Barkley ENP-C Exam 2026–2027|||questions
and answers with rationales/graded A+/2026
update/100% correct /instant download
Questions 1-20: Medical Screening, Triage, and Cardiovascular Emergencies
1. A 58-year-old male presents with crushing substernal chest pain radiating to
the left arm. ECG shows ST-segment elevation in leads II, III, and aVF. Which
immediate medication is indicated?
• A) Metoprolol 5 mg IV
• B) Nitroglycerin 0.4 mg SL
• C) Alteplase 100 mg IV infusion
• D) Aspirin 325 mg PO
Correct Answer: D
Rationale: Aspirin is the immediate priority for any suspected acute coronary
syndrome. It reduces mortality and should be chewed immediately upon
recognition. Nitroglycerin may be given for pain but is not the first priority. Alteplase
is contraindicated without ruling out aortic dissection and is time-dependent.
Metoprolol is indicated but after aspirin and hemodynamic assessment.
2. A 72-year-old male with heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. BP 165/98, HR 118, RR 32, SpO2 88% on 4L
NC. Lung auscultation reveals bilateral crackles. What is the most appropriate
initial management?
• A) Administer IV furosemide and nitroglycerin
, • B) Start IV antibiotics for pneumonia
• C) Begin CPAP and give IV furosemide
• D) Intubate immediately
Correct Answer: C
Rationale: This patient is in acute cardiogenic pulmonary edema. Non-invasive
positive pressure ventilation (CPAP) reduces preload and afterload while improving
oxygenation, and is preferred over intubation if the patient can protect their airway.
IV furosemide for diuresis and nitroglycerin for afterload reduction are appropriate,
but CPAP is the priority before intubation.
3. A patient presents with a "thunderclap" headache, neck stiffness, and
photophobia. Head CT is negative. Which diagnosis is most likely?
• A) Migraine with aura
• B) Meningitis
• C) Subarachnoid hemorrhage
• D) Cluster headache
Correct Answer: C
Rationale: A "thunderclap" headache (worst headache of life) with neck stiffness is
classic for subarachnoid hemorrhage (SAH). CT is ~95% sensitive within 6 hours,
so a negative CT requires lumbar puncture. Xanthochromia in CSF confirms SAH.
Meningitis typically has fever and longer onset. Cluster headaches have autonomic
symptoms.
,4. A patient is brought in after a house fire. Singed nasal hairs, soot in the
oropharynx, hoarseness, and carbonaceous sputum are noted. Which is the
most appropriate immediate airway management?
• A) Awake fiberoptic intubation
• B) Rapid sequence intubation with rocuronium
• C) Nasopharyngeal airway placement
• D) Nebulized epinephrine and observation
Correct Answer: A
Rationale: Signs of inhalation injury (singed nasal hairs, soot, carbonaceous
sputum, hoarseness) indicate airway edema is likely to develop. Awake fiberoptic
intubation is preferred to secure the airway while the patient is still breathing
spontaneously. RSI carries risk of "can't intubate, can't ventilate" as airway edema
progresses.
5. A 45-year-old male has a deep laceration to the palmar hand and cannot
oppose the thumb to the little finger. Which nerve is likely injured?
• A) Radial nerve
• B) Ulnar nerve
• C) Median nerve
• D) Musculocutaneous nerve
Correct Answer: C
Rationale: The median nerve innervates the thenar muscles, including the
opponens pollicis, which enables thumb opposition. Inability to oppose the thumb
to the little finger indicates median nerve injury. Ulnar nerve injury causes claw
hand and loss of finger adduction. Radial nerve injury causes wrist drop.
, 6. A 55-year-old with cirrhosis and ascites presents with fever and abdominal
pain. Paracentesis reveals PMN count of 500 cells/mm3. What is the most
appropriate empiric antibiotic?
• A) Cefotaxime
• B) Piperacillin-Tazobactam
• C) Vancomycin + Cefepime
• D) Metronidazole + Ceftriaxone
Correct Answer: A
Rationale: Spontaneous bacterial peritonitis (SBP) is diagnosed with ascitic PMN
>250 cells/mm3. Empiric therapy is a third-generation cephalosporin (cefotaxime
or ceftriaxone) to cover enteric Gram-negative organisms. Addition of IV albumin is
recommended to prevent hepatorenal syndrome.
