BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review 150 Actual Exam Questions &
Answers with Detailed Rationales
Domain 1: Medical Screening & Differential Diagnosis
1. A 45-year-old male with a history of hypertension 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?
o A) 12-lead ECG
o B) Chest X-ray
o C) Bedside echocardiogram
o D) CT angiogram of the chest
o Rationale: This presentation—sudden, tearing chest pain radiating to the back with
a significant blood pressure differential between arms—is classic for an aortic
dissection. CTA of the chest is the gold standard for rapid diagnosis and extent
mapping.
2. A 30-year-old woman presents with sudden, severe headache described as "the worst
headache of my life." She has no focal neurological deficits and is afebrile with nuchal
rigidity. What is the most appropriate next step?
o A) Administer IV tPA
o B) Lumbar puncture
o C) Non-contrast CT head
o D) MRI brain
o Rationale: A "thunderclap" headache with nuchal rigidity is highly concerning for
subarachnoid hemorrhage. Non-contrast CT head is the first-line imaging study to
detect acute SAH.
3. A 68-year-old male with COPD presents with increased dyspnea, wheezing, and a respiratory
rate of 30/min. What is the most appropriate initial pharmacologic intervention?
o A) IV methylprednisolone
o B) Inhaled high-dose beta-agonist via nebulizer
o C) IV antibiotics
o D) IV magnesium sulfate
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: In an acute COPD exacerbation, the priority is bronchodilation with
inhaled beta-agonists.
4. A patient presents with a deep laceration to the palmar surface of the hand and is unable to
oppose the thumb to the little finger. Which nerve is likely injured?
o A) Radial nerve
o B) Ulnar nerve
o C) Median nerve
o D) Musculocutaneous nerve
o Rationale: The median nerve provides motor function to the thenar muscles,
including the ability to oppose the thumb.
5. A 68-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and
bilateral ophthalmoplegia. What is the most appropriate initial treatment?
o A) IV thiamine 100 mg
o B) IV glucose 50%
o C) IV naloxone
o D) CT head without contrast
o Rationale: This triad (confusion, ataxia, ophthalmoplegia) is Wernicke's
encephalopathy due to thiamine deficiency.
6. A 72-year-old male with a history of heart failure presents with acute onset of severe
dyspnea, orthopnea, and cough producing pink, frothy sputum. Vital signs: BP 165/98, HR
118, RR 32, SpO2 88%. Lung auscultation reveals bilateral crackles. What is the most likely
diagnosis?
o A) Acute cardiogenic pulmonary edema
o B) Pneumonia
o C) Pulmonary embolism
o D) COPD exacerbation
o Rationale: Pink, frothy sputum and bilateral crackles in a patient with heart failure
are classic for acute pulmonary edema.
7. A patient with sudden painless vision loss in one eye is most likely experiencing:
o A) Central retinal artery occlusion
o B) Retinal detachment
o C) Acute angle-closure glaucoma
o D) Corneal abrasion
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: Sudden, painless monocular vision loss is the hallmark of a central retinal
artery occlusion.
8. A 5-year-old presents with a "barking" cough and stridor that worsens at night. Which
diagnosis is most likely?
o A) Epiglottitis
o B) Croup (laryngotracheobronchitis)
o C) Foreign body aspiration
o D) Asthma
o Rationale: Croup classically presents with a harsh, barking cough and inspiratory
stridor that is worse at night.
9. A patient presents with ECG changes suggestive of hyperkalemia. Which finding is most
characteristic?
o A) Peaked T waves and widened QRS
o B) ST elevation in leads V1-V4
o C) Diffuse ST depression
o D) Sinus bradycardia with prolonged PR
o Rationale: Hyperkalemia produces tall, peaked T waves, a prolonged PR, and
eventually a widened QRS as potassium levels rise.
10. A 30-year-old woman presents with lower abdominal pain, a positive pregnancy test, and an
adnexal mass on ultrasound. Which diagnosis is most likely?
o A) Ovarian torsion
o B) Ectopic pregnancy
o C) Ruptured corpus luteum cyst
o D) Pelvic inflammatory disease
o Rationale: Positive pregnancy test with adnexal mass and pain is classic for ectopic
pregnancy.
