NMC CBT NMC-CBT Physiological Observations and Escalation 2

Question 1

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

Accepted Answer

Inform the nurse in charge and increase monitoring frequency

Answer

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

Question 2

Which of the following respiratory rates in an adult patient at rest should be considered ABNORMAL and require documentation?

Accepted Answer

24 breaths per minute

Answer

A respiratory rate above 20 breaths per minute in an adult is abnormal and scores on early warning systems.

Question 3

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

Accepted Answer

30 mmHg

Answer

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

Question 4

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

Accepted Answer

Target SpO2 88–92% with controlled oxygen and escalate

Answer

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

Question 5

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

Accepted Answer

Less than 0.5 mL/kg/hour

Answer

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

(NMC CBT) Nursing and Midwifery Council Computer-Based Test Practice Test

(NMC CBT) Nursing and Midwifery Council Computer-Based Test Practice Test

NMC CBT NMC-CBT Physiological Observations and Escalation 2