CBT Mock Test 4 - NMC Part 1 Test of Competence

NOTE: This is a “mock” test based on some of the references given in the NMC Blue Print. The test covers 4 Domains and 1 field specific competency relating to your specialism – in this case ‘Adult Nursing’. The questions provided is only a guide, individuals should review the all study material and modules provided in MMA Recruitment CBT guide.

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* 1. What serious condition is a possibility for patients positioned in the Lloyd Davies position during surgery?

Stroke

Cardiac arrest

Compartment syndrome

There are no drawbacks to the Lloyd Davies position

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* 2. You have been asked to give Mrs Patel her mid day oral metronidazole. You have never met her before. What do you need to check on the drug chart before you administerit?

Her name and address, the date of the prescription and dose.

Her name, date of birth, the ward, consultant, the dose and route, and that it is due at 12.00.

Her name, date of birth, hospital number, if she has any known allergies, the prescription for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given

Her name and address, date of birth, name of ward and consultant, if she has any known allergies specifically to penicillin, that prescription is for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given and who gave it so you can check with them how she reacted.

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* 3. Accurate postoperative observations are key to assessing a patient's deterioration or recovery. The Modified Early Warning Score (MEWS) is a scoring system that supports that aim. What is the primary purpose of MEWS?

Identifies patients at risk of deterioration.

Identifies potentialrespiratory distress.

Improves communication between nursing staff and doctors.

Assesses the impact of pre existing conditions on postoperative recovery.

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* 4. Why is it important that patients are effectively fasted prior to surgery?

To reduce the risk of vomiting.

To reduce the risk of reflux and inhalation of gastric contents.

To prevent vomiting and chest infections.

To prevent the patient gagging

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* 5. What are the principles of gaining informed consent prior to planned surgery?

Gaining permission for an imminent procedure by providing information in medical terms, ensuring a patient knows the potential risks and intended benefits.

Gaining permission from a patient who is competent to give it, by providinginformation, both verbally and with written material, relating to the planned procedure, for them to read on the day of planned surgery.

Gaining permission from a patient who is competent to give it, by informing them about the procedure and highlighting risks if the procedure is not carried out.

Gaining permission from a patient who is competent to give it, by providing information in understandable terms prior to surgery, allowing time for answering questions, and inviting voluntary participation.

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* 6. On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do?

Check the cupboard, record book and order book. If the missing drugs aren't found, contact pharmacy to resolve the issue. You will also complete an incident form.

Document the discrepancy on an incident form and contact the senior pharmacist on duty.

Check the cupboard, record book and order book. If the missing drugs aren't found the police need to be informed.

Check the cupboard, record book and order book and inform the registered nurse or person incharge of the clinical area. If the missing drugs are not found then inform the most senior nurse on duty. You will also complete an incident form

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* 7. A patient in your care is on regular oral morphine sulphate. As a qualified nurse, what legal checks do youneed to carry out every time you administer it, which are in addition to those you would check for every other drug you administer?

Check to see if the patient has become tolerant to the medication so it is no longer effective as analgesia.

Check to see whether the patient has become addicted.

Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; together, check the correct prescription and the identity of the patient.

Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; then ask the patient to prove their identity to yo

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* 8. As a newly qualified nurse, what would you do if a patient vomits when taking or immediately after taking tablets?

Comfort the patient, check to see if they have vomited the tablets, and ask the doctor to prescribe something different as these obviously don't agree with the patient.

Check to see if the patient has vomited the tablets and, if so, document this on the prescription chart. If possible, the drugs may be given again after the administration of antiemetics or when the patient no longer feels nauseous. It may be necessary to discuss an alternative route of administration with the doctor.

In the future administer antiemetics prior to administration of all tablets.D. Discuss with pharmacy the availability of medication in a liquid form or hide the tablets in food to take the taste away

Discuss with pharmacy the availability of medication in a liquid form or hide the tablets in food to take the taste away

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* 9. Why would the intravenous route be used for the administration of medications?

