Emergency Nurse Practitioner ENP Ultimate
Exam 2026
1. A 58-year-old male presents with sudden onset of severe, ripping abdominal
pain radiating to the back. He is diaphoretic and hypotensive. Which diagnostic
study should be obtained immediately?
A) Abdominal ultrasound
B) CT angiography of the abdomen
C) Upper GI series
D) Colonoscopy
Rationale: The presentation is classic for a ruptured abdominal aortic aneurysm. CT
angiography is the diagnostic study of choice to confirm the diagnosis and guide surgical
intervention.
2. A 24-year-old female presents with right lower quadrant pain, anorexia, and
low-grade fever. Which finding on physical exam is most specific for appendicitis?
A) Rebound tenderness at McBurney's point
B) Rovsing's sign
C) Psoas sign
D) Obturator sign
Rationale: Rovsing's sign (pain in the right lower quadrant when palpating the left lower
quadrant) is highly specific for appendicitis.
3. A 72-year-old female presents with sudden onset of painless vision loss in the
right eye. Fundoscopic exam reveals a cherry-red spot. What is the most likely
diagnosis?
A) Central retinal vein occlusion
B) Central retinal artery occlusion
,C) Retinal detachment
D) Vitreous hemorrhage
Rationale: A cherry-red spot on a pale retina is the classic finding in central retinal artery
occlusion, an ophthalmologic emergency.
4. A 4-year-old child presents with drooling, tripod positioning, and inspiratory
stridor. The child appears toxic. What is the most appropriate initial action?
A) Obtain a lateral neck radiograph
B) Keep the child calm and prepare for emergent airway management
C) Inspect the throat with a tongue depressor
D) Administer nebulized racemic epinephrine
Rationale: The presentation suggests epiglottitis. Any manipulation of the throat or
agitation can precipitate complete airway obstruction. Airway management is the priority.
5. A 68-year-old male with a history of heart failure presents with worsening
dyspnea, orthopnea, and pink frothy sputum. Which medication should be
administered first?
A) Oral furosemide
B) IV furosemide
C) IV metoprolol
D) Oral digoxin
Rationale: This is acute pulmonary edema. IV loop diuretics such as furosemide are the
first-line treatment to reduce preload and relieve pulmonary congestion.
6. A 32-year-old female presents with a severe headache, photophobia, and neck
stiffness. A lumbar puncture is performed. Which CSF finding is consistent with
bacterial meningitis?
A) Clear CSF, normal glucose, normal protein
B) Cloudy CSF, low glucose, elevated protein
,C) Clear CSF, normal glucose, elevated protein
D) Xanthochromic CSF
Rationale: Bacterial meningitis typically shows cloudy CSF, decreased glucose, and
elevated protein with neutrophilic pleocytosis.
7. A 45-year-old male presents with sudden onset of severe testicular pain. The
testicle is high-riding and the cremasteric reflex is absent. What is the priority
action?
A) Obtain a scrotal ultrasound
B) Immediate urology consultation for surgical exploration
C) Administer antibiotics
D) Apply ice and elevate
Rationale: Testicular torsion is a surgical emergency. The absence of the cremasteric reflex
and high-riding testicle are classic. Immediate surgical detorsion is required to save the
testis.
8. A 28-year-old female at 34 weeks gestation presents with a blood pressure of
168/112 mmHg and severe headache. Which medication is indicated for seizure
prophylaxis?
A) Labetalol
B) Magnesium sulfate
C) Hydralazine
D) Nifedipine
Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe
preeclampsia. Labetalol and hydralazine are used for blood pressure control.
9. A 6-month-old infant presents with a fever of 104°F, lethargy, and a petechial
rash. Which action is the priority?
A) Administer acetaminophen
, B) Obtain blood cultures and start IV antibiotics immediately
C) Perform a lumbar puncture
D) Order a chest X-ray
Rationale: The presentation is concerning for meningococcemia. Blood cultures and
immediate IV antibiotics should not be delayed.
10. A 55-year-old male presents with a 3-day history of severe epigastric pain
radiating to the back, nausea, and vomiting. Lipase is elevated. Which intervention
is most important initially?
A) Administer IV antibiotics
B) Aggressive IV fluid resuscitation
C) Start enteral feeding
D) Administer opioids for pain
Rationale: The diagnosis is acute pancreatitis. Aggressive IV fluid resuscitation is the
cornerstone of early management to prevent organ failure.
11. A 70-year-old female presents with new-onset atrial fibrillation with a rapid
ventricular response. She is hemodynamically stable. Which medication is used for
rate control?
A) Amiodarone
B) Diltiazem
C) Adenosine
D) Digoxin
Rationale: For stable atrial fibrillation with rapid ventricular response, IV diltiazem (a
calcium channel blocker) is first-line for rate control.
12. A 20-year-old male presents with a stab wound to the left chest. He is
hypotensive, with distended neck veins and absent breath sounds on the left.
