NMC CBT Test of Competence (UK) — Questions and Answers

Question 1: A patient with full mental capacity refuses a recommended medical treatment, despite serious risk to their health. The nurse should:

Respect the patient's decision while ensuring they have all the information needed to make it (Correct answer)
Seek a court order to enforce the necessary treatment
Contact the patient's family to persuade them to accept treatment
Override the refusal as the nurse has a legal duty of care

Correct answer: Respect the patient's decision while ensuring they have all the information needed to make it

An adult with capacity has the absolute right to refuse treatment, even life-saving treatment; the nurse's duty is to ensure the decision is informed.

Question 2: A nurse is preparing to administer an IV medication via a central venous catheter. Which bundle element is MOST critical to prevent CLABSI?

Flushing the line with heparin after every use
Changing the IV tubing every 24 hours
Performing hand hygiene and using maximal sterile barrier precautions during insertion (Correct answer)
Covering the insertion site with a transparent dressing only when visibly soiled

Correct answer: Performing hand hygiene and using maximal sterile barrier precautions during insertion

Hand hygiene and maximal sterile barrier precautions during insertion are the highest-impact CLABSI prevention measures in the central line bundle.

Question 3: Shared decision-making in person-centred care planning requires the nurse to do which of the following?

Make the decision on the patient's behalf to save time
Present one recommended option to avoid confusing the patient
Follow only the physician's recommendation without discussion
Provide balanced information about all relevant options and support the patient to choose (Correct answer)

Correct answer: Provide balanced information about all relevant options and support the patient to choose

Shared decision-making requires nurses to present all relevant options with balanced information so patients can make informed choices.

Question 4: A patient with diabetes refuses to follow the prescribed dietary plan. Under a person-centred approach, what is the nurse's best first action?

Educate the patient until they agree to comply
Contact the physician immediately to change the prescription
Explore the reasons behind the refusal and negotiate a mutually acceptable plan (Correct answer)
Document the refusal and continue standard care

Correct answer: Explore the reasons behind the refusal and negotiate a mutually acceptable plan

Person-centred care requires understanding the patient's perspective and working collaboratively to find acceptable solutions.

Question 5: The "Making Every Contact Count" (MECC) approach is widely encouraged within the NHS. What is the core principle of this initiative?

To document every single interaction with a patient for legal and audit purposes.
To ensure every patient receives a full health screening at every appointment.
To use routine interactions with patients to deliver brief, opportunistic advice on health and wellbeing. (Correct answer)
To count the number of patient contacts each nurse has per shift to measure workload.

Correct answer: To use routine interactions with patients to deliver brief, opportunistic advice on health and wellbeing.

Making Every Contact Count (MECC) is an approach that uses the millions of daily interactions with people to provide brief, opportunistic advice on health and wellbeing. [4, 18, 20] The goal is to empower individuals to make positive changes regarding factors like smoking, diet, physical activity, and alcohol intake, rather than conducting full screenings or focusing on documentation or workload counts. [26]

Question 6: Under the NMC Code, 'practise effectively' includes which obligation?

Keeping skills and knowledge up to date (Correct answer)
Maintaining confidentiality at all times
Following all physician instructions without question
Treating only NHS patients

Correct answer: Keeping skills and knowledge up to date

Practising effectively requires nurses to maintain and improve their knowledge and skills continuously throughout their career.

Question 7: Which practice is essential when using personal protective equipment (PPE) to prevent self-contamination during doffing?

Perform hand hygiene only after all PPE is removed
Remove the mask first to allow easier breathing
Remove gloves last to protect hands during doffing (Correct answer)
Remove the gown before gloves

Correct answer: Remove gloves last to protect hands during doffing

Gloves should be removed last during doffing because hands are the most common vehicle of self-contamination; hand hygiene follows immediately.

Question 8: The NMC Code requires nurses to ensure care plans are regularly reviewed. How frequently should a person-centred care plan typically be formally reviewed in an acute setting?

At least every 24 hours or when there is a significant change (Correct answer)
Only when the patient's condition deteriorates
Weekly regardless of condition
At discharge only

Correct answer: At least every 24 hours or when there is a significant change

In acute settings, NMC guidance recommends reviewing care plans at least every 24 hours or when clinical conditions change.

Question 9: A patient from a collectivist cultural background wants family members to make care decisions. How should the nurse respond?

Transfer care to a culturally matched nurse only
Respect this preference while ensuring the patient's personal wishes are still explored privately (Correct answer)
Insist the patient alone must make all decisions
Exclude the family from all discussions

Correct answer: Respect this preference while ensuring the patient's personal wishes are still explored privately

Culturally sensitive person-centred care respects family involvement while still safeguarding the individual patient's autonomy.

Question 10: Which of the following is NOT one of the standard 'rights' of medication administration?

Right patient
Right dose
Right nurse (Correct answer)
Right route

Correct answer: Right nurse

The rights of medication administration focus on the patient and the drug (patient, drug, dose, route, time, reason, documentation) — 'right nurse' is not among them.

Question 11: The SBAR tool is a structured method for communicating critical information. What does the 'A' in the SBAR acronym stand for?

Admission
Action
Assessment (Correct answer)
Advice

Correct answer: Assessment

SBAR stands for Situation, Background, Assessment, and Recommendation. The 'Assessment' component is where the healthcare professional states what they think the problem is based on the situation and background information.

Question 12: Which of the following best illustrates distributed leadership in a clinical setting?