It is a useful form of medication for patients who refuse to take tablets because they don't want to comply with treatment.

It is cost effective because there is less waste as patients forget to take oral medication.

The intravenous route reduces the risk of infection because the drugs are made in a sterile environment and kept in aseptic conditions.

The intravenous route provides an immediate therapeutic effect and gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable

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* 10. What are the key reasons for administering medications to patients?

To provide relief from specific symptoms, for example pain, and managing side effects as well as therapeutic purposes.

As part of the process of diagnosing their illness, to prevent an illness, disease or side effect, to offer relief from symptoms or to treat a disease

As part of the treatment of long term diseases, for example heart failure, and the prevention of diseases such as asthma.

To treat acute illness, for example antibiotic therapy for a chest infection, and side effects such as nausea.

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* 11. What are the most common types of medication error?

Nurses being interrupted when completing their drug rounds, different drugs being packaged similarly and stored in the same place and calculation errors.

Unsafe handling and poor aseptic technique.

Doctors not prescribing correctly and poor communication with the multidisciplinary team.

Administration of the wrong drug, in the wrong amount to the wrong patient, via the wrong route

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* 12. A patient has collapsed with an anaphylactic reaction. What symptoms would you expect to see?

The patient will have a low blood pressure (hypotensive) and will have a fast heart rate (tachycardia) usually associated with skin and mucosal changes.

The patient will have a high blood pressure (hypertensive) and will have a fast heart rate (tachycardia).

The patient will quickly find breathing very difficult because of compromise to their airway or circulation. This is accompanied by skin and mucosal changes

The patient will experience a sense of impending doom, hyperventilate and be itchy all over

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* 13. What arethe potential benefits of self-administration of medicines by patients?

Nurses have more time for other aspects of patient care and it therefore reduces length of stay.

It gives patients more control and allows them to take the medications on time, as well as giving them the opportunity to address any concerns with their medication before they are discharged home.

Reduces the risk of medication errors, because patients are in charge of their own medication.D

Creates more space in the treatment room, so there are fewer medication errors

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* 14. What is the most accurate method of calculating a respiratory rate?

Counting the number of respiratory cycles in 15 seconds and multiplying by 4.

Counting the number of respiratory cycles in 1 minute. One cycle is equal to the complete rise and fall of the patient's chest.

Not telling the patient as this may make them conscious of their breathing pattern and influence the accuracy of the rate.

Placing your hand on the patient's chest and counting the number of respiratory cycles in 30 seconds and multiplying by 2

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* 15. You are caring for a 17 year old woman who has been admitted with acute exacerbation of asthma. Her peak flow readings are deteriorating and she is becoming wheezy. What would you do?

Sit her upright, listen to her chest and refer to the chest physiotherapist.

Suggest that the patient takes her Ventolin inhaler and continue to monitor the patient.

Undertake a full set of observations to include oxygen saturations and respiratory rate. Administer humidified oxygen, bronchodilators, corticosteroids and antimicrobial therapy as prescribed

Reassure the patient: you know from reading her notes that stress and anxiety often trigger her asthma.

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* 16. Why is it important to manually assess pulse rate?

Amplitude, volume and irregularities cannot be detectedusing automated electronic methods

Tachycardia cannot be detected using automated electronic methods

Bradycardia cannot be detected using automated electronic methods

It is more reassuring to the patient

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* 17. What are the professional responsibilities of the qualified nurse in medicines management?

Making sure that the group of patients that they are caring for receive their medications on time. If they are not competent to administer intravenous medications, they should ask a competent nursing colleague to do so on their behalf.

The safe handling and administration of all medicines to patients in their care. This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects.

Making sure they know the names, actions, doses and side effects of all the medications used in their area of clinical practice.

To liaise closely with pharmacy so that their knowledge is kept up to date

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* 18. When would an orthostatic blood pressure measurement be indicated?

If the patient has a recent history of falls.

If the patient has a history of dizziness or syncope on changing position.

If the patient has a history of hypertension.

If the patient has a history of hypotension.

