NMC CBT Exam — Questions and Answers

Question 1: Using the Spaulding classification of medical devices, which item is categorised as 'critical' and therefore requires sterilisation before use?

A bedpan used by a patient with a gastrointestinal infection
A flexible bronchoscope used for diagnostic inspection
A reusable surgical instrument that enters sterile body tissue (Correct answer)
A blood pressure cuff used on a patient with a wound infection

Correct answer: A reusable surgical instrument that enters sterile body tissue

The Spaulding classification defines 'critical' items as those that enter sterile tissue or the vascular system (e.g., surgical instruments, implants, cardiac catheters). These carry the highest risk of infection transmission and must be sterilised. Flexible endoscopes are 'semi-critical' (requiring high-level disinfection), while blood pressure cuffs and bedpans are 'non-critical'.

Question 2: According to the 'Rights of Medication Administration', which of the following is a crucial check for a nurse to perform?

Right expiry date (Correct answer)
Right pharmacist who dispensed it
Right time of day (morning vs evening)
Right manufacturer

Correct answer: Right expiry date

The 'Rights' of medication administration are a fundamental safety checklist to prevent errors. Key rights include the Right Patient, Right Drug, Right Dose, Right Route, and Right Time. Checking the expiry date of the medication (Right Drug/Formulation) is essential to ensure its efficacy and safety.

Question 3: When making a best interests decision for an adult who lacks capacity under the Mental Capacity Act 2005, which approach is explicitly prohibited by the Act?

Appointing an Independent Mental Capacity Advocate (IMCA) where appropriate
Consulting with family members, carers, and relevant others
Basing the decision solely on the person's age, appearance, or diagnosis (Correct answer)
Considering what the person's wishes and feelings might have been when they had capacity

Correct answer: Basing the decision solely on the person's age, appearance, or diagnosis

Section 4(1) of the Mental Capacity Act 2005 explicitly states that a person must not make a best interests determination merely on the basis of the person's age, appearance, a condition they have, or an aspect of their behaviour. The Act requires a holistic approach that includes past wishes, values, and consultation with relevant others.

Question 4: A patient with type 1 diabetes develops symptoms of DKA. Which is a typical presentation?

Hypoglycaemia, tremor, profuse sweating
Bradycardia, hypertension, peripheral oedema
Hypothermia, confusion, slow respiratory rate
Hyperglycaemia, Kussmaul breathing, dehydration, ketotic breath (Correct answer)

Correct answer: Hyperglycaemia, Kussmaul breathing, dehydration, ketotic breath

DKA: hyperglycaemia (usually >11 mmol/L), Kussmaul breathing (compensating for acidosis), dehydration, acetone breath, nausea, vomiting.

Question 5: A patient weighing 72 kg is prescribed a drug at a dose of 5 mg per kg. What is the total dose required in mg?

14.4 mg
77 mg
720 mg
360 mg (Correct answer)

Correct answer: 360 mg

To calculate the total dose, multiply the patient's weight in kg by the prescribed dose per kg. The calculation is 72 kg * 5 mg/kg, which equals 360 mg. This ensures the patient receives a dose appropriate for their body weight.

Question 6: A 78-year-old patient is admitted to the ward. When is the most appropriate time to complete a falls risk assessment?

During the first ward round by the medical team
Only if the patient has a known history of falls
On admission and repeated regularly or after any change in condition (Correct answer)
Within 24 hours of admission

Correct answer: On admission and repeated regularly or after any change in condition

A falls risk assessment should be completed on admission to establish a baseline and identify immediate risks. This assessment should then be repeated regularly, especially after a fall or a change in the patient's condition, to ensure ongoing safety.

Question 7: A nurse uses the SBAR tool to hand over a deteriorating patient. What does the 'R' in SBAR stand for?

Response
Recommendation (Correct answer)
Report
Review

Correct answer: Recommendation

In SBAR, 'R' stands for Recommendation, where the nurse states what they believe should happen next.

Question 8: A patient is found unresponsive and not breathing normally. You have sent for help and an AED. What is the correct compression rate per minute during adult CPR?

100–120 compressions per minute (Correct answer)
80–100 compressions per minute
60–80 compressions per minute
120–140 compressions per minute

Correct answer: 100–120 compressions per minute

Resuscitation Council UK guidelines specify a compression rate of 100–120 per minute. Rates below 100 reduce cardiac output and rates above 120 decrease compression quality and depth.

Question 9: You are explaining a treatment plan to a patient, but they seem confused and ask the same questions repeatedly. What should you do?

Ask a colleague to explain instead.
Tell the patient to read the information leaflet provided.
Ignore their questions and proceed with the treatment plan.
Repeat the information using simpler terms and visual aids if necessary. (Correct answer)

Correct answer: Repeat the information using simpler terms and visual aids if necessary.

Effective patient education requires ensuring the patient fully understands their treatment plan. When a patient appears confused and asks repeated questions, it indicates a need to adjust communication strategies. Repeating information using simpler terms, different analogies, or visual aids helps to clarify complex concepts and ensures the patient can make informed decisions about their care.

Question 10: A patient has a DNACPR form. Which statement is correct?

DNACPR means no treatment should be given
DNACPR decisions never need review
DNACPR can only be decided by the patient
DNACPR applies only to CPR — all other appropriate treatment continues (Correct answer)

Correct answer: DNACPR applies only to CPR — all other appropriate treatment continues

DNACPR relates specifically to CPR only. All other treatment should continue as appropriate.

Question 11: When using a validated tool such as the Waterlow score to assess a patient's risk of developing a pressure ulcer, which factor is considered most significant?

Nutritional status
Continence level
Patient's age
Mobility and activity level (Correct answer)

Correct answer: Mobility and activity level

Immobility and reduced mobility are the most significant risk factors for pressure ulcer development. Prolonged pressure on bony prominences restricts blood flow, leading to tissue damage.

Question 12: What is 'Sepsis Six' and within what timeframe should it be delivered?

Six days of antibiotics
Six lab tests within 24 hours
Six interventions (three investigations, three treatments) within one hour (Correct answer)
Six-monthly training

Correct answer: Six interventions (three investigations, three treatments) within one hour

The Sepsis Six: three investigations (blood cultures, lactate, urine output) and three treatments (IV antibiotics, IV fluids, high-flow oxygen) within one hour.

Question 13: Which cleaning agent is required for environmental decontamination of a room previously occupied by a patient with Clostridioides difficile (C. diff)?

A chlorine-releasing agent (Correct answer)
Hot soapy water
Alcohol-based solution
Standard neutral detergent

Correct answer: A chlorine-releasing agent

C. difficile produces spores that are highly resistant to standard detergents and alcohol-based cleaners. A chlorine-releasing agent, such as bleach (sodium hypochlorite), is sporicidal and necessary to effectively kill these spores and decontaminate the environment, preventing further transmission.

Question 14: A patient is admitted with confirmed pulmonary tuberculosis. Which transmission-based precaution must be implemented in addition to standard precautions?

Droplet precautions with a standard surgical mask
Contact precautions in a side room with door closed
Reverse barrier nursing to protect the immunocompromised patient
Airborne precautions in a negative-pressure room with an FFP3 respirator (Correct answer)

Correct answer: Airborne precautions in a negative-pressure room with an FFP3 respirator

Mycobacterium tuberculosis is transmitted via airborne droplet nuclei smaller than 5 micrometres that remain suspended in the air for prolonged periods. This requires airborne precautions: a negative-pressure isolation room and an FFP3 (N95-equivalent) respirator for staff entering the room, not a standard surgical mask.

