NMC OSCE (Objective Structured Clinical Examination) — Questions and Answers

Question 1: 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?

Administer oral diuretics and review in 4 hours
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)
Place in the recovery position
Lie flat and elevate the legs

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 2: A patient is diagnosed with pulmonary tuberculosis. What type of isolation is required?

Droplet precautions only
No isolation required if on treatment for more than 48 hours
Contact precautions in a side room
Airborne precautions in a negative pressure room (Correct answer)

Correct answer: Airborne precautions in a negative pressure room

Active pulmonary tuberculosis requires airborne precautions because M. tuberculosis is transmitted via droplet nuclei that remain suspended in air. A negative pressure room prevents the pathogen from escaping into the general ward environment.

Question 3: What is the term for the practice of caring for patients with the same infective organism together in a bay?

Reverse isolation
Source isolation
Barrier nursing
Cohort nursing (Correct answer)

Correct answer: Cohort nursing

Cohort nursing involves grouping patients infected or colonised with the same organism (e.g., norovirus, MRSA) in the same area, staffed by a dedicated team. It is used when single rooms are insufficient for individual isolation.

Question 4: Under the Equality Act 2010, which of the following is a protected characteristic relevant to healthcare communication?

Disability (Correct answer)
Postcode
Employment status
Marital status only

Correct answer: Disability

The Equality Act 2010 protects individuals from discrimination based on nine characteristics, including disability, age, sex, race, religion or belief, sexual orientation, gender reassignment, pregnancy/maternity, and marriage/civil partnership. Disability is a key protected characteristic in healthcare.

Question 5: A patient with capacity tells you confidential information about plans to harm another specific person. What are your obligations regarding confidentiality?

Document it in the notes and take no further action
Confidentiality may be breached in the public interest to protect an identifiable person from serious harm; inform the nurse in charge and follow local safeguarding policy (Correct answer)
Immediately call the police without telling the patient
Patient confidentiality is absolute and can never be breached

Correct answer: Confidentiality may be breached in the public interest to protect an identifiable person from serious harm; inform the nurse in charge and follow local safeguarding policy

While patient confidentiality is a fundamental principle, it is not absolute. The NMC Code and common law recognise that disclosure may be justified in the public interest where there is a risk of serious harm to an identifiable person. The nurse should inform the patient of their intention to disclose (unless doing so would increase risk), escalate to senior colleagues, and follow local safeguarding and information governance policies.

Question 6: A patient has a urinary catheter in situ. What are the key nursing interventions to prevent catheter-associated urinary tract infection (CAUTI)?

Daily assessment of the need for the catheter, maintain a closed drainage system, keep the drainage bag below bladder level, perform meatal hygiene, ensure adequate fluid intake (Correct answer)
Irrigate the catheter with antiseptic solution daily
Routinely change the catheter every 3 days
Empty the drainage bag only when completely full

Correct answer: Daily assessment of the need for the catheter, maintain a closed drainage system, keep the drainage bag below bladder level, perform meatal hygiene, ensure adequate fluid intake

CAUTI prevention follows the EPIC3 guidelines: review the need for catheterisation daily and remove as soon as possible, maintain a closed drainage system (minimise disconnections), keep the drainage bag below bladder level but off the floor, perform routine meatal hygiene with soap and water, ensure adequate hydration, and secure the catheter to prevent traction. Routine catheter changes, bladder washouts, and antiseptic instillation are NOT recommended.

Question 7: When reconstituting a powdered antibiotic for intravenous administration, which document should you consult for specific dilution instructions?

The Summary of Product Characteristics (SmPC) or local injectable medicines guide (Correct answer)
The ward noticeboard
The patient's care plan
The nurse's personal notes from training

Correct answer: The Summary of Product Characteristics (SmPC) or local injectable medicines guide

The Summary of Product Characteristics (SmPC) provides authoritative information on reconstitution diluent, volume, concentration, rate of administration, and compatibility. Many hospitals also have local injectable medicines guides (e.g., Medusa) accessible via the intranet. Using incorrect diluent or concentration can cause drug precipitation, phlebitis, or adverse reactions.

Question 8: A nurse suspects that a colleague is sexually abusing a patient. What is the immediate action?

Gather evidence by continuing to observe
Discuss with other team members to get their opinion first
Report to the senior nurse or manager immediately and document the concern (Correct answer)
Confront the colleague privately before escalating

Correct answer: Report to the senior nurse or manager immediately and document the concern

Any suspicion of sexual abuse by a colleague must be reported immediately to the most senior person available. This triggers the organisation's safeguarding and HR procedures. Delay, confrontation, or informal discussion risks further harm to the patient and destruction of evidence.

Question 9: According to the NMC Code, what is the primary principle that underpins all nursing practice in the UK?

Follow organisational policies
Maintain documentation
Report to managers
Prioritise people (Correct answer)

Correct answer: Prioritise people

The NMC Code is built around four themes, with 'Prioritise people' being the first and primary principle, meaning nurses must put the interests of people using services first.

Question 10: Which medication would be classified as a Schedule 2 controlled drug in the UK?

Tramadol
Codeine phosphate 30mg tablets
Morphine sulfate (Correct answer)
Temazepam

Correct answer: Morphine sulfate

Morphine sulfate is a Schedule 2 controlled drug requiring full CD register entries and double checking for administration. Temazepam and tramadol are Schedule 3 and 3 respectively, while codeine 30mg is Schedule 5 when in low concentrations.

Question 11: During a clinical handover, a nurse uses the term 'the appendicitis in bed 4' to refer to a patient. Why is this unacceptable practice?

