NMC OSCE Emergency Nursing Scenarios — Questions and Answers
Question 1: You find a patient unresponsive in bed. After calling for help and confirming they are not breathing normally, what is the correct sequence of actions according to the Resuscitation Council UK guidelines?
- Call the resuscitation team (2222), start chest compressions at a rate of 100-120 per minute with a depth of 5-6 cm, apply defibrillator pads as soon as available (Correct answer)
- Place in the recovery position and wait for the resuscitation team
- Attempt to give oral medications to revive the patient
- Perform mouth-to-mouth ventilation only until help arrives
Correct answer: Call the resuscitation team (2222), start chest compressions at a rate of 100-120 per minute with a depth of 5-6 cm, apply defibrillator pads as soon as available
For in-hospital cardiac arrest: call the resuscitation team (2222), begin CPR immediately with chest compressions at 100-120/minute, depth 5-6 cm, with a 30:2 compression to ventilation ratio (or continuous compressions if the patient is intubated). Apply defibrillator pads as soon as available. Early defibrillation for shockable rhythms (VF/pVT) is the single most important intervention for survival.
Question 2: A patient develops anaphylaxis after receiving IV antibiotics. They have widespread urticaria, facial swelling, wheeze, and a blood pressure of 70/40 mmHg. What is the first-line drug treatment?
- Intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh (Correct answer)
- Intravenous hydrocortisone 200 mg
- Oral chlorphenamine 4 mg
- Nebulised salbutamol 5 mg
Correct answer: Intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh
IM adrenaline (epinephrine) 500 micrograms (0.5 mL of 1:1000 concentration) into the anterolateral thigh is the first-line treatment for anaphylaxis. It should be given as soon as anaphylaxis is recognised. It can be repeated every 5 minutes if there is no improvement. Stop the trigger (IV antibiotic), call for help, lie the patient flat with legs raised, and give high-flow oxygen.
Question 3: A patient with type 1 diabetes is found unconscious with a capillary blood glucose of 1.8 mmol/L. They have no IV access. What is the most appropriate immediate treatment?
- Intramuscular glucagon 1 mg (Correct answer)
- Oral glucose gel rubbed inside the cheek
- Wait for IV access to administer dextrose
- Administer insulin as the glucose reading may be inaccurate
Correct answer: Intramuscular glucagon 1 mg
For severe hypoglycaemia in an unconscious patient without IV access, IM glucagon 1 mg is the appropriate treatment. It works by stimulating hepatic glycogenolysis and typically raises blood glucose within 10-15 minutes. Once IV access is obtained, IV glucose (e.g., 100 mL of 20% glucose) can be given. Once conscious, the patient should eat complex carbohydrates to prevent recurrence.
Question 4: A patient develops a major haematemesis (vomiting blood) and becomes haemodynamically unstable. What are the immediate nursing priorities?
- Call for emergency help, secure two large-bore IV cannulae, commence rapid IV fluid resuscitation, monitor vital signs, position patient on their side, prepare for blood transfusion (Correct answer)
- Give oral fluids and reassess in 30 minutes
- Administer oral omeprazole and wait for the doctor
- Perform a PR examination to check for melaena
Correct answer: Call for emergency help, secure two large-bore IV cannulae, commence rapid IV fluid resuscitation, monitor vital signs, position patient on their side, prepare for blood transfusion
Major upper GI bleeding requires immediate action: call for help (medical emergency), secure airway (position on side to prevent aspiration), obtain two large-bore (14G or 16G) IV cannulae, commence rapid IV 0.9% saline, take bloods (FBC, U&E, clotting, crossmatch, group and save), and prepare for blood transfusion. Apply oxygen, monitor vital signs continuously, and prepare for endoscopy.
Question 5: A patient on the ward develops acute chest pain, becomes breathless, and has oxygen saturations of 85%. They have recently undergone hip replacement surgery. What is the most likely diagnosis and what immediate nursing actions are required?
- Pulmonary embolism — sit upright, high-flow oxygen 15L via non-rebreather, IV access, call medical emergency team, prepare for CTPA and anticoagulation (Correct answer)
- Pneumonia — administer oral antibiotics
- Anxiety attack — reassure the patient
- Musculoskeletal chest wall pain — give analgesia
Correct answer: Pulmonary embolism — sit upright, high-flow oxygen 15L via non-rebreather, IV access, call medical emergency team, prepare for CTPA and anticoagulation
Acute chest pain with breathlessness and hypoxia following recent surgery (especially orthopaedic) is highly suspicious for pulmonary embolism. Immediate actions: sit the patient upright, administer high-flow oxygen via non-rebreather mask, obtain IV access, call the medical emergency team, perform an ECG, take arterial blood gas, and prepare for urgent CTPA. Anticoagulation with LMWH should be started while awaiting investigation.
Question 6: A patient with epilepsy has a generalised tonic-clonic seizure that has lasted 5 minutes. What is the first-line medication and how should it be administered?
- Buccal midazolam 10 mg or rectal diazepam 10 mg; if IV access is available, IV lorazepam 4 mg (Correct answer)
- Oral phenytoin 300 mg
- Intramuscular morphine 10 mg
- Inhaled salbutamol 5 mg via nebuliser
Correct answer: Buccal midazolam 10 mg or rectal diazepam 10 mg; if IV access is available, IV lorazepam 4 mg
A seizure lasting 5 minutes or more is treated as status epilepticus. First-line treatment is buccal midazolam 10 mg (placed between the cheek and gum) or IV lorazepam 4 mg if IV access is available. Rectal diazepam 10 mg is an alternative. The dose can be repeated once after 10 minutes. During the seizure, protect the patient from injury, maintain the airway, and time the seizure. Do not restrain or put anything in the mouth.
NMC OSCE Emergency Nursing Scenarios
You find a patient unresponsive in bed.
After calling for help and confirming they are not breathing normally, what is the correct sequence of actions according to the Resuscitation Council UK guidelines?