Domain 2: Medical Decision Making & Patient Management
11. Which of the following is the most appropriate initial action when a patient arrives with
suspected tension pneumothorax?
o A) Obtain a chest X-ray
o B) Perform needle thoracostomy
o C) Administer high-flow oxygen
o D) Start IV fluids
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: Tension pneumothorax is a life-threatening emergency; immediate
needle decompression relieves the intrathoracic pressure before imaging can be
obtained.
12. In a patient with suspected acute coronary syndrome, which cardiac biomarker rises
earliest?
o A) CK-MB
o B) Troponin I
o C) Myoglobin
o D) BNP
o Rationale: Myoglobin appears within 1–2 hours of myocardial injury, earlier than CK-
MB and troponin, though it is less specific.
13. What is the first-line treatment for anaphylaxis in the emergency department?
o A) Diphenhydramine
o B) Epinephrine intramuscularly
o C) Prednisone oral
o D) Albuterol nebulizer
o Rationale: Intramuscular epinephrine rapidly reverses airway edema,
bronchospasm, and hypotension, making it the cornerstone of anaphylaxis
management.
14. A trauma patient with a GCS of 7 should receive:
o A) Nasal cannula
o B) Non-rebreather mask
o C) Endotracheal intubation
o D) CPAP
o Rationale: A GCS ≤ 8 is a standard indication for endotracheal intubation to protect
the airway.
15. Which medication is the first-line therapy for acute severe asthma exacerbation in the
emergency department?
o A) Oral prednisone
o B) Intravenous magnesium sulfate
o C) High-dose inhaled β2-agonist via nebulizer
o D) Theophylline
o Rationale: Rapid bronchodilation with high-dose inhaled beta-agonists is the
cornerstone of acute asthma management.
Barkley Emergency Nurse Practitioner (ENP-C)
Certification Review 150 Actual Exam Questions &
Answers with Detailed Rationales
Domain 1: Medical Screening & Differential Diagnosis
1. A 45-year-old male with a history of hypertension 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?
o A) 12-lead ECG
o B) Chest X-ray
o C) Bedside echocardiogram
o D) CT angiogram of the chest
o Rationale: This presentation—sudden, tearing chest pain radiating to the back with
a significant blood pressure differential between arms—is classic for an aortic
dissection. CTA of the chest is the gold standard for rapid diagnosis and extent
mapping.
2. A 30-year-old woman presents with sudden, severe headache described as "the worst
headache of my life." She has no focal neurological deficits and is afebrile with nuchal
rigidity. What is the most appropriate next step?
o A) Administer IV tPA
o B) Lumbar puncture
o C) Non-contrast CT head
o D) MRI brain
o Rationale: A "thunderclap" headache with nuchal rigidity is highly concerning for
subarachnoid hemorrhage. Non-contrast CT head is the first-line imaging study to
detect acute SAH.
3. A 68-year-old male with COPD presents with increased dyspnea, wheezing, and a respiratory
rate of 30/min. What is the most appropriate initial pharmacologic intervention?
o A) IV methylprednisolone
o B) Inhaled high-dose beta-agonist via nebulizer
o C) IV antibiotics
o D) IV magnesium sulfate
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: In an acute COPD exacerbation, the priority is bronchodilation with
inhaled beta-agonists.
4. A patient presents with a deep laceration to the palmar surface of the hand and is unable to
oppose the thumb to the little finger. Which nerve is likely injured?
o A) Radial nerve
o B) Ulnar nerve
o C) Median nerve
o D) Musculocutaneous nerve
o Rationale: The median nerve provides motor function to the thenar muscles,
including the ability to oppose the thumb.
5. A 68-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and
bilateral ophthalmoplegia. What is the most appropriate initial treatment?
o A) IV thiamine 100 mg
o B) IV glucose 50%
o C) IV naloxone
o D) CT head without contrast
o Rationale: This triad (confusion, ataxia, ophthalmoplegia) is Wernicke's
encephalopathy due to thiamine deficiency.