It depersonalises the patient, reducing them to a diagnosis rather than treating them as an individual, which contravenes NMC standards of person-centred care (Correct answer)
It reveals confidential diagnosis information
It is too informal for a clinical setting
There is nothing wrong with this approach

Correct answer: It depersonalises the patient, reducing them to a diagnosis rather than treating them as an individual, which contravenes NMC standards of person-centred care

Referring to patients by their diagnosis or bed number rather than their name depersonalises them and is inconsistent with the NMC Code's requirement to treat people as individuals and uphold their dignity. Person-centred care requires recognising the individual behind the condition. Using a patient's preferred name demonstrates respect and promotes a therapeutic relationship.

Question 12: What is the minimum time recommended for hand hygiene using the WHO six-step technique with soap and water?

90 seconds
10–15 seconds
20–30 seconds
40–60 seconds (Correct answer)

Correct answer: 40–60 seconds

The WHO recommends that hand hygiene using soap and water using the six-step technique takes 40–60 seconds, including wetting, application of soap, rubbing (six steps), rinsing, and drying. Alcohol hand rub takes 20–30 seconds.

Question 13: A sharps injury occurs when a nurse accidentally pricks their finger with a used insulin needle. What are the immediate first aid actions?

Encourage bleeding by gently squeezing (do not suck), wash under running water with soap, apply a waterproof dressing, and report immediately via occupational health/A&E (Correct answer)
Suck the wound to remove blood
Apply a tourniquet above the injury
Apply antiseptic cream and continue working

Correct answer: Encourage bleeding by gently squeezing (do not suck), wash under running water with soap, apply a waterproof dressing, and report immediately via occupational health/A&E

Immediate first aid for sharps injuries: encourage the wound to bleed freely (gentle squeezing, never suck the wound), wash thoroughly under running water with soap, dry and apply a waterproof dressing. Report immediately to the line manager and occupational health department. A risk assessment for blood-borne viruses (HIV, hepatitis B, hepatitis C) must be performed, and PEP may be required within 1 hour for HIV risk.

Question 14: What is the correct order for donning (putting on) PPE before entering an isolation room?

Gloves, apron, mask, eye protection
Mask, eye protection, apron, gloves
Eye protection, apron, mask, gloves
Apron, mask, eye protection, gloves (Correct answer)

Correct answer: Apron, mask, eye protection, gloves

The correct donning sequence is: apron/gown first, then mask/respirator, then eye protection/face shield, then gloves. Gloves are last as they protect against hand contamination during other PPE donning steps.

Question 15: According to WHO guidelines, what are the 5 moments for hand hygiene?

Before touching a patient, before a clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings (Correct answer)
Before and after each shift only
Before meals and after using the toilet
Before touching a patient and after touching a patient only

Correct answer: Before touching a patient, before a clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings

The WHO 5 Moments for Hand Hygiene are: (1) before touching a patient, (2) before a clean/aseptic procedure, (3) after body fluid exposure/risk, (4) after touching a patient, and (5) after touching patient surroundings. These moments capture all situations where hand hygiene prevents transmission of healthcare-associated infections.

Question 16: Standard precautions apply to which patients?

Only immunocompromised patients
Only patients in isolation rooms
Only patients with known infectious disease
All patients at all times regardless of diagnosis (Correct answer)

Correct answer: All patients at all times regardless of diagnosis

Standard precautions (formerly universal precautions) apply to all patients, all the time, regardless of known infection status. This approach assumes all blood, body fluids, secretions, and non-intact skin may be infectious.

Question 17: What type of isolation precautions are required for a patient with suspected pulmonary tuberculosis?

Airborne precautions in a negative-pressure single room with FFP3 respirator masks for staff (Correct answer)
Droplet precautions with a surgical mask
Contact precautions with apron and gloves
Standard precautions only

Correct answer: Airborne precautions in a negative-pressure single room with FFP3 respirator masks for staff

Pulmonary TB is transmitted via airborne nuclei (<5 micrometres) that remain suspended in air for prolonged periods. Patients require a single room with negative pressure ventilation. Staff must wear FFP3 respirator masks (not standard surgical masks). Visitors should be limited, and the door must remain closed. These precautions continue until the patient is non-infectious.

Question 18: Which piece of legislation provides the legal framework for safeguarding adults in England?

Mental Capacity Act 2005
Children Act 1989
Mental Health Act 1983
Care Act 2014 (Correct answer)

Correct answer: Care Act 2014

The Care Act 2014 introduced statutory adult safeguarding duties in England, placing obligations on local authorities, NHS, and other organisations. It defines who is an adult at risk and outlines the Section 42 safeguarding enquiry process.

Question 19: What is the purpose of a care bundle in infection prevention?

A set of evidence-based practices that, when performed together, improve patient outcomes more than individually (Correct answer)
A checklist of administrative tasks
A summary of the patient's treatment plan
A bundle of leaflets given to patients on admission

Correct answer: A set of evidence-based practices that, when performed together, improve patient outcomes more than individually

A care bundle is a small set of evidence-based interventions that, when performed consistently and together, significantly improve patient outcomes. Examples include the central line-associated bloodstream infection (CLABSI) bundle and the ventilator-associated pneumonia (VAP) bundle.

Question 20: A nurse discovers a colleague has been diverting controlled drugs for personal use. What action must the nurse take according to the NMC Code?

Wait to see if it happens again before reporting
Confront the colleague privately and ask them to stop
Report the concern immediately to the nurse in charge, follow the organisation's incident reporting policy, and if necessary escalate to the NMC as this represents a fitness to practise concern (Correct answer)
Ignore it as it is not their responsibility

Correct answer: Report the concern immediately to the nurse in charge, follow the organisation's incident reporting policy, and if necessary escalate to the NMC as this represents a fitness to practise concern

The NMC Code requires nurses to raise concerns immediately if they believe patients are at risk. Drug diversion is a serious criminal offence and fitness to practise concern. The nurse must report to their manager/nurse in charge, follow the organisation's raising concerns (whistleblowing) policy, and may need to report to the NMC if the organisation does not act. Failure to report could constitute professional misconduct.