Leadership responsibilities are shared across team members according to their expertise and situation (Correct answer)
The ward manager makes all operational decisions to ensure consistency
A senior consultant leads every multidisciplinary team meeting regardless of the issue discussed
Leadership is rotated monthly on a rota basis

Correct answer: Leadership responsibilities are shared across team members according to their expertise and situation

Distributed leadership recognises that different team members take the lead based on the situation and their specific expertise, rather than defaulting to formal hierarchy.

Question 13: Which patient group requires SPECIAL consideration when fulfilling the duty of candour according to NMC guidance?

Patients who lack capacity to understand the disclosure (Correct answer)
Patients who are privately funded
Patients who have previously filed complaints
Patients admitted through the emergency department

Correct answer: Patients who lack capacity to understand the disclosure

When a patient lacks capacity, disclosure should be made to their representative or next of kin, adapting communication to meet the patient's needs.

Question 14: A nurse working in a prenatal clinic screens for perinatal depression using the Edinburgh Postnatal Depression Scale (EPDS). At what score threshold does the EPDS indicate the need for urgent clinical assessment?

Any positive response to question 10 about self-harm (Correct answer)
A score of 5 or above
A score of 10 or above
A score of 13 or above

Correct answer: Any positive response to question 10 about self-harm

Any positive response to EPDS question 10 (about self-harm ideation) requires immediate clinical assessment regardless of the total score.

Question 15: What are the indications and symptoms of shock in the early stages (stages 1–3)?

hypotension
all of the above (Correct answer)
hypoxemia
tachycardia and hyperventilation

Correct answer: all of the above

In the early stages of shock (stages 1-3), the body attempts to compensate for reduced tissue perfusion. Common signs and symptoms include tachycardia (increased heart rate) and hyperventilation (increased breathing rate) as the body tries to increase oxygen delivery. Hypotension (low blood pressure) and hypoxemia (low oxygen in the blood) are also key indicators, reflecting the systemic circulatory compromise.

Question 16: The NMC Code's requirement for nurses to 'act without delay if you believe there is a risk to patient safety' reflects which professional duty?

The duty of confidentiality
The duty of candour and professional advocacy (Correct answer)
The duty of non-maleficence only
The duty to follow the chain of command

Correct answer: The duty of candour and professional advocacy

Raising concerns promptly when patient safety is at risk is a core expression of professional advocacy and the duty of candour in the NMC Code.

Question 17: When setting team goals using the SMART framework, which element is most often omitted in clinical settings, reducing goal effectiveness?

Time-bound (Correct answer)
Specific
Relevant
Measurable

Correct answer: Time-bound

Goals without a defined timeframe lack urgency and accountability; adding a deadline makes progress trackable and improvement sustainable.

Question 18: Which of the following scenarios best illustrates the principle of 'self-neglect' in the context of safeguarding vulnerable adults?

A person with a severe learning disability is left alone in an unsafe environment by a family member.
A family member persuades a vulnerable adult to sign over ownership of their property.
A caregiver consistently fails to provide adequate food for a person with mobility issues.
A person with capacity to make decisions refuses to seek medical treatment for a serious, infected wound, leading to a decline in their health. (Correct answer)

Correct answer: A person with capacity to make decisions refuses to seek medical treatment for a serious, infected wound, leading to a decline in their health.

Self-neglect is characterized by a failure to provide adequately for oneself, which threatens personal health and safety. When a person with capacity makes a decision that results in harm to themselves, such as refusing essential medical care, it falls under the category of self-neglect. The other options describe neglect by others, physical endangerment by others, and financial abuse, respectively.

Question 19: After a notifiable safety incident, the NMC requires that an apology and explanation be provided:

Exclusively through the hospital's Patient Liaison Service
Only after the patient or family requests an explanation
Only in writing, via the hospital's formal letter process
Verbally as soon as practicable, followed by a written summary (Correct answer)

Correct answer: Verbally as soon as practicable, followed by a written summary

The NMC duty of candour requires an initial verbal apology and explanation as soon as possible, followed by a written summary.

Question 20: When documenting a wound assessment, which entry is most appropriate?

3cm x 2cm wound on right shin, minimal serous exudate, no signs of infection, pink granulating tissue noted (Correct answer)
Wound looks a bit better than yesterday
Patient's wound is healing nicely, no action needed
Wound dressed as per usual protocol

Correct answer: 3cm x 2cm wound on right shin, minimal serous exudate, no signs of infection, pink granulating tissue noted

Objective, measurable descriptions using clinical terminology provide the clearest picture of wound status for all clinicians involved in care.

Question 21: A nurse receives a verbal medication order by telephone. The correct action is to:

Administer the medication immediately based on the verbal instruction
Ask another nurse to take the verbal order instead
Refuse all verbal orders regardless of circumstance
Write down the order, read it back to the prescriber, and confirm before acting (Correct answer)

Correct answer: Write down the order, read it back to the prescriber, and confirm before acting

Read-back of verbal orders confirms accuracy and is a critical patient safety step required when verbal orders cannot be avoided.

Question 22: When a patient brings their own medicines into the hospital, what is the correct procedure a nurse should follow?

Send the patient's own drugs home with their family immediately to avoid confusion.
Combine the patient's own drugs with the ward stock of the same medication to ensure an adequate supply.
Use the patient's own supply after they have been assessed as suitable for use by a pharmacist or according to local policy. (Correct answer)
Secure the patient's own drugs and continue administration from ward stock only.