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* 19. What do the adverse effects of hypotension include?

Decreased conscious level, reduced blood flow to vital organs and renal failure.

The patient could become confused and not know who they are.

Decreased conscious level, oliguria and reduced coronary blood flow.

The patient feeling very cold

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* 20. What are the contraindications for the use of the blood glucose meter for blood glucose monitoring?

The patient has a needle phobia andprefers to have a urinalysis.

If the patient is in a critical care setting, staff will send venous samples to the laboratory for verification of blood glucose level.

If the machine hasn't been calibrated

If peripheral circulation is impaired,collection of capillary blood is not advised as the results might not be a true reflection of the physiological blood glucose level.

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* 21. You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions?

Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and document clearly.

This is a medical emergency. Basic airway, breathing and circulation should be attended to urgently and senior help should be sought.

Refer to the neurology team.

Break down the patient's Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX. Use this when you hand over.

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* 22. A patient in your care is about to go for a liver biopsy. What are the most likely potential complications related to this procedure?

Inadvertent puncture of the pleura, a blood vessel or bileduct

Inadvertent puncture of the heart, oesophagus or spleen.

Cardiac arrest requiring resuscitation.

Inadvertent puncture of the kidney and cardiac arrest

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* 23. When should adult patients in acute hospital settings have observations taken?

When they are admitted or initially assessed. A plan should be clearly documented which identifies which observations should be taken and how frequently subsequent observations should be done.

When they are admitted and then once daily unless they deteriorate.

As indicated by the doctor.

Temperature should be taken daily, respirations at night, pulse and blood pressure 4 hourly.

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* 24. Whyare physiological scoring systems or early warning scoring systems used in clinical practice?

They help the nursing staff to accurately predict patient dependency on a shift by shift basis.

The system provides an early accurate predictor of deterioration by identifying physiological criteria that alert the nursing staff to a patient at risk.

These scoring systems are carried out as part of a national audit so we know how sick patients are in the United Kingdom.

They enable nurses to call for assistance from the outreach team or the doctors via an electronic communication system.

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* 25. A patient on your ward complains that her heart is ‘racing’ and you find that the pulse is too fast to manually palpate. What would your actions be?

Shout for help and run to collect the crash trolley.

Ask the patient to calm down and check her most recent set of bloods and fluid balance.

A full set of observations: blood pressure, respiratory rate, oxygen saturation and temperature. It is essential to perform a 12 lead ECG. The patient should then be reviewed by the doctor.

Check baseline observations and refer to the cardiology team.

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* 26. If a patient feels a cramping sensation in their abdomen after a colonoscopy, it is advisable that they should do/have which of the following?

Eat and drink as soon as sedation has worn off.

Drink 500 mL of fluid immediately to flush out any gas retained in the abdomen.

Have half hourly blood pressure performed for 12 hours.

Be nursed flat and kept in bed for 12 hours.

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* 27. How do you ensure the correct blood to culture ratio when obtaining a blood culture specimen from an adult patient?

Collect at least 10 mL of blood.

Collect at least 5 mL of blood.

Collect blood until the specimen bottle stops filling.

Collect as much blood as the vein will give you

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* 28. If blood is being taken for other tests, and a patient requires collection of blood cultures, which should come first to reduce the risk of contamination?

Inoculate the aerobic culture first

Take the other blood tests first.

Inoculate the anaerobic culture first.

The order does not matter as long as the bottles are clean

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* 29. Which of the following would indicate an infection?

Hot, sweaty, a temperature of36.5°C, and bradycardic

Temperature of 38.5°C, shivering, tachycardia and hypertensive.

Raised WBC, elevated blood glucose and temperature of 36.0°C.

Hypotensive, cold and clammy, and bradycardic

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* 30. Which of the following techniques is advisable when obtaining a urine specimen in order to minimize the contamination of a specimen?

Clean around the urethral meatus prior to sample collectionand get a midstream/clean catch urine specimen.

Clean around the urethral meatus prior to sample collection and collect the first portion of urine as this is where the most bacteria will be.