Question 21: A patient has been diagnosed with Clostridioides difficile infection. What specific hand hygiene method must be used and why?

Alcohol hand gel is sufficient
No special hand hygiene is needed beyond standard precautions
Soap and water handwashing, because alcohol gel does not kill C. difficile spores (Correct answer)
Surgical scrubbing with iodine solution

Correct answer: Soap and water handwashing, because alcohol gel does not kill C. difficile spores

C. difficile produces spores that are resistant to alcohol-based hand rubs. Effective decontamination requires physical removal of spores through handwashing with soap and water for at least 15-20 seconds. This is a critical infection control measure — using alcohol gel alone will not remove spores and allows ongoing transmission.

Question 22: You are preparing to administer IV medication through a peripheral cannula. What checks must you perform on the cannula site before administration?

Check the cannula is the correct colour only
Only check that fluid is running through it
Check for signs of phlebitis (redness, swelling, pain, palpable venous cord), infiltration, patency by flushing with 0.9% saline, and check the dressing is intact and dated (Correct answer)
No checks needed if the cannula was inserted today

Correct answer: Check for signs of phlebitis (redness, swelling, pain, palpable venous cord), infiltration, patency by flushing with 0.9% saline, and check the dressing is intact and dated

Before IV administration, assess the cannula site using the Visual Infusion Phlebitis (VIP) score: check for pain, redness, swelling, palpable venous cord, and pyrexia. Flush with 0.9% sodium chloride to confirm patency (no resistance, swelling, or pain). Ensure the dressing is clean, dry, intact, and dated. Replace the cannula if any signs of phlebitis.

Question 23: What are standard precautions in infection prevention and control, and when should they be applied?

Wearing gloves for all patient contact
A set of precautions applied to ALL patients at ALL times regardless of known infection status, including hand hygiene, PPE use, safe sharps management, and environmental cleaning (Correct answer)
Precautions only applied when a patient has a known infection
Hand hygiene at the start and end of each shift only

Correct answer: A set of precautions applied to ALL patients at ALL times regardless of known infection status, including hand hygiene, PPE use, safe sharps management, and environmental cleaning

Standard precautions are the minimum infection prevention practices applied to all patients in all healthcare settings, regardless of suspected or confirmed infection status. They include: hand hygiene, use of PPE based on risk assessment, respiratory hygiene/cough etiquette, safe handling and disposal of sharps, safe handling of linen, environmental cleaning, and waste management.

Question 24: A patient becomes aggressive on the ward. Which de-escalation technique is most appropriate?

Raise your voice to establish authority
Restrain the patient immediately to prevent injury
Use a calm, non-threatening tone, acknowledge their feelings, and maintain a safe distance (Correct answer)
Walk away and leave the patient alone

Correct answer: Use a calm, non-threatening tone, acknowledge their feelings, and maintain a safe distance

De-escalation uses calm verbal and non-verbal communication to reduce agitation. This includes a calm tone, non-threatening body language, validating the patient's feelings, and giving them space. Physical restraint should only be used as a last resort when de-escalation has failed.

Question 25: What is revalidation and what must NMC registrants complete to maintain their registration?

An annual exam on clinical knowledge
A process every 3 years requiring 450 practice hours, 35 hours CPD, 5 pieces of practice-related feedback, 5 written reflective accounts, a reflective discussion, and a health and character declaration (Correct answer)
A single portfolio submission when first registering
A monthly online assessment

Correct answer: A process every 3 years requiring 450 practice hours, 35 hours CPD, 5 pieces of practice-related feedback, 5 written reflective accounts, a reflective discussion, and a health and character declaration

NMC revalidation occurs every three years and requires: 450 hours of registered practice, 35 hours of continuing professional development (20 participatory), 5 pieces of practice-related feedback, 5 written reflective accounts, a reflective discussion with another NMC registrant (the confirmer), a health and character declaration, professional indemnity arrangement, and confirmation from a confirmer.

Question 26: When performing a pain assessment, which validated tool should be used for a patient who is unable to communicate verbally?

Numerical Rating Scale (0-10)
Wong-Baker FACES scale
Visual Analogue Scale (VAS)
Abbey Pain Scale or FLACC scale (observational behavioural tools) (Correct answer)

Correct answer: Abbey Pain Scale or FLACC scale (observational behavioural tools)

For patients who cannot self-report pain (unconscious, severe cognitive impairment, intubated), observational behavioural tools like the Abbey Pain Scale or FLACC scale assess pain through facial expressions, body movements, vocalisations, and physiological changes. Self-report tools like VAS and numerical scales require verbal communication.

Question 27: A nurse is administering insulin. Which of the following is the most important safety check specific to insulin?

Using an orange needle
Checking the expiry date
Checking the manufacturer
Confirming the type of insulin (e.g., rapid-acting vs long-acting) (Correct answer)

Correct answer: Confirming the type of insulin (e.g., rapid-acting vs long-acting)

Insulin errors are a leading cause of serious harm. Confirming the exact type of insulin (e.g., rapid-acting NovoRapid vs long-acting Lantus) is critical because mixing up types can cause severe hypoglycaemia or hyperglycaemia.

Question 28: Which type of wound dressing is CONTRAINDICATED in a clinically infected wound?

Occlusive hydrocolloid dressings (Correct answer)
Antimicrobial silver dressings
Alginate dressings
Foam dressings

Correct answer: Occlusive hydrocolloid dressings

Occlusive hydrocolloid dressings create a sealed anaerobic environment that traps bacteria, potentially worsening clinical infection and are therefore contraindicated in infected wounds.

Question 29: A patient's capillary refill time is measured at 4 seconds. What does this indicate?

