Free NMC-CBT Physiological Observations and Escalation Questions and Answers 1 — Questions and Answers
Question 1: A patient's physiological observations calculate to a National Early Warning Score (NEWS2) of 8. According to standard UK protocol, what is the required level of response?
- Continue routine 4-hourly observations.
- Inform the nurse in charge who will decide on the next steps.
- An urgent response is required from a doctor or critical care outreach team. (Correct answer)
- Increase observations to hourly and inform the doctor at the next ward round.
Correct answer: An urgent response is required from a doctor or critical care outreach team.
A NEWS2 score of 7 or more indicates a high level of clinical risk and the potential for critical illness. This requires an urgent response from a team with critical care skills, such as a doctor or a critical care outreach team, for immediate assessment and intervention.
Question 2: You are assessing a patient for suspected sepsis. Which combination of signs is most indicative of sepsis with organ dysfunction (severe sepsis)?
- Low grade fever, normal heart rate, and clear speech.
- High respiratory rate, low blood pressure, and new confusion. (Correct answer)
- Normal temperature, high blood pressure, and a rash.
- Low urine output, slow capillary refill, and normal respiratory rate.
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 3: Why is an accurate measurement of a patient's respiratory rate considered a crucial part of routine observations?
- It is the best indicator of a patient's cardiac function.
- It is often the earliest and most sensitive indicator of clinical deterioration. (Correct answer)
- It is only important in patients with a known respiratory condition.
- It is easy to measure and less important than blood pressure.
Correct answer: It is often the earliest and most sensitive indicator of clinical deterioration.
An increased respiratory rate (tachypnoea) is a sensitive but non-specific sign of illness. It is often the very first indicator that a patient is deteriorating, as the body tries to compensate for problems like hypoxia or metabolic acidosis.
Question 4: When escalating concerns about a deteriorating patient to a doctor, which communication tool is recommended to ensure information is conveyed clearly and concisely?
- SOAP (Subjective, Objective, Assessment, Plan)
- NEWS2 (National Early Warning Score 2)
- SBAR (Situation, Background, Assessment, Recommendation) (Correct answer)
- ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
Correct answer: SBAR (Situation, Background, Assessment, Recommendation)
SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool widely used in healthcare. It ensures that information is passed between clinicians in a clear, concise, and structured way, reducing the risk of miscommunication.
Question 5: A nurse is assessing a patient's level of consciousness. The patient only opens their eyes and moans in response to a painful stimulus (trapezius squeeze). How would this be recorded using the AVPU scale?
- A (Alert)
- V (Voice)
- P (Pain) (Correct answer)
- U (Unresponsive)
Correct answer: P (Pain)
The AVPU scale assesses consciousness: Alert, Voice, Pain, Unresponsive. Since the patient only responds to a painful stimulus, the correct recording is 'P' for Pain.
Question 6: Using a blood pressure cuff that is too small for a patient's arm is most likely to result in what kind of reading?
- A falsely high reading (Correct answer)
- A falsely low reading
- An accurate reading
- An inability to obtain a reading
Correct answer: A falsely high reading
A cuff that is too small will not compress the brachial artery evenly and will require more pressure to occlude it. This leads to a falsely high blood pressure reading, which could result in unnecessary medical treatment.
Free NMC-CBT Physiological Observations and Escalation Questions and Answers 1
A patient's physiological observations calculate to a National Early Warning Score (NEWS2) of 8.
According to standard UK protocol, what is the required level of response?