NMC CBT - Nursing and Midwifery Council Computer-Based Test Patient Safety and Risk Assessment 1 — Questions and Answers
Question 1: A nurse discovers a patient's identification wristband is missing. What is the most appropriate immediate action?
- Continue care and document the missing wristband in the notes
- Apply a new wristband before performing any further clinical procedures (Correct answer)
- Ask the patient to verbally confirm their name before each intervention
- Inform the ward manager and await further instruction before continuing care
Correct answer: Apply a new wristband before performing any further clinical procedures
Patient identification is a fundamental safety check. A new wristband must be applied before any further procedures to prevent wrong-patient errors, which are a recognised 'Never Event' in NHS settings.
Question 2: Which framework is used in UK healthcare to categorise the severity of patient safety incidents?
- SBAR (Situation, Background, Assessment, Recommendation)
- The NHS Serious Incident Framework grading scale (Correct answer)
- The Beauchamp and Childress Four Principles
- The NMC Code standards of conduct
Correct answer: The NHS Serious Incident Framework grading scale
NHS England's Serious Incident Framework provides a grading structure to classify incidents by actual or potential harm, guiding the level of investigation and reporting required.
Question 3: When using the SBAR tool during a clinical handover, what does the letter 'R' represent?
- Risk
- Recommendation (Correct answer)
- Response
- Reassessment
Correct answer: Recommendation
In the SBAR communication tool, 'R' stands for Recommendation — the nurse states what action they believe is needed. This structured format reduces miscommunication and supports patient safety during handovers.
Question 4: 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?
- Continue observations and reassess in two hours as per routine schedule
- 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
- 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 5: Under the duty of candour (Regulation 20), what must a healthcare provider do when a notifiable safety incident occurs?
- File an internal incident report within 72 hours without contacting the patient
- Notify, apologise to, and provide a written account to the affected patient or their family (Correct answer)
- Refer the case directly to the CQC before speaking with the patient
- Document the incident in the patient's notes and review at the next clinical governance meeting
Correct answer: Notify, apologise to, and provide a written account to the affected patient or their family
The statutory duty of candour requires organisations to be open and transparent with patients when things go wrong. This includes a verbal apology, a written notification, and an explanation of what happened and what will be done to prevent recurrence.
Question 6: Which of the following is an example of a 'Never Event' as defined by NHS England?
- A patient developing a grade 2 pressure ulcer during a prolonged hospital stay
- Wrong-site surgery performed on an incorrect limb (Correct answer)
- A medication administered 30 minutes late due to staffing pressures
- A patient falling from a bed with cot sides in the raised position
Correct answer: Wrong-site surgery performed on an incorrect limb
Never Events are serious, wholly preventable patient safety incidents. Wrong-site surgery is a defined Never Event because robust safety checks (such as the WHO Surgical Safety Checklist) should prevent it entirely.
NMC CBT - Nursing and Midwifery Council Computer-Based Test Patient Safety and Risk Assessment 1
A nurse discovers a patient's identification wristband is missing.
What is the most appropriate immediate action?