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Nursing


ENP-BC


AANPCB Emergency Nurse Practitioner (specialty certification)


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Question: 1


A 45-year-old male patient presents with acute exacerbation of asthma. Which of the following medications is considered a short-acting beta-agonist and should be used as a first-line treatment for acute asthma symptoms?


  1. Montelukast (Singulair)


    ratropium (Atrovent) lbuterol (Proventil)


    wer: D


    anation: In the treatment of acute asthma exacerbation, a short-acting ist such as albuterol (Proventil) is considered a first-line medication. I kly to relieve bronchospasm and improve airflow.


    stion: 2


    ch of the following interventions should be initiated immediately in a nt who is in cardiac arrest?


    dministration of vasopressors acement of an advanced airway efibrillation

    nitiation of cardiopulmonary resuscitation (CPR)

  2. Fluticasone (Flovent)

  3. Ip

  4. A


Ans


Expl beta-

agon t acts

quic


Que


Whi patie


  1. A

  2. Pl

  3. D

  4. I


Answer: D


Explanation: In a patient who is in cardiac arrest, the immediate initiation of cardiopulmonary resuscitation (CPR) is essential. CPR involves chest compressions and rescue breaths to maintain circulation and oxygenation. While the administration of vasopressors, placement of an advanced airway,

and defibrillation are important components of advanced cardiac life support (ACLS), they are initiated after the start of CPR.


Question: 3


Which of the following pharmacological therapies is recommended as the first- line treatment for anaphylaxis?


orticosteroids iphenhydramine lbuterol pinephrine


wer: D


anation: Epinephrine is the first-line treatment for anaphylaxis. It acts constrictor, bronchodilator, and cardiac stimulant, rapidly reversing th hreatening symptoms of anaphylaxis. Diphenhydramine and albuterol adjunctive roles in managing specific symptoms, but they are not idered first-line therapies. Corticosteroids are typically used as an nctive treatment to prevent biphasic reactions and provide long-term ol of inflammation.


stion: 4


ch of the following scenarios would be most appropriate for initiating

  1. C

  2. D

  3. A

  4. E


Ans


Expl as a

vaso e

life-t may

have cons adju contr


Que


Whi a

change in the treatment plan for a patient who is under observation?


  1. The patient's vital signs are stable and within normal limits.

  2. The patient develops new-onset chest pain and shortness of breath.

  3. The patient reports mild improvement in symptoms.

  4. The patient's laboratory results show a slight increase in inflammatory markers.

Answer: B


ment. However, the development of new-onset chest pain and shortne h suggests a potential complication or worsening of the condition, ring a reassessment and modification of the treatment plan.


stion: 5


-year-old female patient presents with a high fever, severe headache, stiffness. You suspect meningitis and plan to perform a lumbar punct erebrospinal fluid (CSF) analysis. Which of the following laboratory ngs is consistent with bacterial meningitis?


levated CSF protein and glucose levels

levated CSF protein and decreased glucose levels ormal CSF protein and glucose levels

ecreased CSF protein and glucose levels


wer: B

Explanation: A change in the treatment plan for a patient under observation would be most appropriate when there is a significant change in the patient's clinical status. While vital signs within normal limits and mild improvement in symptoms may be positive indicators, they may not warrant a change in

treat ss of

breat requi


Que


A 30 and

neck ure

for c findi


  1. E

  2. E

  3. N

  4. D


Ans


Explanation: In bacterial meningitis, the cerebrospinal fluid (CSF) analysis typically shows elevated protein levels and decreased glucose levels, indicating an inflammatory response and bacterial infection.


Question: 6

A 55-year-old male patient presents to the emergency department with altered mental status and signs of severe dehydration. You suspect diabetic ketoacidosis (DKA) as the underlying cause. Which of the following is the most appropriate initial step in managing this patient?


  1. Perform a fingerstick blood glucose test

  2. Administer insulin

    dminister intravenous (IV) fluids wer: D

    anation: In the management of diabetic ketoacidosis (DKA), the initia dminister intravenous (IV) fluids to correct dehydration and improve

    odynamic stability.


    stion: 7


    ch of the following medications is commonly administered to treat acu mic stroke within the thrombolytic window?


    spirin lopidogrel lteplase (tPA) arfarin

  3. Obtain arterial blood gas (ABG) analysis

  4. A


Ans


Expl l step

is to a hem


Que


Whi te

ische


  1. A

  2. C

  3. A

  4. W


Answer: C


Explanation: Alteplase (tPA) is the medication commonly administered within the thrombolytic window (typically within 4.5 hours of symptom onset) to treat acute ischemic stroke. It is a thrombolytic agent that helps dissolve the blood clot causing the stroke and restore blood flow to the affected area of the brain.

Aspirin and clopidogrel are antiplatelet agents that may be used in the secondary prevention of stroke, but they are not the first-line treatment for acute ischemic stroke. Warfarin is an oral anticoagulant and is not used in the acute management of ischemic stroke.


Question: 8


-year-old female patient presents to the emergency department with c nd shortness of breath. You suspect a pulmonary embolism and deci a diagnostic study to confirm the diagnosis. Which of the following t

ost appropriate?


entilation-perfusion (V/Q) scan lectrocardiogram (ECG)

dimer blood test hest X-ray


wer: A


anation: In the evaluation of suspected pulmonary embolism, the most opriate initial diagnostic test is a ventilation-perfusion (V/Q) scan. Thi elp identify perfusion defects in the lungs that are suggestive of a onary embolism.


stion: 9

A 69 hest

pain a de to

order ests

is m


  1. V

  2. E

  3. D-

  4. C

Ans Expl

appr s test

can h pulm


Que


Which of the following diagnostic studies would be most appropriate for a patient with a high pre-test probability of pulmonary embolism?