6. A 72-year-old male with a history of heart failure presents with acute onset of severe
dyspnea, orthopnea, and cough producing pink, frothy sputum. Vital signs: BP 165/98, HR
118, RR 32, SpO2 88%. Lung auscultation reveals bilateral crackles. What is the most likely
diagnosis?
o A) Acute cardiogenic pulmonary edema
o B) Pneumonia
o C) Pulmonary embolism
o D) COPD exacerbation
o Rationale: Pink, frothy sputum and bilateral crackles in a patient with heart failure
are classic for acute pulmonary edema.
7. A patient with sudden painless vision loss in one eye is most likely experiencing:
o A) Central retinal artery occlusion
o B) Retinal detachment
o C) Acute angle-closure glaucoma
o D) Corneal abrasion
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: Sudden, painless monocular vision loss is the hallmark of a central retinal
artery occlusion.
8. A 5-year-old presents with a "barking" cough and stridor that worsens at night. Which
diagnosis is most likely?
o A) Epiglottitis
o B) Croup (laryngotracheobronchitis)
o C) Foreign body aspiration
o D) Asthma
o Rationale: Croup classically presents with a harsh, barking cough and inspiratory
stridor that is worse at night.
9. A patient presents with ECG changes suggestive of hyperkalemia. Which finding is most
characteristic?
o A) Peaked T waves and widened QRS
o B) ST elevation in leads V1-V4
o C) Diffuse ST depression
o D) Sinus bradycardia with prolonged PR
o Rationale: Hyperkalemia produces tall, peaked T waves, a prolonged PR, and
eventually a widened QRS as potassium levels rise.
10. A 30-year-old woman presents with lower abdominal pain, a positive pregnancy test, and an
adnexal mass on ultrasound. Which diagnosis is most likely?
o A) Ovarian torsion
o B) Ectopic pregnancy
o C) Ruptured corpus luteum cyst
o D) Pelvic inflammatory disease
o Rationale: Positive pregnancy test with adnexal mass and pain is classic for ectopic
pregnancy.
Domain 2: Medical Decision Making & Patient Management
11. Which of the following is the most appropriate initial action when a patient arrives with
suspected tension pneumothorax?
o A) Obtain a chest X-ray
o B) Perform needle thoracostomy
o C) Administer high-flow oxygen
o D) Start IV fluids
, BARKLEY EMERGENCY NURSE PRACTITIONER (ENP-C) CERTIFICATION
o Rationale: Tension pneumothorax is a life-threatening emergency; immediate
needle decompression relieves the intrathoracic pressure before imaging can be
obtained.
12. In a patient with suspected acute coronary syndrome, which cardiac biomarker rises
earliest?
o A) CK-MB
o B) Troponin I
o C) Myoglobin
o D) BNP
o Rationale: Myoglobin appears within 1–2 hours of myocardial injury, earlier than CK-
MB and troponin, though it is less specific.
13. What is the first-line treatment for anaphylaxis in the emergency department?
o A) Diphenhydramine
o B) Epinephrine intramuscularly
o C) Prednisone oral
o D) Albuterol nebulizer
o Rationale: Intramuscular epinephrine rapidly reverses airway edema,
bronchospasm, and hypotension, making it the cornerstone of anaphylaxis
management.
14. A trauma patient with a GCS of 7 should receive:
o A) Nasal cannula
o B) Non-rebreather mask
o C) Endotracheal intubation
o D) CPAP
o Rationale: A GCS ≤ 8 is a standard indication for endotracheal intubation to protect
the airway.
15. Which medication is the first-line therapy for acute severe asthma exacerbation in the
emergency department?
o A) Oral prednisone
o B) Intravenous magnesium sulfate
o C) High-dose inhaled β2-agonist via nebulizer
o D) Theophylline
o Rationale: Rapid bronchodilation with high-dose inhaled beta-agonists is the
cornerstone of acute asthma management.
