presents with acute dyspnea, orthopnea, and bilateral lower
extremity edema. She has a history of heart failure with reduced ejection fraction.
Jugular venous pressure is elevated, and lung auscultation reveals crackles. Which
medication should be administered first?
A) IV furosemide
B) IV morphine
