Barkley ENP-C Exam 2026/2027: 250 Practice
Questions with Answers & Rationales Graded
A+ | 2026/2027 Update | 100% Correct
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–40)
Question 1
A 72-year-old male with a history of heart failure presents with acute onset of severe
dyspnea, orthopnea, and a cough producing pink, frothy sputum. Vital signs are BP
165/98 mmHg, HR 118 bpm, RR 32/min, SpO2 88% on 4 L nasal cannula. Lung
auscultation reveals bilateral crackles extending to the mid-lung fields. Jugular venous
distension is noted. What is the most appropriate initial management?
A) Administer IV furosemide 40 mg and place in high-Fowler's position
B) Administer IV nitroglycerin and prepare for intubation
C) Administer IV morphine sulfate and apply BiPAP
D) Administer IV labetalol and obtain a stat chest X-ray
Correct Answer: A) Administer IV furosemide 40 mg and place in high-Fowler's
position
Rationale: This patient is presenting with acute decompensated heart failure with
pulmonary edema. The priority interventions include placing the patient in a high-Fowler's
position to reduce venous return and preload, and administering IV furosemide to reduce
fluid overload. Nitroglycerin may be considered for afterload reduction if BP permits, but
furosemide and positioning are the initial priorities.
Question 2
A 45-year-old male with no significant past medical history presents with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. His ECG shows
ST-segment elevation in leads V1-V4. Which of the following is the priority intervention?
A) Administer sublingual nitroglycerin 0.4 mg
B) Administer aspirin 324 mg chewed
,C) Administer morphine sulfate 4 mg IV
D) Administer oxygen via non-rebreather mask
Correct Answer: B) Administer aspirin 324 mg chewed
Rationale: This patient is experiencing an acute STEMI. Aspirin is the priority intervention
as it reduces mortality by inhibiting platelet aggregation. It should be given as soon as
possible. While nitroglycerin, morphine, and oxygen are important, aspirin is the most
critical initial intervention.
Question 3
A 68-year-old female presents with palpitations, dizziness, and shortness of breath. Her
ECG shows an irregularly irregular rhythm with a ventricular rate of 140 bpm. Which of
the following is the most appropriate initial management?
A) Immediate synchronized cardioversion
B) Administer IV diltiazem 0.25 mg/kg bolus
C) Administer IV amiodarone 150 mg bolus
D) Administer oral metoprolol 25 mg
Correct Answer: B) Administer IV diltiazem 0.25 mg/kg bolus
Rationale: The patient is in atrial fibrillation with rapid ventricular response. The initial
management for hemodynamically stable atrial fibrillation is rate control. IV diltiazem (a
calcium channel blocker) is a first-line agent for rate control. Synchronized cardioversion is
indicated if the patient is unstable. Amiodarone is used for rhythm control, not first-line
rate control.
Question 4
A 55-year-old male with a history of hypertension presents with a sudden onset of
severe "tearing" chest pain radiating to the back. His blood pressure is 180/110 mmHg
in the right arm and 160/90 mmHg in the left arm. Which of the following is the most
likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
,C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain radiating to
the back. Asymmetric blood pressures between arms are a classic finding. Immediate
management includes heart rate and blood pressure control. Emergent surgical
consultation is indicated.
Question 5
A 32-year-old female with no significant past medical history presents with acute-onset
palpitations, chest discomfort, and lightheadedness. Her ECG shows a narrow-complex
tachycardia at 180 bpm without visible P waves. Vagal maneuvers are unsuccessful.
What is the next most appropriate intervention?
A) Administer IV adenosine 6 mg rapid push
B) Administer IV diltiazem 0.25 mg/kg
C) Administer IV amiodarone 150 mg
D) Perform synchronized cardioversion
Correct Answer: A) Administer IV adenosine 6 mg rapid push
Rationale: The patient is presenting with supraventricular tachycardia (SVT). Adenosine is
the first-line medication for acute SVT if vagal maneuvers are unsuccessful. It is
administered as a rapid IV push (6 mg followed by 20 mL NS flush). If unsuccessful, a 12
mg dose may be given. The patient is hemodynamically stable, so cardioversion is not
indicated.
Question 6
A 60-year-old male with a history of coronary artery disease presents with chest pain.
His ECG shows ST-segment depression in leads V3-V6. Which of the following is the
most appropriate diagnosis?
A) STEMI
B) NSTEMI/Unstable angina
, C) Pericarditis
D) Pulmonary embolism
Correct Answer: B) NSTEMI/Unstable angina
Rationale: ST-segment depression in multiple leads indicates subendocardial ischemia,
consistent with NSTEMI or unstable angina. This is distinguished from STEMI, which shows
ST-segment elevation. Management includes antiplatelet therapy, anticoagulation, and
evaluation for early invasive strategy.
Question 7
A 42-year-old male presents with palpitations and near-syncope. His ECG shows a wide-
complex tachycardia at 220 bpm. He is alert and oriented with a BP of 110/70 mmHg.
Which of the following is the most appropriate initial management?
A) Administer IV amiodarone 150 mg bolus
B) Administer IV adenosine 6 mg rapid push
C) Immediate synchronized cardioversion
D) Administer IV procainamide
Correct Answer: A) Administer IV amiodarone 150 mg bolus
Rationale: The patient has a wide-complex tachycardia (likely ventricular tachycardia). For
stable monomorphic VT, IV amiodarone is the first-line antiarrhythmic. Adenosine may be
considered if the rhythm is regular and thought to be SVT with aberrancy, but in
hemodynamically stable wide-complex tachycardia, amiodarone is preferred.
Synchronized cardioversion is indicated if the patient is unstable.
Question 8
A 28-year-old female presents with chest pain that worsens with inspiration and
improves when leaning forward. On exam, a friction rub is auscultated. Which of the
following is the most likely diagnosis?
A) Pericarditis
B) Myocardial infarction
Questions with Answers & Rationales Graded
A+ | 2026/2027 Update | 100% Correct
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–40)
Question 1
A 72-year-old male with a history of heart failure presents with acute onset of severe
dyspnea, orthopnea, and a cough producing pink, frothy sputum. Vital signs are BP
165/98 mmHg, HR 118 bpm, RR 32/min, SpO2 88% on 4 L nasal cannula. Lung
auscultation reveals bilateral crackles extending to the mid-lung fields. Jugular venous
distension is noted. What is the most appropriate initial management?
A) Administer IV furosemide 40 mg and place in high-Fowler's position
B) Administer IV nitroglycerin and prepare for intubation
C) Administer IV morphine sulfate and apply BiPAP
D) Administer IV labetalol and obtain a stat chest X-ray
Correct Answer: A) Administer IV furosemide 40 mg and place in high-Fowler's
position
Rationale: This patient is presenting with acute decompensated heart failure with
pulmonary edema. The priority interventions include placing the patient in a high-Fowler's
position to reduce venous return and preload, and administering IV furosemide to reduce
fluid overload. Nitroglycerin may be considered for afterload reduction if BP permits, but
furosemide and positioning are the initial priorities.
Question 2
A 45-year-old male with no significant past medical history presents with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. His ECG shows
ST-segment elevation in leads V1-V4. Which of the following is the priority intervention?
A) Administer sublingual nitroglycerin 0.4 mg
B) Administer aspirin 324 mg chewed
,C) Administer morphine sulfate 4 mg IV
D) Administer oxygen via non-rebreather mask
Correct Answer: B) Administer aspirin 324 mg chewed
Rationale: This patient is experiencing an acute STEMI. Aspirin is the priority intervention
as it reduces mortality by inhibiting platelet aggregation. It should be given as soon as
possible. While nitroglycerin, morphine, and oxygen are important, aspirin is the most
critical initial intervention.
Question 3
A 68-year-old female presents with palpitations, dizziness, and shortness of breath. Her
ECG shows an irregularly irregular rhythm with a ventricular rate of 140 bpm. Which of
the following is the most appropriate initial management?
A) Immediate synchronized cardioversion
B) Administer IV diltiazem 0.25 mg/kg bolus
C) Administer IV amiodarone 150 mg bolus
D) Administer oral metoprolol 25 mg
Correct Answer: B) Administer IV diltiazem 0.25 mg/kg bolus
Rationale: The patient is in atrial fibrillation with rapid ventricular response. The initial
management for hemodynamically stable atrial fibrillation is rate control. IV diltiazem (a
calcium channel blocker) is a first-line agent for rate control. Synchronized cardioversion is
indicated if the patient is unstable. Amiodarone is used for rhythm control, not first-line
rate control.
Question 4
A 55-year-old male with a history of hypertension presents with a sudden onset of
severe "tearing" chest pain radiating to the back. His blood pressure is 180/110 mmHg
in the right arm and 160/90 mmHg in the left arm. Which of the following is the most
likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
,C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain radiating to
the back. Asymmetric blood pressures between arms are a classic finding. Immediate
management includes heart rate and blood pressure control. Emergent surgical
consultation is indicated.
Question 5
A 32-year-old female with no significant past medical history presents with acute-onset
palpitations, chest discomfort, and lightheadedness. Her ECG shows a narrow-complex
tachycardia at 180 bpm without visible P waves. Vagal maneuvers are unsuccessful.
What is the next most appropriate intervention?
A) Administer IV adenosine 6 mg rapid push
B) Administer IV diltiazem 0.25 mg/kg
C) Administer IV amiodarone 150 mg
D) Perform synchronized cardioversion
Correct Answer: A) Administer IV adenosine 6 mg rapid push
Rationale: The patient is presenting with supraventricular tachycardia (SVT). Adenosine is
the first-line medication for acute SVT if vagal maneuvers are unsuccessful. It is
administered as a rapid IV push (6 mg followed by 20 mL NS flush). If unsuccessful, a 12
mg dose may be given. The patient is hemodynamically stable, so cardioversion is not
indicated.
Question 6
A 60-year-old male with a history of coronary artery disease presents with chest pain.
His ECG shows ST-segment depression in leads V3-V6. Which of the following is the
most appropriate diagnosis?
A) STEMI
B) NSTEMI/Unstable angina
, C) Pericarditis
D) Pulmonary embolism
Correct Answer: B) NSTEMI/Unstable angina
Rationale: ST-segment depression in multiple leads indicates subendocardial ischemia,
consistent with NSTEMI or unstable angina. This is distinguished from STEMI, which shows
ST-segment elevation. Management includes antiplatelet therapy, anticoagulation, and
evaluation for early invasive strategy.
Question 7
A 42-year-old male presents with palpitations and near-syncope. His ECG shows a wide-
complex tachycardia at 220 bpm. He is alert and oriented with a BP of 110/70 mmHg.
Which of the following is the most appropriate initial management?
A) Administer IV amiodarone 150 mg bolus
B) Administer IV adenosine 6 mg rapid push
C) Immediate synchronized cardioversion
D) Administer IV procainamide
Correct Answer: A) Administer IV amiodarone 150 mg bolus
Rationale: The patient has a wide-complex tachycardia (likely ventricular tachycardia). For
stable monomorphic VT, IV amiodarone is the first-line antiarrhythmic. Adenosine may be
considered if the rhythm is regular and thought to be SVT with aberrancy, but in
hemodynamically stable wide-complex tachycardia, amiodarone is preferred.
Synchronized cardioversion is indicated if the patient is unstable.
Question 8
A 28-year-old female presents with chest pain that worsens with inspiration and
improves when leaning forward. On exam, a friction rub is auscultated. Which of the
following is the most likely diagnosis?
A) Pericarditis
B) Myocardial infarction
