EMERGENCY NURSE PRACTITIONER
(ENP-C) CERTIFICATION REVIEW
ACTUAL EXAM QUESTIONS AND
ANSWERS
1. A 65-year-old male presents with sudden onset of ‘tearing’ chest pain radiating to the back.
His blood pressure is 190/110 mmHg. A CT scan confirms a Type B aortic dissection. What is
the initial pharmacological priority?
A. Intravenous Nitroglycerin infusion
B. Intravenous Nitroprusside alone
C. Intravenous Hydralazine bolus
D. Intravenous Esmolol infusion
Answer: D
Conceptual Explanation: In aortic dissection, the primary goal is to reduce heart rate and
shear stress. Beta-blockers (like Esmolol or Labetalol) are first-line to achieve a heart rate <
60 bpm before adding vasodilators to prevent reflex tachycardia.
2. A trauma patient presents with tracheal deviation, absent breath sounds on the right, and
hypotension. Which is the most appropriate immediate intervention?
A. Endotracheal intubation
,B. Needle decompression in the 2nd or 5th intercostal space
C. Obtaining a portable chest X-ray
D. Pericardiocentesis
Answer: B
Conceptual Explanation: The clinical presentation is pathognomonic for tension
pneumothorax. It is a clinical diagnosis that requires immediate needle decompression
before waiting for imaging or intubation.
3. A 4-year-old child is brought to the ED with a high fever, drooling, and sitting in a ‘tripod’
position. What is the most critical contraindication in managing this patient?
A. Placing a peripheral IV line
B. Inspecting the throat with a tongue depressor
C. Administering humidified oxygen
D. Obtaining a lateral neck X-ray
Answer: B
Conceptual Explanation: Suspicion of epiglottitis should preclude any stimulation of the
oropharynx, as it can trigger laryngospasm and complete airway obstruction.
4. Using the NEXUS criteria for C-spine clearance, which of the following patients requires
radiographic imaging?
A. A 40-year-old with no focal neurological deficit
, B. A 25-year-old with a normal level of alertness
C. A 30-year-old with midline cervical tenderness
D. A 50-year-old with no distracting injuries
Answer: C
Conceptual Explanation: NEXUS criteria require imaging if any of the following are
present: midline tenderness, focal neuro deficits, altered level of consciousness,
intoxication, or distracting painful injuries.
5. An 8-year-old boy falls on an outstretched hand. X-ray shows a fracture through the growth
plate and the metaphysis. Which Salter-Harris classification is this?
A. Type I
B. Type IV
C. Type III
D. Type II
Answer: D
Conceptual Explanation: Salter-Harris Type II (the most common) involves a fracture
through the physis (growth plate) and the metaphysis.
6. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign,
what is the target mean arterial pressure (MAP) for fluid resuscitation?
A. > 55 mmHg
(ENP-C) CERTIFICATION REVIEW
ACTUAL EXAM QUESTIONS AND
ANSWERS
1. A 65-year-old male presents with sudden onset of ‘tearing’ chest pain radiating to the back.
His blood pressure is 190/110 mmHg. A CT scan confirms a Type B aortic dissection. What is
the initial pharmacological priority?
A. Intravenous Nitroglycerin infusion
B. Intravenous Nitroprusside alone
C. Intravenous Hydralazine bolus
D. Intravenous Esmolol infusion
Answer: D
Conceptual Explanation: In aortic dissection, the primary goal is to reduce heart rate and
shear stress. Beta-blockers (like Esmolol or Labetalol) are first-line to achieve a heart rate <
60 bpm before adding vasodilators to prevent reflex tachycardia.
2. A trauma patient presents with tracheal deviation, absent breath sounds on the right, and
hypotension. Which is the most appropriate immediate intervention?
A. Endotracheal intubation
,B. Needle decompression in the 2nd or 5th intercostal space
C. Obtaining a portable chest X-ray
D. Pericardiocentesis
Answer: B
Conceptual Explanation: The clinical presentation is pathognomonic for tension
pneumothorax. It is a clinical diagnosis that requires immediate needle decompression
before waiting for imaging or intubation.
3. A 4-year-old child is brought to the ED with a high fever, drooling, and sitting in a ‘tripod’
position. What is the most critical contraindication in managing this patient?
A. Placing a peripheral IV line
B. Inspecting the throat with a tongue depressor
C. Administering humidified oxygen
D. Obtaining a lateral neck X-ray
Answer: B
Conceptual Explanation: Suspicion of epiglottitis should preclude any stimulation of the
oropharynx, as it can trigger laryngospasm and complete airway obstruction.
4. Using the NEXUS criteria for C-spine clearance, which of the following patients requires
radiographic imaging?
A. A 40-year-old with no focal neurological deficit
, B. A 25-year-old with a normal level of alertness
C. A 30-year-old with midline cervical tenderness
D. A 50-year-old with no distracting injuries
Answer: C
Conceptual Explanation: NEXUS criteria require imaging if any of the following are
present: midline tenderness, focal neuro deficits, altered level of consciousness,
intoxication, or distracting painful injuries.
5. An 8-year-old boy falls on an outstretched hand. X-ray shows a fracture through the growth
plate and the metaphysis. Which Salter-Harris classification is this?
A. Type I
B. Type IV
C. Type III
D. Type II
Answer: D
Conceptual Explanation: Salter-Harris Type II (the most common) involves a fracture
through the physis (growth plate) and the metaphysis.
6. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign,
what is the target mean arterial pressure (MAP) for fluid resuscitation?
A. > 55 mmHg
