NMC OSCE Emergency Nursing Scenarios

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?

Accepted 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

Answer

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?

Accepted Answer

Intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh

Answer

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?

Accepted Answer

Intramuscular glucagon 1 mg

Answer

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?

Accepted 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

Answer

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?

Accepted Answer

Pulmonary embolism — sit upright, high-flow oxygen 15L via non-rebreather, IV access, call medical emergency team, prepare for CTPA and anticoagulation

Answer

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.

NMC OSCE Practice Test

NMC OSCE Practice Test

NMC OSCE Emergency Nursing Scenarios