NMC CBT 2017

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CBT REVIEWER FOR NURSES 2017 INTRODUCTION ------------------------------------------------------------- -------------------3 CBT INFORMATION-------------------------------------------------------------------------INFORMATION-------------------------------------------------------------------------- -4-5 PREPARATION PREPARATION TIPS AND STRATEGIES---------------------------------------------------6-7 STUDY GUIDE-----------------------------------------------------------------------------------8 SUMMARY OF TOPICS TO REVIEW  NMC Code of Conduct-------------------------------------------------- -------------9-26  CBT Guide Nursing Blueprint -----------------------------------------------------27-34  Competency Competency Adult Nursing --------------------------------------------------------35-38 ---------------- ----------------------------------------35-38 

TOPIC SUMMARIES FROM THE ROYAL MARSDEN MANUAL OF CLINICAL NURSING Part One – Managing The Patient Journey Assessment Assessment And Discharge-----------------------------------------------------40-49 Discharge-----------------------------------------------------40-49 Infection Prevention And Control---------------------------------------------43-51 Part Two – Supporting The Patient With Human Functioning Communication------------------------------------------------------------------51-57 Elimination-----------------------------------------------------------------------57-62 Moving And Position------------------------------------------------------------62-66 Nutrition, Fluid Balance And Blood Transfusion----------------------------66-69 Patient Comfort And End Of Life Care----------------------------------------69-70 Respiratory Care-----------------------------------------------------------------70-74 Part Three – Supporting The Patient Through The Diagnostic Process Interpreting Interpreting Diagnostic Tests---------------------------------------------------75-76 Observations---------------------------------------------------------------------77-82 Part Four - Supporting The The Patient Through Treatment Treatment Medicines Management--------------------------------------------------------83-86 Perioperative Care---------------------------------------------------------------87-90 Wound Management------------------------------------------------------------91-93 Management------------------------------------------------------------91-93 POINTERS FROM RECENT PASSERS------------------------------------------------------94  

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MOCK QUESTIONS – GAUGE YOUR PASSING RATE CBT PRACTICE EXAM 1------------------------------------------95-113 CBT PRACTICE EXAM 2-----------------------------------------114-132 CBT PRACTICE EXAM 3-----------------------------------------133-147 CBT PRACTICE EXAM 4-----------------------------------------148-166 CBT PRACTICE EXAM 5-----------------------------------------167-184 CBT PRACTICE EXAM 6-----------------------------------------185-200 CBT PRACTICE EXAM 7-----------------------------------------201-218 KEY ANSWERS 1 & 2--------------------------------------------------219 KEY ANSWERS 3 & 4-------------------------------------------------220 KEY ANSWERS 5 & 6-------------------------------------------------221 KEY ANSWERS 7------------------------------------------------------222           


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INTRODUCTION

Congratulations on passing the IELTS, you are now a step closer to becoming a UKRN!

This comprehensive study guide is designed especially for nurses who have limited time and resources to prepare for the CBT. The topics and summaries were carefully drafted to spare you from having to browse through the entire internet links which (some are not working).

This review material has been summarized to cover all of the necessary topics and key points in order for you to pass in 2 weeks or less without having to read numerous pages of books from cover to cover. Aside from that, the preparation tips and strategies here will help you to effectively use your time and aid you to be in the best shape sh ape to conquer the exam with the most efficient information and strategies that is relevant to the actual exam.

Finally, the mock questions are close to what you will encounter during the exam, this will make you more confident so it is important to answer and reflect on it.

P.S. We would appreciate if you will not upload or share it to others, feel free to refer your friends to our FB page. Thank you! https://www.facebook.com/cbtreviewer2017/

Best regards and enjoy reviewing. 


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CBT INFORMATION

WHAT IS CBT (Computer (Computer Based Test)? •

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It is a computerised examination comprising 120 multiple choice questions It can only be booked after finishing the IELTS and registering with the NMC Also known as Nursing Nursing & Midwifery Council Council (NMC) Test of Competence

HOW TO REGISTER FOR CBT? •

Step 1: Go to https://home.pearsonvue.com/

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Step 2:

Click on ‘ For For Test Takers’ Takers’ & then ‘Test ‘Test Takers Home’. Home’. In search bar, enter ‘Nursing and Midwifery Council’ •

Step 3: Download ‘Test of Competence’ handbook Test of Competence Part 1 - Candidate booklet

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Step 4: Make an account

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Step 5: Book your exam (8,320 PHP approximately)

ABOUT THE EXAM: EXAM: The exam lasts for 240 minutes (4 hours) giving the candidate ample time to read, re-read, and double check each answer an swer before submitting the exam paper. Always keep in mind that you need not memorise everything. everything. As long as you get yourself familiarised with the UK practice, you will be fine. Please do not share or distribute the contents of this Ebook.

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The result will only indicate if you have passed or failed. No scores will be given. The result will be sent to your email within 24 to 48 hours or you can check the status on the Pearson Vue website. https://home.pearsonvue.com/


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PREPARATION TIPS AND STRATEGIES 

It is important to exercise and build stamina. The actual exam involves four hours of sitting and thinking, I can never stress enough how thankful I am for working out at least 3x a week before the exam. It also helps your brain to absorb information more effectively. 

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Have a pre-test: Visit (http://www.royalmarsdenmanual.com/student) and test yourself on the 110 sample multiple choice questions. The questions here are close to what you will encounter on the exam. This is to gauge what you need to focus on. Tip is to review first the topic which you are weakest at. This will give you ample time to absorb and learn the necessary concepts and important details. 

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Read the NMC Code and CBT blueprint summary at least twice, you don’t need to memorize it, just absorb and put the concepts at heart. Your decisions as a nurse will be based on these. 

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Pay attention to the highlighted topics, and those with “E”, the summaries that are included here are those that are most likely to appear on the exam. If you need to understand a specific topic in depth, it is best to look at Royal Marsden Manual for reference.

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Read the topic summaries and answer the questions at the end of every chapter at the Royal Marsden Manual book. You can do at least 1 or 2 topics per day; just make sure not to overload yourself. This will crystallize the knowledge and will help to retain the information. 

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DO NOT GET OVERWHELMED, you may have to read a lot, but the exam is relatively easy compared to other board exams. You just


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really have to read through and get the gist of NMC’s Code and practice. 

The answer keys are based from the Royal Marsden Manual, however, some situational questions were based on internet research. If you think you have the best answer and resource, best to stick with it and send us a feedback so we can discuss.

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Once you are done with the pre-test at the Royal Marsden website, and you are also done studying the summaries, try to answer the first set of Mock questions, see if you can score at least 70 out of 100. On the second set of the Mock Questions, aim to score at least 75 to 80 out of 100, if your score is close to this, it is a good indicator of your readiness to take the exam. 

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3 days before the exam, if you need to, visit the exam venue to avoid stress on the day of your exam as this may affect your performance.

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Finally, pamper yourself, relax, do something you enjoy and most importantly, PRAY or MEDITATE. It is important to put your mind in a state that will help you to be calm and think positively so that you can clearly focus during the exam. 

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On the day of the exam, be NICE. Greet and smile at the security guard and staff at the exam venue, this will psychologically help your mind to think that you are confident and relax. While you’re at it, smile at the other candidates too.  

Do some stretching every now and then to keep you awake, don’t be shy, the invigilator will not penalize you for it. Also, if there’s a question that is too challenging for you, PRAY or TRUST your first instinct. You can do it, I’m rooting for your success! 


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STUDY GUIDE DAY 1 -NMC CODE -Nursing Blueprint Summaries -Take the 110 items at Royal Marsden Website as a pre-test http://www.royalmarsdenmanual.com/student (To check which topic you are weakest at, and study it first, so you can allot more time to understand the concepts.) DAY 2 – DAY 5 Familiarize yourself with these topics:  Safeguarding children and elderly  Medication management  Obtaining consent  Infection control  Care for elderly with dementia  Basic drug IV calculation DAY 6 -Assessment and discharge -Communication DAY 7 -Elimination/Catheterization -Moving and positioning -Respiratory Care DAY 8 -Nutrition, Fluid Balance & Blood transfusion -Perioperative Care DAY 9 -Patient Comfort and End of Life Care -Interpreting Diagnostic Tests and Observations DAY 10 ***Study the pointers from recent passers*** DAY 11 Answer mock set 1 and 2 DAY 12 Answer mock set 3 and 4 DAY 13 Answer mock set 4, 5, 6 (if you’re hitting 70 /100 go for it! If not, you can reschedule ) DAY 14 – Visit your Exam Venue if you need to, after that relax and PRAY  Please do not share or distribute the contents of this Ebook.

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SUMMARY OF TOPICS TO REVIEW 

THE CODE  NMC provides guidance and professional standards that registered nurses and midwives must uphold.

It is divided into four domains: I. II. III. IV.

Prioritise people Practice Effectively Preserve Safety Promote Professionalism and Trust

THE CODE PROFESSIONAL STANDARDS OF PRACTICE AND BEHAVIOUR FOR NURSES AND MIDWIVES

Introduction The Code contains the professional standards that registered nurses and midwives must uphold. UK nurses and midwives must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing and midwifery practice in other roles, such as leadership, education or research. While you can interpret the values and principles set out in the Code in a range of different practice settings, they are not negotiable or discretionary. Our role is to set the standards in the Code, but these are not just our standards. They are the standards that patients and members of the public tell us they expect from healthcare professionals. They are the standards shown every day by good nurses and midwives across the UK. When joining our register, and then renewing their registration, nurses and midwives commit to upholding these standards. This commitment to professional standards is fundamental to being part of a profession. We can take action if registered nurses or midwives fail to uphold the Code. In serious cases, this can include removing them from the register. Please do not share or distribute the contents of this Ebook.

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The Code should be useful for everyone who cares about good nursing and midwifery: • Patients and service users, and those who care for them, can use it to provide feedback to nurses and midwives about the care they receive. • Nurses and midwives can use it to promote safe and effective practice in their place of work. • Employer organisations should support their staff in upholding the standards in their professional Code as part of providing the quality and safety expected by service users and regulators. • Educators can use the Code to help students understand what it means to be a registered professional and how keeping to the Code helps to achieve that. For the many committed and expert practitioners on our register, this Code should be seen as a way of reinforcing their professionalism. Through revalidation, you will provide fuller, richer evidence of your continued ability to practise safely and effectively when you renew your registration. The Code will be central in the revalidation process as a focus for professional reflection. This will give the Code significance in your professional life, and raise its status and importance for employers. The Code contains a series of statements that taken together signify what good nursing and midwifery practice looks like. It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism. “I. Prioritise people” You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised , assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged. 1

Treat people as individuals and uphold their dignity


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To achieve this, you must: 1.1

treat people with kindness, respect and compassion

1.2

make sure you deliver the fundamentals of care effectively

1.3

avoid making assumptions and recognise diversity and individual choice

1.4

make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay, and

1.5

respect and uphold people’s human rights.

2 Listen to people and respond to their preferences and concerns To achieve this, you must: 2.1 work in partnership with people to make sure you deliver care effectively _________________________________________________ The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided. _________________________________________________ 2.2 recognise and respect the contribution that people can make to their own health and wellbeing 2.3

encourage and empower people to share decisions about their treatment and care

2.4

respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care

2.5

respect, support and document a person’s right to accept or refuse care and treatment, and


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2.6

recognise when people are anxious or in distress and respond compassionately and politely.

3 Make sure that people’s physical, social and psychological needs are assessed and responded to To achieve this, you must: 3.1

pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages

3.2

recognise and respond compassionately to the needs of those who are in the last few days and hours of life

3.3

act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it, and

3.4

act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care.

4 Act in the best interests of people at all times To achieve this, you must: 4.1

balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment

4.2

make sure that you get properly informed consent and document it before carrying out any action

4.3

keep to all relevant laws about mental capacity that apply in the country in which you are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process, and

4.4

tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular


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procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care (see the note below). 5 Respect people’s right to privacy and confidentiality As a nurse or midwife, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately. To achieve this, you must: 5.1

respect a person’s right to privacy in all aspects of their care

5.2

make sure that people are informed about how and why information is used and shared by those who will be providing care

5.3

respect that a person’s right to privacy and confidentiality continues after they have died

5.4

share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality, and

5.5

share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand.

_________________________________________________ You can only make a ‘conscientious objection’ in limited circumstances. For more information, please visit our website at www.nmcuk.org/standards. _________________________________________________ “II. Practise effectively ” You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay Please do not share or distribute the contents of this Ebook.

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and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice. 6 Always practise in line with the best available evidence To achieve this, you must: 6.1

make sure that any information or advice given is evidence based, including information relating to using any healthcare products or services, and

6.2

maintain the knowledge and skills you need for safe and effective practice.

7

Communicate clearly


use terms that people in your care, colleagues and the public can understand

7.2

take reasonable steps to meet people’s language and communication needs, providing, wherever possible, assistance to those who need help to communicate their own or other people’s needs

7.3

use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people’s personal and health needs

7.4

check people’s understanding from time to time to keep misunderstanding or mistakes to a minimum, and

7.5

be able to communicate clearly and effectively in English.

8 Work cooperatively To achieve this, you must:


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8.1

respect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate

8.2

maintain effective communication with colleagues

8.3

keep colleagues informed when you are sharing the care of individuals with other healthcare professionals and staff

8.4

work with colleagues to evaluate the quality of your work and that of the team

8.5

work with colleagues to preserve the safety of those receiving care

8.6

share information to identify and reduce risk, and

8.7

be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety.

9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues To achieve this, you must: 9.1

provide honest, accurate and constructive feedback to colleagues

9.2

gather and reflect on feedback from a variety of sources, using it to improve your practice and performance

9.3

deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times, and

9.4

support students’ and colleagues’ learning to help them develop their professional competence and confidence.

10 Keep clear and accurate records relevant to your practice This includes but is not limited to patient records. It includes all records that are relevant to your scope of practice. To achieve this, you must: Please do not share or distribute the contents of this Ebook.

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10.1

complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2

identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3

complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4

attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5

take all steps to make sure that all records are kept securely, and

10.6

collect, treat and store all data and research findings appropriately.

11 Be accountable for your decisions to delegate tasks and duties to other people To achieve this, you must: 11.1

only delegate tasks and duties that are within the other person’s scope of competence, making sure that they fully understand your instructions

11.2

make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care, and

11.3

confirm that the outcome of any task you have delegated to someone else meets the required standard.

12 Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse or midwife in the United Kingdom Please do not share or distribute the contents of this Ebook.

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make sure that you have an appropriate indemnity arrangement in place relevant to your scope of practice.

For more information, please visit: www.nmc-uk.org/indemnity “III. Preserve safety ” You make sure that patient and public safety is protected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate. 13 Recognise and work within the limits of your competence To achieve this, you must: 13.1

accurately assess signs of normal or worsening physical and mental health in the person receiving care

13.2

make a timely and appropriate referral to another practitioner when it is in the best interests of the individual needing any action, care or treatment

13.3

ask for help from a suitably qualified and experienced healthcare professional to carry out any action or procedure that is beyond the limits of your competence

13.4

take account of your own personal safety as well as the safety of people in your care, and

13.5

complete the necessary training before carrying out a new role.

14 Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place To achieve this, you must:


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14.1

act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm

14.2

explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers, and

14.3

document all these events formally and take further action (escalate) if appropriate so they can be dealt with quickly.

15

Always offer help if an emergency arises in your practice setting or anywhere else


only act in an emergency within the limits of your knowledge and competence

15.2

arrange, wherever possible, for emergency care to be accessed and provided promptly, and

15.3

take account of your own safety, the safety of others and the availability of other options for providing care.

16 Act without delay if you believe that there is a risk to patient safety or public protection To achieve this, you must: 16.1

raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other healthcare setting and use the channels available to you in line with our guidance and your local working practices

16.2

raise your concerns immediately if you are being asked to practise beyond your role, experience and training

16.3

tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within


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the Code or other national standards, taking prompt action to tackle the causes of concern if you can _________________ __________________________ __________________ __________________ ______________ _____ The professional duty of candour is about openness and honesty when things go wrong. “E very healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.” Joint statement from the Chief Executives of statutory regulators of healthcare professionals. _________________ __________________________ __________________ __________________ ______________ _____ 16.4

acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so

16.5

not obstruct, intimidate, victimise or in any way hinder a colleague, member of of staff, person you care care for or member of the public who wants to raise a concern, and

16.6

protect anyone you have management responsibility for from any harm, detriment, victimisation or unwarranted treatment after a concern is raised.

For more information, please visit: www.nmc-uk.org/r visit: www.nmc-uk.org/raisingconcerns aisingconcerns 17 Raise concerns immediately if you believe a person is vulnerable or at risk risk and needs extra support and protection To achieve this, you must: 17.1

take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse

17.2

share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information, and

17.3

have knowledge of and keep to the relevant laws and policies about protecting and caring for vulnerable people.