Question 15: A child weighing 22 kg is prescribed paracetamol at 15 mg/kg. The oral suspension contains 250 mg in 5 mL. What volume should be administered?

6.0 mL
6.6 mL (Correct answer)
5.6 mL
7.2 mL

Correct answer: 6.6 mL

Dose = 15 x 22 = 330 mg. Volume = (330/250) x 5 = 6.6 mL.

Question 16: You notice a colleague frequently arrives late for duty and appears unfit to practice. What should you do?

Confront the colleague and demand an explanation.
Share your observations with other colleagues to confirm your suspicions.
Report your concerns to your manager. (Correct answer)
Ignore the behavior, as it does not directly affect you.

Correct answer: Report your concerns to your manager.

As a registered professional, you have a duty to ensure patient safety and uphold professional standards. A colleague appearing unfit to practice poses a potential risk to patients and the quality of care. Reporting your concerns to your manager is the appropriate action to ensure the situation is addressed formally and safely, protecting both patients and the colleague.

Question 17: How frequently should a high-risk immobile patient be repositioned for pressure ulcer prevention?

Every 4 hours
At least every 2 hours, or more frequently if indicated (Correct answer)
Only when the patient complains
Every 6 hours

Correct answer: At least every 2 hours, or more frequently if indicated

At least every 2 hours for bed-bound high-risk patients, more frequently based on individual assessment.

Question 18: What minimum Personal Protective Equipment (PPE) is required when caring for a patient with suspected pandemic influenza?

Gloves and apron only
Gloves, apron, fluid-resistant surgical mask, and eye protection (Correct answer)
A full-body hazmat suit
FFP3 mask only

Correct answer: Gloves, apron, fluid-resistant surgical mask, and eye protection

Pandemic influenza is spread by droplets and, in some procedures, aerosols. Therefore, droplet precautions are required, which include a fluid-resistant surgical mask (FRSM), eye protection, gloves, and an apron. This combination protects the mucous membranes of the eyes, nose, and mouth from infectious droplets.

Question 19: For consent to be considered valid, it must be voluntary, informed, and which other key element?

Given by a person with capacity (Correct answer)
Witnessed by a relative
Irreversible once given
Written

Correct answer: Given by a person with capacity

The three pillars of valid consent are that it must be voluntary (given freely), informed (the person has all necessary information), and the person must have the mental capacity to make the decision at that time. While written consent is good practice for major procedures, it is not a universal requirement for validity.

Question 20: A patient takes warfarin. Which blood test monitors its effect, and what is the typical target INR range?

INR, target 2.0-3.0 (Correct answer)
APTT ratio, target 1.5-2.5
Platelet count, target 150-400
PT, target 12-15 seconds

Correct answer: INR, target 2.0-3.0

Warfarin is monitored using INR. Target 2.0-3.0 for most indications (AF, DVT, PE); 2.5-3.5 for mechanical heart valves.

Question 21: What is the purpose of NMC revalidation?

To reduce the number of registered nurses
To test clinical knowledge through an exam
To confirm nurses continue meeting NMC standards, remain fit to practise, and engage in ongoing development (Correct answer)
To ensure payment of registration fees

Correct answer: To confirm nurses continue meeting NMC standards, remain fit to practise, and engage in ongoing development

Revalidation is a three-yearly process demonstrating continued competence, CPD engagement, and reflective practice.

Question 22: An adult patient weighing 70 kg has a normal daily urine output. Which volume is within the expected range?

2500–3500 mL/day
200–400 mL/day
800–2000 mL/day (Correct answer)
400–600 mL/day

Correct answer: 800–2000 mL/day

Normal adult urine output is approximately 0.5–1 mL/kg/hr, equating to roughly 800–2000 mL per day for a 70 kg adult.

Question 23: How should NG tube placement be confirmed before feeding?

Auscultation over the epigastrium (whoosh test)
Observe for coughing during insertion
Aspirate and test with pH paper — pH should be 5.5 or below (Correct answer)
Check external length marking only

Correct answer: Aspirate and test with pH paper — pH should be 5.5 or below

Aspirate gastric contents and test pH (5.5 or below confirms gastric placement). The whoosh test is unreliable and no longer recommended.

Question 24: A patient asks you not to disclose their HIV status to their family. What is the correct course of action?

Tell the patient they must inform their family
Respect the patient's wishes and maintain confidentiality unless there is a specific legal obligation to disclose (Correct answer)
Inform the family as they have a right to know
Document the request but inform the GP to tell the family

Correct answer: Respect the patient's wishes and maintain confidentiality unless there is a specific legal obligation to disclose

Patient confidentiality must be maintained under the NMC Code and Data Protection Act. HIV status should not be disclosed without consent unless there is a specific legal duty.

Question 25: You are about to perform a procedure on a patient and need to obtain consent. What should you do?

Obtain verbal consent before proceeding with the procedure.
Obtain consent from the patient's family member if the patient is unable to provide consent.
Ensure the patient fully understands the procedure, risks, and benefits, and obtain written consent if necessary. (Correct answer)
Proceed with the procedure without consent if it is an emergency.

Correct answer: Ensure the patient fully understands the procedure, risks, and benefits, and obtain written consent if necessary.

Informed consent is a fundamental ethical and legal principle in healthcare, ensuring patient autonomy. It requires the patient to fully understand the procedure, including its purpose, potential risks, benefits, and available alternatives, before agreeing to it. The nurse's role is to ensure this understanding and obtain appropriate consent, often written for invasive procedures, to protect the patient's rights.

Question 26: A nurse is inserting a urinary catheter. Which aseptic technique should be used?

Standard precautions only
Surgical ANTT (Correct answer)
Clean technique with non-sterile gloves
Standard ANTT

Correct answer: Surgical ANTT

Catheterisation involves a large key-part entering a sterile body cavity, requiring Surgical-ANTT with a sterile field and sterile gloves.

Question 27: What is the maximum GCS score, and what does a score of 8 or below indicate?

Maximum 10; 5 or below = coma
Maximum 15; 8 or below = severe brain injury and potential airway compromise (Correct answer)
Maximum 12; 8 or below = moderate injury
Maximum 20; 10 or below = brain death

Correct answer: Maximum 15; 8 or below = severe brain injury and potential airway compromise

GCS maximum is 15 (E4+V5+M6). Score <=8 indicates severe brain injury with risk of airway compromise requiring intubation.

Question 28: According to the Roper-Logan-Tierney model, which is one of the twelve Activities of Living?

Maintaining a safe environment (Correct answer)
Self-actualisation
Social interaction
Financial management

Correct answer: Maintaining a safe environment

Maintaining a safe environment is one of the twelve Activities of Living in the RLT model, widely used in UK nursing.

Question 29: A prescription states: 'morphine 10 mg in 10 mL 0.9% NaCl IV, give 3 mg.' How many mL should be drawn up?

1 mL
3 mL (Correct answer)
0.3 mL
5 mL

Correct answer: 3 mL

Concentration = 10 mg/10 mL = 1 mg/mL. Volume = 3/1 = 3 mL.