What is the immediate intervention?
Exam 2026
1. A 58-year-old male presents with sudden onset of severe, ripping abdominal
pain radiating to the back. He is diaphoretic and hypotensive. Which diagnostic
study should be obtained immediately?
A) Abdominal ultrasound
B) CT angiography of the abdomen
C) Upper GI series
D) Colonoscopy
Rationale: The presentation is classic for a ruptured abdominal aortic aneurysm. CT
angiography is the diagnostic study of choice to confirm the diagnosis and guide surgical
intervention.
2. A 24-year-old female presents with right lower quadrant pain, anorexia, and
low-grade fever. Which finding on physical exam is most specific for appendicitis?
A) Rebound tenderness at McBurney's point
B) Rovsing's sign
C) Psoas sign
D) Obturator sign
Rationale: Rovsing's sign (pain in the right lower quadrant when palpating the left lower
quadrant) is highly specific for appendicitis.
3. A 72-year-old female presents with sudden onset of painless vision loss in the
right eye. Fundoscopic exam reveals a cherry-red spot. What is the most likely
diagnosis?
A) Central retinal vein occlusion
B) Central retinal artery occlusion
,C) Retinal detachment
D) Vitreous hemorrhage
Rationale: A cherry-red spot on a pale retina is the classic finding in central retinal artery
occlusion, an ophthalmologic emergency.
4. A 4-year-old child presents with drooling, tripod positioning, and inspiratory
stridor. The child appears toxic. What is the most appropriate initial action?
A) Obtain a lateral neck radiograph
B) Keep the child calm and prepare for emergent airway management
C) Inspect the throat with a tongue depressor
D) Administer nebulized racemic epinephrine
Rationale: The presentation suggests epiglottitis. Any manipulation of the throat or
agitation can precipitate complete airway obstruction. Airway management is the priority.
5. A 68-year-old male with a history of heart failure presents with worsening
dyspnea, orthopnea, and pink frothy sputum. Which medication should be
administered first?
A) Oral furosemide
B) IV furosemide
C) IV metoprolol
D) Oral digoxin
Rationale: This is acute pulmonary edema. IV loop diuretics such as furosemide are the
first-line treatment to reduce preload and relieve pulmonary congestion.
6. A 32-year-old female presents with a severe headache, photophobia, and neck
stiffness. A lumbar puncture is performed. Which CSF finding is consistent with
bacterial meningitis?
A) Clear CSF, normal glucose, normal protein
B) Cloudy CSF, low glucose, elevated protein
,C) Clear CSF, normal glucose, elevated protein
D) Xanthochromic CSF
Rationale: Bacterial meningitis typically shows cloudy CSF, decreased glucose, and
elevated protein with neutrophilic pleocytosis.
7. A 45-year-old male presents with sudden onset of severe testicular pain. The
testicle is high-riding and the cremasteric reflex is absent. What is the priority
action?
A) Obtain a scrotal ultrasound
B) Immediate urology consultation for surgical exploration
C) Administer antibiotics
D) Apply ice and elevate
Rationale: Testicular torsion is a surgical emergency. The absence of the cremasteric reflex
and high-riding testicle are classic. Immediate surgical detorsion is required to save the
testis.
8. A 28-year-old female at 34 weeks gestation presents with a blood pressure of
168/112 mmHg and severe headache. Which medication is indicated for seizure
prophylaxis?
A) Labetalol
B) Magnesium sulfate
C) Hydralazine
D) Nifedipine
Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe
preeclampsia. Labetalol and hydralazine are used for blood pressure control.
9. A 6-month-old infant presents with a fever of 104°F, lethargy, and a petechial
rash. Which action is the priority?
A) Administer acetaminophen
, B) Obtain blood cultures and start IV antibiotics immediately
C) Perform a lumbar puncture
D) Order a chest X-ray
Rationale: The presentation is concerning for meningococcemia. Blood cultures and
immediate IV antibiotics should not be delayed.
10. A 55-year-old male presents with a 3-day history of severe epigastric pain
radiating to the back, nausea, and vomiting. Lipase is elevated. Which intervention
is most important initially?
A) Administer IV antibiotics
B) Aggressive IV fluid resuscitation
C) Start enteral feeding
D) Administer opioids for pain
Rationale: The diagnosis is acute pancreatitis. Aggressive IV fluid resuscitation is the
cornerstone of early management to prevent organ failure.
11. A 70-year-old female presents with new-onset atrial fibrillation with a rapid
ventricular response. She is hemodynamically stable. Which medication is used for
rate control?
A) Amiodarone
B) Diltiazem
C) Adenosine
D) Digoxin
Rationale: For stable atrial fibrillation with rapid ventricular response, IV diltiazem (a
calcium channel blocker) is first-line for rate control.
12. A 20-year-old male presents with a stab wound to the left chest. He is
hypotensive, with distended neck veins and absent breath sounds on the left.
What is the immediate intervention?