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18 Advise on, prescribe, supply, dispense or administer medicines within the limits limits of your training training and and competence, competence, the law, law, our guidance and other other relevant relevant policies, policies, guidance guidance and regulations To achieve this, you must: 18.1

prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough enough knowledge of that person’s health and are satisfied that the medicines or treatment serve that person’s health needs

18.2

keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs

18.3

make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment treatment they are receiving, including including (where possible) over-the-counter medicines

18.4

take all steps to keep medicines stored securely, and

18.5

wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship. relationship.

For more information, please visit: www.nmc-uk.org/st visit: www.nmc-uk.org/standards andards 19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice To achieve this, you must: 19.1

take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place

19.2

take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures (see the note below)


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19.3

keep to and promote recommended practice in relation to controlling and preventing infection, and

19.4

take all reasonable personal precautions necessary to avoid any potential health risks risks to colleagues, colleagues, people receiving receiving care and the public.

_________________ __________________________ __________________ __________________ ______________ _____ Human factors refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour behav iour at work in a way which can affect health and safety – Health and Safety Executive. You can find more information at www.hse.gov.uk at www.hse.gov.uk _________________ __________________________ __________________ __________________ ______________ _____ “IV. Promote “IV. Promote professionalism and trust” trust ” You uphold the reputation reputation of your profession profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the the Code. You should should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public. 20 Uphold the reputation of your profession at all times To achieve this, you must: 20.1

keep to and uphold the standards and values set out in the Code

20.2

act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment

20.3

be aware at all times of how your behaviour can affect and influence the behaviour of other people

20.4

keep to the laws of the country in which you are practising

20.5

treat people in a way that does not take advantage of their vulnerability or cause them them upset or distress distress


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20.6

stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers

20.7

make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way

20.8

act as a role model of professional behaviour for students and newly qualified nurses and midwives to aspire to

20.9

maintain the level of health you need to carry out your professional role, and

20.10

use all forms of spoken, written and digital communication (including social media and networking sites) responsibly, respecting the right to privacy of others at all a ll times.

For more guidance on using social media and networking sites, please visit: www.nmc-uk.org/guidance visit: www.nmc-uk.org/guidance

21 Uphold your position as a registered nurse or midwife To achieve this, you must: 21.1

refuse all but the most trivial gifts, favours or hospitality as accepting them could be interpreted as an attempt to gain preferential treatment

21.2

never ask for or accept loans from anyone in your care or anyone close to them

21.3

act with honesty and integrity in any financial dealings you have with everyone you have a professional professional relationship with, including people in your care

21.4

make sure that any advertisements, publications or published material you produce or have h ave produced for your professional services are accurate, responsible, ethical, do not mislead or


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exploit vulnerabilities and accurately reflect your relevant skills, experience and qualifications 21.5

never use your professional status to promote causes that are not related to health, and

21.6

cooperate with the media only when it is appropriate to do so, and then always protecting the confidentiality and dignity of people receiving treatment or care.

22 Fulfil all registration requirements To achieve this, you must: 22.1

meet any reasonable requests so we can oversee the registration process

22.2

keep to our prescribed hours of practice and carry out continuing professional development activities, and

22.3

keep your knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop your competence and improve your performance.

For more information, please visit: www.nmc-uk.org/standards 23

Cooperate with all investigations and audits This includes investigations or audits either against you or relating to others, whether individuals or organisations. It also includes cooperating with requests to act as a witness in any hearing that forms part of an investigation, even after you have left the register. To achieve this, you must: 23.1

cooperate with any audits of training records, registration records or other relevant audits that we may want to carry out to make sure you are still fit to practise

23.2

tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty


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of, a criminal offence (other than a protected caution or conviction) 23.3

tell any employers you work for if you have had your practice restricted or had any other conditions imposed on you by us or any other relevant body.

23.4

tell us and your employers at the first reasonable opportunity if you are or have been disciplined by any regulatory or licensing organisation, including those who operate outside of the professional healthcare environment, and

23.5 give your NMC Pin when any reasonable request for it is made (see the note below). For more information, please visit: www.nmc-uk.org 24 Respond to any complaints made against you professionally To achieve this, you must: 24.1

never allow someone’s complaint to affect the care that is provided to them, and

24.2

use all complaints as a form of feedback and an opportunity for reflection and learning to improve practice.

25

Provide leadership to make sure people’s wellbeing is protected and to improve their experiences of the healthcare system


identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first, and

25.2

support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken.


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_________________________________________________ When telling your employers, this includes telling (i) any person, body or organisation you are employed by, or intend to be employed by, as a nurse or midwife; and (ii) any person, body or organisation with whom you have an arrangement to provide services as a nurse or midwife. _________________________________________________ About us The Nursing and Midwifery Council exists to protect the public. We do this by making sure that only those who meet our requirements are allowed to practise as a nurse or midwife in the UK. We take action if concerns are raised about whether a nurse or midwife is fit to practise. _________________________________________________

NMC’s Code of Conduct Summary o o o o o o

o o

o o o

Care of patient is the primary concern Treat patients as individuals Do not Discriminate Treat patients kindly Respect confidentiality Disclose information that might pose risk or harm to a patient Advocate for the patient Collaborate with other members of the multidisciplinary team Maintain clear professional boundaries Monitor quality and maintain safety Consult and take advise from colleagues -delegate effectively (supervise and give feedback) -manage risks -report concerns (first to your immediate superior) -provide high standards of care at all times -evidence based practise (based on the most current research for effectiveness and efficiency)


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The 6 Fundamental Values      

Care Compassion Commitment Courage Competence Communication


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 CBT GUIDE BLUEPRINTS SUMMARY Domain 1: Professional Values *Take note of “*E*” = this means critical item and if tested, must be passed. Competency 1. All nurses must practise with confidence according to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC,2008), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people's choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions.    

Works within the legal framework when seeking consent Applies research based evidence to practice Adheres to Standards of medicine management *E* Safe disposal of drugs

Competency 2. All nurses must practice in a holistic, non judgemental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care. Competency 3. All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, ageing, death and dying. Nurses must understand how these activities influence public health. Competency 4. All nurses must work in partnership with service users, carers, families, groups, communities and organisations. They must manage risk, and promote health and wellbeing while aiming to empower choices that promote self -care and safety.


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

Practice Infection Prevention and Control *E*

Competency 5. All nurses must fully understand the nurse's various role, responsibilities and functions, and adapt their practice to meet the changing needs of people, group’s communities and populations. Competency 6. All nurses must understand the roles and responsibilities of other health and social care professionals, and seek to work with them collaboratively for the benefit of all who need care. Competency 7. All nurses must be responsible and accountable for keeping their knowledge and skills up to date through continuing professional development. They must aim to improve their performance and enhance the safety and quality of care through evaluation, supervision and appraisal. Competency 8. All nurses must practice independently, recognising the limits of their competence and knowledge. They must reflect on these limits and seek advice from, or refer to other professionals where necessary. Competency 9. All nurses must appreciate the value of evidence in practice, be able to understand and appraise research findings to their work, and identify areas for further investigation.

Domain 2: Communication and Interpersonal Skills Competency 1. All nurses must build partnerships and therapeutic relationships through safe, effective and nondiscriminatory communication. They must take account of individual differences, capabilities and needs. Competency 2. All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when Please do not share or distribute the contents of this Ebook.

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language interpretation or other communication support is needed and know how to obtain it. 

 

Importance of personal needs and providing both practical and emotional support Can communicate and understand Verbal and Non-verbal cues Active listening, questioning, paraphrasing and reflection to support therapeutic intervention

Competency 3. All nurses must use the full range of communication methods, including verbal, non-verbal and written, to acquire, interpret and record their knowledge and understanding of people's needs. They must be aware of their own values and beliefs and the impact this may have on their communication with others. They must take account of the many different ways in which people communicate and how they may be influenced by ill health, disability and other factors, and be able to recognise and respond effectively when a person finds it hard to communicate. 



Provide accurate and comprehensive written and verbal reports based on sound evidence Enhance communication and remove barriers

Competency 4. All nurses must recognise when people are anxious or in distress and respond effectively, using therapeutic principles, to promote wellbeing, manage personal safety and resolve conflict. They must use effective communication strategies and negotiation techniques to achieve best outcomes, respecting the dignity and human right of all concerned. They must know when to consult a third party and how to make referrals for advocacy, mediation or arbitration. 

Anticipate how people might feel in a given situation and respond with kindness and empathy


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Competency 5. All nurses must use therapeutic principles to engage maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. Competency 6. All nurses must take every opportunity to encourage health promoting behaviour through education, role modelling and effective communication. Competency 7. All nurses must maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language. 



Provides accurate and comprehensive written reports based on best possible evidence Effectively keep records of medication administered and omitted, including controlled drugs and ensures others to do the same

Competency 8. All nurses must respect individual rights to confidentiality and keep information secure and confidential in accordance with the law and relevant regulatory frameworks, taking account of local protocols. They must actively share personal information with others when the interests of safety and protection override the need for confidentiality.

Domain 3: Nursing Practice and Decision Making Competency 1. - All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidence based judgements and decisions in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the Please do not share or distribute the contents of this Ebook.

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complexity of clinical decisions requires specialist knowledge and expertise and, consult or refer accordingly.  

Demonstrates clinical confidence Works within the code

Competency 2. All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, aging and death. They must have an indepth knowledge of common physical and mental health problems and treatments, including co-morbidity and physiological and psychological vulnerability. Competency 3. All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. 



Acts autonomously and appropriately when faced with sudden determination Accurately undertake and record baseline assessments of height,weight,temperature, pulse rate, respiratory rate and blood pressure

Competency 4. All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. Competency 5. All nurses must understand public health principles, prioritise in order to recognise and respond to the major causes and determinants, of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, Please do not share or distribute the contents of this Ebook.

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communities and populations, and work to improve health, wellbeing and experience of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion. Competency 6. All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes. Different types of prescribing Competent in drug calculation Orders, receives, stores and dispose of medicines drug administration and monitor its effects (including controlled drugs)

  

Competency 7. All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. Acts autonomously and appropriately when faced with sudden deterioration in people’s physical or psychological condition or emergency situations Responds and reports when people have difficulty eating or swallowing 



Competency 8. All nurses must provide educational support, facilitation skills and therapeutic nursing interventions to optimise health and wellbeing. They must promote selfcare and management whenever possible, helping people to make choices about their needs involving families and carers where appropriate, to maximise their ability to care for themselves.


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

Demonstrates respect for the autonomy and rights of people to withhold consent in relation to function within legal framework and in relation to people’s safety

Competency 9. All nurses must be able to recognise when a person is at risk and in need of extra support and protection and take reasonable steps to protect them from abuse. Competency 10. - All nurses must evaluate their care to improve clinical decision-making, quality and outcomes, using a range of methods, amending the plan of care, where necessary, and communicating change to others. Domain 4: Leadership, Management and Team Work Competency 1. All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people's wellbeing and experience of healthcare. Responds appropriately when people want to complain, providing assistance and support Competency 2. All nurses must systematically evaluate care and ensure that they and others use the findings to help improve peoples' experience and care outcomes and to shape future services. 

Competency 3. All nurses must be able to identify priorities and mange time and resources effectively to ensure the quality of care is maintained. 

Manages overall environment to minimise risk

Competency 4. All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback and reflection.


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

Recognises and addresses deficits in knowledge and skill in self and others and takes appropriate action

Competency 5. All nurses must facilitate nursing students and others to develop their competence, using a range of professional and personal development. 

Bases decisions on evidence and uses experience to guide decision making

Competency 6. All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care. 

Works within the code (NMC 2008) in delegating care and when care is delegated to them

Competency 7. All nurses must work effectively across professional and agency boundaries, actively involving and respecting others' contributions to integrated person-centred care. They must know when and how to communicate with and refer to other professionals and agencies in order to respect the choices of service users and others, promoting shared decision making, to deliver positive outcomes and to coordinate smooth, effective transition within and between services and agencies. 

Assist in preparing people and caress for transfer and transition through effective dialogue and accurate information


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

FIELD SPECIFIC COMPETENCY: ADULT NURSING (for items with “E” – in depth details can be found on the Royal Marsden Manual)

Section 1: 1.1 Adult nurses must understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs arising from ageing, cognitive impairment, long-term conditions and those approaching the end of life. You must be able to demonstrate knowledge of the following: Apply current legal, ethical and professional requirements to older people with complex needs. *E* Apply current legal, ethical and professional requirements to people with complex needs and cognitive impairment. Apply current legal, ethical and professional requirements to people with complex needs and Long term conditions. Apply current legal, ethical and professional requirements to people with complex needs as they near end of life. Section 2: 3.1 Adult nurses must promote the concept, knowledge and practice of selfcare with people with acute and long-term conditions, using a range of communication skills and strategies. Refer to NMC blue print for further reading on: Acute medical and surgical conditions *E* Long term conditions *E* Section 3: 1.1 Adult nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with mental health problems, people with physical disabilities, people with learning


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disabilities, older people, and people with long term problems such as cognitive impairment. You must be able to demonstrate knowledge of the following: Responding to the needs of babies and children *E* Responding to the needs of young people Responding to the needs of pregnant women Responding to the needs of postnatal Responding to the needs of people with mental health problem Responding to the needs of people with physical disability Responding to the needs of people with learning disabilities *E* Responding to the needs of older people *E* Responding to people with long term problems Section 4: 3.1 Adult nurses must safely use a range of diagnostic skills, employing appropriate technology, to assess the needs of service users. Refer to NMC blue print for further reading on: A range of diagnostic skills using technology *E* Section 5: 4.1 Adult nurses must safely use invasive and non-invasive procedures, medical devices, and current technological and pharmacological interventions, where relevant, in medical and surgical nursing practice, providing information and taking account of individual needs and preferences.

You must be able to demonstrate knowledge of the following: Invasive and non-invasive procedures Please do not share or distribute the contents of this Ebook.

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Safe use of medical devices Safe use of current technology Pharmacological interventions *E* Medical nursing context *E* Surgical nursing context *E* Section 6: 4.2 Adult nurses must recognise and respond to the changing needs of adults, families and carers during terminal illness. They must be aware of how treatment goals and service users’ choices may change at different stages of progressive illness, loss and bereavement. Refer to NMC blue print for further reading on how to: Understand changing needs of adults, families and carers during terminal illness Section 7: 7.1 Adult nurses must recognise the early signs of illness in people of all ages. They must make accurate assessments and start appropriate and timely management of those who are acutely ill, at risk of clinical deterioration, or require emergency care. You must be able to demonstrate knowledge on how to: Recognise early signs of illness in people of all ages *E* Make accurate initial assessment *E* Manage acute illness *E* Manage clinical deterioration *E* Emergency care *E* Section 8:


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7.2 Adult nurses must understand the normal physiological and psychological processes of pregnancy and childbirth. They must work with the midwife and other professionals and agencies to provide basic nursing care to pregnant women and families during pregnancy and after childbirth. They must be able to respond safely and effectively in an emergency to safeguard the health of mother and baby. Recognise specific risks to health and wellbeing of pregnant women and babies and respond effectively in an emergency to safeguard the health of mother and baby. *E* Section 9: 8.1 Adult nurses must work in partnership with people who have long-term conditions that require medical or surgical nursing, and their families and carers, to provide therapeutic nursing interventions, optimise health and wellbeing, facilitate choice and maximise self-care and self-management. You must be able to demonstrate knowledge of: Partnership working with people, families and carers with long term conditions requiring medical or surgical intervention. *E*


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 TOPIC SUMMARIES from the

ROYAL MARSDEN MANUAL OF CLINICAL NURSING PROCEDURES


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PART ONE – MANAGING THE PATIENT JOURNEY

 ASSESSMENT

AND DISCHARGE

→systematic and

continuous →underpins every aspect of nursing care →nurse and patient identity needs and concerns →cornerstone of individualized care PRINCIPLES: →the first written assessment must begin within 4 hours after admission →must be completed within 24 hours →should focus on patient’s response to a health need →must be structured and clearly documented →includes observation, data collection, clinical judgement and validation of perceptions Nursing Diagnosis 

Clinical judgement and the process of decision making that lead to the judgement

Planning And Implementing Care 

Identifying nursing sensitive patient outcomes and determining appropriate interventions

Evaluation Care 

To analyze the patient’s health status to determine whether the patient condition is stable, has deteriorated, or improved.

Discharge Planning 

Immediate goal is to anticipate changes in patient care needs and whose long-term goal is to ensure continuity of health care


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10 STEPS TO DISCHARGE PLANNING 1. 2. 3. 4.