Question 30: A child weighing 30 kg is prescribed ibuprofen at 10 mg/kg. The suspension available is 100 mg in 5 mL. What volume should be given?

15 mL (Correct answer)
20 mL
10 mL
12 mL

Correct answer: 15 mL

Required dose = 30 kg × 10 mg/kg = 300 mg. Volume = (300 ÷ 100) × 5 = 15 mL.

Question 31: What does the professional 'Duty of Candour' primarily require healthcare professionals to do following a patient safety incident?

Report the incident to their manager within 24 hours.
Offer financial compensation to the patient.
Be open and honest with the patient or their advocate. (Correct answer)
Complete a detailed incident report for legal purposes.

Correct answer: Be open and honest with the patient or their advocate.

The professional Duty of Candour, as outlined in the NMC Code, requires nurses and midwives to be open and honest with patients when something goes wrong with their care that causes, or has the potential to cause, harm or distress. This includes apologising and explaining what happened.

Question 32: A nurse uses the BMI formula to assess a patient's nutritional status. Which BMI range indicates underweight in an adult?

30 kg/m² or above
25–29.9 kg/m²
Less than 18.5 kg/m² (Correct answer)
18.5–24.9 kg/m²

Correct answer: Less than 18.5 kg/m²

A BMI below 18.5 kg/m² is classified as underweight according to standard WHO and NICE guidelines used in clinical nutritional screening.

Question 33: What is the NMC fitness to practise process and what outcomes can it have?

Only applies to nurses with criminal offences
Voluntary self-assessment with no consequences
Annual registration renewal with no sanctions
A formal investigation process that can result in conditions of practice, suspension, or removal from the register (Correct answer)

Correct answer: A formal investigation process that can result in conditions of practice, suspension, or removal from the register

The FtP process investigates concerns about practice, conduct, or health, with sanctions from caution orders to striking off.

Question 34: A nurse caring for a patient with dementia notices that their family carer appears exhausted and frustrated and has shouted at the patient. Which type of abuse does this MOST likely represent?

Self-neglect
Institutional abuse
Carer stress leading to emotional/psychological abuse (Correct answer)
Discriminatory abuse

Correct answer: Carer stress leading to emotional/psychological abuse

Shouting and verbal aggression toward a vulnerable adult constitutes emotional or psychological abuse, which may arise from carer burnout.

Question 35: In line with NICE guidelines, when must a patient be assessed for their risk of venous thromboembolism (VTE)?

Within 72 hours of admission
Only if they are scheduled for surgery
On admission to hospital (Correct answer)
Prior to discharge from the hospital

Correct answer: On admission to hospital

NICE guidelines mandate that all patients must have a VTE risk assessment performed on admission to hospital. This is crucial as hospitalisation is a major risk factor for developing blood clots, and early assessment allows for timely implementation of preventative measures.

Question 36: An infusion pump must be set to deliver 500 mg of an antibiotic in 100 mL of fluid over 30 minutes. What rate should the pump be set to in mL/hour?

150 mL/hr
200 mL/hr (Correct answer)
100 mL/hr
50 mL/hr

Correct answer: 200 mL/hr

The pump needs to deliver 100 mL in 30 minutes. To find the hourly rate, you need to determine how much would be delivered in 60 minutes. Since 60 minutes is twice as long as 30 minutes, you multiply the volume by 2 (100 mL * 2 = 200 mL), so the rate is 200 mL/hour.

Question 37: When measuring blood pressure manually, the cuff should be inflated to approximately how many mmHg above the point at which the radial pulse disappears?

20 mmHg
30 mmHg (Correct answer)
10 mmHg
40 mmHg

Correct answer: 30 mmHg

Inflating 30 mmHg above pulse disappearance ensures the brachial artery is fully occluded before slow deflation.

Question 38: A patient is prescribed a heparin infusion at 1000 units/hour. The infusion bag contains 25,000 units of heparin in 50 mL of 0.9% NaCl. What rate in mL/hr should the pump be set to?

2 mL/hr (Correct answer)
1 mL/hr
4 mL/hr
5 mL/hr

Correct answer: 2 mL/hr

Concentration = 25,000 units ÷ 50 mL = 500 units/mL. Infusion rate = 1000 units/hr ÷ 500 units/mL = 2 mL/hr.

Question 39: What is the recommended thermal disinfection temperature for automated washer-disinfectors?

80 degrees C for 1 minute (Correct answer)
71 degrees C for 3 minutes
90 degrees C for 5 minutes
65 degrees C for 1 minute

Correct answer: 80 degrees C for 1 minute

NHS HTM 01-01 guidelines specify minimum 80 degrees C for 1 minute at the load.

Question 40: What is the purpose of the Bristol Stool Chart?

To classify stool form and consistency on a seven-type scale for bowel function assessment (Correct answer)
To assess bowel obstruction risk
To measure abdominal girth in ascites
To determine which laxative to prescribe

Correct answer: To classify stool form and consistency on a seven-type scale for bowel function assessment

The Bristol Stool Chart classifies stool into seven types from Type 1 (hard lumps) to Type 7 (liquid), standardising description of bowel habits.

Question 41: Prescription: digoxin 125 micrograms daily. Available: 0.25 mg tablets. How many tablets?

1 tablet
0.5 tablets (Correct answer)
2 tablets
0.25 tablets

Correct answer: 0.5 tablets

Convert: 0.25 mg = 250 mcg. Calculate: 125/250 = 0.5 tablet (half).

Question 42: A nurse discovers they gave the wrong insulin dose. What is the correct sequence of actions?

Complete the incident form first, then inform the patient
Assess the patient immediately, take corrective action, inform the medical team, inform the patient, complete an incident report (Correct answer)
Administer glucose and document in notes
Inform the ward manager and wait for instructions

Correct answer: Assess the patient immediately, take corrective action, inform the medical team, inform the patient, complete an incident report

Patient safety is the immediate priority: assess, correct, escalate, be transparent, then document and report.

Question 43: A patient is choking and becomes unconscious. What is the immediate action?

Place in the recovery position and call for help
Perform a blind finger sweep of the mouth
Lower the patient to the floor and begin CPR (Correct answer)
Attempt five further abdominal thrusts

Correct answer: Lower the patient to the floor and begin CPR

If a choking patient becomes unconscious, lower them to the floor, call the resuscitation team (2222), and begin CPR starting with chest compressions.

Question 44: A patient in your care has a blood pressure of 180/110 mmHg. What should you do next?

Administer antihypertensive medication without consulting the doctor.
Inform the doctor and monitor the patient for signs of a hypertensive crisis. (Correct answer)
Reassure the patient that the reading is within normal limits.
Record the reading and wait to see if the pressure lowers on its own.

Correct answer: Inform the doctor and monitor the patient for signs of a hypertensive crisis.

A blood pressure reading of 180/110 mmHg is significantly elevated and indicates a hypertensive urgency or emergency, requiring prompt medical attention. The nurse's immediate responsibility is to report this critical finding to the doctor. Continuous monitoring for signs of a hypertensive crisis, such as headache or vision changes, is essential to prevent serious complications.

Question 45: A patient with BMI 16 is admitted. Using MUST, what does the BMI score contribute?