Correct answer: Use the patient's own supply after they have been assessed as suitable for use by a pharmacist or according to local policy.

Using a patient's own drugs (PODs) is encouraged to ensure continuity of care and reduce waste. However, the nurse must follow local trust policy, which typically involves the medicines being checked by a pharmacist to verify they are correct, in date, and suitable for use during the inpatient stay before they can be administered.

Question 23: A patient unexpectedly refuses to take their prescribed morning dose of an antihypertensive medication. What is the nurse's primary responsibility according to the NMC Code?

Crush the tablet and mix it with food to ensure the patient receives it.
Document the medication as given to maintain the accuracy of the administration record.
Withhold the medication, document the refusal, and inform the prescriber. (Correct answer)
Encourage the patient strongly to take the medication to prevent a rise in blood pressure.

Correct answer: Withhold the medication, document the refusal, and inform the prescriber.

The NMC standards emphasize patient-centred care and the right to refuse treatment. The nurse's professional duty is to respect the patient's autonomy, withhold the dose, accurately document the refusal and the reason (if given), and communicate this to the prescriber to ensure the patient's care plan can be reviewed.

Question 24: A nurse's 'scope of practice' is best defined as:

The geographic area within which they are permitted to work
The range of roles and responsibilities they are competent and authorised to perform (Correct answer)
Their contracted employment specialty
The procedures listed in their original pre-registration training curriculum

Correct answer: The range of roles and responsibilities they are competent and authorised to perform

Scope of practice evolves throughout a career through education and experience; it is not fixed at the point of initial registration.

Question 25: Which of the following does not cause postural hypotension?

recent food consumption
insufficient exercise (Correct answer)
temperature
the time of day

Correct answer: insufficient exercise

Postural hypotension (orthostatic hypotension) is a sudden drop in blood pressure upon standing. It is commonly caused by factors like recent food consumption (blood pooling in the gut), the time of day (often worse in the morning), and temperature (vasodilation in heat). Insufficient exercise, while impacting overall cardiovascular health, is not a direct or immediate cause of an acute drop in blood pressure upon changing position.

Question 26: Which framework best supports nurses in structuring a holistic person-centred assessment?

The medical model focusing solely on pathophysiology
Roper-Logan-Tierney Activities of Living model (Correct answer)
The risk management matrix only
The financial assessment framework

Correct answer: Roper-Logan-Tierney Activities of Living model

The Roper-Logan-Tierney model addresses all activities of living, supporting a holistic person-centred assessment.

Question 27: What does the term 'psychological safety' mean in the context of healthcare team functioning?

A climate where team members feel safe to speak up, ask questions, and report errors without fear of punishment (Correct answer)
Keeping patient information confidential within the team
Ensuring staff have access to mental health services
Providing a physically safe environment for all staff

Correct answer: A climate where team members feel safe to speak up, ask questions, and report errors without fear of punishment

Psychological safety describes a team environment where individuals can voice concerns, admit mistakes, and challenge decisions without fear of negative consequences.

Question 28: A nurse is evaluating whether a person-centred care plan has been effective. Which outcome measure is most aligned with person-centred principles?

Adherence to the standard treatment pathway
Number of clinical procedures completed
Length of hospital stay
Whether the patient's self-identified goals were met (Correct answer)

Correct answer: Whether the patient's self-identified goals were met

Person-centred evaluation measures success by whether the patient's own identified goals and priorities were achieved.

Question 29: Which of the following best describes the chain of infection?

Exposure → incubation → illness → convalescence → carrier state
Pathogen → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host (Correct answer)
Host → pathogen → environment → transmission → outcome
Infection → colonization → disease → recovery → immunity

Correct answer: Pathogen → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host

Breaking any link in the chain of infection — pathogen, reservoir, portal of exit, transmission, portal of entry, susceptible host — prevents disease spread.

Question 30: In the UK, the national Bowel Cancer Screening Programme offers a home testing kit to eligible individuals. What is the primary purpose of this screening test?

To identify and treat advanced, symptomatic bowel cancer in the community.
To genetically screen the population for a predisposition to developing bowel cancer.
To provide a definitive diagnosis of bowel cancer for all participants who test positive.
To detect tiny amounts of blood in a stool sample, which can be an early sign of polyps or cancer. (Correct answer)

Correct answer: To detect tiny amounts of blood in a stool sample, which can be an early sign of polyps or cancer.

The NHS Bowel Cancer Screening Programme uses the Faecal Immunochemical Test (FIT) kit, which is designed to detect tiny, often invisible, amounts of blood in a stool sample. [7, 11] This can indicate the presence of pre-cancerous polyps or early-stage bowel cancer, allowing for earlier investigation (like a colonoscopy) and treatment. [27, 29] It is a screening tool, not a definitive diagnostic test, and it aims to find cancer before symptoms appear.

Question 31: When documenting a person-centred care plan, which element is most critical to include to reflect the individual's priorities?

The nurse's clinical assessment findings only
Standard hospital protocol checklists
The patient's own words describing their goals and preferences (Correct answer)
The physician's treatment orders

Correct answer: The patient's own words describing their goals and preferences

NMC standards require care plans to capture the patient's own expressed goals and preferences to be truly person-centred.

Question 32: Under the NMC Code, a nurse is required to uphold the reputation of their profession. Which behaviour would most likely violate this requirement?

