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A patient presents after a near-drowning event. They are coughing, with SpO2 of 90% on room air. What is the appropriate initial management?

Supplemental oxygen, continuous monitoring for at least 4-6 hours for delayed pulmonary edema, and chest X-ray

Discharge if alert and oriented

Intubation for all near-drowning patients

IV antibiotics immediately

to track

2026 Statistics

Key Facts: ENP-BC Exam

150

Exam Questions

ANCC (130 scored + 20 pretest)

Exam Time

ANCC ENP-BC certification page

350

Passing Scaled Score

ANCC scoring (175-500 scale)

25%

Cardiovascular/Respiratory Weight

ANCC test content outline

20%

Trauma/Musculoskeletal Weight

ANCC test content outline

$295/$395

Member/Non-member Fee

ANCC fee schedule

The ANCC ENP-BC exam uses 150 multiple-choice questions (130 scored, 20 pretest) over 3 hours with a scaled passing score of 350 on a 175-500 scale. Candidates need an MSN or DNP, current NP certification, and emergency NP clinical experience. Content domains: Cardiovascular/Respiratory (25%), Trauma/Musculoskeletal (20%), Neurological/Psychiatric (15%), Abdominal/GI/GU (15%), Pediatric/OB/GYN (10%), Environmental/Toxicological (10%), and Professional Practice (5%).

Sample ENP-BC Practice Questions

Try these sample questions to test your ENP-BC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old man presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST elevation in leads II, III, and aVF. What is the MOST likely diagnosis?

A.Pericarditis

B.Inferior STEMI

C.Pulmonary embolism

D.Aortic dissection

Explanation: ST elevation in leads II, III, and aVF indicates an inferior ST-elevation myocardial infarction (STEMI), typically caused by right coronary artery occlusion. The classic presentation of crushing chest pain with radiation, diaphoresis, and nausea supports this diagnosis. Pericarditis causes diffuse ST elevation, PE presents with right heart strain patterns, and aortic dissection typically presents with tearing pain radiating to the back. Immediate percutaneous coronary intervention (PCI) within 90 minutes is the goal.

2A patient arrives with sudden onset dyspnea, pleuritic chest pain, and tachycardia after a long flight. D-dimer is elevated. What is the NEXT diagnostic step?

A.Chest X-ray

B.CT pulmonary angiography (CTPA)

C.Echocardiogram

D.Ventilation-perfusion scan only

Explanation: CT pulmonary angiography (CTPA) is the gold standard diagnostic test for pulmonary embolism (PE). This patient presents with classic PE risk factors (prolonged immobilization during flight) and symptoms (sudden dyspnea, pleuritic chest pain, tachycardia) with an elevated D-dimer. CTPA provides definitive diagnosis with high sensitivity and specificity. Chest X-ray is often normal in PE and is insufficient for diagnosis. V/Q scan is an alternative when CTPA is contraindicated (contrast allergy, renal insufficiency).

3Which finding on ECG is the EARLIEST indicator of acute myocardial infarction?

A.Pathological Q waves

B.Hyperacute peaked T waves

C.T wave inversion

D.Low voltage QRS complexes

Explanation: Hyperacute peaked T waves are the earliest ECG change in acute myocardial infarction, appearing within minutes of coronary artery occlusion. They represent subendocardial ischemia and are tall, broad, and symmetric. This is followed by ST elevation (minutes to hours), T wave inversion (hours to days), and pathological Q waves (hours to days, indicating transmural necrosis). Recognizing hyperacute T waves enables earlier diagnosis and treatment, potentially before classic ST elevation develops.

4A 45-year-old asthmatic presents with severe wheezing, accessory muscle use, and SpO2 of 88%. Initial treatment with albuterol provides no relief. What is the NEXT appropriate intervention?

A.Discharge with oral prednisone

B.Administer ipratropium bromide, systemic corticosteroids, and prepare for possible magnesium sulfate

C.Perform immediate intubation

D.Order a chest CT scan

Explanation: In severe acute asthma not responding to initial albuterol, the next steps include adding ipratropium bromide (anticholinergic bronchodilator), administering systemic corticosteroids (IV methylprednisolone or oral prednisone), and considering IV magnesium sulfate for refractory bronchospasm. Continuous nebulized albuterol should also be considered. Intubation is reserved for impending respiratory failure (silent chest, altered mental status, rising CO2). The goal is aggressive medical management to avoid mechanical ventilation.