2 points — high risk of malnutrition (Correct answer)
0 points — within normal range
3 points — requires immediate enteral feeding
1 point — medium risk

Correct answer: 2 points — high risk of malnutrition

In MUST, a BMI <18.5 scores 2 points (high risk). A BMI of 16 is significantly underweight.

Question 46: A 70 kg patient requires dopamine at 5 mcg/kg/min. The bag contains 400 mg in 250 mL. What is the infusion rate in mL/hr?

18.0 mL/hr
10.2 mL/hr
15.5 mL/hr
13.1 mL/hr (Correct answer)

Correct answer: 13.1 mL/hr

Dose/min = 5 x 70 = 350 mcg. Dose/hr = 350 x 60 = 21000 mcg = 21 mg. Concentration = 400/250 = 1.6 mg/mL. Rate = 21/1.6 = 13.1 mL/hr.

Question 47: Which values form the 6Cs of nursing?

Caring, Cleaning, Cooking, Comforting, Counselling, Curing
Clinical, Competence, Communication, Coordination, Compliance, Certification
Consent, Confidentiality, Capacity, Competence, Communication, Collaboration
Care, Compassion, Competence, Communication, Courage, Commitment (Correct answer)

Correct answer: Care, Compassion, Competence, Communication, Courage, Commitment

The 6Cs: Care, Compassion, Competence, Communication, Courage, Commitment.

Question 48: A nurse suspects a patient is a victim of human trafficking. Under the Modern Slavery Act 2015, what should they do?

Only report if the patient asks for help
Contact Home Office Immigration directly
Detain the patient until police arrive
Ensure immediate safety, make a referral through the National Referral Mechanism, and report to the DSL (Correct answer)

Correct answer: Ensure immediate safety, make a referral through the National Referral Mechanism, and report to the DSL

Ensure safety, refer through the NRM (UK framework for identifying/supporting victims), and engage the safeguarding lead.

Question 49: Which urine output threshold over 1 hour in an adult indicates oliguria and should trigger escalation?

Less than 0.5 mL/kg/hour (Correct answer)
Less than 2 mL/kg/hour
Less than 30 mL total regardless of weight
Less than 1 mL/kg/hour

Correct answer: Less than 0.5 mL/kg/hour

Oliguria is defined as urine output below 0.5 mL/kg/hour, which may indicate renal impairment or poor perfusion.

Question 50: Which of the following is a core principle of the Mental Capacity Act (MCA) 2005?

Any act done for a person lacking capacity must be in their best interests.
Decisions for someone lacking capacity should be the least restrictive of their rights and freedom.
A person must be assumed to have capacity unless it is established that they lack capacity. (Correct answer)
A person is not to be treated as unable to make a decision because they make an unwise decision.

Correct answer: A person must be assumed to have capacity unless it is established that they lack capacity.

The first principle of the MCA states that a person must be assumed to have capacity unless it is established that they lack it. The burden of proof is on the person assessing capacity to show that the individual lacks it, not the other way around.

Question 51: The NMC Code (2018) has four key themes. Which correctly lists all four?

Diagnose, Treat, Document, Discharge
Care, Compassion, Competence, Communication
Assess, Plan, Implement, Evaluate
Prioritise People, Practise Effectively, Preserve Safety, Promote Professionalism and Trust (Correct answer)

Correct answer: Prioritise People, Practise Effectively, Preserve Safety, Promote Professionalism and Trust

The four themes: Prioritise People, Practise Effectively, Preserve Safety, Promote Professionalism and Trust.

Question 52: Which body fluid compartment contains approximately two-thirds of the body's total water content?

Transcellular compartment
Intracellular compartment (Correct answer)
Intravascular compartment
Interstitial compartment

Correct answer: Intracellular compartment

Approximately 67% (two-thirds) of total body water is located within cells in the intracellular compartment, with the remaining third in extracellular spaces.

Question 53: A patient develops a rash after amoxicillin. Which type of adverse drug reaction is this?

Type C (chronic) — cumulative dose
Type A (augmented) — dose-dependent, predictable
Type D (delayed) — long after administration
Type B (bizarre) — dose-independent, likely allergic (Correct answer)

Correct answer: Type B (bizarre) — dose-independent, likely allergic

An allergic rash is Type B — unpredictable, dose-independent, involving an immunological mechanism.

Question 54: Which sign would MOST alert the nurse to a patient developing refeeding syndrome after commencing nutritional support?

Decreasing blood glucose
Increasing serum potassium
Rising serum phosphate levels
Falling serum phosphate levels (Correct answer)

Correct answer: Falling serum phosphate levels

Refeeding syndrome is characterised by a rapid fall in serum phosphate (hypophosphataemia) as glucose metabolism drives phosphate into cells, causing potentially life-threatening complications.

Question 55: Which clinical supervision model involves a group meeting regularly with a trained supervisor to reflect on practice?

One-to-one clinical supervision
Group clinical supervision (Correct answer)
Peer review
Managerial supervision

Correct answer: Group clinical supervision

Group clinical supervision involves a facilitated group reflecting on practice, sharing experiences, and developing professionally.

Question 56: A patient is prescribed 0.5 g of amoxicillin. The tablets available are 250 mg. How many tablets should be administered?

1 tablet
4 tablets
2 tablets (Correct answer)
0.5 tablets

Correct answer: 2 tablets

First, convert the prescribed dose to the same unit as the available stock. 0.5 grams is equal to 500 milligrams. Then, divide the prescribed dose by the stock strength (500 mg / 250 mg = 2).

Question 57: What do 'professional boundaries' mean in the nurse-patient relationship?

Physical barriers like curtains
Rules about hospital area access
Restrictions on patient numbers
The limits protecting the space between the nurse's professional power and the patient's vulnerability (Correct answer)

Correct answer: The limits protecting the space between the nurse's professional power and the patient's vulnerability

Professional boundaries protect patients from exploitation of the inherent power imbalance in the caring relationship.

Question 58: What does 'Gillick competence' mean?

A patient over 16 who lacks mental capacity
An adult who refuses treatment against medical advice
A child under 16 with sufficient understanding to consent to or refuse medical treatment (Correct answer)
A child whose parents have given consent on their behalf

Correct answer: A child under 16 with sufficient understanding to consent to or refuse medical treatment

From Gillick v West Norfolk (1985): a child under 16 with sufficient understanding and intelligence to fully comprehend what is proposed.

Question 59: Which of the following conditions is MOST likely to cause hyponatraemia (low serum sodium)?

Diabetes insipidus
Addison's disease treated with fludrocortisone
Syndrome of Inappropriate ADH Secretion (SIADH) (Correct answer)
Excessive IV saline infusion

Correct answer: Syndrome of Inappropriate ADH Secretion (SIADH)

SIADH causes excessive retention of water relative to sodium, diluting serum sodium and resulting in hyponatraemia.

Question 60: You are caring for a patient who is receiving intravenous (IV) fluids and develops redness and swelling at the IV insertion site. What is your first action?

Increase the flow rate of the IV fluids.
Administer pain medication and continue the IV fluids.
Apply a warm compress and monitor the site.
Remove the IV and assess for signs of infection. (Correct answer)

Correct answer: Remove the IV and assess for signs of infection.