Do not clean the urethral meatus as we want these bacteria to analyse as well.

Dip the urinalysis strip into the urine in a bedpan mixed with stool

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* 31. If a patient is experiencing dysphagia, which of the following investigations are they likely to have?

Colonoscopy

Gastroscopy

Cystoscopy

Arthroscopy

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* 32. Which of the following can a patient not have if they have a pacemaker in situ?

MRI

X ray

Barium swallow

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* 33. In a fully saturated haemoglobin molecule, responsible for carrying oxygen to the body's tissues, how many of its haem sites are bound with oxygen?

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* 34. Which of the following is NOT a cause of Type 1 (hypoxaemic) respiratory failure?

Asthma

Pulmonary oedema

Drug overdose

Granulomatous lung disease

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* 35. Prior to sending a patient home on oxygen, healthcare providers must ensure the patient and family understand the dangers of smoking in an oxygen-rich environment. Why is this necessary?

It is especially dangerous to the patient's health to smoke while using oxygen

Oxygen is highly flammable and there is a risk of fire

Oxygen and cigarette smoke can combine to produce a poisonous mixture

Oxygen can lead to an increased consumption of cigarette

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* 36. What action would you take if a specimen had a biohazard sticker on it?

Double bag it, in a self-sealing bag, and wear gloves ifhandling the specimen.

Wear gloves if handling the specimen, ring ahead and tell the laboratory the sample is on its way.

Wear goggles and underfill the sample bottle.

Wear appropriate PPE and overfill the bottle.

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* 37. What isthe best way to avoid a haematoma forming when undertaking venepuncture?

Tap the vein hard which will ‘get the vein up’, especially if the patient has fragile veins. This will avoid bruising afterwards.

It is unavoidable and an acceptable consequence of the procedure. This should be explained and documented in the patient's notes.

Choosing a soft, bouncy vein that refills when depressed and is easily detected, and advising the patient to keep their arm straight whilst firm pressure is applied.

Apply pressure to the vein early before the needle is removed, then get the patient to bend the arm at a right angle whilst applying firm pressure

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* 38. You are caring for a patient with a history of COAD who is requiring 70% humidified oxygen via a facemask. You are monitoring his response to therapy by observing his colour, degree of respiratory distress and respiratory rate. The patient's oxygen saturations have been between 95% and 98%. In addition, the doctor has been taking arterial blood gases. What is the reason for this?

Oximeters may be unreliable under certain circumstances, e.g. if tissue perfusion is poor, if the environment is cold and if the patient's nails are covered with nail polish.

Arterial blood gases should be sampled if the patient is receiving >60% oxygen.

Pulse oximeters provide excellent evidence of oxygenation, but they do not measure the adequacy of ventilation.

Arterial blood gases measure both oxygen and carbon dioxide levels and therefore give an indication ofboth ventilation and oxygenation

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* 39. When using nasal cannulae, the maximum oxygen flow rate that should be used is 6 litres/min. Why?

Nasal cannulae are only capable of delivering an inspired oxygen concentration between 24% and 40%

Forany given flow rate, the inspired oxygen concentration will vary between breaths, as it depends upon the rate and depth of the patient's breath and the inspiratory flow rate.

Higher rates can cause nasal mucosal drying and may lead to epistaxis

If oxygen is administered at greater than 40% it should be humidified. You cannot humidify oxygen via nasal cannulae

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* 40. You are currently on placement in the emergency department (ED). A 55 year old city worker is bluelighted into the ED having had a cardiorespiratory arrest at work. The paramedics have been resuscitating him for 3 minutes. On arrival, he is in ventricular fibrillation. Your mentor asks you the following question prior to your shift starting: What will be the most important part of the patient's immediate advanced life support?

Early defibrillation to restart the heart

Early cardiopulmonary resuscitation

Administration of adrenaline every 3 minutes

Correction of reversible causes of hypoxia

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* 41. Why is it essential to humidify oxygen used during respiratory therapy?

