Mixed Deck — All NMC OSCE Topics Flashcards

During patient assessment, a nurse notes that a patient is using accessory muscles to breathe. What does this indicate?

Answer: Increased work of breathing suggesting respiratory distress

Use of accessory muscles (sternocleidomastoid, scalenes, intercostals) during breathing indicates increased work of breathing, a sign of respiratory distress. It suggests the diaphragm and primary respiratory muscles are not meeting ventilatory demands.

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

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.

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

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.

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

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.

The NMC Code states nurses must practise within the limits of their competence. What should a nurse do when asked to perform a task outside their competence?

Answer: Decline and escalate to an appropriate practitioner

The NMC Code requires nurses to recognise and work within the limits of their competence. If asked to perform tasks beyond those limits, they must decline and refer to someone with the appropriate knowledge and skills.

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?

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.

A patient has an advance decision to refuse treatment (ADRT) that specifically refuses blood transfusion in all circumstances. The patient is now unconscious and requires a transfusion to survive. What should the clinical team do?

Answer: Follow the ADRT if it is valid, applicable, and made when the patient had capacity

A valid and applicable ADRT is legally binding under the MCA 2005. If the document specifically refuses treatment that is now being considered, is signed, witnessed, and made when the patient had capacity, the clinical team must respect it, even if it results in the patient's death.

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?

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

The Sepsis Six must be completed within 1 hour: THREE tests (blood cultures, serum lactate, urine output measurement) and THREE treatments (IV broad-spectrum antibiotics, IV fluid resuscitation with 500 mL crystalloid bolus, high-flow oxygen if SpO2 <94%). Early antibiotic administration within the first hour significantly improves survival.

A patient refuses a recommended treatment. According to the NMC Code, what must the nurse do?

Answer: Respect the decision and ensure they are informed of consequences

The NMC Code requires nurses to respect people's right to accept or refuse treatment. The nurse must ensure the patient has all relevant information and document the refusal, but must not override a competent patient's decision.

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

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.

A patient presents with a venous leg ulcer. In which anatomical location is a venous leg ulcer MOST commonly found?

Answer: In the gaiter area around the medial malleolus

Venous leg ulcers characteristically develop in the gaiter area, particularly around and above the medial malleolus, due to venous hypertension and pooling in this region.

Standard precautions apply to which patients?

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.

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

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.

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

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.

A nurse is caring for a patient who is a Jehovah's Witness and refuses a blood transfusion as a competent adult. The patient's condition is deteriorating. What is the correct action?

Answer: Respect the refusal, optimise all alternative treatments, document fully, and seek senior support for non-blood management

A competent adult's refusal of treatment must be respected regardless of the consequences, including death. The nurse and team must maximise alternative treatments (e.g., cell salvage, iron therapy), document the patient's wishes fully, and involve senior clinical staff and ethics support where needed.

A nurse is removing PPE after caring for a patient with norovirus. What is the correct order for doffing (removing) PPE?

Answer: Gloves, apron, eye protection, mask

The correct doffing sequence to minimise self-contamination is: gloves first (most contaminated), then apron/gown, then eye protection, then mask last (least likely to be contaminated on outside). Perform hand hygiene between each step.

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

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.

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?

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

Anaphylaxis should be treated with IM adrenaline as soon as it is recognised — do not wait for cardiovascular compromise. Throat tightness indicates airway swelling which can rapidly progress to complete obstruction. Early adrenaline saves lives. After adrenaline: high-flow oxygen, IV fluid challenge if hypotensive, and secondary treatments (chlorphenamine, hydrocortisone).

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

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.

A patient who has been assessed as lacking mental capacity requires a medical procedure. Under the Mental Capacity Act 2005, on what basis should the decision be made?

Answer: In the patient's best interests, considering their past and present wishes, beliefs, values, and consulting relevant people

Under the Mental Capacity Act 2005, decisions for patients lacking capacity must be made in their best interests. This includes considering the patient's past and present wishes, feelings, beliefs, and values; consulting anyone named by the patient, carers, family, and any donee of lasting power of attorney or court-appointed deputy. A best interests meeting may be required for significant decisions.