Reporting a colleague's unsafe practice
Posting derogatory comments about patients on a private social media account (Correct answer)
Joining a professional nursing association
Declining to work outside your area of competence

Correct answer: Posting derogatory comments about patients on a private social media account

Even on ostensibly private social media, derogatory comments about patients damage public trust in the profession and breach the Code's requirement to uphold its reputation.

Question 33: A team is preparing for a high-acuity patient transfer. Using Crew Resource Management (CRM) principles, what pre-transfer step is most critical for team safety?

Conducting a structured briefing that clarifies roles, anticipated risks, and escalation plans (Correct answer)
Completing paperwork before confirming team readiness
Assigning the most senior nurse to lead without discussion
Informing the receiving unit after the transfer has begun

Correct answer: Conducting a structured briefing that clarifies roles, anticipated risks, and escalation plans

A structured pre-transfer briefing aligns the team on roles, risks, and escalation pathways, reducing error during a high-risk patient movement.

Question 34: A patient with newly diagnosed heart failure is overwhelmed by the amount of information given. To apply a person-centred approach to their care planning, what is the nurse's most appropriate initial action?

Provide a comprehensive set of leaflets and schedule a follow-up appointment for one week later.
Develop a detailed daily care plan for the patient to follow strictly to avoid confusion.
Focus on the most critical medical instructions, such as medication adherence, to ensure immediate safety.
Ask the patient, 'Of all the things we've discussed, what feels most important to you right now?' and start planning from there. (Correct answer)

Correct answer: Ask the patient, 'Of all the things we've discussed, what feels most important to you right now?' and start planning from there.

Person-centred care planning begins by identifying the individual's own priorities, values, and concerns. Asking what is most important to the patient respects their perspective and empowers them to engage in the planning process, making it a true partnership as required by the NMC Code. This approach allows the nurse to tailor subsequent information and planning to the patient's immediate needs, reducing their feeling of being overwhelmed.

Question 35: A newly qualified nurse discovers a medication error made by a senior colleague. The senior colleague insists it is a minor issue and that telling the patient will only cause unnecessary distress. What should the newly qualified nurse's primary action be, in line with the duty of candour?

Agree with the senior colleague to avoid confrontation and document the conversation.
Respectfully explain the professional duty to be open and honest and escalate the concern to the nurse in charge if the colleague refuses to act. (Correct answer)
Discreetly tell the patient's family about the error without informing the colleague.
Anonymously report the senior colleague to the NMC.

Correct answer: Respectfully explain the professional duty to be open and honest and escalate the concern to the nurse in charge if the colleague refuses to act.

The professional duty of candour includes fostering a culture of openness and honesty. The nurse should first encourage the colleague to do the right thing. If that fails, they have a professional responsibility to escalate the concern to ensure the duty to the patient is met. This supports both patient safety and the professional standards expected of all registrants.

Question 36: A patient develops sudden urticaria, bronchospasm, and hypotension minutes after receiving IV penicillin. What is the FIRST intervention?

Call the physician before acting
Give oral antihistamine
Apply high-flow oxygen and observe
Administer IM adrenaline (epinephrine) 0.5 mg (Correct answer)

Correct answer: Administer IM adrenaline (epinephrine) 0.5 mg

IM epinephrine (adrenaline) 0.5 mg into the outer thigh is the immediate first-line treatment for anaphylaxis.

Question 37: Which approach best demonstrates person-centered communication?

Talking about the patient in the third person while they are present
Giving standardized information without asking about individual preferences
Using the patient's preferred name and involving them in discussions about their care (Correct answer)
Communicating exclusively with relatives to avoid upsetting the patient

Correct answer: Using the patient's preferred name and involving them in discussions about their care

Person-centered communication respects individual preferences, uses the patient's chosen name, and actively includes them in care decisions.

Question 38: A nurse is handing over care to a colleague. Which information is most critical to communicate first?

Administrative details such as insurance information
Immediately life-threatening or clinically urgent changes in the patient's condition (Correct answer)
The patient's visitors during the shift
The patient's dietary preferences

Correct answer: Immediately life-threatening or clinically urgent changes in the patient's condition

Urgent clinical changes must be prioritized in handover to ensure patient safety; life-threatening information cannot wait.

Question 39: During care of a patient with chickenpox, which respiratory protection is required for a non-immune nurse?

N95 respirator (Correct answer)
No mask needed
Face shield only
Surgical mask

Correct answer: N95 respirator

Varicella (chickenpox) spreads via airborne transmission; non-immune healthcare workers must wear a fit-tested N95 respirator.

Question 40: A public health nurse is planning a program to reduce cardiovascular disease risk. Which behavior change is associated with the GREATEST reduction in cardiovascular mortality at a population level?

Reducing dietary salt intake by 3g per day across the population (Correct answer)
Encouraging annual cholesterol screening in primary care
Promoting daily aspirin use in all adults over 50
Increasing gym membership uptake in adults over 40

Correct answer: Reducing dietary salt intake by 3g per day across the population

Population-wide reductions in salt intake significantly lower average blood pressure and are associated with large reductions in cardiovascular mortality at a population level.

Question 41: When conducting a health needs assessment for a local population, which data source provides the MOST objective measure of population health status?

Routine epidemiological data from public health registries (Correct answer)
Focus group interviews with community leaders
Patient satisfaction surveys from local clinics
Anecdotal reports from community health workers

Correct answer: Routine epidemiological data from public health registries

Routine epidemiological data such as mortality rates, disease incidence, and hospital admission data provide objective, population-level health status information.

Question 42: Standard precautions apply to which of the following?