Start planning for discharge before or on admission Identify if simple or complex discharge plan Coordinate Set an expected date of discharge or transfer within 24 to 48 hours of admission 5. Handover 6. Review CMP (care management plan) 7. Involve patients and carers 8. Plan to take place over 7 days to deliver 9. Use a checklist 24-48 hours before transfer 10. Make decisions to discharge and transfer patients each day 

INFECTION PREVENTION AND CONTROL

→has

been defined as the clinical application of microbiology in practice. (RCN 2010) UNIVERSAL PRECAUTIONS → universal

blood and body fluid precautions

→ based

on the principle that no individual can be regarded as completely ‘risk free’ and may pose a risk for blood borne virus, such as HIV or hepatitis B. →Incorporated within standard precautions

STANDARD PRECAUTIONS →actions

that should be taken in every care situation to protect patients and others from infection, regardsless of what is know n of the patient’s status with respect to infection. Please do not share or distribute the contents of this Ebook.

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It includes:      

Hand hygiene (5 moements of hand washing) Correct disposal of sharps PPE Clean environement and equipment Safe disposal of waste Safe management of used linen

TRANSMISSION-BASED PRECAUTIONS   



Contact – touch /physical contact Enteric – diarrhea/vomiting Droplet – droplets of body fluid (ex.respiratory secretions); should wear a mask, gloves, apron Airborne – smaller droplets that stay longer in the air (<5 mm diameter) ; needs negative pressure ventilation or positive pressure lobby; should wear a fitted respirator, apron and gloves

ISOLATION Source – prevent the spread of organism from the patient Protective – protect the patient especially the immune-compromised patients COHORTING -nursing patients in a room with the same highly infectious such as norovirus BARRIER NURSING – if patient is infectious REVERSE BARRIER NURSING – protecting a particularly vulnerable patient

MOST COMMON HEALTH CARE ASSOCIATE INFECTIONS (IATROGENIC)


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-respiratory tract -urinary tract -surgical site infections CAUSES OF INFECTION →normally caused by →infections

micro-organisms

agent – anything that can be transmitted

→important to understand

the “route of transmission” to determine the

needed precautions “CLOSTRIDIUM DIFFICLE INFECTION” →need

to physically remove them from the hands with soap and water because the spores are extremely tough and durable. They are not destroyed by boiling (hence, need sterilization such as autoclave) →causes antibiotic associated

pseudo-membranous colitis

MYCOBACTERIA →tuberculosis and leprosy

VIRUS → much →ex.

more susceptible to alcohol; with lipid exchange

Herpes zoster virus (chicken pox and shingles)

VIRUS LIFE CYCLE 1. attachment to a host 2. penetration – enters the host cell 3. uncoating – breaks down and exposes virus 4. replication – create more viral


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particles 5. release – released from the cell

NOROVIRUS → causes

viral gastroenteritis

→less susceptible

to alcohol

FUNGI →causes “pneumocystis

jirovecii”

PNEUMONIA – considered as clinical indication of AIDS PROTOZOA → ex.

Malaria (parasites) ; gastroenteritis; trichomonas ;

→ sexually transmitted

disease – vaginitis

HELMINTHS → transmission

– ingestion of eggs/larvae ex.ascaris, elepanthiasis

ARTHOROPOD → lice,

mites

SCABIES →usually

starts around the wirist and in between fingers →mode of transmission: through close contact “rash” → thickening of the skin, formation of crust “Norwegian scabies” →long stay care settings PRIONS →transmissible spongiform encephalopathies (TSE’s)

Creutzfeldt-Jakob disease (CJD) spongiform encephalopathy (BSE) →

*E*

- associated with bovine


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→causes

serious irreversible damage to the central nervous system and are

fatal →characterized by “plagues” in the brain, looks like sponge →CJD – usually appears in older people → vCJD – usually appears in younger age group →Mode of transmission: food and health care interventions; dura matter and cornel grafts; treatment with huan derived growth hormone blood transfusion and surgical instruments MODE OF TRANSMISSION DIRECT CONTACT

Physical contact; can be prevented by good hand hygiene, use of barriers such as gloves and aprons and non-touch technique for aseptic procedures

INDIRECT CONTACT

Through contaminated object; can be solved with effective cleaning,decontamination and good hand hygiene

DROPLET

Cough, sneeze, talking, respiratory secretions and saliva ex. Influenza, TB Solution: isolating the infected patient, using masks, apron and gloves Good hand hygiene

AIRBORNE

Droplet or particles, small enough to remain suspended in the air for long periods of time ex. Measles and chicken pox Solution: same with droplet transmission


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PARENTERAL

Blood/body fluids come into contact wth mucoud membranes or exposed tissue Transplantation or infusion INOCULATION INJURY – where blood splashes into eyes or a used sharp item penetrates the skin “needle stick injury” Solution: good practice in handling the disposal of sharps and the appropriate use of PPE including eye protection.

FECAL-ORAL

Ex.gastroenteriets Solution: hand hygiene with soap and water, use of PPE and good food hygiene Isolate the patient until symptoms such as vomiting and diarrhea subsides

VECTOR

Mosquitoes ex. Malaria

SOURCES OF INFECTION ENDOGENOUS – already present in the body, normal flora EXOGENOUS – introduced from elsewhere (ex. Cross infection)

EVIDENCE-BASED RATIONALE → the

principle of all infection control is preventing the transmission of infectious agents 10 CRITERIA OF THE HYGIENE CODE Please do not share or distribute the contents of this Ebook.

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1.

systems to manage and monitor

2.

clean and appropriate environment

3.

accurate information

4.

nursing medical care in a timely fashion

5.

identify promptly and reduce the risk

6.

all staff must be fully involved

7.

isolation facilities

8.

lab support

9.

policies

10.

protection and education for staff

STANDARD PRECAUTION    

Hand hygiene PPE (personal protective equipment) Proper waste disposal (sharps) Appropriate decontamination

ORANGE BIN – for hazardous infectious wastes →all waste

contaminated with blood, body fluids, excretions,secretions and infectious agents but does not require incineration ex.used gloves RED BIN – for infected linen ASEPTIC TECHNIQUE →minimize

the risk of introducing contamination, using alcohol

ANTT (aseptic non-touch technique) →avoiding

contamination by not touching key elements such as the tip of a

needle SOURCE ISOLATION →for infectious patients


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→to

protect other patients and staff

→ must

be in a single room or COHORT for group of patient with similar nfection → must

be in a negative or neutral air pressure to contain the contaminant

Priority for single occupancy rooms: >enteric symptoms such as: →diarrhea → vomiting

>serious airborne infection ATTENDING TO PATIENT IN ISOLATION 

MEALS

-→cutlery and crockery should be washed disinfected with a final rinse of 80⁰C for 2-3 minutes. 

LINEN

→place 

infected linen in a RED water-soluble polythene bag

WASTE

→orange

waste bags must be sealed and labelled with the name of the ward/dept before it s removed from the room. *if enteric precaution – must wash hands with soap and water *if airborne/droplet – must wear well-fitting mask or respirator PROTECTIVE ISOLATION Room for vulnerable patient must be single occupancy with neutral or positive air pressure with respect to the surrounding area


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→High

efficiency particular air (HEPA) filtration of the air in the room may reduce exposure to airborne pathogens, particularly fungal spores →Positive

pressure ventilation must NOT be used for any patient infected or colonized with an airborne pathogen. →If

the vulnerable patient is infected with an airborne pathogen, they should be nursed in a room with neutral air pressure or with a positive pressure lobby. INFECTION CONTROL WASTE COLOR CODES YELLOW

Wastes which requires ncineration

ORANGE

Wastes which may be treated

PURPLE

Cytotoxic and cytostatic wastes

YELLOW/BLACK

Offensive/hygienic waste

RED

Anatomical Waste

BLACK

Domestic wastes

BLUE

Medicinal wastes

WHITE

Amalgam wastes


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PART TWO – SUPPORTING THE PATIENT WITH HUMAN FUNCTIONING



COMMUNICATION

MENTAL CAPACITY ACT (2005) →First

principle is the presumption of capacity and so we must presume a person has mental capacity unless they:    

Are unable to understand understand information given to them them to make choices Can understand but unable to retain info Unable to weigh up and relate the info accurately to their situation Unable to communicate their wihe r choices by any means

Four Key areas by Brady Wagner – in order to have the capacity to make a decision: 1. 2. 3. 4.

Understanding Manipulating those options Reasoning through a decision Communication the preference/decision

Remember SAGE & THYME for THYME for communicating patients who are worried or distressed: S – setting A – ask G – gather E – empathy T-talk H-help Y-you Please do not share or distribute the contents of this Ebook.

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M-me E-end Denial and Collusion Denial – Denial – is a coping mechanism of slowing down and filtering the absorption of traumatic information; allowing for avoidance of painful or distressing information Collusion – when two or more parties develop a sharerd sometimes secret understanding Supporting a person in Denial →provide

honest information

→listening, reflecting, summarizing → be

gentle in challenging by either either questioning any inconsistencies in the patient’s patient’s story story or asking if at any point they have thought that their illness may be more serious →if

the patient remains in denial it shouldn’ shouldn’t be challenged any further

→keep clear

records

Anxiety →individual

guided self help

→psycho educational groups →CBT (cognitive

behavioural therapy)

→drug treatments

Panic Attack (Acute Anxiety) → be

firm, calm, look them in the the eye and hold them if appropriate appropriate

Pharmacological support: -benzodiazepines Please do not share or distribute the contents of this Ebook.

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-antipsychotics -sedating antihistamines -TCA/SSRI antidepressants Depression →encourage

the patient to identify their own abilities a bilities to cope with the

situation →low

mood that persists for more the 2 weeks wee ks

→key

is to relieve symptoms

Core Management Skills -good communication skills -assessment -medication -refer/consent -sensitivity -awareness of any cognitive impairments Pharmacological Support: SSRI – should be avoided for patients taking NSAIDS and for those with heart condition -increase risk of gastrointestinal bleeding (citalopram and sertraline –fewer interactions) *2 main considerations with antidepressants 1. Presence of other problems 2. Side effect of drugs which may m ay affect the underlying disease


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MAOI – can affect blood pressure especially when certain food types are a re eaten. *antidepressant treatment should continue for at least 6 months after a response to a treatment ANGER, AGGRESSION AGGRESSION AND VIOLENCE MANAGEMENT MANAGEMENT →prevention

is the most effective method of managing mana ging anger

→communicate

openly, honestly and frequently (NHS 2013)

“Remain Calm” AND Calm” AND “Maintain safety for all” Delirium →acute

alteration in mental state

Core features:     

Impaired consciousness and attention Disorientation Psychomotor disturbances Disturbed sleep/wake cycle Emotional disturbances THREE FORMS OF DELIRIUM DELIRIUM hypoactive delirium – patient is quiet hyperactive delirium – heightened arousal mixed delirium – combination

→delirium is frequently →end

iatrogenic

of life management of delirium focuses on alleviating symptoms

→if

risk factors are identified, should focus on minimizing hyper arousal from the environment Please do not share or distribute the contents of this Ebook.

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Physical restrain: →last

resort if patient is putting himself/others at risk

→shortest possible

time/minimum force

Pharmacological Support →can

be treated with sedatives (ex. haloperidol)

→ benzodiazepines

if alcohol, withdrawal

Principles: -visual and hearing aids functional -clock/calendar and photographs is provided -decrease background noise -limit the number of health care professional handling the patient -use short statements / close questioning Dementia →Is

an umbrella describing a syndrome

→not

a normal part of the aging process

→progressive

and incurable Four common types: 1.Alzheimer’s (60%) 2. Vascular (15-30%) 3.Lewy body (4-20%) 4.fronto-temporal (22%)

Evidence based approach


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  

can use communication book/cards allowing non-verbal communication; let them point at things encourage the patient to communicate in whichever way suits him best ACQUIRED COMMUNICATION DISORDERS

APHASIA/DYSPHASIA -affect how someone uses language; may be temporary or permanent DYSARTHRIA – slurred speech “garalgal” DYSPRAXIA – jumbled words “bulol” DYSPHONIA – voice disorder Support: -writing/drawing can help -signposting -interpreter/sign language THE PERSON WHO IS BLIND OR PARTIALLY SIGHTED: -always say who you are -provide his/her glasses within reach -indicate when you are leaving DEAF/HARD OF HEARING: -suitable place to communicate (avoid loud noisy places) -use natural facial expressions -be prepared to repeat yourself



ELIMINATION


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VOMITING → When

CTZ (Chemoreceptor trigger zone) and vomiting center are triggered CLASSES OF ANTIEMETICS 





Antihistamines -Cyclizine – less sedating, commonly used as first-line treatment for post-op patients Dopamine antagonist -Metoclopramide and domperidone also act on receptors in GIT which can reduce abdominal bloating -neurological side effects with long term used and higher doses -Levomeprazine – broad spectrum sedating and analgesic effect often for palliative care setting Other antiemetics Benzodiazepine – works in CNS to inhibit GABA neurotransmitter Hyoscine hydrobromide – anticholinergic –acts directly on the vomiting center Cannabinoids –inhibit nausea and vomiting caused by substances that irritate the CTZ Neurokinin – 1 antagonist –acts on NK1 receptors in CTZ, most effective treatment of chemotheraphy induced nausea and vomiting when used in conjuction with HT3 antagonist and dexamethasone

INSERTION OF NGT (NASOGASTRIC TUBE) →for

patients who are vomiting large amounts

→for drainage

of gastric contents

Wide-bore NGT – for drainage Fine-bore NGT – for enteral feeding →must

be decided by at least 2 health care professional (including the

doctor)


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→needs

verbal consent

*Most effective way to check for placement of NGT is through Xray *testing if ph level is between 1 - 5.5 means gastric acid →if

ph is more than 5.5 may be pulmonary aspirate (wrong placement) STEPS FOR NGT INSERTION

Explain → Consent → Preparation of materials →Wash hands → Don gloves → Place the patient on a Sittingposition→ Measure from the tip of the nose to earlobe then measure 5cm below the sternum → note the insertion length→ Lubricate the tip of the tube →offer sips of water to the patient while advancing the tube→ Advance the tube until the desired length of insertion is reached→ secure the NGT → Attempt to aspirate gastric contents (to assess ph atleast30ml ) → close the NGT port → Dispose the materials to the clinical waste bin → disinfect and inform the patient that the procedure is over → document → request forCXRtoconfirm placementofthetube

URINARY CATHERIZATION →use

aseptic technique

→use

sterile water only to fill the catheter balloons

→choose

the smallest size of the catheter necessary for adequate drainage

TYPES OF CATHETHER 





Balloon (two way foley) – for short , medium or long term bladder drainage Balloon (three way foley) – for continuous irrigation ex. Post prostatectomy Non balloon (intermittent, one channel only) – to empty bladder intermittently, to instill solutions to the bladder


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*Avoid contact between the drainage bag and the cathether to prevent infection. *Ensure that the drainage bag is placed lower than the patients bladder to prevent back flow which may lead to infection. SUPRAPUBIC CATHETERIZATION →insertion

of the catheter through the anterior abdominal wall into the dome of the bladder →done

by experienced urology staff using ultrasound imaging

Indication:    

Post op drainage of urine after lower urinary tract and bowel surgery Management of neuropathic bladders Long term conditions(MS) or spinal cord injuries People with long term catheters to decrease the risk of urethral infection or drainage

BLADDER IRRIGATION →Continuous

washing out of the bladder with sterile fluid usually 0.9% normal saline →3 way catheters are used →performed to prevent formation and retention of blood clots, for example following prostatic surgery *Catheter bag changes are every 5-7 days Pharmacological support: →0.9% sodium chrloride

is used instead of sterile water for irrigation because the latter can be absorbed by osmosis →it

is important to monitor the fluid balance during irrigation

NEPROSTOMY TUBES Indications: 

Relief of urinary obstruction


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  

Urinary diversion Access for therapeutic interventions Diagnostic testing >if flushing is required, must be 5 ml of 0.9% sodium chloride using an aseptic technique >nephrostomy bag changes once it is ¾ full >drainage bag should be every 5-7 days >tubes must be change every 3 months

ALTERED FECAL ELIMINATION Diarrhea – passage of 3 or more loose stools per day

Constipation

Acute diarreha – less than 2 weeks

→type

Chronic diarrhea – more than 2 weeks

→less

Pharmacological support: drugs – loperamide or codeine; must rule out any infective agent first



→fluid replacement



Support:







Maintain dignity, skin care

than 3 bowel movements per week

Support:

→ Antimotility

– 1st step in managing diarrhea; additional 200ml per loose stool

1 and 2 bristol chart



Diet – increase fiber (insoluble/soluble) Positioning – ‘ccrouch like; using bed pan) Exercise Other treatment – biofeedback, rectal irrigation

Diet – decrease fiber, roughage


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Enemas →administration

of liquid substance into the rectum either to aid bowel evacuation or to administer medication Contraindication:       

Paralytic ileus Colonic obstruction Prone to circulatory overload Prone to hemorrhage/perforation With sutures in gastro/gyne Ulcerative conditions in the large bladder Recent radiotherapy to the lower pelvis unless with medical consent

Suppositories →semi-solid

bullet shaped, melts once into the rectum

Indications: -To empty the bowel prior to certain types of surgery or investigations -acute constipation -before endoscopic exam -to introduce medication into the system To soothe and treat haemorrhoids or anal pruritus Digital Rectal Examination →invasive

procedure, nursing assessment and consent is needed

Digital removal of feces → beware

of autonomic dysreflexia especially for patients with injury in sixth thoracic vertebrae or above. Please do not share or distribute the contents of this Ebook.

