ENP-C — Emergency Nurse Practitioner
Certified Exam| YEAR 2026–2027 |
Comprehensive 150-Question Practice Test
with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
1. Acute Coronary Syndrome
A 64-year-old patient presents with crushing substernal chest pain radiating to the left arm and
diaphoresis. ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is
most likely involved?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF most commonly results from right
coronary artery occlusion.
2. STEMI Management
A patient with STEMI arrives at an emergency department without PCI capability. PCI cannot be
performed within the recommended time window. What treatment should be considered if
there are no contraindications?
A. Warfarin
B. Fibrinolytic therapy
C. Digoxin
D. Amiodarone
,Answer: B. Fibrinolytic therapy
Rationale: When timely PCI is unavailable, fibrinolysis may be appropriate for eligible STEMI
patients after contraindications are assessed.
3. Ventricular Fibrillation
A patient suddenly becomes unresponsive. The monitor shows ventricular fibrillation. What is
the priority intervention?
A. Atropine
B. Synchronized cardioversion
C. Defibrillation
D. Transcutaneous pacing
Answer: C. Defibrillation
Rationale: VF is a pulseless shockable rhythm. Immediate unsynchronized defibrillation with
high-quality CPR is indicated.
4. Pulseless Electrical Activity
A patient is pulseless with organized electrical activity on the monitor. What is the priority?
A. Defibrillation
B. CPR and epinephrine
C. Adenosine
D. Synchronized cardioversion
Answer: B. CPR and epinephrine
Rationale: PEA is nonshockable. High-quality CPR, epinephrine, and identification of reversible
causes are essential.
5. Supraventricular Tachycardia
A stable adult has a regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail.
Which medication is commonly used next?
A. Adenosine
B. Lidocaine
,C. Atropine
D. Magnesium sulfate
Answer: A. Adenosine
Rationale: IV adenosine is commonly used for stable regular narrow-complex SVT after vagal
maneuvers.
6. Unstable Tachycardia
A patient with a heart rate of 180/min develops hypotension, altered mental status, and chest
discomfort. What is the priority treatment?
A. Oral beta blocker
B. Synchronized cardioversion
C. Vagal maneuvers only
D. Observation
Answer: B. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia requires immediate
synchronized cardioversion.
7. Bradycardia
A symptomatic patient has a heart rate of 32/min with hypotension. Atropine is ineffective.
What intervention should be considered?
A. Transcutaneous pacing
B. Adenosine
C. Defibrillation
D. Oral amiodarone
Answer: A. Transcutaneous pacing
Rationale: Symptomatic unstable bradycardia unresponsive to atropine requires pacing and/or
appropriate chronotropic support.
8. Cardiac Tamponade
Which finding most strongly suggests cardiac tamponade?
, A. Unilateral absent breath sounds
B. Beck triad
C. Hyperresonance
D. Wheezing
Answer: B. Beck triad
Rationale: Hypotension, muffled heart sounds, and jugular venous distention are classic findings
of tamponade.
9. Tension Pneumothorax
A trauma patient develops severe respiratory distress, hypotension, unilateral absent breath
sounds, and tracheal deviation. What is the immediate treatment?
A. Chest CT
B. Needle/finger thoracic decompression followed by chest tube
C. Antibiotics
D. Bronchoscopy
Answer: B. Needle/finger thoracic decompression followed by chest tube
Rationale: Tension pneumothorax is a clinical emergency requiring immediate decompression
without waiting for imaging.
10. Massive Pulmonary Embolism
A patient with suspected massive PE is hypotensive and has signs of obstructive shock. If there
are no contraindications, what therapy may be indicated?
A. Systemic thrombolysis
B. Aspirin only
C. Oral antihistamine
D. Diuresis
Answer: A. Systemic thrombolysis
Rationale: Hemodynamically unstable PE may require urgent reperfusion therapy, including
systemic thrombolysis when appropriate.
Certified Exam| YEAR 2026–2027 |
Comprehensive 150-Question Practice Test
with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
1. Acute Coronary Syndrome
A 64-year-old patient presents with crushing substernal chest pain radiating to the left arm and
diaphoresis. ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is
most likely involved?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF most commonly results from right
coronary artery occlusion.
2. STEMI Management
A patient with STEMI arrives at an emergency department without PCI capability. PCI cannot be
performed within the recommended time window. What treatment should be considered if
there are no contraindications?
A. Warfarin
B. Fibrinolytic therapy
C. Digoxin
D. Amiodarone
,Answer: B. Fibrinolytic therapy
Rationale: When timely PCI is unavailable, fibrinolysis may be appropriate for eligible STEMI
patients after contraindications are assessed.
3. Ventricular Fibrillation
A patient suddenly becomes unresponsive. The monitor shows ventricular fibrillation. What is
the priority intervention?
A. Atropine
B. Synchronized cardioversion
C. Defibrillation
D. Transcutaneous pacing
Answer: C. Defibrillation
Rationale: VF is a pulseless shockable rhythm. Immediate unsynchronized defibrillation with
high-quality CPR is indicated.
4. Pulseless Electrical Activity
A patient is pulseless with organized electrical activity on the monitor. What is the priority?
A. Defibrillation
B. CPR and epinephrine
C. Adenosine
D. Synchronized cardioversion
Answer: B. CPR and epinephrine
Rationale: PEA is nonshockable. High-quality CPR, epinephrine, and identification of reversible
causes are essential.
5. Supraventricular Tachycardia
A stable adult has a regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail.
Which medication is commonly used next?
A. Adenosine
B. Lidocaine
,C. Atropine
D. Magnesium sulfate
Answer: A. Adenosine
Rationale: IV adenosine is commonly used for stable regular narrow-complex SVT after vagal
maneuvers.
6. Unstable Tachycardia
A patient with a heart rate of 180/min develops hypotension, altered mental status, and chest
discomfort. What is the priority treatment?
A. Oral beta blocker
B. Synchronized cardioversion
C. Vagal maneuvers only
D. Observation
Answer: B. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia requires immediate
synchronized cardioversion.
7. Bradycardia
A symptomatic patient has a heart rate of 32/min with hypotension. Atropine is ineffective.
What intervention should be considered?
A. Transcutaneous pacing
B. Adenosine
C. Defibrillation
D. Oral amiodarone
Answer: A. Transcutaneous pacing
Rationale: Symptomatic unstable bradycardia unresponsive to atropine requires pacing and/or
appropriate chronotropic support.
8. Cardiac Tamponade
Which finding most strongly suggests cardiac tamponade?
, A. Unilateral absent breath sounds
B. Beck triad
C. Hyperresonance
D. Wheezing
Answer: B. Beck triad
Rationale: Hypotension, muffled heart sounds, and jugular venous distention are classic findings
of tamponade.
9. Tension Pneumothorax
A trauma patient develops severe respiratory distress, hypotension, unilateral absent breath
sounds, and tracheal deviation. What is the immediate treatment?
A. Chest CT
B. Needle/finger thoracic decompression followed by chest tube
C. Antibiotics
D. Bronchoscopy
Answer: B. Needle/finger thoracic decompression followed by chest tube
Rationale: Tension pneumothorax is a clinical emergency requiring immediate decompression
without waiting for imaging.
10. Massive Pulmonary Embolism
A patient with suspected massive PE is hypotensive and has signs of obstructive shock. If there
are no contraindications, what therapy may be indicated?
A. Systemic thrombolysis
B. Aspirin only
C. Oral antihistamine
D. Diuresis
Answer: A. Systemic thrombolysis
Rationale: Hemodynamically unstable PE may require urgent reperfusion therapy, including
systemic thrombolysis when appropriate.