No clinical significance
Possible peripheral vasoconstriction or poor perfusion (Correct answer)
Dehydration only
Normal peripheral perfusion

Correct answer: Possible peripheral vasoconstriction or poor perfusion

Normal capillary refill time is less than 2 seconds. A CRT of 4 seconds suggests peripheral vasoconstriction or poor perfusion, which may indicate shock, hypothermia, or peripheral vascular disease. It should be interpreted alongside other perfusion markers.

Question 30: Norovirus has been identified on a hospital ward. What specific infection control measures should be implemented?

Continue normal operations with standard precautions
Close the ward to new admissions, isolate symptomatic patients, use soap and water hand hygiene, enhanced environmental cleaning with chlorine-based products, cohort nursing (Correct answer)
Prescribe antibiotics to all patients on the ward
Transfer all patients to other wards immediately

Correct answer: Close the ward to new admissions, isolate symptomatic patients, use soap and water hand hygiene, enhanced environmental cleaning with chlorine-based products, cohort nursing

Norovirus outbreaks require: bay/ward closure to new admissions, isolation or cohorting of symptomatic patients, soap and water handwashing (alcohol gel is less effective against norovirus), enhanced cleaning with chlorine-based disinfectant (1,000 ppm), dedicated nursing staff, and restriction of staff movement between areas. Symptomatic staff must be excluded until 48 hours after symptoms resolve.

Question 31: A patient has a nasogastric tube and is prescribed a modified-release tablet. What should the nurse do?

Contact the prescriber to request an alternative formulation (Correct answer)
Withhold the medication until the tube is removed
Administer the tablet whole via the tube
Crush the tablet and administer via the tube

Correct answer: Contact the prescriber to request an alternative formulation

Modified-release (MR) tablets must never be crushed as this destroys the release mechanism and can cause toxicity from rapid drug release. The prescriber should be contacted to prescribe a suitable alternative formulation for NG administration.

Question 32: When documenting patient care in the UK, which principle underpins all nursing records?

Digital records are optional in most NHS trusts
Only significant events require documentation
Records should be brief to save time
Documentation should be timely, accurate, factual, and legible (Correct answer)

Correct answer: Documentation should be timely, accurate, factual, and legible

NMC guidance requires that nursing records are factual, accurate, legible, dated, signed, and completed as soon as possible after care is given. Records serve as a legal document, support continuity of care, and provide evidence of care given.

Question 33: A patient is colonised with MRSA. What is the difference between colonisation and infection, and what are the appropriate nursing actions?

There is no difference — both require immediate IV antibiotics
Colonisation means MRSA is present but not causing illness; infection means it is causing clinical signs. Both require contact precautions, but only infection requires antibiotic treatment (Correct answer)
Colonised patients do not need any special precautions
Colonisation is more serious than infection

Correct answer: Colonisation means MRSA is present but not causing illness; infection means it is causing clinical signs. Both require contact precautions, but only infection requires antibiotic treatment

MRSA colonisation means the organism is present (usually in the nose, skin, or groin) without causing symptoms. Infection means MRSA is causing clinical illness (wound infection, bacteraemia). Colonised patients require contact precautions (apron, gloves), decolonisation treatment (mupirocin nasal ointment, chlorhexidine body wash), and screening of contacts. Systemic antibiotics are only used for active infection.

Question 34: What is the significance of the Equality Act 2010 for nursing practice in the UK?

It was replaced by the NMC Code and is no longer relevant
It only applies to employment and has no relevance to patient care
It applies only to race and gender discrimination
It protects patients and staff from discrimination based on nine protected characteristics and requires reasonable adjustments to ensure equal access to healthcare (Correct answer)

Correct answer: It protects patients and staff from discrimination based on nine protected characteristics and requires reasonable adjustments to ensure equal access to healthcare

The Equality Act 2010 protects against discrimination based on nine protected characteristics: age, disability, gender reassignment, marriage/civil partnership, pregnancy/maternity, race, religion/belief, sex, and sexual orientation. In nursing, this means providing equitable care to all patients, making reasonable adjustments for disabled patients, and challenging discriminatory practices.

Question 35: A nurse discovers that their colleague has falsified a patient's observation chart. Under the NMC Code, what is the nurse's obligation?

Document it personally without escalating
Ignore it as it does not directly involve them
Report the concern to an appropriate person without delay (Correct answer)
Speak to the colleague informally and give them a chance to correct it

Correct answer: Report the concern to an appropriate person without delay

Falsifying records is a serious breach of the NMC Code. Nurses have a duty to report concerns about the conduct, performance, or health of a colleague if it places patients at risk, without delay.

Question 36: In England, which organisation is responsible for conducting Section 42 safeguarding enquiries for adults?

The police
The Care Quality Commission
The NHS Trust
The local authority (Correct answer)

Correct answer: The local authority

Under the Care Act 2014, the local authority (usually via its adult social services) is responsible for conducting or ensuring Section 42 enquiries when there is a reasonable cause to suspect an adult with care and support needs is experiencing or at risk of abuse or neglect.

Question 37: A patient who speaks limited English requires consent for a surgical procedure. What is the most appropriate way to ensure informed consent?

Proceed without consent as treatment is needed
Use a professional interpreter service (in person or telephone) to ensure the patient fully understands the procedure, risks, benefits, and alternatives (Correct answer)
Use hand gestures and simple words
Ask a family member to translate

Correct answer: Use a professional interpreter service (in person or telephone) to ensure the patient fully understands the procedure, risks, benefits, and alternatives

Professional interpreters should always be used rather than family members, who may filter or misinterpret information, may have conflicts of interest, or may not understand medical terminology. The patient must understand what the procedure involves, its risks and benefits, and alternatives (including no treatment) to give valid informed consent.

Question 38: 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?

Musculoskeletal chest wall pain — give analgesia
Anxiety attack — reassure the patient
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

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 39: What does the term 'therapeutic communication' mean in nursing practice?