  1. Chest X-ray

  2. Electrocardiogram (ECG)

  3. Ventilation-perfusion (V/Q) scan

  4. D-dimer assay Answer: C

seful screening test, but it has a high false positive rate. The V/Q sca monly used test with high sensitivity and specificity for diagnosing onary embolism, making it the most appropriate choice in this scenari


stion: 10


tient presents to the emergency department with symptoms of severe ma exacerbation. Which of the following medications would be most opriate to administer?


rednisone uprofen

lbuterol nebulizer treatment iphenhydramine


wer: C

Explanation: A patient with a high pre-test probability of pulmonary embolism would require a diagnostic study that has a high specificity and sensitivity for detecting the condition. While a chest X-ray and ECG may provide some information, they are not specific for pulmonary embolism. The D-dimer assay is a u n is a

com

pulm o.


Que


A pa asth appr


  1. P

  2. Ib

  3. A

  4. D


Ans


Explanation: In the management of severe asthma exacerbation, the administration of a bronchodilator such as albuterol via nebulizer is the most appropriate initial intervention. Albuterol acts by relaxing the smooth muscles of the airways, providing rapid relief of bronchospasm. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and may have a limited role in managing asthma exacerbation. Prednisone, a systemic corticosteroid, is typically used as an adjunctive therapy to reduce airway inflammation.

Diphenhydramine is an antihistamine and is not indicated for acute asthma exacerbation.


Question: 11



eedle thoracostomy

AST (Focused Assessment with Sonography for Trauma) exam elvic binder application

ndotracheal intubation


wer: B


anation: In a trauma resuscitation setting, performing a FAST (Focuse ssment with Sonography for Trauma) exam is important to identify ntial sources of bleeding. The FAST exam involves using ultrasound t s the abdomen and pericardial space for the presence of free fluid, ating internal bleeding.


stion: 12


ritically ill patient with septic shock, which of the following diagnost

During a trauma resuscitation, a patient's blood pressure drops significantly despite fluid resuscitation. Which of the following procedures/skills should be performed to address potential sources of bleeding?


  1. N

  2. F

  3. P

  4. E


Ans


Expl d

Asse

pote o

asses indic


Que


In a c ic

studies would be most helpful in guiding management?


  1. Complete blood count (CBC)

  2. Serum lactate level

  3. Blood culture

  4. Urinalysis

Answer: B


ide direct information about tissue perfusion. Urinalysis is not specifi shock and would not be the most helpful study in guiding managem


stion: 13


ch of the following interventions is essential for initiating and maintai gency stabilization in a trauma patient?


onitoring blood pressure and heart rate pplication of a cervical collar dministration of intravenous fluids

erforming a focused assessment with sonography for trauma (FAST) e


wer: A


anation: When initiating and maintaining emergency stabilization in a ma patient, monitoring vital signs such as blood pressure and heart rate

Explanation: In a critically ill patient with septic shock, serum lactate level is a valuable diagnostic study for guiding management. Elevated lactate levels indicate tissue hypoperfusion and are associated with increased mortality in septic shock. A complete blood count (CBC) and blood culture are important for assessing infection and identifying the causative organism, but they do not prov c for

septic ent.


Que


Whi ning

emer


  1. M

  2. A

  3. A

  4. P xam


Ans Expl

trau is

essential. These parameters provide crucial information about the patient's hemodynamic status and guide the need for further interventions. While administration of intravenous fluids, application of a cervical collar, and performing a FAST exam are important components of trauma management, monitoring vital signs takes precedence in the initial stages of stabilization.

A 65-year-old male patient presents to the emergency department with severe chest pain consistent with acute myocardial infarction. In addition to administering aspirin and oxygen, which of the following medications should be initiated within 12 hours of symptom onset to reduce mortality and myocardial damage?


etoprolol lteplase torvastatin


wer: D


anation: In the management of acute myocardial infarction, initiating s py such as atorvastatin within 12 hours of symptom onset has been sh duce mortality and myocardial damage. Statins have beneficial effects ue stabilization and anti-inflammatory properties.


stion: 15


ch of the following procedures/skills would an Emergency Nurse itioner be qualified to perform?


umbar puncture

entral venous catheter insertion

  1. Nitroglycerin

  2. M

  3. A

  4. A


Ans


Expl tatin

thera own

to re on

plaq


Que


Whi Pract


  1. L

  2. C

  3. Tracheostomy tube change

  4. Arterial line placement


Answer: C

stion: 16


When managing multiple patients in the emergency department, which of t wing strategies is most effective for maintaining situational awareness


ocusing on completing one task at a time before moving on to the nex ssigning specific roles and responsibilities to each member of the hcare team.

tilizing a standardized handoff process to communicate patient mation.

mplementing a visual tracking system to monitor the status and progre patient.


wer: D


anation: When managing multiple patients in a fast-paced environmen ementing a visual tracking system is the most effective strategy for taining situational awareness. This system allows healthcare provider

practice, there are certain procedures/skills that may require specialized training or certification. Lumbar puncture and central venous catheter insertion are typically performed by physicians or advanced practice providers with additional training. Arterial line placement is another invasive procedure that may require specialized training. However, tracheostomy tube change is within the scope of practice for an Emergency Nurse Practitioner and can be performed as indicated.


Que


he

follo ?


  1. F t.

  2. A

    healt

  3. U

    infor

  4. I ss of

each Ans

Expl t,

impl

main s to

monitor the status and progress of each patient at a glance, minimizing the risk of oversight or forgetting critical tasks. Whilefocusing on completing one task at a time, assigning specific roles, and utilizing a standardized handoff process are important strategies, they may not provide the same level of visual awareness as a tracking system.