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May cause severe headache – stop immediately! Indications: -fecal impaction -incomplete defecation -inabilty to defecate -neurogenic bowel dysfunction -patients with spinal cord injury STOMA CARE →primary

aim for stoma care is to promote patient independence by providing care and advice on managing the stoma

Types of Stoma 





Colostomy – any section of the large bowel most commonly sigmoid colon -formed stool, 2 to 3x stool passage/day -uses closed appliance drainage -change 1 or 2x a day when bag is half full -advise balance and mixed diet Ileostomy – more liquid stool -uses drainage applicance -empty when half full -change bag every 1 to 3 days -may excoriate skin so change promptly when needed -may sometimes need to decrease peristalsis so take loperamide or codeine at least ½ before food for optimal effect Urostomy/ileal conduit – urine and stool -uses urostomy appliance -empty when half full -change every 1-3 days -normal output is 1500 ml/day or less depending on fluid intake


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-may place (fine bore catheters) to maintain patency = may be in situ for 7-10 days -diet: 1.5 to 2 liters/day -may want to avoid wind causing food such as beans 

MOVING AND POSITIONING

→The

aim is to reduce impairment, facilitate function and alleviate symptomatic discomfort and to assist future rehabilitation where appropriate. →To

prevent pressure ulcer, turn the patient side to side every 2 hours unless contraindicated. Effects of bed rest/ decreased mobility • deconditioning of many of the body’s systems (particularly cardiorespiratory and musculoskeletal) • deterioration of symptoms • fear of movement • loss of independence • social isolation (Creditor 1993, Hanks 2010). RISK ASSESSMENT – REMEMBER “TILE” T Task/operation : achieving the desired position or movement. I Individual : this refers to the handler/s. In patient handling, this relates to the skills, competencies and physical capabilities of the handlers. It is also important to consider health status, gender, pregnancy, age and disability. It is also important to consider the competency and abilities of all staff involved with the task. L Load : in the case of patient handling, the load is the patient. The aim of rehabilitation is where possible to encourage patients to move for themselves or contribute towards this goal. This may mean that Please do not share or distribute the contents of this Ebook.

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additional equipment is needed. For assistance with regard to this, liaise with the physiotherapist and/or occupational therapist. E Environment : before positioning or moving the patient, think about the space, placement of equipment and removal of any hazards. PREVENTION OF FALLS • Hydration: making sure patients have something to drink. • Checking toilet needs. • Ensuring patients have the right footwear. • Decluttering the area. • Making sure patients can reach what they need, such as the call bell. • Making sure bedrails are correctly fi tted. • Ensuring patients have an appropriate walking aid, if applicable Positioning the patient: in bed SUPINE Evidence-based approaches Rationale: Falls from the bed are common and this must be considered when positioning a patient in bed. Equipment Sliding sheets are used to assist patients to roll or change position in bed. Due to the slippery surface of the slide sheet fabric, friction is reduced and it is easier to move or relocate the patient with very minimal eff ort or discomfort. Positioning the patient: sitting in bed Evidence-based approaches Rationale: Patients should be encouraged to sit up in bed periodically if their medical condition prevents them from sitting out in the chair. If the patient is unable to participate fully in the procedure, manual handling equipment should be used to help achieve the desired position. Attention should also be given to sitting posture. Poor posture is one of the most common causes of low back pain which may frequently be brought on by sitting for a long time in a poor position (McKenzie 2 006 ) as it causes increased pressure in the disc (Claus et al. 2008 ). Please do not share or distribute the contents of this Ebook.

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Contraindications Post lumbar puncture, patients should lie fl at to prevent dural headache in accordance with local policy. Spinal instability - Log rolling for suspected/confi rmed cervical spinal instability).

Positioning the patient: side-lying Evidence-based approaches Indications - This can be a useful position for patients with: • compromised venous return, for example; pelvic/abdominal mass, pregnancy • global motor weakness • risk of developing pressure sores • unilateral pelvic or lower limb pain • altered tone (see ‘Moving and positioning the patient with neurological impairment’) • fatigue • chest infection, for gravity -assisted drainage of secretions • lung pathology (see ‘Moving and positioning the patient with respiratory compromise’) • abdominal distension, for example ascites (intraperitoneal accumulation of a watery fl uid), bulky disease, to optimize lung volume (see ‘Moving and positioning the patient with respiratory compromise’). Contraindications : Suspected or actual spinal fracture or instability. ASSISTING THE PATIENT FROM LYING DOWN TO SITTING UP → Ask

the patient to push through the underneath elbow and the upper arm on the bed to push up into sitting. As the patient sits up, monitor changes in Please do not share or distribute the contents of this Ebook.

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pain or dizziness which could indicate postural hypotension or vertigo. Be aware that the patient with neurological symptoms or weakness may not have safe sitting balance and may be at risk of falling. → To

help to lever the patient into a sitting position using the weight of their legs. E

ASSITING THE PATIENT TO WALK →Stand

next to and slightly behind the patient. If patient requires support, place your arm nearest the patient lightly around their pelvis. Your other hand should hold the patient’s hand closest to you. Observe changes in pain as the patient walks. To give appropriate support. E To assess patient safety and reduce the risk of falls. E To increase patient confidence. E Pressure cushion - This is a piece of equipment designed to evenly redistribute the weight of a patient to provide pressure relief for those who are vulnerable to skin breakdown . It is an effective aid to increasing patients’ sitting tolerance. There are various types available and they are usually provided by the OT (occupational therapist) specific to the needs of the patient.

POSITIONING TO MAXIMIZE DRAINAGE SECRETION →Position

patient with segment to be drained uppermost. Use gravity to facilitate drainage of secretions. Bronchopulmonary segment needs to be perpendicular to gravity. E 

NUTRITION, FLUID BALANCE AND BLOOD TRANSFUSION →Human

body is 60% water


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Fluid balance charting – allows to carefully monitor the fluid intake and output and calculate the fluid balance Positive fluid balance means Input is greater than output.

HYPERVOLEMIA -edema initially apparent in ankles/legs or buttocks/sacrum -bounding pulse Increase blood pressure -one of the most dangerous symptoms is pulmonary edema Management: -restrict fluid intake -monitor electrolytes -diuretics -vasodilators

HYPOVOLEMIA (Dehydration) -negative fluid balance Management: -replace fluid loss *If patient has low BMI or malnourished, refer to dietician *If patient cannot sit or stand, use bed scales to measure weight, and use wrist and elbow to Please do not share or distribute the contents of this Ebook.

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measure height. 

SIP FEEDS – are considered as ‘complete feeds’  Glucose polymer –unsuitable for diabetic patients  Anti-emetics – must be given 30 minutes before meal tme DYSPHAGIA MANAGEMENT →refer

to speech and language therapist E

→possible

need for enteral tube feeding

TRANSFUSION OF BLOOD AND BLOOD COMPONENTS →all

blood donated in the UK is given voluntarily and without remuneration 3 Key Principles for blood component transfusion process 

Patient identification  Documentation  Communication *Jehovah’s witness – may refuse blood transfusion -important to document and record consent -may ask guidance to hospital liason committee (HLC) if autologous (self blood) is okay MASSIVE BLOOD LOSS MANAGEMENT -50% blood volume loss within 3 hours or 150ml/min -if emergency, transfuse blood type O; then ask the lab (10 mins result) transfuse correct specific blood. *BLOOD TRANSFUSION SET* -changed every 12 hours or after every second unit for a continuing transfusion -aseptic technic *Blood warming device – maintain blood below 38⁰C POST PROCEDURE Please do not share or distribute the contents of this Ebook.

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Watch out for: Shivering, pain, shortness of breath, anxiety ; Check VS INITIAL MANAGEMENT OF SUSPECTED TRANSFUSION REACTION       

STOP the blood transfusion and seek medical help Keep vein open Call emergency team if appropriate ex.Hyperkalemia signs Check VS Recheck patient identity Inform transfusion lab and urgently seek for haematologist Return transfused product to the lab with new blood sample from patient opposite arm

ACUTE HEMOLYTIC REACTIONS -due to ABO incompatibility -Reverse hypotension and adequate renal perfusion

ACUTE ANAPHYLAXIX REACTIONS -bronchial spasm -respiratory distress -abdominal cramps -shock -potential loss of consciousness


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HYPERKALEMIA – SEEK MEDICAL TEAM -anxiety -abdominal cramps 

PATIENT COMFORT AND END OF LIFE CARE

-diarrhea -Weakness in extremities

PALLIATIVE CARE → total care for incurable patient END OF LIFE CARE → holistic care until death care and bereavement ; for both patient and family TERMINAL CARE → irreversible death ;few hours to weeks care 4 MOST COMMON SYMPTOM OF DYING PATIENT -pain -sickness -nausea -respiratory secretions GUIDELINES FOR SYMPTOM CONTROL 

Pain – assess; analgesics  Nausea and vomiting – antiemetics  Respiratory secretions – antimuscarinic  Agitation – anxiolytics discuss with relatives  Breathlessness – low dose opiods and anxiolytics IMMEDIATE CARE: →dead

body must stay in the ward for 1-2 hours only



RESPIRATORY CARE


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RESPIRATORY FAILURE 



Type 1 (hypoxemic respiratory failure) -failure to oxygenate the tissues PaO2 is less than 8 -ex. Pneumonia pulmonary edema, respiratory distress syndrome Type 2 (hypercapnic) -raised carbon dioxide or respiratory pump failure -alveolar ventilation is insufficient -the PCO2 iis more than 6 -ex. COPD, chest wall deformities, drug overdose, chest injury

Oxygen must be prescribed. *E* Venturi mask → for those at risk of CO2 retention. HUMIDIFICATION →less

than optimal humidification will lead to reduction of adequate ciliary activity causing mucus to thichken which might cause infection TRACHEOSTOMY →surgical

creation of an opening (stoma) in the anterior wall of the trachea to facilitate ventilation TOTAL LARYNGECTOMY →permanent

stoma is formed by stiching the end of trachea to the skin of

the neck INDICATIONS FOR TRACHEOSTOMY      

Obstructed upper airway Prolonged artificial ventilation Reduced consciousness levels Prolonged cough, at risk of aspiration Upper airway surgery Patient has undergone laryngectomy - permanent

SPEECH AND LANGUAGE THERAPIST → assessment and management of patients with impaired swallowing and speech


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ANESTHETIST → for airway emergency, discharge coordinators and community teams for patients with airway concerns who are going home *Humidification of a tracheostomy is important to prevent drying of the airway resulting in thickened airway secretion TRACHEAL SUCTIONING insert catheter 10-1cm, slowly withdrawing the catheter, suction for max of 10 seconds only. →

CARDIOPULMONARY RESUSCITATION *SA Node – is the natural pacemaker of the heart CARDIAC ARREST → a sudden interruption of cardiac output 4 ARRYTHMIAS THAT CAUSE CARDIAC ARREST 

Asystole  Ventricular fibrillation (VF)  Pulseless ventricular tachycardia (VT)  Pulseless electrical activity (PEA) ***VF and PULSELES VT require DEFIBRILLATION. E RESUSCITATION- is the emergency treatment of any condition in which the brain fails to receive enough oxygen. TAMPONADE

→ acute

effusion of fluid in the pericardial space

-usually by trauma -immediate treatment: insertion of a catheter or surgical drainage of the fluid CPR - Principles of care: Stages of assessment 1. Check for safety 2. 2. Check for injury (especially cervical spine) 3. Check for level of consciousness by gently shaking the shoulders asking if he’s okay Please do not share or distribute the contents of this Ebook.

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IF UNRESPONSIVE   

call for help open airway IF NOT BREATHING: GIVE 30 CHEST COMPRESSIONS THEN 2 RESCUE BREATHS

DEFIBRILLATION → causes simultaneous depolarization of the myocardium   

aims to restore normal rhythm of the heat definitive treatment for VF and pulseless VT early defibrillation is vital link in the chain of survival

VENTRICULAR FIBRILLATION → a condition which the lower chambers of the heart beat too fast Symptoms: *loss of consciousness is the most common sign of VF Management:   



call for help immediately if unconscious: check for pulse if no pulse: begin CPR to help maintain blood flow until defibrillator can be given push hard and fast on the persons chest about 100 compressions per minute METHODS OF BASIC LIFE SUPPORT – ABC

AIRWAY  check for obstruction  Head tilt chin lift maneuver BREATHING  Look, listen and feel for breathing for 10 seconds >if breathing – recovery position >if not – call for help >artificial ventilation must commence Please do not share or distribute the contents of this Ebook.

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>compression then ventilation, bag valve can be used to prevent cross infection >most effective method of airway management is endotracheal tube because it can deliver 100% 02. CIRCULATION  Look for any signs of movement including swallowing or breathing >check if carotid pulse for 10 seconds >if no circulation: perform compressions – lower half of sternum depth – 5 to 6 cm >100-120 times/min; 30 compressions then 2 breaths (30:2 according to RCUK) ***if no trained nurse is available, any staff should attempt to use AED defibrillator.*** right electrode – right sternum below clavicle left paddle – vertically midaxillary line

Pharmacological Support for Cardiac arrest: 

Drugs should be considered only after a sequence of shocks and compressions started (RCUK)

Adrenaline (1mg) – given IV every 3-5 minutes; inotropic effect; to maintain coronary and cerebral perfusion Amiodarone (300mg in 20 ml) – should be considered in VF or pulseless VT; increases the duration of the action potential in the atrial and ventricular myocardium Lidocaine can still be used if amiodarone is not available (RCUK) Calcium chloride (10ml of 10%) – only given during resuscitation; for treatment of pulseless electrical activity caused by hyperkalemia, hypocalcemia or overdose of calcium channel blocking drugs (RCUK) Sodium Bicarbonate 8.4% - only used for prolonged cardiac arrest or according to serial blood gas analyses. Please do not share or distribute the contents of this Ebook.

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ASSESSMENT AND RECORDING TOOLS UTSTEIN TEMPLATE (RCUK) – during and after cardiac arrest should be documented for auditing purposes NEWS (NATIONAL EARLY WARNING SCORE) -a track and trigger system which alert nurses when a patient is deteriorating in order to initiate interventions and ealy referral to critical care outreach teams (NICE) SBAR (SITUATION, BACKGROUND, ASSESSMENT, RECOMMENDATION) -a structured communication tool to help identify at risk patients in a timely manner (RCUK)


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PART THREE – SUPPORTING THE PATIENT THROUGH THE DIAGNOSTIC PROCESS



INTERPRETING DIAGNOSTIC TESTS

*If a specimen is infectious – put “danger of infection’ label *If a specimen is biohazard -put a ‘biohazard label’ -double bagged it -transport it to the lab in a secure box with fascinable lid *If a patient suffers from loss of consciousness – call for assistance and ensure the patient’s safety until they recover BIOCHEMISTRY 



SODIUM ( 135-145 MMOL/L) -main function is to maintain ECF volume; acid base balance; transmitting nerve impulses HYPERNATREMIA – may be due to dehydration; diarrhea; excessive sweating; increase urinary output or poor oral fluid intake HYPONATREAMIA – may be due to fluid retention POTASSIUM (3.5-5.3 MMOL/L) -major role is nerve conduction; muscle function; acid base balance and osmotic pressure(PULL) -helps to control the heart muscle contraction HYPERKALEMIA – MOST COMMON CAUSE IS CHRONIC RENAL FAILURE (KIDNEYS ARE UNABLE TO EXCREE POTASSIU) -urgent treatment is required because it may result to cardiac arrest HYPOKALEMIA – loss of potassium in the kidneys during treatment with thiazide diuretics; excessive/chronic diarrhea



UREA (2.5-6.5 MMOL/L)


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-elevated levels may indicate poor kidney function 



CREATININE (55-105MMOL/L) -elevated levels may indicate poort kidney function CALCIUM (2.20-2.60MMOL/L) -mostly stored in the bone but ionized calcium is in the blood plasma circulation -importance in transmission of nerve impulses and functioning of cardiac and skeletal muscle -also vital for blood coagulation HYPERCALCEMIA – can be due to hyperthyroidism; hyperparathyroidism; malignancy – can lead to cadiac arrythhimia – cardiac arrest HYPOCALCEMIA – often associated with vitamin D deficiency; excitability and cardiac arryhtmias; common in chronic renal failure



C-REACTIVE PROTEIN (<10MG/L) -useful indication of bacterial infection; monitored after surgery if high risk Antimicrobial drug assay – monitoring of blood serum of particular antimicrobial drug to be therapeutically effective and to prevent toxicity *In venipuncture, Metacarpal veins are used only when others are not accessible. * 3 sputum samples are required in care of suspected mycobacterium tuberculosis. *The patient needs to fast for 4 hours prior to gastroscopy to ensure that the stomach is relatively empty. *MRI does NOT use ionizing radiation so it can be used for repeated examinations. 