Redness and swelling at an IV insertion site are signs of potential complications such as phlebitis or infiltration. The immediate and safest action is to remove the IV catheter to prevent further tissue damage or infection. After removal, the site should be assessed for the severity of the complication and appropriate interventions initiated.

Question 61: Prepare adrenaline infusion: 5 mg in 500 mL NaCl. What is the concentration in micrograms per mL?

100 mcg/mL
1 mcg/mL
10 mcg/mL (Correct answer)
5 mcg/mL

Correct answer: 10 mcg/mL

5 mg = 5000 mcg. Concentration = 5000/500 = 10 mcg/mL.

Question 62: An IV infusion of 1 litre of 0.9% NaCl is prescribed over 8 hours. The giving set delivers 20 drops per mL. What is the drip rate?

25 drops/min
42 drops/min (Correct answer)
33 drops/min
50 drops/min

Correct answer: 42 drops/min

Drip rate = (1000 x 20) / (8 x 60) = 20000/480 = 41.67, rounded to 42 drops/min.

Question 63: Which best describes 'therapeutic communication' in nursing practice?

Verbal communication using only open-ended questions
Communication that occurs exclusively during formal assessments
Purposeful interaction that promotes the patient's wellbeing and supports the nurse-patient relationship (Correct answer)
Communication focused on gathering clinical data efficiently

Correct answer: Purposeful interaction that promotes the patient's wellbeing and supports the nurse-patient relationship

Therapeutic communication is purposeful, patient-centred interaction that promotes wellbeing and builds the therapeutic relationship.

Question 64: A nurse is asked by police to disclose a patient's medical records as part of a child protection investigation. What should the nurse do?

Share only the minimum necessary information relevant to the safeguarding concern, following organisational policy (Correct answer)
Share all records immediately without any conditions
Only share records if the patient provides written consent
Refuse because patient confidentiality is absolute

Correct answer: Share only the minimum necessary information relevant to the safeguarding concern, following organisational policy

Nurses should share the minimum necessary information required for the safeguarding investigation in line with the NMC Code, GDPR, and organisational safeguarding policy.

Question 65: What are the essential bedside safety checks before commencing a blood transfusion?

Verify blood group against medical notes only
Check temperature and expiry date only
Two registered practitioners independently verify: patient identity (patient states name and DOB), compatibility label, blood group, unit number, and expiry date (Correct answer)
One nurse checks blood group on bag matches the wristband

Correct answer: Two registered practitioners independently verify: patient identity (patient states name and DOB), compatibility label, blood group, unit number, and expiry date

Two registered practitioners must independently verify all details. The patient must state their name and DOB. ABO-incompatible transfusion is a Never Event.

Question 66: What is the minimum contact time for chlorine disinfectant (1000 ppm) when cleaning a blood spillage?

1 minute
30 seconds
5 minutes (Correct answer)
10 minutes

Correct answer: 5 minutes

A minimum of 5 minutes contact time is required for 1000 ppm chlorine to effectively kill blood-borne viruses.

Question 67: A patient's NEWS2 (National Early Warning Score 2) has increased from 2 to 7 over four hours. What is the most appropriate nursing response?

Inform the nurse in charge and escalate to a senior clinician urgently (Correct answer)
Administer prescribed PRN analgesia and repeat the score in one hour
Continue observations and reassess in two hours as per routine schedule
Document the score and await the next scheduled medical review

Correct answer: Inform the nurse in charge and escalate to a senior clinician urgently

A NEWS2 score of 7 or above indicates a high clinical risk and requires urgent escalation to a senior clinician or rapid response team. Delay in escalation is a common factor in preventable deterioration.

Question 68: A patient's BP is 88/52 mmHg. How many NEWS2 points does the systolic BP contribute?

3 points (Correct answer)
0 points
1 point
2 points

Correct answer: 3 points

A systolic BP of 88 falls in the <=90 category, scoring 3 points — the maximum for this parameter.

Question 69: What is the primary purpose of completing an incident report (e.g., using a Datix or IR1 form) after a patient safety event?

To provide evidence for potential legal action
To learn from the event and prevent recurrence (Correct answer)
To inform the patient's family that an error has occurred
To discipline the staff member involved in the incident

Correct answer: To learn from the event and prevent recurrence

The primary goal of incident reporting is not to assign blame but to learn from events, identify patterns or system failures, and implement changes to improve patient safety. This fosters a culture of safety and continuous improvement.

Question 70: A patient refuses to communicate with you because of a past negative experience with healthcare staff. What should you do?

Ignore their behavior and provide care as usual.
Apologize for their past experience and reassure them of your commitment to their care. (Correct answer)
Assign another nurse to their care.
Explain that their behavior is not acceptable.

Correct answer: Apologize for their past experience and reassure them of your commitment to their care.

A patient's past negative experiences can significantly impact their trust in healthcare providers. Apologizing for their past experience acknowledges their feelings and validates their concerns, which is a crucial first step in rebuilding trust. Reassuring them of your commitment to their care demonstrates empathy and helps establish a positive therapeutic relationship, essential for effective treatment.

Question 71: When documenting observations on a paper-based track and trigger chart, what should be done if a parameter cannot be measured?

Enter the last recorded value
Write 'N/A' and document the clinical reason (Correct answer)
Skip that observation entirely
Leave the field blank and continue

Correct answer: Write 'N/A' and document the clinical reason

Documenting 'N/A' with a clinical reason maintains accurate records and avoids a falsely reassuring score.

Question 72: During an aseptic wound dressing procedure, a nurse accidentally touches the sterile field with a non-sterile gloved hand. What is the CORRECT action?

Continue the procedure as gloves provide sufficient protection against contamination
Discard all contaminated sterile items and restart the procedure with new sterile equipment (Correct answer)
Wipe the contaminated area with a chlorhexidine swab and continue
Apply alcohol hand rub over the gloves and continue with the dressing

Correct answer: Discard all contaminated sterile items and restart the procedure with new sterile equipment

Once the sterile field has been breached, it is no longer considered sterile regardless of the method used to attempt recovery. The key parts — sterile equipment and the wound bed — must never be directly touched. The only safe course is to discard all contaminated items, reperform hand hygiene, and restart with fresh sterile equipment.

Question 73: When obtaining informed consent, which element is NOT a requirement for valid consent under UK law?

Consent must be given voluntarily without coercion
The patient must have capacity to make the decision
The patient must sign a written consent form for all procedures (Correct answer)
The patient must be provided with sufficient information to make an informed decision

Correct answer: The patient must sign a written consent form for all procedures

Written consent is not always required. Verbal or implied consent can be valid provided the patient has capacity, gives consent voluntarily, and has sufficient information.

Question 74: A patient's fluid balance shows: IV NaCl 1000 mL, oral 350 mL, IV antibiotics 100 mL x 3 doses. Output: urine 1100 mL, vomit 200 mL. What is the fluid balance?

+150 mL
+250 mL
+350 mL (Correct answer)
+450 mL

Correct answer: +350 mL

Intake = 1000 + 350 + 300 = 1650 mL. Output = 1100 + 200 = 1300 mL. Balance = +350 mL.

Question 75: Which four harms does the NHS Safety Thermometer measure?

