NMC OSCE Mental Capacity & Professional Communication

Question 1

The Mental Capacity Act 2005 is underpinned by five key principles. Which of the following correctly states the first principle?

Accepted Answer

A person must be assumed to have capacity unless it is established that they lack it

Answer

The first principle of the MCA 2005 is the presumption of capacity: every adult is assumed to have capacity unless it is established otherwise. This prevents unnecessary paternalism and respects individual autonomy.

Question 2

A patient with advanced dementia needs a tooth extraction. They cannot consent to the procedure. Under the MCA 2005, how should clinicians proceed?

Accepted Answer

Make a best interests decision following MCA principles, consulting relevant people

Answer

When an adult lacks capacity to consent, clinicians must make a best interests decision under the MCA 2005. This involves considering the patient's past and present wishes, values, and beliefs, and consulting those close to them (family, carers). Next of kin cannot legally consent on behalf of an adult — only the Court of Protection or a Lasting Power of Attorney (Health) can do so.

Question 3

What is a Lasting Power of Attorney (LPA) for Health and Welfare?

Accepted Answer

A legal document allowing a nominated person to make health and welfare decisions on behalf of someone who loses capacity

Answer

A Health and Welfare LPA is a legal document that allows a person (the donor) to appoint someone they trust (the attorney) to make decisions about their health and personal welfare if they lose mental capacity. The attorney can only act when the donor lacks capacity.

Question 4

Which of the following correctly describes the two-stage test for mental capacity assessment under the MCA 2005?

Accepted Answer

Does the person have an impairment of the mind or brain, AND does that impairment cause them to be unable to make the specific decision?

Answer

The MCA two-stage test asks: (1) Does the person have an impairment of, or disturbance in the functioning of, the mind or brain? (2) Does that impairment mean they cannot understand, retain, weigh, or communicate information about the decision? Both stages must be met.

Question 5

A patient with a learning disability is being consented for surgery. Which approach best supports their ability to make an informed decision?

Accepted Answer

Provide information in an accessible format (easy read, pictures) and allow extra time

Answer

The MCA 2005 requires that all practicable steps are taken to support a person to make their own decision before concluding they lack capacity. For someone with a learning disability, this means providing accessible information, using communication aids, and allowing sufficient time.

NMC OSCE Practice Test

NMC OSCE Practice Test

NMC OSCE Mental Capacity & Professional Communication