5A patient presents with sudden onset tearing chest pain radiating to the back, blood pressure of 200/120 mmHg in the right arm and 160/90 mmHg in the left arm. What diagnosis should be suspected?

A.Acute myocardial infarction

B.Aortic dissection

C.Tension pneumothorax

D.Esophageal rupture

Explanation: Acute aortic dissection classically presents with sudden onset severe tearing or ripping chest pain radiating to the back, with blood pressure differential between arms (>20 mmHg systolic). Type A involves the ascending aorta and is a surgical emergency; Type B involves the descending aorta and is often managed medically. Immediate blood pressure reduction with IV labetalol or esmolol plus nitroprusside is critical. CT angiography or transesophageal echocardiography confirms the diagnosis.

6During the primary survey of a trauma patient, what does the 'C' in ABCDE stand for?

A.Consciousness

B.Circulation with hemorrhage control

C.Cervical spine

D.Cardiovascular assessment

Explanation: In the ATLS primary survey (ABCDE), C stands for Circulation with hemorrhage control. This step involves assessing pulse quality, skin color and temperature, capillary refill, and identifying and controlling external hemorrhage with direct pressure, tourniquets, or hemostatic agents. Two large-bore IV lines are established, and fluid resuscitation is initiated. A = Airway with cervical spine protection, B = Breathing, D = Disability (neurological assessment), E = Exposure with environmental control.

7A 30-year-old presents after a motorcycle accident with paradoxical chest wall movement on the right side. What is the MOST likely injury?

A.Simple rib fracture

B.Flail chest

C.Hemothorax

D.Cardiac tamponade

Explanation: Flail chest occurs when three or more adjacent ribs are fractured in two or more places, creating a free-floating segment that moves paradoxically (inward during inspiration, outward during expiration). This is typically caused by high-impact blunt trauma. The primary concern is the underlying pulmonary contusion, not the mechanical flail itself. Treatment includes pain control (epidural or intercostal nerve blocks), positive pressure ventilation if respiratory failure develops, and monitoring for complications.

8A patient with a stab wound to the left chest develops hypotension, distended neck veins, and muffled heart sounds. What is the MOST likely diagnosis?

A.Tension pneumothorax

B.Cardiac tamponade

C.Massive hemothorax

D.Aortic rupture

Explanation: Beck's triad (hypotension, distended neck veins, muffled heart sounds) is the classic presentation of cardiac tamponade from penetrating chest trauma. Pericardial blood accumulation restricts cardiac filling (diastolic collapse). Emergency treatment is pericardiocentesis (needle aspiration of pericardial fluid) followed by emergent thoracotomy. Tension pneumothorax also causes hypotension and JVD but with tracheal deviation and absent breath sounds. Massive hemothorax presents with decreased breath sounds and dullness to percussion.

9What is the Glasgow Coma Scale (GCS) score for a patient who opens eyes to pain, makes incomprehensible sounds, and demonstrates flexion withdrawal to pain?

A.6

B.8

C.10

D.12

Explanation: The Glasgow Coma Scale score is calculated as: Eye opening to pain = 2 + Verbal (incomprehensible sounds) = 2 + Motor (flexion withdrawal) = 4, totaling 8. A GCS of 8 or below is the threshold for endotracheal intubation to protect the airway. GCS ranges from 3 (deep coma) to 15 (fully alert). The motor component is the most prognostically significant. Serial GCS assessments track neurological status trends and guide management decisions.

10A 68-year-old woman presents with acute onset right-sided weakness, facial droop, and slurred speech that began 90 minutes ago. What is the MOST critical first diagnostic study?