Communication using only medical terminology
Communication that involves discussing drug therapy
Purposeful, patient-centred communication that supports the patient's emotional and psychological wellbeing (Correct answer)
Any communication that takes place in a clinical setting

Correct answer: Purposeful, patient-centred communication that supports the patient's emotional and psychological wellbeing

Therapeutic communication is intentional, patient-centred communication that builds the therapeutic relationship and supports the patient's wellbeing. It involves active listening, empathy, open-ended questions, and non-verbal attunement.

Question 40: A healthcare worker sustains a needlestick injury from a known HIV-positive patient. What is the first action?

Encourage bleeding, wash with soap and water, report to occupational health (Correct answer)
Immediately go to the emergency department for HIV testing
Apply a tourniquet and go to the emergency department
Take post-exposure prophylaxis immediately without reporting

Correct answer: Encourage bleeding, wash with soap and water, report to occupational health

The immediate response to needlestick injury is to encourage bleeding from the wound (do not suck), wash thoroughly with soap and water (not scrubbing), and report immediately to occupational health or the emergency department for risk assessment and PEP (if indicated within 72 hours).

Question 41: A nurse is caring for a patient whose religious beliefs mean they refuse a blood transfusion despite it being clinically indicated. What ethical principles are in tension and how should the nurse respond?

Religious beliefs are irrelevant in a clinical setting
The nurse should discharge the patient for non-compliance
The nurse should override the refusal as saving life takes priority
Autonomy (patient's right to refuse) versus beneficence (duty to act in the patient's best interests); the nurse must respect the competent patient's informed refusal while ensuring alternatives are explored (Correct answer)

Correct answer: Autonomy (patient's right to refuse) versus beneficence (duty to act in the patient's best interests); the nurse must respect the competent patient's informed refusal while ensuring alternatives are explored

This scenario illustrates the tension between autonomy (the patient's right to self-determination) and beneficence (the healthcare team's duty to act in the patient's best interests). A competent adult has the legal right to refuse any treatment, even if the refusal may result in death. The nurse must ensure the refusal is informed and voluntary, document it, explore alternatives, and continue to provide compassionate care. The Mental Capacity Act 2005 reinforces this right.

Question 42: According to the NMC Code, what does 'promote professionalism and trust' require?

Wearing a uniform at all times
Joining the Royal College of Nursing
Upholding NMC standards both inside and outside of work (Correct answer)
Only behaving professionally while on duty

Correct answer: Upholding NMC standards both inside and outside of work

The NMC Code's fourth domain requires nurses to uphold and promote the reputation of the profession both at work and in their personal lives. Conduct outside of work that undermines public trust can still result in fitness to practise proceedings.

Question 43: A nurse wants to implement a new evidence-based catheter care protocol on their ward. What framework can guide the implementation of evidence into practice?

Simply tell staff to follow the new protocol from Monday
Wait for national NICE guidance before making any changes
Only implement changes suggested by medical staff
The PARIHS framework (Promoting Action on Research Implementation in Health Services) — considers evidence, context, and facilitation (Correct answer)

Correct answer: The PARIHS framework (Promoting Action on Research Implementation in Health Services) — considers evidence, context, and facilitation

The PARIHS framework considers three key elements for successful implementation: Evidence (research, clinical experience, patient preferences), Context (culture, leadership, evaluation), and Facilitation (type, characteristics of the facilitator). Other frameworks include the Iowa Model and the Knowledge-to-Action cycle. Successful implementation requires engagement, education, audit, and ongoing evaluation.

Question 44: When handing over patient care using the SBAR communication tool, what does each letter stand for?

Symptoms, Blood results, Actions, Review
Status, Breathing, Airway, Response
Summary, Baseline, Allergies, Results
Situation, Background, Assessment, Recommendation (Correct answer)

Correct answer: Situation, Background, Assessment, Recommendation

SBAR is a structured communication framework: Situation (what is happening right now), Background (relevant clinical history), Assessment (what you think the problem is), and Recommendation (what you think needs to be done). It is widely used in NHS handovers and escalation calls to ensure clear, concise, and complete communication.

Question 45: A patient is from a non-English-speaking background. A family member offers to interpret. What is the safest approach?

Proceed with consultation and use the family member only for sensitive topics
Use basic hand gestures and hope for the best
Use the family member as this is most convenient
Use a professional interpreter service to ensure accuracy and confidentiality (Correct answer)

Correct answer: Use a professional interpreter service to ensure accuracy and confidentiality

Professional interpreter services ensure accurate clinical communication, preserve confidentiality, and avoid placing family members in difficult roles where they may filter, alter, or be unable to interpret clinical terminology accurately. Using untrained interpreters is a patient safety risk.

Question 46: When performing an aseptic non-touch technique (ANTT) for a wound dressing, what is the key principle?

Wear sterile gloves for all wound dressings regardless of wound type
Identify and protect key parts (parts that if contaminated cause infection) and key sites (wounds, insertion sites) by ensuring they are not touched or contaminated (Correct answer)
Use the largest possible sterile field for all procedures
Work as quickly as possible to reduce air exposure time

Correct answer: Identify and protect key parts (parts that if contaminated cause infection) and key sites (wounds, insertion sites) by ensuring they are not touched or contaminated

ANTT is based on identifying key parts (parts of equipment that come into contact with the patient's key site or connect with key parts of other equipment) and key sites (wounds, device insertion sites). The fundamental principle is that key parts and key sites must not be touched or exposed to contamination. This applies to both surgical-ANTT (complex procedures) and standard-ANTT (simpler procedures).

Question 47: The NMC Code (2018) is structured around four key themes. What are they?

