BARKLEY ENP REVIEW QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
Medical Screening and Triage
Medical Decision Making and Differential Diagnosis
Patient Management and Therapeutic Interventions
Transitions of Care and Patient Disposition
Professional Practices, Ethics, and Regulatory Compliance
Cardiovascular and Thoracic-Respiratory Emergencies
Abdominal, Gastrointestinal, and Genitourinary Disorders
Neurological and Psychobehavioral Emergencies
Trauma, Environmental, and Toxicological Disorders
Pharmacology and Diagnostic Studies
Introduction
This comprehensive examination is designed to assess the clinical knowledge and decision-making skills essential
for the Emergency Nurse Practitioner (ENP) in a high-acuity, fast-paced environment. The test items evaluate
foundational theory, applied professional knowledge, and the ability to synthesize complex patient data to
formulate accurate differential diagnoses and evidence-based management plans. Candidates will encounter a
variety of multiple-choice questions and realistic, scenario-based prompts that emphasize real-world application,
critical thinking, and safe, patient-centered care. The exam also covers regulatory and legal standards, ethical
,practice, and effective transitions of care, ensuring the candidate is prepared for the full scope of emergency care
practice.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of hypertension presents with acute onset of severe, tearing chest pain
radiating to the back. His blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left
arm. Which diagnostic study is most appropriate to confirm the suspected diagnosis?
A. Chest X-ray
B. Computed tomography angiography (CTA) of the chest
C. Transthoracic echocardiogram
D. Electrocardiogram
🟢 B. Computed tomography angiography (CTA) of the chest
🔴 RATIONALE: The presentation of acute, severe tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. CTA of the chest is the gold standard for
diagnosis, offering high sensitivity and specificity for detecting intimal flaps and assessing the extent of
dissection. Chest X-ray may show a widened mediastinum but is not definitive. An echocardiogram can be
useful but is less sensitive than CTA. An ECG is important to rule out myocardial infarction but will not diagnose
aortic dissection.
2. A 45-year-old male presents with a deep laceration to the palmar surface of his hand. During the physical
exam, he is unable to oppose his thumb to his little finger. Which nerve is most likely injured?
,A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Musculocutaneous nerve
🟢 C. Median nerve
🔴 RATIONALE: The median nerve innervates the thenar muscles, including the opponens pollicis, which is
responsible for thumb opposition. Inability to oppose the thumb to the little finger is a classic sign of median
nerve injury. The ulnar nerve controls intrinsic hand muscles and adduction of the thumb, while the radial nerve
primarily provides sensation to the dorsum of the hand and motor function to the wrist extensors. The
musculocutaneous nerve supplies the biceps and brachialis.
3. Which of the following ECG findings is most indicative of acute pericarditis?
A. ST-segment elevation in all leads except aVR and V1
B. ST-segment depression in leads V1–V4
C. Pathological Q waves in leads II, III, and aVF
D. Peaked T waves in leads V2–V4
🟢 A. ST-segment elevation in all leads except aVR and V1
🔴 RATIONALE: Acute pericarditis typically presents with diffuse ST-segment elevation across most leads (I, II,
III, aVL, aVF, V2–V6) with reciprocal ST depression in aVR and V1. This is due to widespread epicardial
inflammation. ST-segment depression is more indicative of ischemia, pathological Q waves suggest prior
infarction, and peaked T waves are associated with hyperkalemia.
, 4. A 72-year-old female is brought to the emergency department after a ground-level fall. She reports right
hip pain and is unable to bear weight. Her right leg is shortened and externally rotated. What is the most
appropriate initial imaging study?
A. Pelvic X-ray
B. CT scan of the hip without contrast
C. MRI of the hip
D. Ultrasound of the hip
🟢 A. Pelvic X-ray
🔴 RATIONALE: An anteroposterior (AP) pelvic X-ray and a cross-table lateral view of the affected hip are the
standard initial imaging studies for suspected hip fracture. The classic presentation of a shortened and
externally rotated leg in an elderly patient after a fall is highly suggestive of a femoral neck or intertrochanteric
fracture, which is typically visible on plain radiographs. CT or MRI may be used if X-rays are inconclusive, but
they are not the first-line imaging modality. Ultrasound is not useful for diagnosing fractures.
5. A 34-year-old male presents with sudden onset of sharp, pleuritic chest pain and shortness of breath. He is
tachycardic and hypoxic. A CT pulmonary angiography reveals a filling defect in the left main pulmonary
artery. What is the most appropriate initial anticoagulation strategy?