OBSERVATIONS


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*All patients in hospital should have their observations taken at least once every 12 hours; unless specified by senior staff. *Must take into consideration: -the patient diagnosis -plan for treatment -any co morbidities *ASSESSMENT OF PATIENT WITH BRAIN DYSFUNCTION A - alert V - verbal P - pain U – unresponsive *SBAR TOOL (Situation – Background – Assessment – Recommendation) -assist with structuring and standardizing communication when reporting concern *Pulse - note for: rate; rhythm; amplitude NORMAL PULSE RATE PER MINUTE AGE

APPROX. RANGE

1 WEEK – 3 MONTHS

100-160

3 MONTHS – 2 YEARS

80-150

2 – 10 YEARS

70 -110

10 YEARS - ADULT

55 – 90

CARDIAC OUTPUT (CO) – amount of blood pumped out by each ventricle in 1 minute. -product of HR (heart rate) and SV (stroke volume) 

TACHY CARDIA - heart rate of >100bpm


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-may result from increase temperature; stress; certain drugs or heart disease BRADYCARDIA – heart rate of less than 60 bpm -may result from decrease temperature; certain drugs or parasympathetic nervous system -may result in inadequate circulation to body tissues -often a warning of brain edema after head trauma and is one of the indications of increase intracranial pressure RHYTHM - sequence of beats; regular ability of cardiac muscle to contract inherently without nervous control FIBRILLATON – a condition of rapid and irregular heart contractions -ineffective pumping of the heart ATRIAL FIBRILLATION –is a disruption of the rhythm in the atrial areas of the heart occurring at extremely rapid and uncorordinated intervals VENTRICULAR FIBRILLATION –results in cardiac arrest and death if not reversed with defibrillation and the injection of adrenaline. ECG – identify abnormalities in electrical activity as the heart beats; changes in the pattern or timing of the deflection AMPLITUDE – reflection of pulse strength and elasticity of the arterial wall 12 lead ECG – gold standard for diagnostic purposes. BLOOD PRESSURE  

SYSTOLIC PRESSURE – peak pressure of the left ventricle DIASTOLIC PRESSURE – when the aortic valve closes ; aorta recoils back


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HYPOTENSION - bp <100mmmhg; may indicate orthostatic hypotension HYPERTENSION –BP =>140/90 MMHG RESPIRATION – 2 ZONES 1. CONDUCTING ZONE -nasal cavity -trachea -bronchi 2. RESPIRATORY ZONE -bronchioles -alveolar ducts -alveoli AIRWAY ASSESSMENT – ask a question to the patient; normal verbal response confirms that the patient’s airway is clear PULSE OXIMETRY – check if continuous ; change site every four hours -below 90% O2sat is of concern ; normal is between 94 – 98% ABG

→ gold standard for monitoring

arterial o2sat →invasive; time consuming ; costly and provides intermittent information

PEAK FLOW – PEAK EXPIRATION FLOW (PEF) → highest flow achieved on forced expiration from maixmum lung inflation in LPM (liters per minute). →a test of lung function; to detect respiratory disease; particularly asthma and airway obstruction PEF <50% = severe asthma PEF 33% = acute life threatening asthma TEMPERATURE – balance between heat production and heat loss *41⁰C - can cause convulsions *43⁰C - renders life unsustainable Please do not share or distribute the contents of this Ebook.

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HYPOTHERMIA - occurs when body loses more heat 35⁰C

Mild

28-32⁰C

Moderate

<28⁰C

Severe

HYPERTHRMIA 38⁰C

Low grade pyrexia

38-40⁰C

Moderate to high grade pyrexia

40⁰C and above

High grade pyrexia

URINALYSIS >urinary tract is the most common site of bacterial infection >no urine testing for women 2-3 days after menstruation finishes because it may contain leukocytes and erythrocytes Timed urinalysis – focuses on renal creatinine clearance of sodium and potassium protein.; to determine glomerular filtration rate and follow progress of renal disease. BLOOD GLUCOSE DIABETES – heterogenous disorder chronic hyperglycemia due to lack of insulin or complete insulin deficiency or the body’s resistance to it.

TWO MAIN TYPES 1. TYPE 1 – autoimmune process; destruction of pancrease ; complete loss of insulin – younger patients, need insulin replacement 2. TYPE 2 – resistance to insulin Please do not share or distribute the contents of this Ebook.

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- Older patients; obesity, age, family history - Also steroid use, pancreatic cancer NEUROLOGICAL OBSERVATION NERVOUS SYSTEM – most complete body system responsible for the coordination of all body functions; adapting to changes in internal and external environments >assessment of arousal – focuses on patient’s ability to respond appropriately to verbal and non verbal stimuli 1. normal tone 2. increased voice tone 3. gentle shaking 4. noxious (painful stimuli) RESPIRATORY RATE – is the clearest indication of brain function because it is controlled by: -cerebral hemispheres -cerebellum -brainstem *protect airway is essential especially if reduced consciousness or coma GCS <8 ABNORMAL RESPIRATORY PATTERNS CHEYNE-STOKES - >16-24 breaths/min -may indicate deep cerebral or cerebellar lesions CENTRAL NEUROGENIC HYPERVENTILATION -rapid forced respiration APNEUSTIC -prolonged inspiration with pauses CLUSTER BREATHING -irregular breathing with long periods of apnea ATAXIC BREATHING -irregular breathing with deep and shallow irregular pauses 









BP AND PULSE


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

CUSHING’S REFLEX – widening pulse pressure, bradycardia and decrease respiration may indicate increasing intracranial pressure.

FRQUENCY OF OBSERVATION -if deteriorating – as frequent as q10-15mins then 1-2 hourly further for 48 hours. GLASGOW COMA SCALE -widely used to assess level of consciousness – patients with head injury E – EYE OPENING (4) V – VERBAL RESPONNSE (5) M – MOTOR RESPONSE (6) PROPRIOCEPTION – is the receipt of information from muscles and tendons in the labyrinth that enables the brain to determine movements and position of the body. Acccording to NICE (2007) recommended observations in the hospital must be taken at least every 12 hours.

BREATHING ASSESSMENT 4 KEY COMPONENTS: 1. SKIN COLOR 2. 2. USE OF ACCESSORY MUSCLES 3. RATE, RHYTHM AND DEPTH OF RR 4. SHAPE AND EXPANSION OF CHEST


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PART FOUR - SUPPORTING THE PATIENT THROUGH TREATMENT 

 



MEDICINES MANAGEMENT

PHARMACOLOGY – study of the effecs of drugs PHARMACOKINETICS –absorption, distribution, metabolism and excretion drugs; concentration of the drug in the body over a period of time can be determined ; what the BODY does to the drug PHARMACODYNAMMICS – what the DRUG does to the body

THE MEDICINES ACT OF 1968 –licensing procedures for medicinal products CATEGORIES: 

 

Prescription only medicines (POM)/Patient Group Direction (PGD) Pharmacy only medicine (P) General Sales List medicines (GSL)

*All medicines administered in the hospital must be considered ‘prescription only’ INDEPENDENT PRESCRIBING – allows nurses to prescribe medicines after training of 26 days. SUPPLEMENTARY PRESCRIBING – voluntary prescribing; partnership between independent and supplementary prescriber according to care management plan of the patient

KEY PRINCIPLES IN SUPPLEMENTRARY PRESCRIBING   

Communication between prescribers Access to shared patient records Patient is treated as a partner


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UNLICENSED AND “OFF LABEL” MEDS – drugs with no marketing permission (imported); drugs used not for their intended effect VERBAL ORDERS - are not acceptable; changes must be updated before drug can be administered within 24 hours; must be authorized before the new dosage is administered. DISPENSING – to label from stock and supply a clinically appropriate medicine usually against a written prescription (usually from pharmacy department)

    

5 RIGHTS PATIENT MEDICINE ROUTE TIME DOSE

ADVERSE DRUG REACTIONS (ADR) 



TYPE A (AUGMENTED) –exagerration of medicine’s normal effect (ex. respiratory depression with opiods; bleeding with warfarin) ; more common TYPE B (BIZAARE) – not predictable (ex. Anaphylaxis with betalactam antibiotics)

PHARMACOVIGILANCE – preventing and detecting adverse effects from medicine YELLOW CARD SCHEME – post marketing surveillance, how medicines affect the patients. CONTROLLED DRUGS MIDAZOLAM GUIDANCE -ensure storage and use of high strength midazolam are restricted to general anesthesia, ICU, palliative care -ensure other clinical areas use low strength midazolam (1mg/ml in 2ml or 5 ml amps) Please do not share or distribute the contents of this Ebook.

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-ensure stocks of flumazenil is available -ensure sedation is covered by organization protocol and that overall responsibilities are assigned to a senior clinician (anesthetist) FLUMAZENIL – used for reversal of benzodiazepine toxicity NALOXONE – a specific opiod antagonist reverses the effect of opiod analgesic *All patients who are prescribed an opiod regularly should be prescribed laxatives concurrently to prevent constipation *care must be given to patients who have opiod induced drowsiness, confusion, hallucination that are not life threatening as this may reverse the opiod analgesic effect *Naloxone may rarely be needed opiod induced respiratory depression is <8/min ROUTES OF ADMINISTRATION Enteral – uses GI Parenteral – injections (bypasses GIT) Topical 0 thru the skin and mucous membranes (also bypasses the GIT)   

PULMONARY ADMINISTRATION Nebulization – passage of air or 02 driven thru a solution drug using facemask Metered dose inhalations – using a spacer device Dry powder inhalers – useful when there’s a problem with coordination 

 

SUBCUTANEOUS INJECTION -maximum 2 ml of drugs -usually 25G needle; 45⁰ angle INTRAVENOUD INJECTIONS AND INFUSIONS *Metacarpal veins are used if other veins are not accessible. *Direct intermittent injection aka (IV push or bolus) - administered within 3 minutes -if maximum concentration of drug is required to vital oragans as in an emergency Please do not share or distribute the contents of this Ebook.

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→ Asepsis

and reducing the risk of infection →replace solu-sets and stoplocks used for continuous infusion every 96 hours unless clinically indicated →replace blood administration sets at least every 12 hours andafter every second unit of blood (5hours) Safety: -check details/compatibility -drugs should never be added: blood, blood products, plasma or plasma concentrate -ensure accurate labelling -if with latex allergy = use vinyl gloves -prevent needle stick injuries DRUG AND IV CALCULATION (D / S) X Q *Required dose (D) divided by Stock (S) multiply by quantity (Q) usually in ml. FLOW RATE CALCULATION Volume to be infused divided by time in hours to be consumed Multiply by drop rate divided by 60 minutes = drops per minute *Don’t get overwhelmed; there are only about 3 to 5 computation questions which are BASIC ones, just brush up on simple conversions to make it a lot easier. PATIENT CONTROLLED ANALGESIA (PCA) – for patients who require pain control -initial bolus is called “loading dose”, has a “lock out” prevention to prevent overdose -if the patient cannot control it, ask the pain management team to discuss other options COMPLICATIONS Please do not share or distribute the contents of this Ebook.

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PHLEBITIS – redness and swelling on IV site -discontinue if Grade 2; if over Grade 3 refer to doctor -apply warm or cold compress -if with bacterial infection – specimen culture and send the cannula to microbiology HEMATOMA – careful selection of the vein and device is key -apply ice pack if bruising INFILTRATION –leakage of non-vesicant solutions/meds into the surrounding tissues -document, observe and assess ALLERGIC REACTION –chills, fever, erythema, itching and wheezing with or without shortness of breath -if with shortness of breath may indicate anaphylactic shock -infusion should be stopped immediately -keep vein patent, notify the doctor CIRCULATORY OVERLOAD -sit the patient upright -may withhold fluid, give diuretics -monitor fluid balance DEHYDRATION - Fluid intake, ensure fluid and electrolyte balance - SPEED SHOCK - -systemic reaction when a substance foreign to the body is rapidly introduced into the circulation (ex IV bolus) - -for high risk meds, an electronic flow control device is recommended *MHRA – responsible for Licensing Medicinal Products


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

PERIOPERATIVE CARE

INTRAOPERATIVE CARE (3 PHASES) 1. Induction of anesthesia 2. Surgery 3. Recover within (PACU) PREOPERATIVE CARE →psychosocial preparation; prevention of peri and post op complication →assessment aims to reduce cancellations and to reduce patient anxiety PREOP HISTORY -central nervous system - Medical history -endocrine system - Family history -musculoskeletal system - Body system review -surgical and anaesthetic history - Cardiovascular system -medication allergies - Respiratory system - Gastrointestinal system -social history - Alcohol -ECG - Smoking -Chest Xray CARDIOPULMONARY EXERCISE TESTING →2 indicators are derived from the patient’s ability to: 1. body’s maximum 02 uptake 2. anaerobic threshold STRESS TESTING – gold standard in measuring exercise tolerance PREOPERATIVE ASSESSMENT CINIC Assessor roles: - Take a comprehensive health history - Perform physical examination - Order appropriate investigations *If patient is complicated – further review by an anaesthetist is needed


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3 FORMS OF PATIENT EDUCATION  Face to face  Paper based  Internet based CONSENT – is the principle that a person must give their permission before they receive any type of medical treatment -pre op must be done well inn advance -written form; without medications administered yet To be considered VALID *must be given willingly *must be informed *capacity to consent based on Mental Health Act →The surgeon who will perform the procedure ideally asks for consent. PREOP PATIENT SAFETY MEASURES  Namebands  Anticoagulants and Anti-embolic stockings – to prevent blood clots (must be removed for 30 mins max daily)  Pre op fasting – at least 6 hours prior to surgery  Skin prep  Marking skin for surgery – to prevent wrong site  Pregnancy testing – check for consent  Prevent toxic shock from tampons – use pads  Assess latex allergy  Comprehensive pre op checks THEATRE – positive pressure to carry pathogens away from the wound COMPARTMENT SYNDROME – life threatening complication of Lloyd Davies position -causes decrease perfusion below tissue pressure due to prolonged ischemia -remove legs from support every 2 hours PACU Please do not share or distribute the contents of this Ebook.

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Pain → most common adverse effect of surgery →should not be discharged from PACU until satisfactory pain control has been achieved Post of Nausea and Vomiting – most common as side effect of opiods Hypothermia → <36C monitor for shivering, measure temperature every 30 minutes →record bp, pr, rr 5 minutes interval unless patient condition is stable Hyperthermia >40C → dantolene is used to treat this life threatening condition POST-OP CARE –after transfer from recovery room to ward ;prevention of potential complications is key WATCH OUT FOR THE FF:  COMPENSATED SHOCK –decrease blood flow to the brain -confusion, shallow respirations, pallor,cool skin, visible bleeding  HYPOVOLEMIC SHOCK –aim is to restore adequate tissue perfusion  RESPIRATORY RATE –first vital sign to check for cardiac or neurological complication  SURGICAL WOUNDS – sterile strips and staples are usually removed 7-10 days post op (NICE) 3 CATEGORIES OF WOUND DRESSING Passive – cover wound (ex. gauze) Interactive – promote wound healing (ex. Hydrocolloid dressing, aginates) Active – manipulates or alters wound healing process (ex. collagen, negative pressure therapy) -dressing change within 48 hours of surgery using aseptic non touch technique using sterile normal saline  



COMPLICATION Please do not share or distribute the contents of this Ebook.

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

   

Dehiscence – partial or total disruption of any or all layers of the surgical wound -contact surgical team if major wound; if minor – call wound manager Surgical site infection (SSI) – swab for pus sample, for blood culture Hematoma –if large, contact the surgical team Seroma – collection of serous flud; if large contact the surgical team Allergic reaction – remove allergen; documentation of allergy

URINARY OUTPUT AND CATHETERS IMPORTANT: patient should urinate 6-8 hours ater surgery -oluguria – lees than .5ml for 2 consecutive hours could indicate hypovolemic shock – contact the surgical team NEUROGENIC BLADDER → inability to urinate after surgery BOWEL FUNCTION → if decrease GI peristalsis for more than 3 days may indicate paralytic ileus → withold food unless flatus passage is positive or unless contraindicated  WOUND

MANAGEMENT

Wound → an injury to living tissue

6 Basic Categories 1. contussion (bruise) 2. Abrasion (graze) 3. Laceration (tear) 4. Incision (cut) 5. Puncture (stab) 6. Burn 2 Main Layers of skin 1. Dermis – inner 2. Epidermis – outer layer Methods of wound healing Please do not share or distribute the contents of this Ebook.