Blood and all body fluids, secretions, and excretions (except sweat) (Correct answer)
Only blood and visibly bloody fluids
Only patients with confirmed infections
Patients identified as high risk only

Correct answer: Blood and all body fluids, secretions, and excretions (except sweat)

Standard precautions apply to blood and all body fluids, secretions, and excretions (except sweat), regardless of infection status.

Question 43: How does motivational interviewing support person-centred care planning?

It documents patient non-compliance for legal purposes
It provides a standardised script for lifestyle education
It directs patients toward the clinically preferred behaviour change
It helps patients explore their own ambivalence and motivation for change (Correct answer)

Correct answer: It helps patients explore their own ambivalence and motivation for change

Motivational interviewing is a collaborative, person-centred communication technique that helps patients identify their own motivation for change.

Question 44: Which of the following is an example of non-verbal communication that conveys empathy?

Crossing arms and looking away from the patient
Maintaining appropriate eye contact and leaning slightly forward (Correct answer)
Standing in the doorway while speaking to a patient
Checking a watch repeatedly during a conversation

Correct answer: Maintaining appropriate eye contact and leaning slightly forward

Appropriate eye contact and a forward lean signal attentiveness and empathy, reinforcing verbal expressions of care.

Question 45: According to the WHO 5 Moments of Hand Hygiene, when must hand hygiene be performed in relation to patient care?

Before patient contact, before aseptic procedures, after body fluid exposure, after patient contact, and after contact with patient surroundings (Correct answer)
Only before and after direct patient contact
Only when gloves are not worn
After every procedure, regardless of glove use

Correct answer: Before patient contact, before aseptic procedures, after body fluid exposure, after patient contact, and after contact with patient surroundings

The WHO 5 Moments framework specifies five distinct indications for hand hygiene to protect both patients and healthcare workers.

Question 46: A nurse preceptor notices that a student consistently rushes through hand hygiene. Using a supportive leadership approach, what is the best response?

Observe once more before acting
Provide immediate constructive feedback, explain the infection control risk, and observe a return demonstration (Correct answer)
Ask another student to model the correct technique without speaking to the student directly
Formally report the student to the education team immediately

Correct answer: Provide immediate constructive feedback, explain the infection control risk, and observe a return demonstration

Supportive preceptorship involves timely, specific feedback combined with demonstration to correct unsafe practice and promote learning.

Question 47: A registered nurse is approached by a colleague asking her to sign off a procedure the colleague performed but that the nurse did not witness. What should the nurse do?

Sign with a note saying 'not witnessed'
Sign off as a professional courtesy
Decline to countersign as she cannot verify what she did not witness (Correct answer)
Ask the ward manager to sign instead

Correct answer: Decline to countersign as she cannot verify what she did not witness

The NMC Code requires nurses to only sign for what they can personally verify; countersigning unwitnessed procedures is dishonest and violates professional standards.

Question 48: Reflective practice following a patient safety incident supports the duty of candour primarily because it:

Satisfies the NMC revalidation requirement automatically
Helps nurses understand what went wrong and identify improvements to prevent recurrence (Correct answer)
Provides legal protection for the nurse if sued
Allows nurses to avoid being named in incident reports

Correct answer: Helps nurses understand what went wrong and identify improvements to prevent recurrence

Reflection helps nurses learn from incidents, which is central to the candour principle of taking steps to prevent recurrence and improve patient safety.

Question 49: When communicating with a patient who has dementia, the nurse should:

Use short, simple sentences and allow extra time for responses (Correct answer)
Rely entirely on written information
Use complex medical terminology to maintain professional credibility
Raise their voice to ensure understanding

Correct answer: Use short, simple sentences and allow extra time for responses

Short, simple sentences and allowing processing time are evidence-based strategies that support communication with patients who have cognitive impairment.

Question 50: Which of the following best demonstrates that a nurse has applied the NMC's person-centred care planning standards correctly?

The care plan was completed within 2 hours of admission
The consultant has signed off the care plan
The care plan follows the ward's standard template without individualisation
The patient can describe their own care goals and confirm the plan reflects their wishes (Correct answer)

Correct answer: The patient can describe their own care goals and confirm the plan reflects their wishes

The strongest evidence of person-centred care planning is the patient's ability to describe and confirm their own goals are reflected in the plan.

Question 51: A patient asks a healthcare assistant for information about their diagnosis. The HCA is uncertain. What is the correct response?

Look up the information online and relay it
Direct the patient to ask the responsible registered nurse (Correct answer)
Tell the patient the information is confidential
Provide the best answer they know

Correct answer: Direct the patient to ask the responsible registered nurse

HCAs should refer clinical enquiries to a registered nurse, ensuring the patient receives accurate information within the correct scope of practice.

Question 52: A nurse's reflective discussion for NMC revalidation must be conducted with:

Their line manager
Any registered healthcare professional
An NMC-approved assessor
Another NMC registrant (Correct answer)

Correct answer: Another NMC registrant

The NMC specifies that the reflective discussion must take place with another NMC registrant, though this does not have to be the confirmer.

Question 53: How does the NMC Code address the use of social media by registered nurses and midwives?

You should only post publicly about clinical matters with employer approval
Social media use is entirely personal and outside the Code's scope
You must maintain professional standards and patient confidentiality on social media (Correct answer)
You must never use social media in any professional context

Correct answer: You must maintain professional standards and patient confidentiality on social media

The Code makes clear that professional standards, including confidentiality, apply to social media and online activity just as they do in face-to-face practice.

