NMC OSCE Emergency Nursing Scenarios 2 — Questions and Answers
Question 1: A patient with a known peanut allergy accidentally eats food containing peanuts. They develop throat tightness but maintain their airway. Their blood pressure is normal. According to the Resuscitation Council UK anaphylaxis algorithm, what action should be taken?
- Administer IM adrenaline 500 micrograms immediately — do not wait for cardiovascular collapse as anaphylaxis can deteriorate rapidly (Correct answer)
- Wait to see if symptoms worsen before giving any medication
- Give oral antihistamine and observe for 2 hours
- Administer nebulised adrenaline only
Correct answer: Administer IM adrenaline 500 micrograms immediately — do not wait for cardiovascular collapse as anaphylaxis can deteriorate rapidly
Anaphylaxis should be treated with IM adrenaline as soon as it is recognised — do not wait for cardiovascular compromise. Throat tightness indicates airway swelling which can rapidly progress to complete obstruction. Early adrenaline saves lives. After adrenaline: high-flow oxygen, IV fluid challenge if hypotensive, and secondary treatments (chlorphenamine, hydrocortisone).
Question 2: A patient develops acute left ventricular failure and presents with severe breathlessness, pink frothy sputum, and bilateral crackles. What is the correct patient positioning and immediate management?
- Sit upright with legs dependent, high-flow oxygen, IV furosemide, IV morphine (if not contraindicated), GTN spray, and call for urgent medical review (Correct answer)
- Lie flat and elevate the legs
- Place in the recovery position
- Administer oral diuretics and review in 4 hours
Correct answer: Sit upright with legs dependent, high-flow oxygen, IV furosemide, IV morphine (if not contraindicated), GTN spray, and call for urgent medical review
Acute pulmonary oedema requires the patient to sit bolt upright with legs dependent (reduces venous return and preload). Administer high-flow oxygen (aim SpO2 94-98%), IV furosemide 40-80 mg (diuresis and venodilation), consider IV diamorphine 2.5-5 mg (reduces anxiety and preload), sublingual GTN (vasodilation). Non-invasive ventilation (CPAP) may be needed. Call for urgent medical/critical care review.
Question 3: A diabetic patient has a blood glucose of 2.5 mmol/L but is conscious and able to swallow. What is the most appropriate initial treatment?
- 15-20 grams of fast-acting glucose (e.g., 150-200 mL fruit juice, 4-5 glucose tablets, or GlucoGel), recheck glucose after 15 minutes (Correct answer)
- A full meal with complex carbohydrates
- Intramuscular glucagon 1 mg
- Intravenous 50% dextrose 50 mL
Correct answer: 15-20 grams of fast-acting glucose (e.g., 150-200 mL fruit juice, 4-5 glucose tablets, or GlucoGel), recheck glucose after 15 minutes
For a conscious, cooperative hypoglycaemic patient, the first-line treatment is 15-20 grams of fast-acting oral glucose. This can be glucose tablets, fruit juice (150-200 mL), or GlucoGel. Recheck blood glucose after 15 minutes and repeat treatment if still below 4 mmol/L. Once glucose is above 4 mmol/L, give a long-acting carbohydrate snack to prevent recurrence.
Question 4: During CPR, the defibrillator shows ventricular fibrillation (VF). According to the Resuscitation Council UK adult ALS algorithm, what is the correct shock energy and subsequent action?
- Deliver one shock at 150-200J biphasic, then immediately resume CPR for 2 minutes before reassessing the rhythm (Correct answer)
- Deliver three stacked shocks, then check the pulse
- Deliver one shock, then immediately check the pulse
- Do not shock — VF requires medication only
Correct answer: Deliver one shock at 150-200J biphasic, then immediately resume CPR for 2 minutes before reassessing the rhythm
For VF/pulseless VT, deliver a single shock (150-200J biphasic or 360J monophasic), then immediately resume CPR for 2 minutes before reassessing the rhythm. Do NOT stop to check the pulse after the shock. After the third shock, administer IV adrenaline 1 mg and IV amiodarone 300 mg. Adrenaline is then given every 3-5 minutes (alternate cycles).
Question 5: A post-operative patient develops signs of sepsis with a temperature of 38.5 degrees C, heart rate 110, respiratory rate 24, and new confusion. According to the Sepsis Six pathway, what must be delivered within the first hour?
- Take blood cultures, measure lactate, administer IV antibiotics, start IV fluid resuscitation, measure urine output, and give high-flow oxygen if needed (Correct answer)
- Administer paracetamol for the fever and recheck in 4 hours
- Take blood cultures and wait for results before starting antibiotics
- Start oral antibiotics and increase observation frequency
Correct answer: Take blood cultures, measure lactate, administer IV antibiotics, start IV fluid resuscitation, measure urine output, and give high-flow oxygen if needed
The Sepsis Six must be completed within 1 hour: THREE tests (blood cultures, serum lactate, urine output measurement) and THREE treatments (IV broad-spectrum antibiotics, IV fluid resuscitation with 500 mL crystalloid bolus, high-flow oxygen if SpO2 <94%). Early antibiotic administration within the first hour significantly improves survival.
Question 6: A patient develops acute severe asthma with an inability to complete sentences, respiratory rate of 30, heart rate of 125, and SpO2 of 90%. According to BTS/SIGN guidelines, what is the immediate management?
- High-flow oxygen, nebulised salbutamol 5 mg driven by oxygen, oral prednisolone 40-50 mg (or IV hydrocortisone 100 mg), nebulised ipratropium bromide 500 micrograms, and urgent medical review (Correct answer)
- Metered dose inhaler with two puffs of salbutamol and reassess
- Intravenous aminophylline as first-line
- Intramuscular adrenaline
Correct answer: High-flow oxygen, nebulised salbutamol 5 mg driven by oxygen, oral prednisolone 40-50 mg (or IV hydrocortisone 100 mg), nebulised ipratropium bromide 500 micrograms, and urgent medical review
Acute severe asthma requires: high-flow oxygen (target SpO2 94-98%), nebulised salbutamol 5 mg back-to-back if needed (driven by oxygen), oral prednisolone 40-50 mg (or IV hydrocortisone 100 mg if unable to swallow), and nebulised ipratropium bromide 500 micrograms. If life-threatening features develop (SpO2 <92%, silent chest, poor respiratory effort), consider IV magnesium sulphate 1.2-2g over 20 minutes and escalate to critical care.
NMC OSCE Emergency Nursing Scenarios 2
A patient with a known peanut allergy accidentally eats food containing peanuts.
They develop throat tightness but maintain their airway.
Their blood pressure is normal.
According to the Resuscitation Council UK anaphylaxis algorithm, what action should be taken?