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 



Primary interntion – suture or skin adhesive Secondary – wound is left open and heal by contraction and epithelialisation Tertiary – left open and closed primarily after a few days once infection or bleeding decreases

Phases of wound healing 1. hemostastasis (5-10 mins) – clotting cascare 2. inflammatory (1-5 days) – vasodilation 3. proliferation or reconstructive phase (3-24 days) – healing ridge; fibroblasts; granulation 4. maturation or remodelling phase (21 days onward) – may last for more than a year; re-eepithelialization; re-organization METHODS OF WOUND ASSESSMENT (TIME) T- tissue I –infection M-moisture balance E-edge advancement PRESSURE ULCERS –areas of localized tissue damage due to excess pressure, shearing or friction process usually from compromised circulation 4 STAGES 1. superficial damage 2. partial loss of dermis/epidermis 3. damage to dermis and subcutaneous layer 4. tissue necrosis and full thickness skin loss often with tunnelling sinus tracts

NEGATIVE PRESSURE WOUND THERAPY → previously known as topical negative pressure (TNP) → is the application of controlled negative pressure across the wound bed to promote healing Benefits: Please do not share or distribute the contents of this Ebook.

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-management of exudates -decrease wound odour -increase local blood flow -decrease number of dressing changes required Rationale: Negative pressure wound therapy optimized wound healing by stimulating granulation in an enhanced well vascularised wound bed.


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POINTERS FROM RECENT PASSERS (READ ABOUT THESE)



Patient Group Direction Rules (PGD)

 Asystole 

Rotavirus



Sickle Cell Anemia Management

 Adrenaline 

Cardiac Failure



Chronic Renal Failure Signs

 Anaphylaxis

Management



Septic Shock Signs



Supplemental Prescribing



Neutropenia Signs and Management

 Adrenaline/Noradrenaline 

Blood Glucose Monitoring



Tissue viability nurse



COPD


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MOCK QUESTIONS SET 1 1. Which is not a cause of postural hypotension? A. the time of day B. lack of exercise C. temperature D. recent food intake 2. Which is not an expected side effect of lumbar tap? A. Headache B. Back pain C. Swelling and bruising D. Nausea and vomiting 3. A client was diagnosed to have infection. What is not a sign or symptom of infection? A. A temperature of more than 38°C B. warm skin C. Chills and sweats D. Aching muscles 4. What is respiration? A. the movement of air into and out of the lungs to continually refresh the gases there, commonly called ‘breathing’ B. movement of oxygen from the lungs into the blood, and carbon dioxide from the lungs into the blood, commonly called ‘gaseous exchange’ C. movement of oxygen from blood to the cells, and of carbon dioxide from the cells to the blood D. the transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the opposite direction. 5. You noticed that a colleague committed a medication administration error. Which should be done in this situation? A. You should provide a written statement and also complete a Trust incident form. B. You should inform the doctor. C. You should report this immediately to the nurse in charge. D. You should inform the patient.


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6. A patient on your ward complains that her heart is ‘racing’ and you find that the pulse is too fast to the manually palpate. What would your actions be? A. Shout for help and run to collect the crash trolley. B. patient to calm down and check her most recent set of bloods and fluid balance. C. A full set of observations: blood pressure, respiratory rate, oxygen saturation and temperature. It is essential to perform a 12 lead ECG. The patient should then be reviewed by the doctor. D. Check baseline observations and refer to the cardiology team. 7. You are looking after a postoperative patient and when carrying out their observations, you discover that they are tachycardic and anxious, with an increased respiratory rate. What could be happening? What would you do? A. The patient is showing symptoms of hypovolaemic shock. Investigate source of fluid loss, administer fluid replacement and get medical support. B. The patient is demonstrating symptoms of atelectasis. Administer a nebulizer, refer to physiotherapist for assessment. C. The patient is demonstrating symptoms of uncontrolled pain. Administer prescribed analgesia, seek assistance from medical team. D. The patient is demonstrating symptoms of hyperventilation. Offer reassurance, administer oxygen. 8. Why are elderly prone to postural hypotension? Select which does not apply: A. The baroreflex mechanisms which control heart rate and vascular resistance decline with age. B. Because of medications and conditions that cause hypovolaemia. C. Because of less exercise or activities. D. Because of a number of underlying problems with BP control. 9. When do you see problems or potential problems? A. Assessment B. Planning C. Implementation D. Evaluation 10. A COPD patient is about to be discharged from the hospital. What is the best health teaching to provide this patient? A. Increase fluid intake B. Do not use home oxygen C. Quit smoking D. Nebulize as needed


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11. A patient is to be subjected for surgery but the patient’s BMI is low. Where will you refer the patient? A. Speech and Language Therapist B. Dietician C. Chef D. Family member 12. All of the staff nurses on duty noticed that a newly hired staff nurse has been selective of her tasks. All of them thought that she has a limited knowledge of the procedures. What should the manager do in this situation? A. Reprimand the new staff nurse in front of everyone that what she is doing is unacceptable. B. Call the new nurse and talk to her privately; ask how the manager can be of help to improve her situation. C. Ignore the incident and just continue with what she was doing. D. Assign someone to guide the new staff nurse until she is competent in doing her tasks. 13. One busy day on your shift, a manager told you that all washes should be done by 10am. What would you do? A. Follow the manager and ensure that everything is done on time. B. Talk to the manager and tell her that the quality of care will be compromised if washes are rushed. C. Ignore the manager and just continue with what you are doing. D. Provide a written statement of the incident. 14. What do you have to consider if you are obtaining a consent from the patient? A. Understanding B. Capacity C. Intellect D. Patient’s condition 15. A nurse documented on the wrong chart. What should the nurse do? A. Immediately inform the nurse in charge and tell her to cross it all off. B. Throw away the page C. Write line above the writing; put your name, job title, date, and time. D. Ignore the incident. 16. A patient is in the immediate recovery post-surgery. What should you monitor? A. Breathing B. Temperature C. Blood loss D. Pain


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17. You have a DM patient who is non-insulin dependent. How many portions of fruits and vegetables will you administer per day? A. 3 portions B. 4 portions C. 5 portions D. 6 portions 18. A newly qualified nurse is not yet well versed when it comes to documentation. A nurse-in-charge noticed that this is the case and went to report the new nurse to their manager. What could the newly qualified nurse have done in order to prevent this incident? A. Ignore the report and just continue with what she was doing. B. She could have told the manager beforehand in order to have a support and additional training. C. Apologize that she was not able to inform her immediate head beforehand. D. Ask for the policies of the hospital in relation to documentation. 19. What ABG readings will you expect among COPD patients? A. Increased PCO2, decreased PO2 B. Decreased PCO2 & PO2 C. Increased PCO2 & PO2 D. Decreased PCO2, increased PO2 20. A patient was brought to the A&E and manifested several symptoms: loss of intellect and memory; change in personality; loss of balance and co-ordination; slurred speech; vision problems and blindness; and abnormal jerking movements. Upon laboratory tests, the patient got tested positive for prions. Which disease is the patient possibly having? A. Acute Gastroenteritis B. Creutzfeldt-Jakob Disease C. HIV/AIDS D. Hepatitis 21. All are risk factors of Coronary Artery Disease except: A. Obesity B. Smoking C. High Blood Pressure D. Female 22. When would it be beneficial to use a wound care plan? A. On all chronic wounds B. On all complex wounds C. On all infected wounds D. On every wound


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23. What factors are essential in demonstrating supportive communication to patients? A. Listening, clarifying the concerns and feelings of the patient using open questions. B. Listening, clarifying the physical needs of the patient using closed questions. C. Listening, clarifying the physical needs of the patient using open questions. D. Listening, reflecting back the patient’s concerns and providing a solution. 24.How do you value dignity & respect in nursing care? Select which does not apply: A. We value every patient, their families or carers, or staff. B. We respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. C. We find time for patients, their families and carers, as well as those we work with. D. We are honest and open about our point of view and what we can and cannot do. 25.When dealing with a patient who has a biohazard specimen, how will you ensure proper disposal? Select which does not apply: A. the specimen must be labelled with a biohazard B. the specimen must be labelled with danger of infection C. it must be in a double self-sealing bag D. it must be transported to the laboratory in a secure box with a fastenable lid 26. For which of the following modes of transmission is good hand hygiene a key preventative measure? A. Airborne B. Direct Contact C. Droplet D. All of the above 27. What may not be cause of diarrheoa? A. Colitis B. intestinal obstruction C. food allergy D. food poisoning 28. What is the most definitive sign/complication 24 hours after liver biopsy? A. intraperitoneal haemorrhage B. Infection C. biliary peritonitis D. referred pain 29. UK policy for needle prick injury includes all but one: A. Encourage the wound to bleed B. Suck the wound Please do not share or distribute the contents of this Ebook.

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C. Wash the wound using running water and plenty of soap D. Don’t scrub the wound while washing it 30. The following fruits can be eaten by a person with Crohn’s Disease except: A. Mango B. Papaya C. Strawberries D. Cantaloupe 31. A patient was recommended to undergo lumbar puncture. As the nurse caring for this patient, what should you not expect as its complications: A. Swelling and bruising B. Headache C. Back pain D. Infection 32. Mrs Jones has had a cerebral vascular accident, so her left leg is increased in tone, very stiff and difficult to position comfortably when she is in bed. What would you do? A. Give Mrs Jones analgesia and suggest she sleeps in the chair. B. Try to diminish increased tone by avoiding extra stimulation by ensuring her foot doesn’t come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed. C. Give Mrs Jones diazepam and tilt the bed. D. Suggest a warm bath before she lies on the bed. Then use pillows to support the stiff limb. 33. A patient is agitated and is unable to settle. She is also finding it difficult to sleep, reporting that she is in pain. What would you do at this point? A. Ask her to score her pain, describe its intensity, duration, the site, any relieving measures and what makes it worse, looking for non-verbal clues, so you can determine the appropriate method of pain management. B. Give her some sedatives so she goes to sleep. C. Calculate a pain score, suggest that she takes deep breaths, reposition her pillows, return in 5 minutes to gain a comparative pain score. D. Give her any analgesia she is due. If she hasn’t any, contact the doctor to get some prescribed. Also give her a warm milky drink and reposition her pillows. Document your action. 34. A patient has been confined in bed for months now and has developed pressure ulcers in the buttocks area. When you checked the waterlow it is at level 20. Which type of bed is best suited for this patient? A. water mattress Please do not share or distribute the contents of this Ebook.

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B. Egg crater mattress C. air mattresses D. Dynamic mattress 35. What is positive fluid balance? A. A deficit in fluid volume. B. A state when fluid intake is greater than output. C. Retention of both electrolytes and water in proportion to the levels in the extracellular fluid. D. A state where the body has less water than it needs to function properly. 36. How should you position a patient after lumbar puncture? A. flat on bed B. Fowler’s C. semi-fowlers D. side-lying 37. Why would the intravenous route be used for the administration of medications? A. It is a useful form of medication for patients who refuse to take tablets because they don’t want to comply with treatment. B. It is cost effective because there is less waste as patients forget to take oral medication. C. The intravenous route reduces the risk of infection because the drugs are made in a sterile environment and kept in aseptic conditions. D. The intravenous route provides an immediate therapeutic effect and gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable. 38. A patient has collapsed with an anaphylactic reaction. What symptoms would you expect to see? A. The patient will have a low blood pressure and will have a fast heart rate usually associated with skin and mucosal changes. B. The patient will have a high blood pressure and will have a fast heart rate C. The patient will quickly find breathing very difficult because of compromise to their airway or circulation. This is accompanied by skin and mucosal changes. D. The patient will experience a sense of impending doom, hyperventilate and be itchy all over. 39. When is the time to take the vital signs of the patients? Select which does not apply: A. At least once every 12 hours, unless specified otherwise by senior staff. B. When they are admitted or initially assessed. C. On transfer to a ward setting from critical care or transfer from one ward to Please do not share or distribute the contents of this Ebook.

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another. D. Every four hours. 40.What are the principles of gaining informed consent prior to planned surgery? A. Gaining permission for an imminent procedure by providing information in medical terms, ensuring a patient knows the potential risks and intended benefits. B. Gaining permission from a patient who is competent to give it, by providing information, both verbally and with written material, relating to the planned procedure, for them to read on the day of planned surgery. C. Gaining permission from a patient who is competent to give it, by informing them about the procedure and highlighting risks if the procedure is not carried out. D. Gaining permission from a patient who is competent to give it, by providing information in understandable terms prior to surgery, allowing time for answering questions, and inviting voluntary participation. 41.What do you need to consider when helping a patient with shortness of breath sit out in a chair? A. They shouldn’t sit out in a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure on the lungs. B. Sitting in a reclining position with the legs elevated to reduce the u se of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don’t expend any unnecessary energy. C. The patient needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others. D. There are two possible positions, either sitting upright or side lying. 42. If you were told by a nurse at handover to take ‘standard precautions’, what would you expect to be doing? A. Taking precautions when handling blood and ‘high risk’ body fluids so as not to pass on any infection to the patient. B. Wearing gloves, an apron and a mask when caring for someone in protective isolation. C. Asking relatives to wash their hands when visiting patients in the clinical setting. D. Using appropriate hand hygiene, wearing gloves and an apron when necessary, disposing of used sharp instruments safely, and providing care in a suitably clean environment to protect yourself and the patients. 43. On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do? A. Check the cupboard, record book and order book. If the missing drugs aren’t Please do not share or distribute the contents of this Ebook.

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found, contact pharmacy to resolve the issue. Make sure to fill out an incident form. B. Document the discrepancy on an incident form and contact the senior pharmacist on duty. C. Check the cupboard, record book and order book. If the missing drugs aren’t found the police need to be informed. D. Check the cupboard, record book and order book and inform the registered nurse or person in charge of the clinical area. If the missing drugs are not found then inform the most senior nurse on duty. Make sure to fill out an incident form. 44.The following are signs & symptoms of hypovolemic shock, except: A. Confusion C. Strong pulse B. Rapid heart rate D. Decrease Blood Pressure 45.The following must be considered in procuring a consent, except: A. respect and support people’s rights to accept or decline treatment or care B. withhold people’s rights to be fully involved in decisions about their care C. be aware of the legislation regarding mental capacity D. gain consent before treatment or care starts 46. Which is not an appropriate way to care for patients with Dementia/Alzheimer’s? A. Ensure people with dementia are excluded from services because of their diagnosis, age, or any learning disability. B. Encourage the use of advocacy services and voluntary support. C. Allow people with dementia to convey information in confidence. D. Identify and wherever possible accommodate preferences (such as diet, sexuality and religion). 47.All but one, are characteristics of an ideal wound dressing: A. Cost-effective B. allows gaseous exchange C. Low humidity D. Absorbent 48.A 45-year old patient was diagnosed to have Piles (Haemorrhoids). During your health education with the patient, you informed him of the risk factors of Piles. You would tell him that it is caused by all of the following except: A. Straining when passing stool B. being overweight C. Lack of fibre in the diet D. prolonged walking 49.Which behaviours will encourage a patient to talk about their concerns? A. Giving re assurance and telling them not to worry. B. Asking the patient about their family and friends. C. Tell the patient you are interested in what is concerning them and that you are Please do not share or distribute the contents of this Ebook.