Hospital-acquired pneumonia, pressure ulcers, falls, readmissions
Cardiac arrests, drug errors, wrong site surgery, complaints
Pressure ulcers, falls, catheter-associated UTIs, and VTE (Correct answer)
Falls, medication errors, surgical complications, infections

Correct answer: Pressure ulcers, falls, catheter-associated UTIs, and VTE

The four key harms: pressure ulcers, falls, CAUTIs, and VTE. Harm-free care means none of these occurred.

Question 76: What are the four principles of biomedical ethics (Beauchamp and Childress)?

Autonomy, beneficence, non-maleficence, justice (Correct answer)
Privacy, dignity, respect, equality
Honesty, loyalty, fairness, courage
Care, compassion, competence, communication

Correct answer: Autonomy, beneficence, non-maleficence, justice

Autonomy (self-determination), beneficence (doing good), non-maleficence (avoiding harm), justice (fairness).

Question 77: A nurse notices a colleague's social media post identifying a patient by first name and describing their condition. What should they do?

Comment asking for a disclaimer
Like the post to show support
Report to line manager and advise the colleague to remove the post immediately (Correct answer)
Ignore it as social media is personal

Correct answer: Report to line manager and advise the colleague to remove the post immediately

Sharing identifiable patient information on social media breaches the NMC Code, Data Protection Act, and common law confidentiality.

Question 78: Which validated tool is appropriate for pain assessment in a patient who cannot verbally communicate?

Visual Analogue Scale (VAS)
Simply ask family members to rate the pain
Numerical Rating Scale (NRS) 0-10
Abbey Pain Scale or FLACC scale (Correct answer)

Correct answer: Abbey Pain Scale or FLACC scale

Behavioural observation tools like Abbey Pain Scale (dementia/non-verbal adults) or FLACC scale should be used.

Question 79: A patient asks to see their medical records. Under the Data Protection Act 2018, what is their right?

Only if a doctor approves
Patients have no right to access records
Patients have a legal right through a Subject Access Request (Correct answer)
Only records over 5 years old

Correct answer: Patients have a legal right through a Subject Access Request

Under UK GDPR, patients can make a Subject Access Request, which must be responded to within one month, free of charge.

Question 80: During a handover, a nurse says: 'Mrs Smith is a 72-year-old admitted two days ago with a UTI. She has type 2 diabetes and is on metformin.' Which SBAR component is this?

Recommendation
Assessment
Background (Correct answer)
Situation

Correct answer: Background

This provides the Background component: relevant medical history, context, and current treatment.

Question 81: A patient has been NBM for 12 hours before surgery with dry mucous membranes. What is the appropriate nursing action?

Continue NBM without intervention
Provide mouth care, assess hydration, and contact surgical team to clarify fasting guidelines (Correct answer)
Commence IV fluids without prescription
Give sips of water without checking

Correct answer: Provide mouth care, assess hydration, and contact surgical team to clarify fasting guidelines

Current guidelines recommend clear fluids up to 2 hours before anaesthesia. A 12-hour fast exceeds guidelines. Provide mouth care and contact the surgical team.

Question 82: What is a 'Deprivation of Liberty Safeguard' (DoLS) designed to protect?

Children subject to care orders from arbitrary placement changes
The rights of care home or hospital patients who lack capacity and are deprived of their liberty in their best interests (Correct answer)
Detained mental health patients' rights to appeal their section
Staff members accused of abuse from unfair dismissal

Correct answer: The rights of care home or hospital patients who lack capacity and are deprived of their liberty in their best interests

DoLS (under the Mental Capacity Act 2005) provides a legal framework to authorise and safeguard deprivations of liberty for adults lacking capacity in hospitals and care homes.

Question 83: Which capillary refill time is considered ABNORMAL in adults and should prompt further assessment?

2–3 seconds
More than 3 seconds (Correct answer)
Less than 1 second
1–2 seconds

Correct answer: More than 3 seconds

A capillary refill time greater than 3 seconds suggests impaired peripheral perfusion and warrants clinical escalation.

Question 84: Under the Domestic Violence, Crime and Victims Act 2004, what offence was created?

Failing to report domestic violence to police
Causing or allowing the death of a child or vulnerable adult (Correct answer)
Financial exploitation of a vulnerable person
Verbal abuse towards a vulnerable person

Correct answer: Causing or allowing the death of a child or vulnerable adult

Section 5 created the offence of causing or allowing death (amended 2012 to include serious physical harm) of a child or vulnerable adult.

Question 85: A patient is identified as at HIGH risk of malnutrition using the MUST tool. Which action is MOST appropriate as an immediate step?

Encourage additional oral snacks without referral
Reassess in one month
Commence parenteral nutrition without dietitian review
Refer to the dietitian and implement a nutritional care plan (Correct answer)

Correct answer: Refer to the dietitian and implement a nutritional care plan

A MUST score of 2 or above (high risk) requires immediate referral to the dietitian and implementation of an individualised nutritional care plan per NICE guidelines.

Question 86: You are assigned to lead a shift and are managing a team of nurses. How can you ensure effective teamwork and collaboration?

Delegate all tasks and leave the team to work independently.
Monitor each nurse closely and avoid giving them any autonomy.
Focus solely on completing tasks without engaging with the team.
Foster open communication, encourage feedback, and provide support where needed. (Correct answer)

Correct answer: Foster open communication, encourage feedback, and provide support where needed.

Effective leadership in a healthcare team involves creating an environment of trust and mutual respect. Fostering open communication allows team members to share information and concerns freely, while encouraging feedback promotes continuous improvement. Providing support where needed ensures that team members feel valued and can perform their duties effectively, leading to better patient outcomes.

Question 87: You are assessing a patient for suspected sepsis. Which combination of signs is most indicative of sepsis with organ dysfunction (severe sepsis)?

Normal temperature, high blood pressure, and a rash.
High respiratory rate, low blood pressure, and new confusion. (Correct answer)
Low urine output, slow capillary refill, and normal respiratory rate.
Low grade fever, normal heart rate, and clear speech.

Correct answer: High respiratory rate, low blood pressure, and new confusion.

The combination of a high respiratory rate (tachypnoea), low blood pressure (hypotension), and an altered mental state are key red flag signs for sepsis. These indicate the body's systemic inflammatory response is causing organ dysfunction.

Question 88: A patient appears anxious and avoids eye contact during your conversation. What should you do?

Continue speaking without acknowledging their behavior.
End the conversation to avoid making them more anxious.
Gently ask them if they feel comfortable discussing their concerns. (Correct answer)
Speak louder to ensure they hear you clearly.

Correct answer: Gently ask them if they feel comfortable discussing their concerns.

Recognizing non-verbal cues like anxiety and avoidance of eye contact is crucial for effective therapeutic communication. Gently asking the patient if they are comfortable or have concerns demonstrates empathy and creates a safe space for them to express themselves. This approach helps build trust and facilitates open communication, which is essential for patient-centered care.

Question 89: When breaking bad news, which communication framework is recommended for structuring the conversation?

The SPIKES protocol (Correct answer)
The SBAR framework
The NEWS2 assessment tool
The ABCDE approach

Correct answer: The SPIKES protocol

The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary) is widely used for breaking bad news.

Question 90: A 4-year-old child is admitted requiring urgent surgery. His parents are not married and were never in a formal relationship. His mother is present and consents. His biological father, whose name does not appear on the birth certificate, also arrives and objects to the procedure. Whose decision is legally determinative under the Children Act 1989?

