NMC CBT Physiological Observations and Escalation 2 — Questions and Answers

Question 1: A patient's BP is 88/52 mmHg. How many NEWS2 points does the systolic BP contribute?

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

Correct answer: 3 points

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

NEWS2 systolic BP: <=90 = 3; 91-100 = 2; 101-110 = 1; 111-219 = 0; >=220 = 3. A score of 3 in any single parameter triggers urgent clinical response. Hypotension at this level may indicate shock, dehydration, medication effects, or acute cardiac events. Repeat measurement, ABCDE assessment, IV access, escalate urgently.

Question 2: A COPD patient has target SpO2 88-92%. Using NEWS2 Scale 2, what SpO2 range scores 0?

88-92% (Correct answer)
93-94%
95-96%
97-100%

Correct answer: 88-92%

On Scale 2, 88-92% (the prescribed target range) scores 0 points.

Scale 2 (for prescribed 88-92% targets): <=83% = 3; 84-85% = 2; 86-87% = 1; 88-92% = 0; 93-94% on air = 0; 93-94% on O2 = 1; 95-96% on O2 = 2; >=97% on O2 = 3. Scale 2 recognises lower sats are expected in COPD, and over-oxygenation can suppress respiratory drive. Only use when clinician specifically prescribes it.

Question 3: 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.

GCS: Eye (spontaneous=4, voice=3, pressure=2, none=1); Verbal (orientated=5, confused=4, words=3, sounds=2, none=1); Motor (obeys=6, localising=5, normal flexion=4, abnormal flexion=3, extension=2, none=1). 13-15 = mild; 9-12 = moderate; 3-8 = severe. GCS <=8: unable to protect airway, intubation needed. Always document individual components (e.g., E2V3M5).

Question 4: A patient's capillary refill time is 5 seconds. What does this suggest?

Normal perfusion
Mild dehydration — encourage fluids
Impaired peripheral perfusion — may indicate shock or cardiovascular compromise (Correct answer)
Test was performed incorrectly

Correct answer: Impaired peripheral perfusion — may indicate shock or cardiovascular compromise

Normal CRT is <2 seconds. A CRT of 5 seconds is significantly prolonged, suggesting impaired perfusion.

CRT: apply pressure to nail bed or sternum for 5 seconds, release, count until colour returns. Normal <2 seconds. 5 seconds indicates impaired perfusion from: hypovolaemic/cardiogenic/septic shock; peripheral vascular disease; hypothermia; dehydration. Part of 'C' assessment. Measure centrally (sternum) for accuracy. Combined with tachycardia, hypotension, reduced urine output = circulatory failure.

Question 5: Where should the V4 electrode be placed for a 12-lead ECG?

Right sternal edge, 4th intercostal space
Left sternal edge, 4th intercostal space
5th intercostal space, midclavicular line (Correct answer)
5th intercostal space, anterior axillary line

Correct answer: 5th intercostal space, midclavicular line

V4: 5th intercostal space, left midclavicular line. It is the reference point for V3, V5, and V6.

Precordial leads: V1 = 4th ICS, right sternal border; V2 = 4th ICS, left sternal border; V3 = midway V2-V4; V4 = 5th ICS, midclavicular line; V5 = same level as V4, anterior axillary line; V6 = same level, mid-axillary line. V4 is placed first as the reference. Incorrect placement can simulate or mask pathology.

Question 6: Using qSOFA, a patient has RR 25, BP 95/60, HR 110, temp 38.5, and is newly confused. How many criteria are met?

1
2
3 (Correct answer)
Does not meet criteria

Correct answer: 3

qSOFA has three criteria: RR >=22, SBP <=100, altered mental status. This patient meets all three.

qSOFA: (1) RR >=22 (patient has 25, met); (2) SBP <=100 (patient has 95, met); (3) Altered mentation (patient newly confused, met). Score >=2 indicates higher mortality risk. Prompts: urgent senior review; full sepsis screening; blood cultures and lactate; Sepsis Six within one hour if confirmed. In UK, NEWS2 is the primary tool, with qSOFA useful for rapid screening.

NMC CBT Physiological Observations and Escalation 2

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