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available to listen. D. Tell the patient you are interested in what is concerning them and if they tell you, they will feel better. 50. What is the difference between denial and collusion? A. Denial is when a healthcare professional refuses to tell a patient their diagnosis for the protection of the patient whereas collusion is when healthcare professionals and the patient agree on the information to be told to relatives and friends. B. Denial is when a patient refuses treatment and collusion is when a patient agrees to it. C. Denial is a coping mechanism used by an individual with the intention of protecting themselves from painful or distressing information whereas collusion is the withholding of information from the patient with the intention of ‘protecting them’. D. Denial is a normal acceptable response by a patient to a life threatening diagnosis whereas collusion is not. 51. Effect of toxins released by Clostridium Difficile: A. Ulcerative colitis B. Crohn’s Disease C. Hashimotos Diseases D. Pseudomembranous Colitis 52. Where is the common aneurysm location for an elderly? A. Abdominal B. Hepatic C. Renal D. loop of Willis 53. Patient’s husband died. The brother of the patient saw that she was upset but mentally and physically well. After a few weeks, the patient called her brother and said that her husband died yesterday, she verbalized “I didn’t know he was sick”. She also told her brother that she has been seeing mice and rats in the house. The pt. had difficulty sleeping, had incontinence and pain in urinating. A community nurse visited the patient. She observed that the patient is reclusive, passive but pleasant. What could be the problem? A. delirium due to UTI B. uncoping ability because her husband just died C. onset of Alzheimer’s disease from dementia D. delayed bereavement due to dementia

54. Early signs of phlebitis would include: Please do not share or distribute the contents of this Ebook.

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A. slight pain and redness B. increased WBC C. Pyrexia D. swelling 55. Infected linen should be separated from soiled linen. What type of bag should be used? A. white linen bag to be washed in high temperature B. red plastic bag to be incinerated C. red linen bag to be washed in high temperature D. yellow plastic bag for disposal 56. What to teach a young patient when he is taking antibiotics A. take it during morning and complete the dose B. don’t take it with alcohol C. take it with food or after meal and complete dose D. medication may cause hypotension 57. What do you need to consider when helping a patient with shortness of breath sit out in a chair? A . They shouldn’t sit out in a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure on the lungs. B. Sitting in a reclining position with the legs elevated to reduce the use of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don’t expend any unnecessary energy. C. The patient needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others. D. There are two possible positions, either sitting upright or side lying. Which is used is determined by the age of the patient. It is also important to remember that they will always need a nebulizer and oxygen and the air temperature must be below 20° C. 58. Normal HR of a 2-yr old child: A. 70-130 per minute C. 80-150 per minute B. 60-100 per minute D. 120-160 per minute 59. A doctor is about to apply oxygen therapy to patient via nasal cannula at 2L per minute when he was called for an emergency, and gave the task to you. However you are not trained. What should you do? A. Inform your supervisor that the doctor left you to do it. Please do not share or distribute the contents of this Ebook.

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B. Apply the cannula since you have seen it done before. C. Do not give because you’re not trained and assessed as competent. D. Have a friend help you apply it. 60. Who should be responsible in proper disposal of sharps A. healthcare assistant B. doctor C. registered nurse D. the professional who used the sharp 61. What is clinical benchmarking? A. A systematic process in which current practice and care are compared to, and amended to attain, best practice and care. B. A system that provides a non-structured approach for realistic and supportive practice development. C. The use of clinical data and process analysis to identify possible outcomes. D. Is the process of comparing a practice’s performance with an external standard. 62. How long does the proliferation phase of a wound occur? A. 3-24 days B. 5-21 days C. 4-18 days D. 3-30 days 63. Signs & Symptoms of an Ectopic Pregnancy: • Light vaginal bleeding. • Nausea and vomiting with pain. • Lower abdominal pain. • Sharp abdominal cramps. • Pain on one side of your body. • Dizziness or weakness. • Pain in your shoulder, neck, or rectum. • If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting. Which one is not a sign: A. Vaginal bleeding B. Shoulder tip pain C. Positive pregnancy test D. Protein excretion exceeds 2 g/day 64. Scenario: You are the nurse in charge of the unit and you are accompanied by 4th year nursing students. A. Allow students to give meds B. Assess competence of student C. Get consent of patient D. Have direct supervision


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65. Among the following drugs, which does not cause falls in an elderly? A. Diuretics B. NSAIDS C. Beta blockers D. Hypnotics 66. Which is not a definition of an informed consent? A. a decision to participate in research, taken by a competent individual who has received the necessary information; who has adequately understood the information, and who, after considering the information,has arrived at a decision without having been subjected to coercion, undue influence or inducement, or intimidation. B. a process for getting permission before conducting a healthcare intervention on a person C. the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. D. For consent to be valid, it must be involuntary and informed, and the person consenting must have the capacity to make the decision. 67. What is Supportive Communication? A. To listen and clarify using close-ended questions B. A communication that seeks to preserve a positive relationship between the communicators while still addressing the problem at hand. C. It involves a self-perceived flaw that an individual refuses to admit to another person, a sensitivity to that flaw, and an attack by another person that focuses on the flaw. D. the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. 68. Patient had CVA and can’t speak nor read. What does the loss of speech mean? A. Dysphagia B. Progressive Aphasia C. Aphasia D. Apraxia 69. 5 moments of hand hygience include all of the ff except: A. Before Patient Contact B. Before a clean / aseptic procedure C. Before Body Fluid Exposure Risk D. After Patient contact E. After Contact with Patient’s surrounding 70. All are purposes of NMC except: A. NMC’s role is to regulate nurses and midwives in England, Wales, Scotland and Please do not share or distribute the contents of this Ebook.

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Northern Ireland. B. It sets standards of education, training, conduct and performance so that nurses and midwives can deliver high quality healthcare throughout their careers. C. It makes sure that nurses and midwives keep their skills and knowledge up to date and uphold its professional standards. D. It is responsible for regulating hospitals or other healthcare settings. 71. All but one are Nursing teachings for patients taking Allopurinol: A. Instruct patient to take the drug after meals; B. Educate patient that he may experience these side effects: nausea, vomiting, loss of appetite; drowsiness C. Encourage patient to report unusual bleeding or bruising; fever, chills; gout attack; numbness or tingling; flank pain, skin rash. D. instruct patient to chew medication 72. Select which is not a proper way of Administering Eye Drops? A. Administer the prescribed number of drops, holding the eye dropper 1–2 cm above the eye. If the patient links or closes their eye, repeat the procedure B. Ask the patient to close their eyes and keep them closed for 1–2 minutes. C. If administering both drops and ointment, administer ointment first. D. Ask the patient to sit back with neck slightly hyperextended or lie down. 73. How should we transport controlled drugs? Select which does not apply: A. Controlled drugs should be transferred in a secure, locked or sealed, tamper-evident container. B. A person collecting controlled drugs should be aware of safe storage and security and the importance of handing over to an authorized person to obtain a signature. C. Have valid ID badge D. None of the above 74. In a patient with hourly monitoring, when does a nurse formally document the monitoring? A. Every hour C. When there are significant changes to the patient’s condition B. At the end of the shift D. Mid of shift 75. Appropriate wound dressing criteria includes all but one: A. Allows gaseous exchange. B. Maintains optimum temperature and pH in the wound. C. Forms an effective barrier to Please do not share or distribute the contents of this Ebook.

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D. Allows removal of the dressing without pain or skin stripping. E. Is non-absorbent 76. Signs of denture related stomatitis A. whiteness on the tongue B. patches of shiny redness on the cheek and tongue C. patches of shiny redness on the palette and gums D. patches of shiny redness on the tongue 77. When do you plan a discharge? A. 24 hrs within admission B. 72 hrs within admission C. 48 hrs within admission D. 12 hrs within admission 78. Postpartum haemorrhage: A patient gave birth via NSD. After 48 hours, patient came back due to bleeding, bleeding after birth is called post partumhaemorrhage. What type? A. primary post partumhaemorrhage B. secondary post partumhaemorrhage C. tertiary postpartum haemorrhage D. lochia 79. The AVPU scale means: A. Alert, Verbal, Pain, Unresponsive C. Awake, Verbal, Pain, Unconscious B. Alert, verbal, Pressure, Unconscious D. Awake, Verbal, Pressure, Unresponsive 80. Management in Blood Transfusion Reaction would include the ff but: A. Close IV line B. Disconnect pack from patient. C. Complete Transfusion Reaction Report Form. D. Obtain blood/urine samples as directed. E. Send pack, Transfusion Reaction Report Form and samples to hospital Blood Bank 81. Which of the ff is not a cause of gingival bleeding? A. Vigorous brushing of teeth C. Vitamin deficiency (Vitamins C and K) B. Intake of blood thinning medications (warfarin, aspirin, and heparin) D. Lifestyle 82. Your patient has bronchitis and has difficulty in clearing his chest. What position would help to maximize the drainage of secretions? A. Lying flat on his back while using a nebulizer. Please do not share or distribute the contents of this Ebook.

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B. Sitting up leaning on pillows and inhaling humidified oxygen. C. Lying on his side with the area to be drained uppermost after the patient has had humidified air. D. Standing up in fresh air taking deep breaths. 83. Signs of denture-related stomatitis include all except: A. Redness underneath the area where the dentures are placed B. Red sores at the corners of lips or on the roof of the mouth C. Presence of white patches inside the mouth D. Gingivitis 84. Which of the ff should be considered before giving digoxin? 1. Allergies 2. Drug interactions 3. Other interactions with food or substances like alcohol and tobacco 4. Medical problems (Thyroid problem, Kidney disease, etc.) A. 1&2 B. 3&4 C. 1, 3, & 4 D. All of the above 85. Signs of hypovolemic shock would include all except: A. restlessness, anxiety or confusion B. shallow respiratory rate, becoming weak C. rising pulse rate D. low urine output of <0.5 mL/kg/h E. pallor (pale, cyanotic skin) and later sweating 86. All but one are signs of opioid toxicity: A. CNS depression (coma) B. Pupillary miosis C. Respiratory depression (cyanosis) D. Tachycardia 87. Patient had undergone post lumbar tap and is exhibiting increase HR, decrease BP, and alteration in consciousness and dilated pupils. What is the patient likely experiencing? A. Headache B. Shock C. Brain herniation D. Hypotension 88. NMC defines record keeping as all of the following except: Please do not share or distribute the contents of this Ebook.

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A. Helping to improve advocacy B. Showing how decisions related to patient care were made C. Supporting effective clinical judgements and decisions D. Helping in identifying risks, and enabling early detection of complications 89. How to position patient for abdominal tap A. Supine B. Prone C. Supine with HOB 40-50 degree elevated D. Sitting 90. Initial intervention when a patient collapsed: A. Call a code B. Check for responsiveness C. Check if the scene is safe D. Assess VS 91. Revisions should be included in what nursing process? A. Assessment B. Planning C. Intervention D. Evaluation 92. Which is not part of tuckman's team formation A. norming B. Storming C. Forming D. accepting 93. Patient had CVA, who will assess swallowing capability? A. physiotherapy nurse B. psychotherapy nurse C. speech and language therapist D. neurologic nurse 94. What is the most common cause of hypotension in elderly? A. Decrease response in adrenaline & noradrenaline B. Hyperglycemia C. Atheroma changes in vessel walls D. Age 95. The best way to verify enteral tube prior to feeding: A. Abdominal xray Please do not share or distribute the contents of this Ebook.

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B. Aspirate gastric content ph<4 C. Introduce air D. Immerse in a basin of water 96. What is not a good route for IM injection? A. upper arm B. stomach C. thigh D. buttocks 97. What angle to inject via subcutaneous route? A. 90 B. 45 C. 60 D. 15 98. Causes of gingival bleeding A. poor removal plaque B. poor flossing C. poor nutrition D. poor taking of drugs 99. Describe the breathing pattern when a patient is suffering from Opioid toxicity: A. Slow and shallow B. fast and shallow C. slow and deep D. Fast and deep 100. Information can be disclosed in all cases except: A. When effectively anonymized. B. When the information is required by law or under a court order. C. In identifiable form, when it is required for a specific purpose, with the individual’s written consent or with support under the Health Service D. In Child Protection proceedings if it is considered that the information required is in the public or child’s interest.


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MOCK QUESTIONS SET 2 1. A patient is admitted to the ward with symptoms of acute diarrheoa. What should your initial management be? A. Assessment, protective isolation, universal precautions. B. Assessment, source isolation, antibiotic therapy. C. Assessment, protective isolation, antimotility medication. D. Assessment, source isolation, universal precautions. 2. What should be included in your initial assessment of your patient’s respiratory status? A. Review the patient’s notes and charts, to obtain the patient’s history. B. Review the results of routine investigations. C. Observe the patient’s breathing for ease and comfort, rate and pattern. D. Perform a systematic examination and ask the relatives for the patient’s history. 3. What should be included in a prescription for oxygen therapy? A. You don’t need a prescription for oxygen unless in an emergency. B. The date it should commence, the doctor’s signature and bleep number. C. The type of oxygen delivery system, inspired oxygen percentage and duration of the therapy. D. You only need a prescription if the patient is going to have home oxygen. 4. What would make you suspect that a patient in your care had a urinary tract infection? A. The doctor has requested a midstream urine specimen. B. The patient has a urinary catheter in situ, and the patient’s wife states that he seems more forgetful than usual. C. The patient has spiked a temperature, has a raised white cell count (WCC), has newonset of confusion and the urine in his catheter bag is cloudy. D. The patient has complained of frequency of faecal elimination and hasn’t been drinking enough. 5. You are caring for a patient who was told to be in a “source isolation”. What would you do and why? A. Isolating a patient so that they don’t catch any infections. B. Nurse the patient in isolation, ensure that you wear appropriate personal protective equipment (PPE) and adhere to strict hand hygiene, for the purpose of preventing the spread of organisms from that patient to others. Please do not share or distribute the contents of this Ebook.

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C. Nursing an individual who is regarded as being particularly vulnerable to infection in such a way as to minimize the transmission of potential pathogens to that person. D. Nursing a patient who is carrying an infectious agent that may be a risk to others in such a way as to minimize the risk of the infection spreading elsewhere in their body. 6. Why should healthcare professionals take extra care when washing and drying an elderly patient’s skin? A. As the older generation deserve more respect and tender loving care (TLC). B. As the skin of an elder person has reduced blood supply, is thinner, less elastic and has less natural oil. This means the skin is less resistant to shearing forces and wound healing can be delayed. C. All elderly people lose dexterity and struggle to wash effectively so they need support with personal hygiene. D. As elderly people cannot reach all areas of their body, it is essential to ensure all body areas are washed well so that the colonization of Gram-positive and negative microorganisms on the skin is avoided. 7. How can risks be reduced in the healthcare setting? A. By adopting a culture of openness and transparency and exploring the root causes of patient safety incidents. B. Healthcare will always involve risks so incidents will always occur; we need to accept this. C. Healthcare professionals should be encouraged to fill in incident forms; this will create a culture of ‘no blame’. D. By setting targets which measure quality. 8. You are told a patient is in ‘source isolation’. What would you do and why? A. Isolating a patient so that they don’t catch any infections. B. Nursing an individual who is regarded as being particularly vulnerable to infection in such a way as to minimize the transmission of potential pathogens to that person. C. Nurse the patient in isolation, ensure that you wear appropriate personal protective equipment (PPE) and adhere to strict hand hygiene, for the purpose of preventing the spread of organisms from that patient to others. D. Nursing a patient who is carrying an infectious agent that may be a risk to others in such a way as to minimize the risk of the infection spreading elsewhere in their body. 9. A patient has just returned from theatre following surgery on his left arm. He has a PCA infusion connected and from the admission, you remember that they have poor dexterity with his right hand. He is currently pain free. What actions would you take? A. Educate the patient’s family to push the button when the patient asks for it. Encourage them to tell the nursing staff when they leave the ward so that staff can take over. Please do not share or distribute the contents of this Ebook.

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B. Routinely offer the patient a bolus and document this clearly. C. Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed. D. The patient has paracetamol q.d.s. written up, so this should be adequate pain relief. 10. What specifically do you need to monitor to avoid complications and ensure optimal nutritional status in patients being enterally fed? A. Blood glucose levels, full blood count, stoma site and bodyweight. B. Eye sight, hearing, full blood count, lung function and stoma site. C. Assess swallowing, patient choice, fluid balance, capillary refill time. D. Daily urinalysis, ECG, protein levels and arterial pressure. 11. Perdue (2005) categorizes constipation as primary, secondary or iatrogenic. What could be some of the causes of iatrogenic constipation? A. Inadequate diet and poor fluid intake. B. Anal fissures, colonic tumours or hypercalcaemia. C. Lifestyle changes and ignoring the urge to defaecate. D. Antiemetic or opioid medication. 12. In which of the following situations might nitrous oxide (Entonox) be considered? A. A wound dressing change for short-term pain relief or the removal of a chest drain for reduction of anxiety. B. Turning a patient who has bowel obstruction because there is an expectation that they may have pain from pathological fractures. C. For pain relief during the insertion of a chest drain for the treatment of a pneumothorax. D. For pain relief during a wound dressing for a patient who has had radical head and neck cancer that involved the jaw. 13. Why is it essential to humidify oxygen used during respiratory therapy? A. Oxygen is a very hot gas so if humidification isn’t used, the oxygen will burn the respiratory tract and cause considerable pain for the patient when they breathe. B. Oxygen is a dry gas which can cause evaporation of water from the respiratory tract and lead to thickened mucus in the airways, reduction of the movement of cilia and increased susceptibility to respiratory infection. C. Humidification cleans the oxygen as it is administered to ensure it is free from any aerobic pathogens before it is inhaled by the patient. D. Humidifying oxygen adds hydrogen to it, which makes it easier for oxygen to be absorbed to the blood in the lungs. This means the cells that need it for intracellular function have their needs met in a more timely manner. 14. You are currently on placement in the emergency department (ED). A 55 -year-old city worker is bluelighted into the ED having had a cardiorespiratory arrest at work. The Please do not share or distribute the contents of this Ebook.