The mother's consent is sufficient as the father does not hold parental responsibility (Correct answer)
The father's objection overrides consent as both biological parents share equal rights
The surgeon must apply to the Family Court before proceeding
Both parents must reach agreement before treatment can proceed

Correct answer: The mother's consent is sufficient as the father does not hold parental responsibility

Under the Children Act 1989, an unmarried father does not automatically acquire parental responsibility. Parental responsibility is obtained by being named on the birth certificate (for registrations after 1 December 2003 in England and Wales), entering a Parental Responsibility Agreement, or obtaining a court order. As the father is not on the birth certificate, he has no parental responsibility, and the mother's consent alone is legally sufficient.

Question 91: What are the six principles of adult safeguarding under the Care Act 2014?

Prevention, Protection, Proportionality, Partnership, Accountability, Empowerment (Correct answer)
Safety, Effectiveness, Caring, Responsiveness, Well-led, Compliance
Assessment, Planning, Implementation, Evaluation, Documentation, Review
Care, Compassion, Competence, Communication, Courage, Commitment

Correct answer: Prevention, Protection, Proportionality, Partnership, Accountability, Empowerment

The six principles: Empowerment, Prevention, Proportionality, Protection, Partnership, Accountability.

Question 92: A patient confides in you that they are experiencing emotional distress but asks you not to tell anyone. What is your responsibility?

Keep the information confidential, as requested.
Ignore the patient's concern as it is not within your role.
Encourage the patient to seek help and explain the need to share information if safety is at risk. (Correct answer)
Inform the multidisciplinary team without the patient’s consent.

Correct answer: Encourage the patient to seek help and explain the need to share information if safety is at risk.

Nurses have a professional duty to maintain patient confidentiality. However, this duty is overridden when there is a risk of harm to the patient or others. Encouraging the patient to seek help while explaining the limits of confidentiality in situations of risk upholds both patient autonomy and the nurse's safeguarding responsibilities, aligning with ethical guidelines like the NMC Code.

Question 93: Which of the following best describes the AVPU scale used in neurological assessment?

Alert, Verbal, Pain, Unresponsive (Correct answer)
Awake, Vocalising, Posturing, Unconscious
Arousable, Vocal, Purposeful, Unconscious
Alert, Verbal, Pupils, Unresponsive

Correct answer: Alert, Verbal, Pain, Unresponsive

AVPU assesses consciousness level as Alert, responding to Voice, responding to Pain, or Unresponsive.

Question 94: A patient with COPD has an SpO2 of 82%. Which action is MOST appropriate?

Apply high-flow oxygen at 15 L/min immediately
Reassure the patient and recheck in one hour
Document and continue current care plan
Target SpO2 88–92% with controlled oxygen and escalate (Correct answer)

Correct answer: Target SpO2 88–92% with controlled oxygen and escalate

COPD patients risk hypercapnic drive suppression, so oxygen is titrated to 88–92% target and the clinical team alerted.

Question 95: A patient's Early Warning Score (EWS) increases from 2 to 5 within one hour. What is the MOST appropriate immediate action?

Continue monitoring at the scheduled interval
Inform the nurse in charge and increase monitoring frequency (Correct answer)
Call a cardiac arrest immediately
Administer oxygen without further assessment

Correct answer: Inform the nurse in charge and increase monitoring frequency

An EWS of 5 triggers an urgent clinical review; the nurse in charge must be informed and observations increased.

Question 96: What is the purpose of a root cause analysis (RCA)?

To assign blame for a clinical incident
To document the incident for legal proceedings
To determine the financial cost of a clinical error
To systematically investigate underlying causes and identify system improvements (Correct answer)

Correct answer: To systematically investigate underlying causes and identify system improvements

RCA identifies underlying causes and contributing factors, focusing on system improvements rather than individual blame.

Question 97: A patient develops signs of fluid overload. Which combination of findings is MOST consistent with this condition?

Bradycardia, weight loss, and sunken eyes
Hypertension, peripheral oedema, and bibasal crackles (Correct answer)
Tachycardia, dry mucous membranes, and oliguria
Hypotension, poor skin turgor, and concentrated urine

Correct answer: Hypertension, peripheral oedema, and bibasal crackles

Fluid overload presents with hypertension, dependent oedema, and pulmonary oedema signs such as bibasal crackles due to excess intravascular and interstitial fluid.

Question 98: During a busy shift, a patient asks for assistance, but you are attending to an emergency. What should you do?

Ask a colleague to assist the patient while you manage the emergency. (Correct answer)
Inform the patient you are too busy and will come back later.
Stop attending to the emergency and help the patient immediately.
Ignore the patient until you complete the emergency task.

Correct answer: Ask a colleague to assist the patient while you manage the emergency.

During an emergency, the nurse's primary focus is on the immediate life-threatening situation to ensure patient safety. However, other patients' needs should not be neglected. Delegating the non-emergency task to a colleague ensures that all patients receive timely care while the emergency is effectively managed, demonstrating good teamwork and prioritization skills.

Question 99: A vial contains 1 g of amoxicillin powder. After reconstitution with 10 mL of water for injection, a patient requires 250 mg IV. What volume should be drawn up?

2.5 mL (Correct answer)
3 mL
1.5 mL
2 mL

Correct answer: 2.5 mL

Post-reconstitution concentration = 1000 mg ÷ 10 mL = 100 mg/mL. Volume = 250 mg ÷ 100 mg/mL = 2.5 mL.

Question 100: You are caring for a patient who does not speak your language. What is the best course of action?

Arrange for a professional interpreter to assist with communication. (Correct answer)
Use hand gestures and facial expressions to communicate.
Ask the patient’s family member to interpret.
Avoid detailed communication to prevent misunderstandings.

Correct answer: Arrange for a professional interpreter to assist with communication.

Accurate and clear communication is paramount for patient safety and effective care, especially when there is a language barrier. Professional interpreters are trained to convey medical information precisely and impartially, ensuring informed consent and accurate symptom assessment. Relying on family members can lead to misunderstandings, bias, or a lack of medical terminology.

Question 101: A patient requires a morphine infusion at 2 mg/hour. The available bag contains 50 mg of morphine in 50 mL of 0.9% NaCl. What infusion rate in mL/hr should be set on the pump?

2 mL/hr (Correct answer)
1 mL/hr
4 mL/hr
5 mL/hr

Correct answer: 2 mL/hr

Concentration = 50 mg ÷ 50 mL = 1 mg/mL. Infusion rate = 2 mg/hr ÷ 1 mg/mL = 2 mL/hr.

Question 102: When documenting in nursing notes, which principle must be followed according to NMC record-keeping standards?

Entries should be made as soon as possible after the event (Correct answer)
Only significant events need documenting
Records should be completed at the end of the shift
Abbreviations should be used freely to save time

Correct answer: Entries should be made as soon as possible after the event

NMC standards require entries as soon as possible after the event to ensure accuracy and completeness.

Question 103: A nurse makes a safeguarding referral in good faith but it turns out no abuse had occurred. What protection does the nurse have?

