NMC OSCE Emergency Nursing Scenarios 2

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?

Accepted Answer

Administer IM adrenaline 500 micrograms immediately — do not wait for cardiovascular collapse as anaphylaxis can deteriorate rapidly

Answer

Wait to see if symptoms worsen before giving any medication

Answer

Give oral antihistamine and observe for 2 hours

Answer

Administer nebulised adrenaline only

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?

Accepted Answer

Sit upright with legs dependent, high-flow oxygen, IV furosemide, IV morphine (if not contraindicated), GTN spray, and call for urgent medical review

Answer

Lie flat and elevate the legs

Answer

Place in the recovery position

Answer

Administer oral diuretics and review in 4 hours

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?

Accepted 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

Answer

A full meal with complex carbohydrates

Answer

Intramuscular glucagon 1 mg

Answer

Intravenous 50% dextrose 50 mL

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?

Accepted Answer

Deliver one shock at 150-200J biphasic, then immediately resume CPR for 2 minutes before reassessing the rhythm

Answer

Deliver three stacked shocks, then check the pulse

Answer

Deliver one shock, then immediately check the pulse

Answer

Do not shock — VF requires medication only

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?

Accepted Answer

Take blood cultures, measure lactate, administer IV antibiotics, start IV fluid resuscitation, measure urine output, and give high-flow oxygen if needed

Answer

Administer paracetamol for the fever and recheck in 4 hours

Answer

Take blood cultures and wait for results before starting antibiotics

Answer

Start oral antibiotics and increase observation frequency

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?

Accepted 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

Answer

Metered dose inhaler with two puffs of salbutamol and reassess

Answer

Intravenous aminophylline as first-line

Answer

Intramuscular adrenaline