NMC OSCE Patient Assessment & NEWS2 2 — Questions and Answers
Question 1: When performing a head-to-toe patient assessment, which system should be assessed first if the patient appears acutely unwell?
- Neurological
- Cardiovascular
- Airway, Breathing, Circulation using the ABCDE approach (Correct answer)
- Gastrointestinal
Correct answer: Airway, Breathing, Circulation using the ABCDE approach
In any acutely unwell patient, the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is used. This systematic method prioritises life-threatening problems by assessing and treating in order of urgency.
Question 2: A patient's blood pressure is recorded as 88/56 mmHg and they have a respiratory rate of 26 breaths per minute. What is the most appropriate immediate action?
- Reassess in 30 minutes
- Document findings and handover at the end of the shift
- Escalate immediately to the medical team and apply ABCDE approach (Correct answer)
- Encourage oral fluids and reassess in one hour
Correct answer: Escalate immediately to the medical team and apply ABCDE approach
Hypotension (systolic <90 mmHg) combined with tachypnoea (>20 breaths/min) are red flag signs suggesting haemodynamic instability or sepsis. Immediate escalation using a structured communication tool (e.g., SBAR) and the ABCDE approach is essential.
Question 3: What does SBAR stand for in the context of clinical communication?
- Situation, Background, Assessment, Recommendation (Correct answer)
- Situation, Baseline, Action, Response
- Summary, Background, Assessment, Referral
- Situation, Background, Analysis, Result
Correct answer: Situation, Background, Assessment, Recommendation
SBAR stands for Situation, Background, Assessment, Recommendation. It is a structured communication tool widely used in the NHS to ensure safe, efficient handover of clinical information, particularly during escalation of deteriorating patients.
Question 4: During patient assessment, a nurse notes that a patient is using accessory muscles to breathe. What does this indicate?
- The patient is hyperventilating due to anxiety
- Increased work of breathing suggesting respiratory distress (Correct answer)
- Normal breathing in an elderly patient
- The patient needs repositioning only
Correct 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.
Question 5: A patient's capillary refill time is measured at 4 seconds. What does this indicate?
- Normal peripheral perfusion
- Possible peripheral vasoconstriction or poor perfusion (Correct answer)
- Dehydration only
- No clinical significance
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 6: Which GCS score indicates a severe brain injury?
- GCS 13–15
- GCS 9–12
- GCS 8 or below (Correct answer)
- GCS 6–7
Correct answer: GCS 8 or below
The Glasgow Coma Scale (GCS) ranges from 3 (no response) to 15 (fully alert). A GCS of 8 or below indicates severe brain injury and typically necessitates airway protection, often with intubation. Moderate injury is 9–12 and mild is 13–15.
NMC OSCE Patient Assessment & NEWS2 2
When performing a head-to-toe patient assessment, which system should be assessed first if the patient appears acutely unwell?