Prioritise people, practise effectively, preserve safety, promote professionalism and trust (Correct answer)
Care, compassion, competence, communication
Assess, plan, implement, evaluate
Diagnose, treat, monitor, discharge

Correct answer: Prioritise people, practise effectively, preserve safety, promote professionalism and trust

The NMC Code (2018) 'The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates' is structured around four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. All registered nurses must uphold these standards, and failure to do so may result in fitness to practise proceedings.

Question 48: A patient is prescribed insulin via subcutaneous injection. Which sites are appropriate for subcutaneous insulin injection and what technique should be used?

The antecubital fossa at 45 degrees
Only the deltoid muscle at 90 degrees
Any site on the torso at 15 degrees
Abdomen (avoiding 5cm around the umbilicus), outer thigh, upper arm, or buttock; inject at 90 degrees into a skin fold using a short needle (Correct answer)

Correct answer: Abdomen (avoiding 5cm around the umbilicus), outer thigh, upper arm, or buttock; inject at 90 degrees into a skin fold using a short needle

Subcutaneous insulin injection sites include the abdomen (fastest absorption, avoiding 5cm around the umbilicus), outer thigh, upper outer arm, and buttock. A 90-degree angle with a short needle (4-8mm) into a gentle skin fold is recommended. Sites should be rotated systematically within the same body region to prevent lipohypertrophy.

Question 49: According to the NMC Code (2018), what does the duty of candour require when something goes wrong with a patient's care?

Being open and honest with the patient, telling them what has happened, apologising, and explaining the likely effects and what actions will be taken (Correct answer)
Discussing the incident only with colleagues
Waiting for a formal investigation before telling the patient
Apologising only if the patient asks what happened

Correct answer: Being open and honest with the patient, telling them what has happened, apologising, and explaining the likely effects and what actions will be taken

The NMC Code requires nurses to be open and honest with patients when things go wrong. This includes telling the patient (or their family) what has happened, offering an apology, explaining the likely effects, and outlining remedial steps. This is consistent with the statutory duty of candour under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Question 50: When documenting in patient records, which of the following meets NMC standards for record-keeping?

Records can be completed at the end of the week from memory
Only significant events need to be documented
Entries should be factual, consistent, accurate, made as soon as possible after the event, signed, dated, and timed, with no abbreviations that could be misinterpreted (Correct answer)
Brief notes in pencil are acceptable if time is limited

Correct answer: Entries should be factual, consistent, accurate, made as soon as possible after the event, signed, dated, and timed, with no abbreviations that could be misinterpreted

NMC standards require records to be completed as soon as possible after an event, be factual and not include unnecessary abbreviations or jargon. Entries must be signed, dated, and timed. Records should be legible (if handwritten), attribute any information from others, and not be altered retrospectively without a clear audit trail. Good record-keeping is a professional responsibility.

Question 51: What are the five moments for hand hygiene according to the WHO?

Before and after every clinical procedure only
Before entering the ward, after using the toilet, before meals, after patient contact, after removing gloves
Before patient contact, after patient contact, before a procedure, after a procedure, after touching the patient's environment (Correct answer)
Before contact, after contact, before meals, after toileting, after removing PPE

Correct answer: Before patient contact, after patient contact, before a procedure, after a procedure, after touching the patient's environment

The WHO Five Moments for Hand Hygiene are: (1) before patient contact, (2) before a clean/aseptic procedure, (3) after body fluid exposure risk, (4) after patient contact, and (5) after contact with patient surroundings. These moments form the framework for hand hygiene compliance.

Question 52: Which hand hygiene method is most effective against Clostridioides difficile (C. diff) spores?

Either soap or alcohol — both equally effective
Soap and water handwashing (Correct answer)
Chlorhexidine hand wipes
Alcohol-based hand rub

Correct answer: Soap and water handwashing

Alcohol-based hand rubs are ineffective against C. difficile spores. Soap and water handwashing physically removes the spores from hands. For this reason, soap and water must be used when caring for patients with confirmed or suspected C. diff infection.

Question 53: A nurse has been off work with norovirus. When is it safe to return to clinical practice?

24 hours after the last episode of vomiting or diarrhoea
After a negative stool sample result
As soon as symptoms resolve
48 hours after the last episode of vomiting or diarrhoea (Correct answer)

Correct answer: 48 hours after the last episode of vomiting or diarrhoea

The standard guideline for return to work after norovirus is 48 hours after the last episode of vomiting or diarrhoea. This reduces the risk of transmitting infection to vulnerable patients. Stool sample clearance is not routinely required for norovirus.

Question 54: What does the abbreviation PRN mean on a prescription chart?

Prolonged release night
Pre-operative routine notation
As required (Correct answer)
Per rectum now

Correct answer: As required

PRN comes from the Latin 'pro re nata' meaning 'as required' or 'as needed'. It indicates that the medication should be given when a specific condition or need arises, not on a regular scheduled basis.

Question 55: 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
Administer insulin as the glucose reading may be inaccurate
Wait for IV access to administer dextrose

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 56: A patient asks for information about their prognosis. The doctor has not yet discussed this with the patient. What should the nurse do?

Refuse to discuss it as it is not within the nurse's remit
Tell the patient to wait until the doctor comes
Explain what you know in your professional role, acknowledge what has not yet been discussed, and facilitate a conversation with the doctor (Correct answer)
Provide a detailed prognosis based on clinical knowledge

Correct answer: Explain what you know in your professional role, acknowledge what has not yet been discussed, and facilitate a conversation with the doctor

Nurses must communicate honestly and transparently within their scope. They can acknowledge the patient's concern, provide information within their competence, and facilitate a meeting with the treating doctor for detailed prognostic discussion. Evading the question or refusing is not appropriate.

Question 57: What is clinical governance and why is it relevant to nursing practice?