A.Carotid ultrasound

B.Non-contrast CT of the head

C.MRI with diffusion-weighted imaging

D.Lumbar puncture

Explanation: A non-contrast CT of the head is the most critical initial diagnostic study for acute stroke to differentiate ischemic stroke from hemorrhagic stroke. This distinction is essential because thrombolytic therapy (alteplase/tPA) is indicated for ischemic stroke within the 4.5-hour window but is absolutely contraindicated in hemorrhagic stroke. CT should be completed within 25 minutes of arrival with interpretation within 45 minutes (door-to-CT interpretation). MRI is more sensitive but takes longer and delays treatment.

About the ENP-BC Exam

The ENP-BC certification from ANCC validates advanced practice competency in emergency care. It covers cardiovascular, trauma, neurological, abdominal, pediatric, environmental, and toxicological emergencies for nurse practitioners practicing in emergency settings.

Assessment

130 scored + 20 pretest

Time Limit

3 hours

Passing Score

350 scaled (175-500 scale)

Exam Fee

$295 ANA members / $395 non-members (ANCC)

ENP-BC Exam Content Outline

25%

Cardiovascular/Respiratory Emergencies

Chest pain, STEMI, PE, CHF, asthma, COPD exacerbation, pneumothorax, and airway management

20%

Trauma/Musculoskeletal

Primary/secondary survey, fractures, wound management, head/spinal injury, and burns

15%

Neurological/Psychiatric Emergencies

Stroke assessment (NIH scale), seizures, meningitis, altered mental status, and psychiatric crisis

15%

Abdominal/GI/GU Emergencies

Acute abdomen, appendicitis, GI bleeding, renal colic, and testicular torsion

10%

Pediatric/OB/GYN Emergencies

Pediatric assessment, febrile child, ectopic pregnancy, preeclampsia, and sexual assault

10%

Environmental/Toxicological Emergencies

Overdose management, heat stroke, hypothermia, envenomation, and chemical exposure

Professional Practice/Ethics

Scope of practice, informed consent, EMTALA, evidence-based practice, and collaboration

How to Pass the ENP-BC Exam

What You Need to Know

Passing score: 350 scaled (175-500 scale)
Assessment: 130 scored + 20 pretest
Time limit: 3 hours
Exam fee: $295 ANA members / $395 non-members

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ENP-BC Study Tips from Top Performers

1Focus on cardiovascular and trauma content — together they account for 45% of the exam

2Master the primary and secondary trauma survey sequence and know when to escalate to surgical consultation

3Study stroke assessment using the NIH Stroke Scale and know the tPA inclusion/exclusion criteria

4Know key toxicology antidotes: naloxone for opioids, N-acetylcysteine for acetaminophen, flumazenil for benzodiazepines

5Review pediatric-specific vital signs, medication dosing (weight-based), and common pediatric emergency presentations

Frequently Asked Questions

How many questions are on the ENP-BC exam?

The ANCC ENP-BC exam contains 150 multiple-choice questions: 130 are scored and 20 are unscored pretest items. You have 3 hours to complete the exam. Pretest questions look identical to scored questions and cannot be identified during testing.

What are the ENP-BC eligibility requirements?

ENP-BC candidates must hold a current active RN license, have an MSN or DNP from an accredited NP program, hold current national NP certification (FNP, ACNP, or equivalent), and have at least 2,000 clinical hours in emergency NP practice within the past 3 years.

How much does the ENP-BC exam cost?

The ENP-BC exam costs $295 for American Nurses Association (ANA) members and $395 for non-members. ANA membership can save $100 on the exam fee.

What is the passing score for ENP-BC?

The ENP-BC uses a scaled score of 175-500, with a passing score of 350. The passing standard is set using a criterion-referenced method, meaning it is based on the difficulty of the exam content rather than a percentage of questions correct.

How long is ENP-BC certification valid?

ENP-BC certification is valid for 5 years. Renewal requires 75 contact hours of continuing education (including pharmacology hours) and 1,000 practice hours in emergency NP practice, or re-examination.

What content areas should I prioritize for the ENP-BC exam?

Prioritize Cardiovascular/Respiratory Emergencies (25%) and Trauma/Musculoskeletal (20%) as they represent 45% of the exam. Key topics include chest pain algorithms, STEMI management, PE diagnosis, ATLS primary survey, fracture management, and airway emergencies.