BARKLEY EMERGENCY/CRITICAL CARE
PRACTICE EXAM Comprehensive 200-
Question Practice Examination – New
Edition
INTRODUCTION
The Barkley Emergency/Critical Care Practice Exam is a
comprehensive, standardized practice examination designed to evaluate
the clinical knowledge, diagnostic reasoning, and management skills
required for safe, effective emergency and critical care advanced practice
nursing. This examination mirrors the content blueprint of the
Emergency Nurse Practitioner (ENP) and Adult-Gerontology Acute
Care Nurse Practitioner (AGACNP) certification exams and emphasizes
the clinical judgment required for independent practice in high-acuity
settings.
This examination is structured around the core emergency/critical care
domains:
• Cardiovascular Emergencies
• Respiratory Failure and Mechanical Ventilation
• Neurological Emergencies
• Shock States and Hemodynamic Monitoring
• Trauma and ATLS Protocols
• Toxicology and Environmental Emergencies
• Sepsis and Infectious Emergencies
• Endocrine and Metabolic Crises
• Gastrointestinal and Hepatic Emergencies
• Renal and Electrolyte Emergencies
• Procedural Skills and Emergency Management
• Professional Practice and Systems-Based Care
, Each of the 200 questions is presented in a clinical scenario-based
format, requiring the emergency/critical care NP to apply the diagnostic
reasoning process (Subjective Data, Objective Data,
Assessment/Differential Diagnosis, Plan/Management) and evidence-
based emergency/critical care guidelines.
Answer Format:
• Correct answers and detailed explanations are presented in italics.
• Rationales and clinical reasoning are presented in bold.
This examination is intended for ENP and AGACNP students preparing
for certification, practicing emergency/critical care NPs seeking
continuing education, and educators developing comprehensive
assessment tools.
TABLE OF CONTENTS
Section Content Area Question Ran
I Cardiovascular Emergencies 1–35
II Respiratory Failure and Mechanical Ventilation 36–65
III Neurological Emergencies 66–90
IV Shock States and Hemodynamic Monitoring 91–115
V Trauma and ATLS Protocols 116–140
VI Toxicology and Environmental Emergencies 141–160
VII Sepsis and Infectious Emergencies 161–175
VIII Endocrine and Metabolic Crises 176–190
,Section Content Area Question Ran
IX Gastrointestinal, Renal, and Electrolyte Emergencies 191–200
Answer Key & Rationales 1–200
SECTION I: CARDIOVASCULAR EMERGENCIES (Questions 1–35)
Question 1
A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm and jaw, diaphoresis, and nausea. His ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA).
Rationale: The LAD (A) supplies the anterior wall (leads V1–V4). The
circumflex (B) supplies the lateral wall (leads I, aVL, V5–V6). The left
main (D) supplies a large territory and would cause widespread
changes. The RCA (C) supplies the inferior wall.
Question 2
A 62-year-old female presents with acute onset of severe dyspnea,
orthopnea, and pink frothy sputum. Her blood pressure is 180/100
, mmHg, heart rate 120 bpm, and oxygen saturation 82% on room air.
Which medication is most appropriate initially?
A. IV furosemide
B. IV metoprolol
C. IV diltiazem
D. Oral lisinopril
Answer: A
This patient is presenting with acute decompensated heart failure and
pulmonary edema with adequate blood pressure. IV furosemide is the first-
line medication to reduce preload and relieve pulmonary congestion.
Rationale: IV metoprolol (B) and IV diltiazem (C) are rate-control
agents that may worsen heart failure acutely. Oral lisinopril (D) is
not appropriate for acute management. IV furosemide (A) is the
priority.
Question 3
A 55-year-old male presents with a heart rate of 180 bpm, narrow-
complex tachycardia, and stable blood pressure. Which intervention is
most appropriate initially?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Amiodarone 150 mg IV
D. Defibrillation
Answer: B
For stable narrow-complex tachycardia (likely SVT), adenosine is the first-
line pharmacologic intervention after vagal maneuvers.
Rationale: Synchronized cardioversion (A) is for unstable patients.