7. A 62-year-old with sudden onset of severe, tearing chest pain radiating to the
back has a BP 110/70 in the right arm and 85/50 in the left arm. What is the
most likely diagnosis?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden severe "tearing"
chest pain radiating to the back, with pulse or blood pressure differential between
arms. Risk factors include hypertension and connective tissue disorders.
and answers with rationales/graded A+/2026
update/100% correct /instant download
Questions 1-20: Medical Screening, Triage, and Cardiovascular Emergencies
1. A 58-year-old male presents with crushing substernal chest pain radiating to
the left arm. ECG shows ST-segment elevation in leads II, III, and aVF. Which
immediate medication is indicated?
• A) Metoprolol 5 mg IV
• B) Nitroglycerin 0.4 mg SL
• C) Alteplase 100 mg IV infusion
• D) Aspirin 325 mg PO
Correct Answer: D
Rationale: Aspirin is the immediate priority for any suspected acute coronary
syndrome. It reduces mortality and should be chewed immediately upon
recognition. Nitroglycerin may be given for pain but is not the first priority. Alteplase
is contraindicated without ruling out aortic dissection and is time-dependent.
Metoprolol is indicated but after aspirin and hemodynamic assessment.
2. A 72-year-old male with heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. BP 165/98, HR 118, RR 32, SpO2 88% on 4L
NC. Lung auscultation reveals bilateral crackles. What is the most appropriate
initial management?
• A) Administer IV furosemide and nitroglycerin
, • B) Start IV antibiotics for pneumonia
• C) Begin CPAP and give IV furosemide
• D) Intubate immediately
Correct Answer: C
Rationale: This patient is in acute cardiogenic pulmonary edema. Non-invasive
positive pressure ventilation (CPAP) reduces preload and afterload while improving
oxygenation, and is preferred over intubation if the patient can protect their airway.
IV furosemide for diuresis and nitroglycerin for afterload reduction are appropriate,
but CPAP is the priority before intubation.
3. A patient presents with a "thunderclap" headache, neck stiffness, and
photophobia. Head CT is negative. Which diagnosis is most likely?
• A) Migraine with aura
• B) Meningitis
• C) Subarachnoid hemorrhage
• D) Cluster headache
Correct Answer: C
Rationale: A "thunderclap" headache (worst headache of life) with neck stiffness is
classic for subarachnoid hemorrhage (SAH). CT is ~95% sensitive within 6 hours,
so a negative CT requires lumbar puncture. Xanthochromia in CSF confirms SAH.
Meningitis typically has fever and longer onset. Cluster headaches have autonomic
symptoms.
,4. A patient is brought in after a house fire. Singed nasal hairs, soot in the
oropharynx, hoarseness, and carbonaceous sputum are noted. Which is the
most appropriate immediate airway management?
• A) Awake fiberoptic intubation
• B) Rapid sequence intubation with rocuronium
• C) Nasopharyngeal airway placement
• D) Nebulized epinephrine and observation
Correct Answer: A
Rationale: Signs of inhalation injury (singed nasal hairs, soot, carbonaceous
sputum, hoarseness) indicate airway edema is likely to develop. Awake fiberoptic
intubation is preferred to secure the airway while the patient is still breathing
spontaneously. RSI carries risk of "can't intubate, can't ventilate" as airway edema
progresses.
5. A 45-year-old male has a deep laceration to the palmar hand and cannot
oppose the thumb to the little finger. Which nerve is likely injured?
• A) Radial nerve
• B) Ulnar nerve
• C) Median nerve
• D) Musculocutaneous nerve
Correct Answer: C
Rationale: The median nerve innervates the thenar muscles, including the
opponens pollicis, which enables thumb opposition. Inability to oppose the thumb
to the little finger indicates median nerve injury. Ulnar nerve injury causes claw
hand and loss of finger adduction. Radial nerve injury causes wrist drop.
, 6. A 55-year-old with cirrhosis and ascites presents with fever and abdominal
pain. Paracentesis reveals PMN count of 500 cells/mm3. What is the most
appropriate empiric antibiotic?
• A) Cefotaxime
• B) Piperacillin-Tazobactam
• C) Vancomycin + Cefepime
• D) Metronidazole + Ceftriaxone
Correct Answer: A
Rationale: Spontaneous bacterial peritonitis (SBP) is diagnosed with ascitic PMN
>250 cells/mm3. Empiric therapy is a third-generation cephalosporin (cefotaxime
or ceftriaxone) to cover enteric Gram-negative organisms. Addition of IV albumin is
recommended to prevent hepatorenal syndrome.
7. A 62-year-old with sudden onset of severe, tearing chest pain radiating to the
back has a BP 110/70 in the right arm and 85/50 in the left arm. What is the
most likely diagnosis?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden severe "tearing"
chest pain radiating to the back, with pulse or blood pressure differential between
arms. Risk factors include hypertension and connective tissue disorders.