Question 54: Which structured communication tool is widely recommended in NHS settings to improve handover safety and team communication?

SWOT
PDSA
SBAR (Correct answer)
RACI

Correct answer: SBAR

SBAR (Situation, Background, Assessment, Recommendation) provides a standardised framework for clear, concise clinical communication during handovers and escalations.

Question 55: Which of the following best explains why 'accountability' and 'responsibility' are treated as distinct concepts in NMC standards?

They are interchangeable terms used for different audiences
Responsibility relates to assigned tasks while accountability relates to being answerable for the outcome of those tasks (Correct answer)
Responsibility is a legal concept; accountability is purely ethical
Accountability applies only to registered nurses while responsibility applies to all staff

Correct answer: Responsibility relates to assigned tasks while accountability relates to being answerable for the outcome of those tasks

Responsibility is about the tasks assigned to or accepted by a nurse, while accountability is about being answerable — legally and professionally — for how those tasks are carried out.

Question 56: A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) wound infection. Which precaution level is required?

Standard precautions only
Droplet precautions
Contact precautions (Correct answer)
Airborne precautions

Correct answer: Contact precautions

MRSA is transmitted by direct or indirect contact with the patient or their environment, requiring contact precautions.

Question 57: A nurse notices that a colleague consistently delegates complex assessments to HCAs to reduce her own workload. What is the most appropriate response?

Raise a concern with the line manager or through the clinical governance process (Correct answer)
Delegate the same tasks to avoid extra work herself
Confront the colleague aggressively in front of patients
Ignore it as it is not the nurse's responsibility

Correct answer: Raise a concern with the line manager or through the clinical governance process

Unsafe delegation that compromises patient care must be escalated through appropriate governance channels in line with the NMC Code's duty to raise concerns.

Question 58: A midwife fails to detect signs of fetal distress, resulting in an emergency caesarean section. After the birth, the parents ask if everything was done correctly. The midwife should:

Say that all standard procedures were followed and leave it at that
Explain that a full investigation is underway and decline further comment
Acknowledge what occurred, apologize, explain the sequence of events honestly, and outline support available (Correct answer)
Refer all questions to the consultant and leave the room

Correct answer: Acknowledge what occurred, apologize, explain the sequence of events honestly, and outline support available

The midwife must be open about what happened, offer a sincere apology, and explain what support and follow-up the family can expect.

Question 59: Which element is NOT required in a legally defensible nursing note?

Nurse's signature and designation
The nurse's personal opinion of the patient's character (Correct answer)
Date and time of entry
Objective observations

Correct answer: The nurse's personal opinion of the patient's character

Personal opinions about a patient's character are inappropriate and have no place in clinical documentation, which must remain factual and objective.

Question 60: Which of the following is a key principle of the Mental Capacity Act 2005?

Once a person is deemed to lack capacity for one decision, they lack capacity for all decisions.
If a person makes an unwise decision, it is proof of their lack of capacity.
Decisions for a person who lacks capacity should be made by their next of kin.
A person must be assumed to have capacity unless it is established that they lack capacity. (Correct answer)

Correct answer: A person must be assumed to have capacity unless it is established that they lack capacity.

The first principle of the Mental Capacity Act 2005 is the presumption of capacity. Every adult has the right to make their own decisions and must be assumed to have the capacity to do so unless it is proven otherwise. The other options are common misconceptions; the Act requires decisions to be made in the person's best interests (not necessarily by next of kin), clarifies that unwise decisions do not prove lack of capacity, and states that capacity is decision-specific.

Question 61: Under the NMC duty of candour, what must a nurse do FIRST when a patient safety incident occurs?

Wait for a formal investigation to conclude before disclosure
File an internal incident report before speaking to the patient
Consult a senior colleague before disclosing anything
Inform the patient or their representative as soon as practicable (Correct answer)

Correct answer: Inform the patient or their representative as soon as practicable

The NMC requires nurses to inform the patient or their representative as soon as practicable after recognizing a notifiable safety incident.

Question 62: A midwife is counseling a postpartum woman about contraception and breastfeeding. Which statement about the Lactational Amenorrhea Method (LAM) is CORRECT?

LAM is equally effective whether the infant receives any formula supplementation or not
LAM begins to fail as soon as the postpartum woman resumes menstruation after 12 months
LAM provides 98% protection if the infant is fully breastfed, the woman is amenorrheic, and the infant is under 6 months (Correct answer)
LAM is effective for up to 12 months regardless of breastfeeding frequency

Correct answer: LAM provides 98% protection if the infant is fully breastfed, the woman is amenorrheic, and the infant is under 6 months

LAM is 98% effective when all three criteria are met: full breastfeeding, amenorrhea, and infant under 6 months of age.

Question 63: A community health nurse is addressing social determinants of health in a low-income neighborhood. Which action MOST directly targets a social determinant of health?

Setting up a blood glucose screening booth at a community fair
Collaborating with housing authorities to improve substandard housing conditions (Correct answer)
Distributing blood pressure cuffs for home monitoring
Teaching residents about the importance of hand washing

Correct answer: Collaborating with housing authorities to improve substandard housing conditions

Housing quality is a social determinant of health; improving housing conditions directly addresses structural factors that drive health inequities.

Question 64: What does the 'five rights' framework in medication administration include?