The administrative management of hospital buildings
The process of obtaining clinical placements for student nurses
A framework through which NHS organisations are accountable for continuously improving the quality and safety of care, encompassing clinical audit, risk management, education, and patient feedback (Correct answer)
A government committee that oversees NHS spending

Correct answer: A framework through which NHS organisations are accountable for continuously improving the quality and safety of care, encompassing clinical audit, risk management, education, and patient feedback

Clinical governance is the framework through which NHS organisations ensure and improve the quality of patient care. Its seven pillars include: clinical audit, risk management, education and training, patient and public involvement, using information, staffing and staff management, and clinical effectiveness. Every nurse contributes to clinical governance through evidence-based practice, incident reporting, and continuous professional development.

Question 58: A patient with advanced dementia needs a tooth extraction. They cannot consent to the procedure. Under the MCA 2005, how should clinicians proceed?

Apply to the Court of Protection for a consent order
Make a best interests decision following MCA principles, consulting relevant people (Correct answer)
Ask the patient's next of kin to consent on their behalf
Refuse to proceed without valid consent from any source

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

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 59: What is the correct order for donning (putting on) personal protective equipment when preparing to enter a patient room requiring full contact precautions?

Mask first, then gloves, then gown
Any order is acceptable
Gown/apron first, then mask/respirator, then eye protection, then gloves last (Correct answer)
Gloves first, then gown, then mask

Correct answer: Gown/apron first, then mask/respirator, then eye protection, then gloves last

The correct donning sequence is: (1) gown/apron, (2) mask or respirator, (3) eye protection/face shield, (4) gloves last (so they cover the gown cuffs). This sequence ensures all areas are covered and minimises self-contamination. The doffing (removal) sequence is the reverse, with gloves removed first as they are the most contaminated.

Question 60: Which of the following correctly describes a 'clean' technique as distinct from an 'aseptic' technique?

Clean technique is appropriate for IV line insertion; aseptic is for wound care
Clean technique uses sterile equipment throughout; aseptic does not
There is no distinction — they are interchangeable terms
Clean technique aims to reduce pathogen introduction; aseptic technique aims to prevent all microorganism introduction (Correct answer)

Correct answer: Clean technique aims to reduce pathogen introduction; aseptic technique aims to prevent all microorganism introduction

Aseptic technique aims to prevent any microorganisms from reaching a susceptible site, used for invasive procedures like catheter insertion. Clean technique aims to reduce microbial introduction but accepts some degree of contamination, used for less invasive procedures like chronic wound dressing.

Question 61: What is the recommended procedure for decontaminating a blood spillage on a hard floor surface?

Mop it up with water immediately
Cover with paper towels and leave for the cleaning team
Spray with alcohol and wipe
Apply chlorine-based disinfectant (10,000 ppm available chlorine) or granules to the spill, leave for the recommended contact time, then clean up wearing appropriate PPE (Correct answer)

Correct answer: Apply chlorine-based disinfectant (10,000 ppm available chlorine) or granules to the spill, leave for the recommended contact time, then clean up wearing appropriate PPE

Blood spills require chlorine-based disinfectant at 10,000 ppm (parts per million) of available chlorine, or proprietary chlorine-releasing granules. The process: wear PPE (gloves, apron), apply granules/disinfectant, allow the recommended contact time (typically 2-5 minutes), clean up the waste into a clinical waste bag, then clean the area with detergent and water. A lower concentration (1,000 ppm) is used for general environmental disinfection.

Question 62: What is the purpose of a clinical supervision session for a nurse?

To complete mandatory training requirements
To provide regular protected time for reflection on practice, emotional support, and professional development (Correct answer)
To monitor performance for disciplinary purposes
To discuss workload allocation

Correct answer: To provide regular protected time for reflection on practice, emotional support, and professional development

Clinical supervision provides a structured, supportive relationship in which a nurse can reflect on their clinical practice, process challenging cases, develop professionally, and receive support. It is distinct from performance management and is not primarily a monitoring tool.

Question 63: An aseptic non-touch technique (ANTT) is being performed for urinary catheter insertion. What is the key principle of ANTT?

Performing the procedure in a sterile room
Using sterile water for all cleaning
Wearing gloves throughout the procedure
Never touching key parts or key sites (Correct answer)

Correct answer: Never touching key parts or key sites

The key principle of ANTT is never directly touching key parts (e.g., catheter tip, syringe nozzle) or key sites (e.g., catheter insertion point). Non-touch technique protects critical components from microbial contamination even if the environment is not fully sterile.

Question 64: How long should a peripheral IV cannula site be assessed daily for signs of phlebitis?

Every 24 hours using a standardised phlebitis score (Correct answer)
Only when the cannula is removed
At every drug administration but not formally scored
Every 3 days or at clinical concern only

Correct answer: Every 24 hours using a standardised phlebitis score

Peripheral IV cannula sites should be assessed at least once every 24 hours using a validated phlebitis scoring tool (e.g., Visual Infusion Phlebitis score). Regular assessment allows early identification of infection or chemical phlebitis before complications develop.

Question 65: During a respiratory assessment, a nurse auscultates and hears coarse crackles bilaterally at the lung bases. What is the most likely cause?

Normal breath sounds
Pulmonary oedema or consolidation (Correct answer)
Pulmonary fibrosis
Pleural effusion

Correct answer: Pulmonary oedema or consolidation

Coarse crackles at the lung bases are typically associated with pulmonary oedema (from fluid in the alveoli) or pulmonary consolidation (e.g., pneumonia). Fine crackles are more associated with fibrosis. Pleural effusion typically causes reduced or absent breath sounds.

Question 66: In NEWS2, what ACVPU score is assigned to a patient who is confused but responds to voice?

U
A
V
C (Correct answer)

Correct answer: C

In NEWS2, ACVPU stands for Alert, Confusion, Voice, Pain, Unresponsive. A patient who is confused (new confusion or disorientation) is coded as 'C' (Confusion), which scores 3 — the same score as V, P, or U in the consciousness component.

