NMC CBT - Nursing and Midwifery Council Computer-Based Test Physiological Observations and Escalation 1 — Questions and Answers
Question 1: A patient's respiratory rate is 24 breaths per minute. How many NEWS2 points does this score?
- 0 points — within normal range
- 1 point — mildly elevated
- 2 points — moderate concern (Correct answer)
- 3 points — critical range
Correct answer: 2 points — moderate concern
On the NEWS2 chart, a respiratory rate of 21–24 breaths per minute scores 2 points. The normal range (12–20) scores 0; rates of 9–11 score 1; rates ≤8 or ≥25 score 3. A rate of 24 falls in the 21–24 band, which is 2 points.
Question 2: A patient has a recorded temperature of 38.5°C. How many NEWS2 points does this temperature contribute?
- 0 points
- 1 point (Correct answer)
- 2 points
- 3 points
Correct answer: 1 point
In NEWS2, the temperature band 38.1–39.0°C scores 1 point. Temperatures of 36.1–38.0°C are normal (0 points); ≥39.1°C scores 2 points; and ≤35.0°C scores 3 points. At 38.5°C the patient is in the mildly elevated band.
Question 3: A patient's total aggregated NEWS2 score is 7. Which escalation response does this trigger according to the Royal College of Physicians guidance?
- Minimum 4–6 hourly monitoring with a nurse review
- Urgent review by a senior clinical decision-maker within 30 minutes
- Emergency response — continuous monitoring and immediate senior or critical care team review (Correct answer)
- Minimum 12-hourly monitoring with routine medical review
Correct answer: Emergency response — continuous monitoring and immediate senior or critical care team review
A NEWS2 total score of 7 or above triggers an emergency response: the patient must be continuously monitored and an emergency senior clinician or critical care team review must occur immediately. Scores of 5–6 require urgent review; 1–4 require increased monitoring; 0 requires minimum 12-hourly monitoring.
Question 4: A patient who was previously alert is now responding only to voice on the AVPU scale. How many NEWS2 points does their current level of consciousness score?
- 0 points — only unresponsiveness scores points
- 1 point — a mild reduction in consciousness
- 2 points — moderate reduction
- 3 points — any deviation from 'Alert' scores the maximum (Correct answer)
Correct answer: 3 points — any deviation from 'Alert' scores the maximum
In NEWS2, the consciousness parameter scores 0 only if the patient is Alert (A on AVPU). Any deviation — whether Voice (V), Pain (P), or Unresponsive (U), or new confusion — automatically scores 3 points. This reflects how sensitively the system treats any altered level of consciousness.
Question 5: A patient's radial pulse is 112 beats per minute. How many NEWS2 points does this heart rate contribute?
- 0 points
- 1 point
- 2 points (Correct answer)
- 3 points
Correct answer: 2 points
On the NEWS2 chart the heart rate band 111–130 bpm scores 2 points. The normal range (51–90 bpm) scores 0; 91–110 bpm scores 1; ≥131 bpm scores 3; and ≤40 bpm also scores 3. At 112 bpm the patient falls in the 2-point band.
Question 6: A patient requires 2 L/min of oxygen via nasal cannula to maintain adequate oxygen saturation. How many additional NEWS2 points does receiving supplemental oxygen contribute?
- 0 points — only the SpO2 value itself is scored
- 1 point — a small penalty for low-flow oxygen
- 2 points — any supplemental oxygen scores 2 points regardless of flow rate (Correct answer)
- 3 points — supplemental oxygen always triggers the maximum score
Correct answer: 2 points — any supplemental oxygen scores 2 points regardless of flow rate
NEWS2 includes a dedicated parameter for supplemental oxygen: if the patient is receiving any supplemental oxygen — regardless of flow rate or device — 2 points are added automatically. If the patient is breathing room air, 0 points are scored. This parameter is separate from and in addition to the SpO2 score.
NMC CBT - Nursing and Midwifery Council Computer-Based Test Physiological Observations and Escalation 1
A patient's respiratory rate is 24 breaths per minute.
How many NEWS2 points does this score?