Right patient, right drug, right dose, right route, right time (Correct answer)
Right nurse, right drug, right dose, right ward, right chart
Right patient, right drug, right dose, right prescriber, right signature
Right patient, right drug, right storage, right route, right cost

Correct answer: Right patient, right drug, right dose, right route, right time

The five rights — right patient, drug, dose, route, and time — form the foundational safety check before every medication administration.

Question 65: A nurse notices a patient's care plan goals have not changed in two weeks despite the patient expressing new concerns. What is the most appropriate action?

Escalate to the ward manager before making any updates
Revise the care plan immediately to reflect the patient's current concerns (Correct answer)
Inform the patient that goals cannot change mid-admission
Leave the plan unchanged until the next scheduled review

Correct answer: Revise the care plan immediately to reflect the patient's current concerns

Care plans must be responsive and updated whenever the patient's needs, concerns, or priorities change.

Question 66: Two nurses on a ward have a professional disagreement regarding the best approach to managing a patient's pain. The disagreement is becoming disruptive to the team. As the nurse in charge, what is your most appropriate initial action?

Facilitate a private, constructive conversation with both nurses to find a resolution that prioritises the patient's best interests. (Correct answer)
Immediately report both nurses to the ward manager for unprofessional conduct.
Instruct the junior nurse to defer to the senior nurse's opinion to resolve the conflict quickly.
Ask other team members to vote on which pain management approach they prefer.

Correct answer: Facilitate a private, constructive conversation with both nurses to find a resolution that prioritises the patient's best interests.

The NMC Code requires nurses to work cooperatively and respect the contributions of colleagues. Effective leadership involves addressing conflict constructively to maintain team function and ensure patient safety. Facilitating a discussion allows both perspectives to be heard and encourages a collaborative, patient-centred resolution, which is a key leadership skill.

Question 67: Section 47 of the Children Act 1989 places a statutory duty to investigate child welfare concerns on which body?

Police service
The child's school
The local authority (Correct answer)
NHS Trust

Correct answer: The local authority

Section 47 places a duty on the local authority to investigate when there is reasonable cause to suspect a child is suffering or likely to suffer significant harm.

Question 68: When a patient lacks capacity to participate in their care plan, who should the nurse primarily involve according to NMC and MCA principles?

The hospital management team
Only the multidisciplinary clinical team
The patient's nominated next of kin or legal advocate acting in the patient's best interests (Correct answer)
The most senior nurse on the ward

Correct answer: The patient's nominated next of kin or legal advocate acting in the patient's best interests

Under the Mental Capacity Act, decisions must be made in the patient's best interests, involving their advocate or nominated representative.

Question 69: A nurse must perform a clean wound dressing change. Which principle of medical asepsis is most important to maintain throughout?

Changing gloves between each step of the dressing change
Keeping all supplies above waist level and within the line of sight (Correct answer)
Using sterile gloves for all wound contact
Avoiding touching the patient's intact skin

Correct answer: Keeping all supplies above waist level and within the line of sight

In medical asepsis, supplies and hands must remain above waist level and in sight to prevent contamination from non-sterile surfaces below or behind the nurse.

Question 70: When performing a surgical dressing change, the nurse selects sterile gloves and a sterile field. This reflects which principle?

Barrier nursing
Standard precautions
Surgical asepsis (Correct answer)
Medical asepsis

Correct answer: Surgical asepsis

Surgical asepsis requires maintaining a completely sterile environment to prevent any microorganism introduction into a wound.

Question 71: The 'Making Safeguarding Personal' (MSP) approach in adult safeguarding primarily emphasizes:

Person-centered outcomes and meaningful engagement with the individual (Correct answer)
Prioritizing professional judgment over individual preferences
Rapid removal from the abusive situation as the first step
Standardized procedures applied uniformly to all cases

Correct answer: Person-centered outcomes and meaningful engagement with the individual

MSP shifts the focus from process compliance to achieving the outcomes that matter to the person, keeping them central to the safeguarding process.

Question 72: A patient's medication is labelled 'enteric-coated.' What does this mean for administration?

The coating is purely cosmetic
The tablet must not be crushed or chewed as it is designed to dissolve in the intestine (Correct answer)
The tablet should be taken on an empty stomach only
The tablet should be crushed and mixed with water before giving

Correct answer: The tablet must not be crushed or chewed as it is designed to dissolve in the intestine

Enteric coating protects the drug from stomach acid and the gastric mucosa; crushing or chewing destroys this protection and may cause drug inactivation or gastric irritation.

Question 73: Which quality improvement methodology uses repeated small tests of change to evaluate and refine a clinical intervention before full implementation?

Root Cause Analysis (RCA)
Plan-Do-Study-Act (PDSA) cycles (Correct answer)
Failure Mode and Effects Analysis (FMEA)
Significant Event Audit (SEA)

Correct answer: Plan-Do-Study-Act (PDSA) cycles

PDSA cycles enable teams to test changes on a small scale, learn from results, and iteratively refine interventions before wider rollout.

Question 74: A nurse conducts a breast self-examination education session. At which point in the menstrual cycle should premenopausal women be advised to perform self-examination?

Three to five days after menstruation ends (Correct answer)
At mid-cycle when estrogen peaks
On the first day of menstruation
At the same time each month regardless of cycle

Correct answer: Three to five days after menstruation ends

Breast self-examination is most accurate 3–5 days after menstruation when breast tissue is least tender and swollen.

Question 75: A patient is taking St John's Wort herbal supplement and is prescribed sertraline. What is the primary concern?