A. Unfractionated heparin (UFH) intravenous bolus followed by continuous infusion
B. Low-molecular-weight heparin (LMWH) subcutaneous injection
C. Warfarin 5 mg orally daily
D. Aspirin 325 mg orally
🟢 A. Unfractionated heparin (UFH) intravenous bolus followed by continuous infusion
Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
Medical Screening and Triage
Medical Decision Making and Differential Diagnosis
Patient Management and Therapeutic Interventions
Transitions of Care and Patient Disposition
Professional Practices, Ethics, and Regulatory Compliance
Cardiovascular and Thoracic-Respiratory Emergencies
Abdominal, Gastrointestinal, and Genitourinary Disorders
Neurological and Psychobehavioral Emergencies
Trauma, Environmental, and Toxicological Disorders
Pharmacology and Diagnostic Studies
Introduction
This comprehensive examination is designed to assess the clinical knowledge and decision-making skills essential
for the Emergency Nurse Practitioner (ENP) in a high-acuity, fast-paced environment. The test items evaluate
foundational theory, applied professional knowledge, and the ability to synthesize complex patient data to
formulate accurate differential diagnoses and evidence-based management plans. Candidates will encounter a
variety of multiple-choice questions and realistic, scenario-based prompts that emphasize real-world application,
critical thinking, and safe, patient-centered care. The exam also covers regulatory and legal standards, ethical
,practice, and effective transitions of care, ensuring the candidate is prepared for the full scope of emergency care
practice.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of hypertension presents with acute onset of severe, tearing chest pain
radiating to the back. His blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left
arm. Which diagnostic study is most appropriate to confirm the suspected diagnosis?
A. Chest X-ray
B. Computed tomography angiography (CTA) of the chest
C. Transthoracic echocardiogram
D. Electrocardiogram
🟢 B. Computed tomography angiography (CTA) of the chest
🔴 RATIONALE: The presentation of acute, severe tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. CTA of the chest is the gold standard for
diagnosis, offering high sensitivity and specificity for detecting intimal flaps and assessing the extent of
dissection. Chest X-ray may show a widened mediastinum but is not definitive. An echocardiogram can be
useful but is less sensitive than CTA. An ECG is important to rule out myocardial infarction but will not diagnose
aortic dissection.
2. A 45-year-old male presents with a deep laceration to the palmar surface of his hand. During the physical
exam, he is unable to oppose his thumb to his little finger. Which nerve is most likely injured?
,A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Musculocutaneous nerve
🟢 C. Median nerve
🔴 RATIONALE: The median nerve innervates the thenar muscles, including the opponens pollicis, which is
responsible for thumb opposition. Inability to oppose the thumb to the little finger is a classic sign of median
nerve injury. The ulnar nerve controls intrinsic hand muscles and adduction of the thumb, while the radial nerve
primarily provides sensation to the dorsum of the hand and motor function to the wrist extensors. The
musculocutaneous nerve supplies the biceps and brachialis.
3. Which of the following ECG findings is most indicative of acute pericarditis?
A. ST-segment elevation in all leads except aVR and V1
B. ST-segment depression in leads V1–V4
C. Pathological Q waves in leads II, III, and aVF
D. Peaked T waves in leads V2–V4
🟢 A. ST-segment elevation in all leads except aVR and V1
🔴 RATIONALE: Acute pericarditis typically presents with diffuse ST-segment elevation across most leads (I, II,
III, aVL, aVF, V2–V6) with reciprocal ST depression in aVR and V1. This is due to widespread epicardial
inflammation. ST-segment depression is more indicative of ischemia, pathological Q waves suggest prior
infarction, and peaked T waves are associated with hyperkalemia.
, 4. A 72-year-old female is brought to the emergency department after a ground-level fall. She reports right
hip pain and is unable to bear weight. Her right leg is shortened and externally rotated. What is the most
appropriate initial imaging study?
A. Pelvic X-ray
B. CT scan of the hip without contrast
C. MRI of the hip
D. Ultrasound of the hip
🟢 A. Pelvic X-ray
🔴 RATIONALE: An anteroposterior (AP) pelvic X-ray and a cross-table lateral view of the affected hip are the
standard initial imaging studies for suspected hip fracture. The classic presentation of a shortened and
externally rotated leg in an elderly patient after a fall is highly suggestive of a femoral neck or intertrochanteric
fracture, which is typically visible on plain radiographs. CT or MRI may be used if X-rays are inconclusive, but
they are not the first-line imaging modality. Ultrasound is not useful for diagnosing fractures.
5. A 34-year-old male presents with sudden onset of sharp, pleuritic chest pain and shortness of breath. He is
tachycardic and hypoxic. A CT pulmonary angiography reveals a filling defect in the left main pulmonary
artery. What is the most appropriate initial anticoagulation strategy?
A. Unfractionated heparin (UFH) intravenous bolus followed by continuous infusion
B. Low-molecular-weight heparin (LMWH) subcutaneous injection
C. Warfarin 5 mg orally daily
D. Aspirin 325 mg orally
🟢 A. Unfractionated heparin (UFH) intravenous bolus followed by continuous infusion
