NMC OSCE Clinical Assessment Skills — Questions and Answers
Question 1: You are performing a systematic patient assessment using the ABCDE approach. A patient has noisy, gurgling respirations. What is your immediate priority?
- Open the airway using head tilt, chin lift and suction if necessary (Correct answer)
- Administer high-flow oxygen via a non-rebreather mask
- Obtain intravenous access
- Perform a full set of observations
Correct answer: Open the airway using head tilt, chin lift and suction if necessary
In the ABCDE approach, Airway always comes first. Gurgling indicates fluid in the airway which must be cleared immediately using suction and appropriate airway manoeuvres. You cannot move to Breathing, Circulation, Disability, or Exposure until the airway is secured.
Question 2: A patient's NEWS2 (National Early Warning Score) is calculated as 7. According to the Royal College of Physicians guidance, what escalation response is required?
- Emergency response — urgent clinical review by a team with critical care competencies, including a practitioner with advanced airway management skills (Correct answer)
- Continue routine observations every 12 hours
- Increase observations to every 4 hours
- Inform the nurse in charge at the next handover
Correct answer: Emergency response — urgent clinical review by a team with critical care competencies, including a practitioner with advanced airway management skills
A NEWS2 score of 7 or above triggers an emergency response, requiring urgent assessment by a team with critical care competencies. This may include the critical care outreach team or medical emergency team. The patient should be considered for transfer to a higher level of care.
Question 3: When measuring blood pressure manually, where should the lower edge of the cuff be positioned?
- Approximately 2-3 cm above the antecubital fossa (Correct answer)
- Directly over the antecubital fossa
- On the wrist
- On the upper forearm
Correct answer: Approximately 2-3 cm above the antecubital fossa
The blood pressure cuff should be placed with the lower edge approximately 2-3 cm above the antecubital fossa (the crease of the elbow). The bladder centre should be over the brachial artery. The cuff should be snug but allow two fingers to be placed underneath. The arm should be supported at heart level.
Question 4: You are assessing a patient's neurological status using the Glasgow Coma Scale (GCS). The patient opens their eyes to pain, makes incomprehensible sounds, and withdraws from pain. What is their GCS score?
- 8 (E2 + V2 + M4) (Correct answer)
- 10
- 6
- 12
Correct answer: 8 (E2 + V2 + M4)
GCS is scored across three components: Eye opening to pain = 2, Verbal response (incomprehensible sounds) = 2, Motor response (withdrawal from pain) = 4. Total = 8. A GCS of 8 or below generally indicates the need for airway protection and is a critical threshold in clinical practice.
Question 5: When performing capillary blood glucose monitoring, which finger should ideally be used and where on the finger should the lancet be applied?
- The side of any finger except the thumb and index finger, avoiding the fingertip centre (Correct answer)
- The centre of the fingertip of the index finger
- The thumb pad
- The palm of the hand
Correct answer: The side of any finger except the thumb and index finger, avoiding the fingertip centre
Capillary blood glucose samples should be taken from the side of the finger (the third or fourth finger is preferred) as this area has fewer nerve endings and causes less pain. The thumb and index finger should be avoided as they are used for fine motor tasks. The centre of the fingertip has more nerve endings and should be avoided.
Question 6: A patient's oxygen saturation is reading 88% on pulse oximetry. They have no history of COPD. What is the target oxygen saturation range according to BTS guidelines, and what action should you take?
- Target 94-98%; administer oxygen therapy and escalate to medical team immediately (Correct answer)
- Target 88-92%; no action needed as this is within range
- Target 100%; administer 15L via non-rebreather
- Target 90-94%; monitor and reassess in 1 hour
Correct answer: Target 94-98%; administer oxygen therapy and escalate to medical team immediately
BTS guidelines recommend a target saturation of 94-98% for most acutely ill patients. A saturation of 88% in a patient without COPD requires immediate oxygen therapy and urgent medical review. The 88-92% target range applies only to patients at risk of hypercapnic respiratory failure (e.g., severe COPD).
NMC OSCE Clinical Assessment Skills
You are performing a systematic patient assessment using the ABCDE approach.
A patient has noisy, gurgling respirations.
What is your immediate priority?