Reduced absorption of sertraline
Risk of serotonin syndrome due to combined serotonergic effects (Correct answer)
Increased bleeding risk
Hypertensive crisis

Correct answer: Risk of serotonin syndrome due to combined serotonergic effects

St John's Wort has serotonergic properties; combining it with SSRIs like sertraline can precipitate serotonin syndrome, a potentially life-threatening condition.

Question 76: Which principle is most central to conducting a safeguarding enquiry for a vulnerable adult?

Confidentiality — information must never be shared between agencies
Proportionality — responses should be proportionate to the risk and individual need (Correct answer)
Immediacy — all safeguarding cases require urgent police involvement
Unanimity — all professionals must agree before any action is taken

Correct answer: Proportionality — responses should be proportionate to the risk and individual need

Proportionality is one of the six Care Act 2014 safeguarding principles, ensuring that the least intrusive response appropriate to the risk is used.

Question 77: The NMC Code requires registrants to 'act with honesty and integrity at all times.' Which scenario would most clearly violate this standard?

Declining to share an opinion on a matter outside your expertise
Omitting a medication error from a patient's records to avoid disciplinary action (Correct answer)
Asking a senior colleague to verify your clinical reasoning
Reporting a near-miss incident you were personally involved in

Correct answer: Omitting a medication error from a patient's records to avoid disciplinary action

Omitting an error from records is dishonest and potentially dangerous; the Code requires transparency about errors and actively prohibits falsification of records.

Question 78: Which item is classified as 'critical' in the Spaulding classification and requires sterilization before use?

Blood pressure cuff
Bedpan
Surgical instrument entering sterile tissue (Correct answer)
Flexible endoscope used for upper GI endoscopy

Correct answer: Surgical instrument entering sterile tissue

Critical items penetrate sterile body tissue or the vascular system and carry the highest infection risk, requiring full sterilization.

Question 79: A patient refuses to have their care discussed in front of a student nurse. The nurse should:

Respect the patient's decision and ask the student to leave (Correct answer)
Insist the student must stay for learning purposes
Ignore the request as students are part of the team
Document the refusal and continue the discussion anyway

Correct answer: Respect the patient's decision and ask the student to leave

Patients have the right to control who is present during their care discussions; respecting this upholds dignity and the NMC Code.

Question 80: Effective closed-loop communication during an emergency requires:

The sender repeats the message until acknowledged
Only the team leader communicates to avoid confusion
All team members speak simultaneously to save time
The receiver reads back the instruction and the sender confirms it is correct (Correct answer)

Correct answer: The receiver reads back the instruction and the sender confirms it is correct

Closed-loop communication requires the receiver to read back the instruction and the sender to confirm, reducing errors in high-stakes situations.

Question 81: When a nurse identifies a safeguarding concern involving a child, what must be the primary consideration?

The welfare and safety of the child (Correct answer)
Preserving the relationship between the child and their parents
Respecting the wishes of the person with parental responsibility
Avoiding action unless abuse is definitively confirmed

Correct answer: The welfare and safety of the child

Under the Children Act 1989, the child's welfare is the paramount consideration, overriding all other factors including parental wishes.

Question 82: A patient is placed in a negative-pressure isolation room. What does this room design accomplish?

Filters room air to remove bacterial spores before recirculation
Keeps contaminated air inside and prevents it from escaping into the corridor (Correct answer)
Allows higher oxygen concentration for critically ill patients
Prevents contact transmission via surfaces

Correct answer: Keeps contaminated air inside and prevents it from escaping into the corridor

Negative pressure rooms maintain air pressure lower than the corridor, so air flows inward and infected air exhausted out is not shared with other areas.

Question 83: Which of the following is a key duty of a nurse when accepting a delegation from a senior colleague?

Complete the task and report outcomes only if something goes wrong
Accept only if it falls within the nurse's own knowledge, skills, and competence (Correct answer)
Decline unless the task is listed in the nursing policy manual
Always comply to avoid conflict with senior staff

Correct answer: Accept only if it falls within the nurse's own knowledge, skills, and competence

A nurse must only accept delegated tasks that fall within their verified competence; accepting a task beyond one's ability breaches the NMC Code.

Question 84: Which of the following is NOT one of the six safeguarding principles established by the Care Act 2014?

Empowerment
Prevention
Punishment (Correct answer)
Proportionality

Correct answer: Punishment

The six Care Act 2014 safeguarding principles are: Empowerment, Prevention, Proportionality, Protection, Partnership, and Accountability — punishment is not included.

Question 85: A patient is being discharged and requires ongoing care at home. What is the most important person-centred step in the discharge care plan?

Providing a standard discharge leaflet
Confirming the patient understands their plan, has agreed to it, and that community support is in place (Correct answer)
Scheduling a follow-up appointment without patient input
Notifying the GP by letter only

Correct answer: Confirming the patient understands their plan, has agreed to it, and that community support is in place

Effective person-centred discharge planning ensures the patient actively understands, agrees to, and has the community support needed for their plan.

Question 86: When a registered nurse delegates a task to a healthcare assistant, accountability for the outcome remains with:

The ward manager
The delegating registered nurse (Correct answer)
The healthcare assistant
The employing organisation

Correct answer: The delegating registered nurse

Delegation does not transfer accountability; the registered nurse who delegates remains responsible for ensuring the task is appropriate and performed safely.

NMC CBT Test of Competence (UK)

The NMC Computer Based Test assesses internationally trained nurses and midwives seeking UK registration, covering numeracy, clinical knowledge, and professional practice.

Questions

240 min

Time Limit

69%

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