Amiodarone (C) is for ventricular arrhythmias. Defibrillation (D) is
PRACTICE EXAM Comprehensive 200-
Question Practice Examination – New
Edition
INTRODUCTION
The Barkley Emergency/Critical Care Practice Exam is a
comprehensive, standardized practice examination designed to evaluate
the clinical knowledge, diagnostic reasoning, and management skills
required for safe, effective emergency and critical care advanced practice
nursing. This examination mirrors the content blueprint of the
Emergency Nurse Practitioner (ENP) and Adult-Gerontology Acute
Care Nurse Practitioner (AGACNP) certification exams and emphasizes
the clinical judgment required for independent practice in high-acuity
settings.
This examination is structured around the core emergency/critical care
domains:
• Cardiovascular Emergencies
• Respiratory Failure and Mechanical Ventilation
• Neurological Emergencies
• Shock States and Hemodynamic Monitoring
• Trauma and ATLS Protocols
• Toxicology and Environmental Emergencies
• Sepsis and Infectious Emergencies
• Endocrine and Metabolic Crises
• Gastrointestinal and Hepatic Emergencies
• Renal and Electrolyte Emergencies
• Procedural Skills and Emergency Management
• Professional Practice and Systems-Based Care
, Each of the 200 questions is presented in a clinical scenario-based
format, requiring the emergency/critical care NP to apply the diagnostic
reasoning process (Subjective Data, Objective Data,
Assessment/Differential Diagnosis, Plan/Management) and evidence-
based emergency/critical care guidelines.
Answer Format:
• Correct answers and detailed explanations are presented in italics.
• Rationales and clinical reasoning are presented in bold.
This examination is intended for ENP and AGACNP students preparing
for certification, practicing emergency/critical care NPs seeking
continuing education, and educators developing comprehensive
assessment tools.
TABLE OF CONTENTS
Section Content Area Question Ran
I Cardiovascular Emergencies 1–35
II Respiratory Failure and Mechanical Ventilation 36–65
III Neurological Emergencies 66–90
IV Shock States and Hemodynamic Monitoring 91–115
V Trauma and ATLS Protocols 116–140
VI Toxicology and Environmental Emergencies 141–160
VII Sepsis and Infectious Emergencies 161–175
VIII Endocrine and Metabolic Crises 176–190
,Section Content Area Question Ran
IX Gastrointestinal, Renal, and Electrolyte Emergencies 191–200
Answer Key & Rationales 1–200
SECTION I: CARDIOVASCULAR EMERGENCIES (Questions 1–35)
Question 1
A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm and jaw, diaphoresis, and nausea. His ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA).
Rationale: The LAD (A) supplies the anterior wall (leads V1–V4). The
circumflex (B) supplies the lateral wall (leads I, aVL, V5–V6). The left
main (D) supplies a large territory and would cause widespread
changes. The RCA (C) supplies the inferior wall.
Question 2
A 62-year-old female presents with acute onset of severe dyspnea,
orthopnea, and pink frothy sputum. Her blood pressure is 180/100
, mmHg, heart rate 120 bpm, and oxygen saturation 82% on room air.
Which medication is most appropriate initially?
A. IV furosemide
B. IV metoprolol
C. IV diltiazem
D. Oral lisinopril
Answer: A
This patient is presenting with acute decompensated heart failure and
pulmonary edema with adequate blood pressure. IV furosemide is the first-
line medication to reduce preload and relieve pulmonary congestion.
Rationale: IV metoprolol (B) and IV diltiazem (C) are rate-control
agents that may worsen heart failure acutely. Oral lisinopril (D) is
not appropriate for acute management. IV furosemide (A) is the
priority.
Question 3
A 55-year-old male presents with a heart rate of 180 bpm, narrow-
complex tachycardia, and stable blood pressure. Which intervention is
most appropriate initially?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Amiodarone 150 mg IV
D. Defibrillation
Answer: B
For stable narrow-complex tachycardia (likely SVT), adenosine is the first-
line pharmacologic intervention after vagal maneuvers.
Rationale: Synchronized cardioversion (A) is for unstable patients.
Amiodarone (C) is for ventricular arrhythmias. Defibrillation (D) is