Oxygen is a very hot gas so if humidification isn't used, the oxygen will burn the respiratory tract and cause considerable pain for the patient when they breathe.

Oxygen is a dry gas which can cause evaporation of water from the respiratory tract and lead to thickened mucus in the airways, reduction of the movement of cilia and increased susceptibility to respiratory infection.

Humidification cleans the oxygen as it is administered to ensure it is free from any aerobic pathogens before it is inhaled by the patient.

Humidifying oxygen adds hydrogen to it, which makes it easier for oxygen to be absorbed to the blood in the lungs. This means the cells that need it for intracellular function have their needs met in a more timely manner

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* 42. Which of the following is NOT a symptom of impacted earwax?

Dizziness

Dull hearing

Reflux cough

Sneezing

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* 43. After death, who can legally give permission for a patient's body to be donated to medical science?

Only the patient, if they left instructions for this

The patient's spouse or next-of-kin

The patient's GP

The doctor in charge at the time of death

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* 44. What should be included in your initial assessment of your patient's respiratory status?

Review the patient's notes and charts, to obtain the patient's history.

Review the results of routine investigations.

Observe the patient's breathing for ease and comfort, rate and pattern.

Perform a systematic examination and ask the relatives for the patient's history

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* 45. What should be included in a prescription for oxygen therapy?

You don't need a prescription for oxygen unless in an emergency.

The date it should commence, the doctor's signature and bleep number.

The type of oxygen delivery system, inspired oxygen percentage and duration of the therapy.

You only need a prescription if the patient is going to have home oxygen

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* 46. You are caring for a patient with a tracheostomy in situwho requires frequent suctioning. How long should you suction for?

If you preoxygenate the patient, you can insert the catheter for 45 seconds.

Never insert the catheter for longer than 10-15 seconds.

Monitor the patient's oxygen saturations and suction for 30 seconds

Suction for 50 seconds and send a specimen to the laboratory if the secretions are purulent

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* 47. What does the term ‘breakthrough pain’ mean, and what type of prescription would you expect for it?

A patient who has adequately controlled pain reliefwith short lived exacerbation of pain, with a prescription that has no regular time of administration of analgesia.

Pain on movement which is short lived, with a q.d.s. prescription, when necessary.

Pain that is intense, unexpected, in a location that differs from that previously assessed, needing a review before a prescription is written.

A patient who has adequately controlled pain relief with short lived exacerbation of pain, with a prescription that has 4 hourly frequency of analgesia if necessary

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* 48. A patient has just returned from theatre following surgery on their left arm. They have a PCA infusion connected and from the admission, you remember that they have poor dexterity with their right hand. They are currently pain free. What actions would you take?

A. Educate the patient's family to push the button when the patient asks for it. Encourage them to tell the nursing staff when they leave the ward so that staff can take over.

Routinely offer the patient a bolus and document this clearly.

Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed.

The patient has paracetamol q.d.s. written up, so this should be adequate pain relief

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* 49. In which of the following situations might nitrous oxide (Entonox) be considered?

A wound dressing change for short term pain relief or the removal of a chest drain for reduction of anxiety.

Turning a patient who has bowel obstruction because there is an expectation that they may have pain from pathological fractures

For pain relief during the insertion of a chest drain for the treatment of a pneumothorax.

For pain relief during a wound dressing for a patient who has had radical head and neck cancer that involved the jaw.

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* 50. What are the key nursing observations needed for a patient receiving opioids frequently?

Respiratory rate, bowel movement record and pain assessment and score.

Checking the patent is not addicted by looking at their blood pressure.

Lung function tests, oxygen saturations and addiction levels

Daily completion of a Bristol stool chart, urinalysis, and a record of the frequency with which the patient reports breakthrough pain

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* 51. We are always striving to improve our service and support to overseas nurses. Any feedback or suggestions that you might have can be made in the comment box below. If you are not registered with MMA Healthcare Recruitment and would like to receive a copy of our free CBT study guide, please provide your name and e-mail address.
http://www.mmarecruitment.com/

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