Protection under whistleblowing and safeguarding legislation provided the referral was made honestly and in good faith (Correct answer)
No protection; the nurse could face a civil claim for defamation
Protection only if the referral was authorised by a consultant
Protection only if the patient also consented to the referral

Correct answer: Protection under whistleblowing and safeguarding legislation provided the referral was made honestly and in good faith

Professionals who raise safeguarding concerns in good faith are protected by the Public Interest Disclosure Act 1998 and relevant safeguarding frameworks, even if concerns are not substantiated.

Question 104: A nurse caring for a vulnerable adult with a learning disability observes unexplained genital bruising. What type of abuse should be suspected?

Neglect
Financial abuse
Sexual abuse (Correct answer)
Emotional abuse

Correct answer: Sexual abuse

Unexplained genital injuries in a vulnerable adult are a potential indicator of sexual abuse and must be reported to the safeguarding team immediately.

Question 105: A patient's cultural beliefs conflict with recommended treatment. How should the nurse approach this?

Refer to a nurse who shares their culture
Insist on the medical treatment
Ignore cultural beliefs as medically irrelevant
Respect beliefs, provide information, support informed decisions, and document choices (Correct answer)

Correct answer: Respect beliefs, provide information, support informed decisions, and document choices

Respect values and beliefs, provide unbiased information, support autonomy in decision-making, and document the discussion.

Question 106: Which of the following is the correct action when using an AED and the device advises 'no shock indicated'?

Begin chest compressions immediately (Correct answer)
Check for a pulse before continuing
Reposition the pads and reanalyse
Switch off the AED and continue ventilations only

Correct answer: Begin chest compressions immediately

When the AED advises no shock, the rescuer should immediately resume CPR starting with chest compressions for 2 minutes before the AED reanalyses.

Question 107: A patient becomes angry and shouts about waiting times. What is the most appropriate initial response?

Walk away and return when they've calmed down
Contact security immediately
Acknowledge their frustration and use active listening to de-escalate (Correct answer)
Firmly tell the patient their behaviour is unacceptable

Correct answer: Acknowledge their frustration and use active listening to de-escalate

Acknowledging frustration and using active listening demonstrates empathy and is the most effective initial de-escalation strategy.

Question 108: Which medication requires regular serum potassium monitoring?

Metformin
Paracetamol
Furosemide (Correct answer)
Amoxicillin

Correct answer: Furosemide

Furosemide is a loop diuretic causing significant potassium loss. Hypokalaemia can cause dangerous cardiac arrhythmias.

Question 109: A patient is discharged with new heart failure. What is the most important nursing intervention?

Ensuring all paperwork is completed
Providing written medication instructions only
Comprehensive discharge planning including medication education, symptom recognition, lifestyle advice, and follow-up arrangements (Correct answer)
Telling the patient to see their GP if they have problems

Correct answer: Comprehensive discharge planning including medication education, symptom recognition, lifestyle advice, and follow-up arrangements

Comprehensive discharge planning reduces readmission rates and includes medication education, symptom recognition, lifestyle modifications, and follow-up.

Question 110: A nurse is caring for a patient with suspected pulmonary TB. Which face mask should the nurse wear?

No mask if the patient is wearing one
FFP3 respirator (Correct answer)
Standard surgical mask
FFP2 respirator

Correct answer: FFP3 respirator

FFP3 respirator masks are required for TB as it is transmitted via airborne droplet nuclei. FFP3 filters 99%+ of particles.

Question 111: Which safeguarding principle from the Care Act 2014 statutory guidance emphasises that a person's wishes and feelings should be central to all safeguarding decisions?

Prevention
Partnership
Proportionality
Empowerment (Correct answer)

Correct answer: Empowerment

Empowerment is the principle that people are supported and encouraged to make their own decisions and give informed consent in safeguarding processes.

Question 112: You need to administer 30 mg of a drug that is available as a 50 mg/2 mL solution. What volume in mL do you need to draw up?

0.6 mL
3.3 mL
1.5 mL
1.2 mL (Correct answer)

Correct answer: 1.2 mL

Using the formula (Dose required / Stock strength) x Stock volume, the calculation is (30 mg / 50 mg) x 2 mL. This simplifies to 0.6 x 2 mL, which equals 1.2 mL. This ensures the correct dose is administered from the available solution.

Question 113: A nurse is caring for a young person aged 16 who discloses they are in a sexual relationship with a 30-year-old adult. What is the nurse's primary safeguarding concern?

Concern only if there is evidence of physical injury
No concern — 16 is the legal age of consent in England
Potential grooming and sexual exploitation given the significant age gap and power imbalance (Correct answer)
Only a concern if the young person reports feeling unhappy

Correct answer: Potential grooming and sexual exploitation given the significant age gap and power imbalance

A significant age gap and power imbalance raise concerns about grooming and exploitation even when the young person is 16, as consent may not be truly free or informed.

Question 114: A patient from a minority ethnic background expresses concerns about discrimination during their hospital stay. What should you do?

Reassure them there is no discrimination in the hospital.
Acknowledge their concerns and report them to the relevant department. (Correct answer)
Ignore their concerns unless a formal complaint is made.
Advise them to speak directly to the hospital management.

Correct answer: Acknowledge their concerns and report them to the relevant department.

Nurses are advocates for their patients and must ensure they receive equitable care free from discrimination. Acknowledging the patient's concerns validates their experience and demonstrates empathy. Reporting these concerns to the relevant department ensures that the issue can be formally investigated and addressed, upholding the hospital's commitment to inclusive and respectful care.

Question 115: What is the difference between accountability and responsibility in nursing?

Accountability applies only to senior nurses
Responsibility is the obligation to perform a task (can be delegated); accountability is being answerable for decisions (cannot be delegated) (Correct answer)
They are the same thing
Responsibility is legal; accountability is only professional

Correct answer: Responsibility is the obligation to perform a task (can be delegated); accountability is being answerable for decisions (cannot be delegated)

Responsibility (duty to perform) can be delegated. Accountability (answerable for outcomes) cannot be delegated.

Question 116: What is the legal significance of the Montgomery v Lanarkshire (2015) ruling on consent?

Patients must be told about material risks a reasonable person would consider significant (Correct answer)
Doctors alone decide what to disclose about risks
Written consent before surgery was removed
Patients under 18 cannot give informed consent

Correct answer: Patients must be told about material risks a reasonable person would consider significant

Montgomery replaced the Bolam test with a patient-centred standard: clinicians must inform about material risks a reasonable person would consider significant.

Question 117: A patient's National Early Warning Score (NEWS2) is 7 or above. According to NHS escalation protocols, what level of response is required?

Increase monitoring frequency to every 4 hours
Routine medical review within 12 hours
Urgent clinical review by a team with critical care competencies (Correct answer)
Inform the nurse in charge and increase monitoring to hourly

Correct answer: Urgent clinical review by a team with critical care competencies

A NEWS2 score of 7 or above triggers an emergency response, requiring urgent clinical review by a team with critical care competencies, including airway management skills.

NMC CBT Exam

The NMC Computer Based Test (CBT) is a two-part exam administered by the Nursing and Midwifery Council for internationally trained nurses and nursing associates seeking registration in the UK. It assesses numeracy skills and clinical nursing competence.

115

Questions

180 min

Time Limit

68%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

nmc.org.uk — Eligibility, score validity, test delivery, fees, retake policy, score release, exam format, passing score, time limit, exam information · verified Nov 2026
pearsonvue.com — Test delivery, eligibility · verified Oct 2026