Question 67: A nurse is working with a patient from a different cultural background and notices patterns that could indicate female genital mutilation (FGM). What are they required to do?

Maintain confidentiality as it is a cultural practice
Report under the mandatory reporting duty for FGM if the patient is under 18, or refer to safeguarding if an adult (Correct answer)
Ask the patient if they consented to the procedure as an adult
Take no action unless the patient complains of symptoms

Correct answer: Report under the mandatory reporting duty for FGM if the patient is under 18, or refer to safeguarding if an adult

In England, there is a mandatory reporting duty for healthcare professionals who identify or suspect FGM in a girl under 18 — they must report to the police. For adults, FGM is handled through the standard adult safeguarding pathway. FGM is illegal in the UK regardless of cultural background.

Question 68: You are performing a systematic patient assessment using the ABCDE approach. A patient has noisy, gurgling respirations. What is your immediate priority?

Administer high-flow oxygen via a non-rebreather mask
Obtain intravenous access
Perform a full set of observations
Open the airway using head tilt, chin lift and suction if necessary (Correct answer)

Correct answer: Open the airway using head tilt, chin lift and suction if necessary

In the ABCDE approach, Airway always comes first. Gurgling indicates fluid in the airway which must be cleared immediately using suction and appropriate airway manoeuvres. You cannot move to Breathing, Circulation, Disability, or Exposure until the airway is secured.

Question 69: What are the 6Cs of nursing, introduced by the Chief Nursing Officer for England?

Cure, contain, control, comply, check, complete
Caring, capable, calm, cautious, consistent, conscientious
Care, compassion, competence, communication, courage, commitment (Correct answer)
Clinical, competent, careful, courteous, clean, certified

Correct answer: Care, compassion, competence, communication, courage, commitment

The 6Cs were introduced by Jane Cummings (Chief Nursing Officer) in 2012 as part of the Compassion in Practice strategy. They define the values and behaviours expected of all nursing staff: Care (core business), Compassion (intelligent kindness), Competence (skills and knowledge), Communication (central to relationships), Courage (to do the right thing), and Commitment (to improving care).

Question 70: A pressure ulcer shows full thickness skin and tissue loss with exposed bone, tendon, and muscle visible in the wound base. According to the EPUAP classification, what category is this?

Category 2
Unstageable
Category 4 (Correct answer)
Category 3

Correct answer: Category 4

Category 4 is the most severe EPUAP classification, describing full thickness tissue loss with exposed or directly palpable bone, tendon, or muscle.

Question 71: A nurse has completed a research study that shows a new wound dressing significantly reduces healing time. What level of evidence does a single randomised controlled trial (RCT) provide in the evidence hierarchy?

Level II — below systematic reviews and meta-analyses of RCTs (Level I) but above cohort studies and case-control studies (Correct answer)
Level IV — expert opinion
Level V — case reports
Level I — the highest level of evidence

Correct answer: Level II — below systematic reviews and meta-analyses of RCTs (Level I) but above cohort studies and case-control studies

In the evidence hierarchy, Level I is systematic reviews and meta-analyses of RCTs (the strongest evidence). A single RCT is Level II. Level III includes cohort and case-control studies, Level IV case series and reports, and Level V expert opinion and consensus. Nursing practice should be based on the best available evidence, ideally Level I or II.

Question 72: What does the term 'source isolation' mean?

Isolating the source of an infection on a different ward
Removing a patient from the hospital entirely
Placing a patient with an infectious condition in a single room to prevent spread to others (Correct answer)
Isolating staff who have been exposed to infection

Correct answer: Placing a patient with an infectious condition in a single room to prevent spread to others

Source isolation (barrier nursing) involves placing an infectious patient in a single room with a closed door to contain the infection. It aims to prevent spread from the source (the infected patient) to others, using appropriate PPE and strict hand hygiene.

Question 73: MRSA stands for methicillin-resistant Staphylococcus aureus. A patient screens positive for MRSA on admission. What precautions are required?

Airborne precautions in negative pressure room
Standard precautions only
No precautions needed if the patient is asymptomatic
Contact precautions: side room, apron and gloves for contact with patient/environment (Correct answer)

Correct answer: Contact precautions: side room, apron and gloves for contact with patient/environment

MRSA is transmitted primarily by direct and indirect contact. Contact precautions require isolating the patient in a side room where possible, using a disposable apron and gloves for all contact with the patient and their immediate environment, and strict hand hygiene.

Question 74: Which organisation regulates nurses and midwives in the United Kingdom?

Health Education England
Nursing and Midwifery Council (Correct answer)
Care Quality Commission
General Medical Council

Correct answer: Nursing and Midwifery Council

The Nursing and Midwifery Council (NMC) is the regulator for nurses and midwives in the UK. It sets standards, maintains the register, and can investigate and remove registrants.

Question 75: When performing capillary blood glucose monitoring, which finger should ideally be used and where on the finger should the lancet be applied?

The centre of the fingertip of the index finger
The thumb pad
The side of any finger except the thumb and index finger, avoiding the fingertip centre (Correct answer)
The palm of the hand

Correct answer: The side of any finger except the thumb and index finger, avoiding the fingertip centre

Capillary blood glucose samples should be taken from the side of the finger (the third or fourth finger is preferred) as this area has fewer nerve endings and causes less pain. The thumb and index finger should be avoided as they are used for fine motor tasks. The centre of the fingertip has more nerve endings and should be avoided.

NMC OSCE (Objective Structured Clinical Examination)

The NMC OSCE is the practical component of the Test of Competence for internationally educated nurses seeking registration with the Nursing and Midwifery Council (NMC) in the UK. It assesses clinical skills, medicines management, infection prevention, professional values, and patient communication across simulated nursing stations.

Questions

35 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds