BARKLEY EMERGENCY NURSE
PRACTITIONER (ENP-C) 2026
COMPREHENSIVE REVIEW
1. A 45-year-old male presents with severe mid-sternal chest pain. The EKG shows ST-
segment elevation in leads V1-V4. Which coronary artery is most likely occluded?
A. Right Coronary Artery (RCA)
B. Left Anterior Descending (LAD)
C. Left Circumflex (LCx)
D. Right Marginal Artery
Answer: B
Conceptual Explanation: ST elevation in V1-V4 corresponds to the anterior wall of the
heart, which is primarily supplied by the Left Anterior Descending (LAD) artery.
2. Which of the following findings is most specific for a diagnosis of cardiac tamponade?
A. Pulsus paradoxus
B. Tachycardia
C. Low voltage EKG
,D. Electrical alternans
Answer: D
Conceptual Explanation: While pulsus paradoxus is common, electrical alternans
(alternating QRS amplitude) is highly specific for a large pericardial effusion and
tamponade due to the heart swinging in the fluid.
3. In a patient with a suspected Le Fort II fracture, which physical exam finding is most likely?
A. Mobility of the midface, including the nose and infraorbital rim
B. Mobility of the hard palate and upper teeth only
C. Complete craniofacial dysjunction
D. Isolated fracture of the zygomatic arch
Answer: A
Conceptual Explanation: Le Fort II is a pyramidal fracture involving the midface, nose,
and infraorbital rims. Le Fort I involves only the palate, and Le Fort III is craniofacial
dysjunction.
4. A 22-year-old athlete presents with sudden syncope. EKG reveals a ‘coved’ ST-segment
elevation in V1-V3 followed by an inverted T-wave. What is the most likely diagnosis?
A. Brugada Syndrome
B. Hypertrophic Cardiomyopathy
C. Arrhythmogenic Right Ventricular Dysplasia
, D. Wellens Syndrome
Answer: A
Conceptual Explanation: Brugada Syndrome Type 1 is characterized by the coved ST
elevation in right precordial leads (V1-V3) and carries a high risk of ventricular
arrhythmias and sudden death.
5. A patient presents with a ‘curtain coming down’ over their vision in the right eye. The eye
is painless. What is the most appropriate next step?
A. Obtain an emergent CT scan of the head
B. Administer IV acetazolamide
C. Consult ophthalmology for suspected retinal detachment
D. Perform a fluorescein stain to check for corneal abrasion
Answer: C
Conceptual Explanation: A painless ‘curtain’ sensation is classic for retinal detachment,
requiring immediate ophthalmological evaluation to prevent permanent vision loss.
6. Which of the following represents the correct management of a symptomatic patient with
a heart rate of 35 bpm and EKG showing a Mobitz Type II second-degree AV block?
A. Transcutaneous pacing
B. Observation and repeat EKG in 6 hours
C. Atropine 1mg IV push
PRACTITIONER (ENP-C) 2026
COMPREHENSIVE REVIEW
1. A 45-year-old male presents with severe mid-sternal chest pain. The EKG shows ST-
segment elevation in leads V1-V4. Which coronary artery is most likely occluded?
A. Right Coronary Artery (RCA)
B. Left Anterior Descending (LAD)
C. Left Circumflex (LCx)
D. Right Marginal Artery
Answer: B
Conceptual Explanation: ST elevation in V1-V4 corresponds to the anterior wall of the
heart, which is primarily supplied by the Left Anterior Descending (LAD) artery.
2. Which of the following findings is most specific for a diagnosis of cardiac tamponade?
A. Pulsus paradoxus
B. Tachycardia
C. Low voltage EKG
,D. Electrical alternans
Answer: D
Conceptual Explanation: While pulsus paradoxus is common, electrical alternans
(alternating QRS amplitude) is highly specific for a large pericardial effusion and
tamponade due to the heart swinging in the fluid.
3. In a patient with a suspected Le Fort II fracture, which physical exam finding is most likely?
A. Mobility of the midface, including the nose and infraorbital rim
B. Mobility of the hard palate and upper teeth only
C. Complete craniofacial dysjunction
D. Isolated fracture of the zygomatic arch
Answer: A
Conceptual Explanation: Le Fort II is a pyramidal fracture involving the midface, nose,
and infraorbital rims. Le Fort I involves only the palate, and Le Fort III is craniofacial
dysjunction.
4. A 22-year-old athlete presents with sudden syncope. EKG reveals a ‘coved’ ST-segment
elevation in V1-V3 followed by an inverted T-wave. What is the most likely diagnosis?
A. Brugada Syndrome
B. Hypertrophic Cardiomyopathy
C. Arrhythmogenic Right Ventricular Dysplasia
, D. Wellens Syndrome
Answer: A
Conceptual Explanation: Brugada Syndrome Type 1 is characterized by the coved ST
elevation in right precordial leads (V1-V3) and carries a high risk of ventricular
arrhythmias and sudden death.
5. A patient presents with a ‘curtain coming down’ over their vision in the right eye. The eye
is painless. What is the most appropriate next step?
A. Obtain an emergent CT scan of the head
B. Administer IV acetazolamide
C. Consult ophthalmology for suspected retinal detachment
D. Perform a fluorescein stain to check for corneal abrasion
Answer: C
Conceptual Explanation: A painless ‘curtain’ sensation is classic for retinal detachment,
requiring immediate ophthalmological evaluation to prevent permanent vision loss.
6. Which of the following represents the correct management of a symptomatic patient with
a heart rate of 35 bpm and EKG showing a Mobitz Type II second-degree AV block?
A. Transcutaneous pacing
B. Observation and repeat EKG in 6 hours
C. Atropine 1mg IV push