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paramedics have been resuscitating him for 3 minutes. On arrival, he is in ventricular fibrillation. Your mentor asks you the following question prior to your shift starting: What will be the most important part of the patient’s immediate advanced life support? A. Early defibrillation to restart the heart. B. Early cardiopulmonary resuscitation. C. Administration of adrenaline every 3 minutes. D. Correction of reversible causes of hypoxia. 15. What are the key nursing observations needed for a patient receiving opioids frequently? A. Respiratory rate, bowel movement record and pain assessment and score. B. Checking the patent is not addicted by looking at their blood pressure. C. Lung function tests, oxygen saturations and addiction levels. D. Daily completion of a Bristol stool chart, urinalysis, and a record of the frequency with which the patient reports breakthrough pain. 16. What does the term ‘breakthrough pain’ mean, and what type of prescription would you expect for it? A. A patient who has adequately controlled pain relief with short-lived exacerbation of pain, with a prescription that has no regular time of administration of analgesia. B. Pain on movement which is short-lived, with a q.d.s. prescription, when necessary. C. Pain that is intense, unexpected, in a location that differs from that previously assessed, needing a review before a prescription is written. D. A patient who has adequately controlled pain relief with short-lived exacerbation of pain, with a prescription that has 4-hourly frequency of analgesia if necessary. 17. A patient in your care knocks their head on the bedside locker when reaching down to pick up something they have dropped. What do you do? A. Let the patient’s relatives know so that they don’t make a complaint and write an incident report for yourself so you remember the details in case there are problems in the future. B. Help the patient to a safe comfortable position, commence neurological observations and ask the patient’s doctor to come and review them, checking the injury isn’t serious. When this has taken place, write up what happened and any future care in the nursing notes. C. Discuss the incident with the nurse in charge, and contact your union representative in case you get into trouble. Please do not share or distribute the contents of this Ebook.

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D. Help the patient to a safe comfortable position, take a set of observations and report the incident to the nurse in charge who may call a doctor. Complete an incident form. At an appropriate time, discuss the incident with the patient and, if they wish, their relatives. 18. You are caring for a patient with a tracheostomy in situ who requires frequent suctioning. How long should you suction for? A. If you preoxygenate the patient, you can insert the catheter for 45 seconds. B. Never insert the catheter for longer than 10–15 seconds. C. Monitor the patient’s oxygen saturations and suction for 30 seconds. D. Suction for 50 seconds and send a specimen to the laboratory if the secretions are purulent. 19. You are caring for a patient in isolation with suspected Clostridium difficile. What are the essential key actions to prevent the spread of infection? A. Regular hand hygiene and the promotion of the infection prevention link nurse role. B. Encourage the doctors to wear gloves and aprons, to be bare below the elbow and to wash hands with alcohol handrub. Ask for cleaning to be increased with soap-based products. C. Ask the infection prevention team to review the patient’s medication chart and provide regular teaching sessions on the ‘5 moments of hand hygiene’. Provide the patient and family with adequate information. D. Review antimicrobials daily, wash hands with soap and water before and after each contact with the patient, ask for enhanced cleaning with chlorine-based products and use gloves and aprons when disposing of body fluids. 20. What steps would you take if you had sustained a needlestick injury? A. Ask for advice from the emergency department, report to occupational health and fill in an incident form. B. Gently make the wound bleed, place under running water and wash thoroughly with soap and water. Complete an incident form and inform your manager. Co-operate with any action to test yourself or the patient for infection with a bloodborne virus but do not obtain blood or consent for testing from the patient yourself; this should be done by someone not involved in the incident. C. Take blood from patient and self for Hep B screening and take samples and form to Bacteriology. Call your union representative for support. Make an appointment with your GP for a sickness certificate to take time off until the wound site has healed so you don’t contaminate any other patients. D. Wash the wound with soap and water. Cover any wound with a waterproof dressing to prevent entry of any other foreign material. Wear gloves while working until the


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wound has healed to prevent contaminating any other patients. Take any steps to have the patient or yourself tested for the presence of a bloodborne virus. 21. A patient needs weighing, as he is due a drug that is calculated on bodyweight. He experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do? A. Document clearly in the patient’s notes that a weight cannot be obtained. B. Offer the patient pain relief and either use bed scales or a hoist with scales built in. C. Discuss the case with your colleagues and agree to guess his bodyweight until he agrees to stand and use the chair scales. D. Omit the drug as it is not safe to give it without this information; inform the doctor and document your actions. 22. Fred is going to receive a blood transfusion. How frequently should we do his observations? A. Temperature and pulse before the blood transfusion begins, then every hour, and at the end of bag/unit. B. Temperature, pulse, blood pressure and respiration before the blood transfusion begins, then after 15 minutes, then as indicated in local guidelines, and finally at the end of the bag/unit. C. Temperature, pulse, blood pressure and respiration and urinalysis before the blood transfusion, then at end of bag. D. Pulse, blood pressure and respiration every hour, and at the end of the bag. 23. A patient’s daughter wants to visit her mom in the hospital, she has been experiencing diarrhea, what will you advise her? A. advise to visit when she feels better B. advise her that she can visit when she is 48 hours symptom free? C. she can visit when she is fully recovered D. None of the above 24. Before administering Digoxin, you must check specifically for what? A. Breathing B. Heart Rate C. Temperature D. LOC 25. Which law provides communication aid to patient with disability? A. Communication Act B. Equality Act Please do not share or distribute the contents of this Ebook.

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C. Mental Capacity Act D.Children and Family Act 26. Which medicine does digoxin interact with? A. NSAID B. rasagiline C. amoxicillin D. Anticoagulants 27. Patient has Low BMI but patient thinks she is fat- to whom should you refer? A. Dietician B. mental health C. Professional D. GP 28. You are caring for a patient with a history of COAD who is requiring 70% humidified oxygen via a facemask. You are monitoring his response to therapy by observing his colour, degree of respiratory distress and respiratory rate. The patient’s oxygen saturations have been between 95% and 98%. In addition, the doctor has been taking arterial blood gases. What is the reason for this? A. Oximeters may be unreliable under certain circumstances, e.g. if tissue perfusion is poor, if the environment is cold and if the patient’s nails are covered w ith nail polish. B. Arterial blood gases should be sampled if the patient is receiving >60% oxygen. C. Pulse oximeters provide excellent evidence of oxygenation, but they do not measure the adequacy of ventilation. D. Arterial blood gases measure both oxygen and carbon dioxide levels and therefore give an indication of both ventilation and oxygenation. 29. You are looking after a 75-year-old woman who had an abdominal hysterectomy 2 days ago. What would you do to reduce the risk of her developing a deep vein thrombosis (DVT)? A. Give regular analgesia to ensure she has adequate pain relief so she can mobilize as soon as possible. Advise her not to cross her legs. B. Make sure that she is fitted with properly fitting antiembolic pressure stockings that are removed daily. C. Ensure that she is wearing antiembolic stockings and that she is prescribed prophylactic anticoagulation and is doing hourly limb exercises. D. Give adequate analgesia so she can mobilize to the chair with assistance, give subcutaneous low molecular weight heparin as prescribed. Make sure that she is wearing antiembolic stockings.


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30.When using nasal cannulae, the maximum oxygen flow rate that should be used is 6 litres/min. Why? A. Nasal cannulae cannulae are only capable capable of delivering delivering an inspired oxygen concentratio concentration n between 24% and 40%. B. For any given flow rate, the inspired oxygen concentration will vary between breaths, as it depends upon the rate and depth of the patient’s breath and the inspiratory flow rate. C. Higher rates can cause nasal mucosal drying and may lead to epistaxis. D. If oxygen is administered at greater than 40% it should be humidified. You cannot humidify oxygen via nasal cannulae 31. You are looking after an emaciated 80-year-old man who has been admitted to your ward with acute acute exacerbation of chronic chronic obstructive obstructive airways disease disease (COPD). He is currently so short of breath that it is difficult for him to mobilize. What are some of the actions you take to prevent him developing a pressure ulcer? A. He will be at high risk of developing a pressure pressure ulcer so place place him on a pressure pressure relieving mattress. B. Assess his risk of developing a pressure ulcer with a risk assessment tool. If indicated, procure an appropriate pressure-relieving pressure-relieving mattress for his bed and cushion for his chair. Reassess the patient’s pressure areas at least twice a day and keep them clean and dry. Review his fluid and nutritional intake and support him to make changes as indicated. C. Assess his risk of developing a pressure ulcer with a risk assessment tool and reassess every week. Reduce his fluid intake to avoid him becoming incontinent incontinent and the pressure areas becoming damp with urine. D. He is at high risk of developing a pressure ulcer because of his recent acute illness, poor nutritional intake and reduced mobility. By giving him his prescribed antibiotic therapy, referring him to the dietician and physiothera physiotherapist, pist, the risk will be reduced. 32. You are looking after a 76-year-old woman who has had a number of recent falls at home. What would you do to try and ensure her safety whilst she is in hospital? A. Refer her to the the physiotherapist physiotherapist and provide her with with lots of reassurance reassurance as she has has lost a lot of confidence recently. B. Make sure that the bed area is free of clutter. Place the patient in a bed near the nurses’ station so that you can keep an eye on her. Put her on an hourly toileting chart. Obtain lying and standing blood pressures as postural hypotension may be contributing to her falls. C. Make sure that the bed area is free of clutter and that the patient p atient can reach everything she needs, including the call bell. Check regularly to see if the patient needs assistance mobilizing to the toilet. Ensure that she has properly fitting slippers and appropriate walking aids. D. Refer her to the community falls team who will assess her when she gets home.


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33. Your patient has a bulky oesophageal tumour and is waiting for surgery. When he tries to eat, food gets stuck and gives him heartburn. What is the most likely route that will be chosen chosen to provide him with the nutritional support support he needs? A. Nasogastric Nasogastric tube feeding. B. Feeding via a percutaneous endoscopic gastrostomy gastrostomy (PEG). C. Feeding via a radiologically inserted gastrostomy (RIG). D. Continue oral food. 34. A patient has been admitted for nutritional support and started receiving a hyperosmolar hyperosmo lar feed yesterday. He presents with diarrhoea but has no pyrexia. What is likely to be the cause? A. The feed. C. Food poisoning. poisoning. B. An infection. D. Being in hospital. 35. What would you do if a patient with diabetes and peripheral neuropathy neuropathy requires assistancee cutting his toe nails? assistanc A. Document clearly clearly the reason reason for not cutting cutting his toe nails and and refer him to a chiropodist. B. Document clearly the reason for not cutting his nails and ask the ward sister to do it. C. Have a go and if you run into trouble, stop and refer to the chiropodist. D. Speak to the patient’s GP to ask for referral to the chiropodist, but make a start while the patient is in hospital. 36. If the prescribed volume is taken, which of the following types of feed will provide all protein, vitamins, minerals and trace elements to meet a patient’s nutritional requirements? A. Protein shakes/suppleme shakes/supplements. nts. B. Sip feeds. C. Energy drinks. D. Mixed fat and glucose polymer solutions/powders. 37. On which step of the WHO analgesic ladder would you place tramadol and codeine? A. Step 1: Non-Opioid Non-Opioid Drugs. B. Step 2: Opioids for Mild to Moderate Pain. C. Step 3: Opioids for Moderate to Severe Pain. D. Herbal medicine. 38. What would be your main objectives in providing stoma education when preparing a patient with a stoma for discharge home? A. That the patient patient can independently independently manage their their stoma, and can can get supplies. B. That the patient has had their appliance changed regularly, and knows their community stoma nurse.


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C. That the patient knows the community stoma nurse, and has a prescription prescription.. D. That the patient has a referral to the District Nurses for stoma care. 39. What type of diet would you recomm recommend end to your patient who has a newly formed stoma? A. Encourage high-fibre high-fibre foods to avoid constipation. constipation. B. Encourage lots of vegetables and fruit to avoid constipation. C. Encourage a varied diet as people can react differently. D. Avoid spicy foods because they can cause erratic function. 40. Your patient has undergone u ndergone a formation of a loop colostomy. What important considerations should be borne in mind when selecting an appropriate stoma appliance for your patient? A. Dexterity of the patient, consistency consistency of effluent, effluent, type of stoma. B. Patient preference, type of stoma, consistence consistence of effluent, state of peristomal skin, dexterity of patient. C. Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, dexterity of patient, type of stoma. D. Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency consistenc y of effluent, patient preference. 41. Which of these is an example of an open question? A. Are you feeling better better today? B. When you said you are hurt, what do you mean? C. Can you tell me what is concerning you? D. Is that what you are looking for? 42. Which of the following are barriers to effective communication? A. Cultural differences differences B. Unfamiliar accents C. Overly technical language and terminology D. Hearing problems E. All of the above 43. What infection is thought to be caused by prions? A. Leprosy B. Pneumocystis jirovecii C. Norovirus D. Creutzfeldt Jakob disease E. None of the above


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44. What are the most common effects of inactivity? A. Pulmonary embolism, embolism, urinary urinary tract infection infection and fear of people. people. B. Deep arterial thrombosis, respiratory infection, fear of movement, loss of consciousness, consciousn ess, deconditioning of cardiovascular cardiovasc ular system leading to an increased risk of angina. C. Loss of weight, frustration and deep vein thrombosis. D. Social isolation, loss of independence, exacerbation of symptoms, rapid loss of strength in leg muscles, deconditioning deconditionin g of cardiovascula cardiovascularr system leading to increased risk of chest infection, and pulmonary embolism. 45. Which of the following is a behavioural risk factor when assessing the potential risks of falling in an older person? A. Poor nutrition/fluid nutrition/fluid intake B. Poor heating C. Foot problems D. Fear of falling 46. When positioning the supine patient in bed, why should you ensure the patient is lying centrally in the bed? A. To ensure spinal spinal and limb alignment alignment B. To ensure patient comfort C. To ensure the airway is patent D. To minimize the risk of injury to the practitioner 47. In what instances shouldn’t y ou ou position a patient in a side-lying position? A. If they are pregnant pregnant B. If they have a spinal fracture C. If they have pressure sores D. If they have lower limb pain 48. What does ‘muscle atrophy’ mean? A. Increase in in muscle mass B. Loss of muscle mass C. A change in the shape of muscles D. Disease of the muscle 49. Approximately how long is the spinal cord in an adult? A. 30cm B. 45cm C. 60cm D. 120cm


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50. A new, postsurgical wound is assessed by the nurse and is found to be hot, tender and swollen. How could this wound be best described? A. In the inflammation phase of healing. B. In the haemostasis phase of healing. C. In the reconstructive phase of wound healing. D. As an infected wound. 51. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: A. Left leg and right crutch then right leg and left crutch B. Crutches and then both legs simultaneously C. Crutches and the right leg then advance the left leg D. Crutches and the left leg then advance the right leg 52. A patient was diagnosed to have Chron’s disease. What would the patient be manifesting? A. Blood and mucous in the faeces C. Loss of appetite B. Fatigue D. Urgent bowel 53. What is Disclosure according to NHS? A. It is asking action to help people say what they want, secure their rights, represent their interests and obtain the services they need. B. This is the divulging or provision of access to data. C. It is the response to the suffering of others that motivates a desire to help. D. It is a set of rules or a promise that limits access or places restrictions on certain types of information. 54. All but one are signs of anaphylaxis: A. itchy skin or a raised, red skin rash B. swollen eyes, lips, hands and feet C. hypertension and tachycardia D. abdominal pain, nausea and vomiting 55. What is comprehensive nursing assessment? A. It provides the foundation for care that enables individuals to gain greater control over their lives and enhance their health status. B. An in-depth assessment of the patient’s health status, physical examination, risk factors, psychological and social aspects of the patient’s health that usually takes place on admission or transfer to a hospital or healthcare agency. C. An assessment of a specific condition, problem, identified risks or assessment of care; for example, continence assessment, nutritional assessment, neurological assessment following a head injury, assessment for day care, outpatient consultation for a specific Please do not share or distribute the contents of this Ebook.

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condition. D. It is a continuous assessment of the patient’s health status accompanied by monitoring and observation of specific problems identified. 56. Define standard precaution: A. The precautions that are taken with all blood and ‘high-risk’ body fluids. B. The actions that should be taken in every care situation to protect patients and others from infection, regardless of what is known of the patient’s status with respect to infection. C. It is meant to reduce the risk of transmission of bloodbourne and other pathogens from both recognized and unrecognized sources. D. The practice of avoiding contact with bodily fluids, by means of wearing of nonporous articles such as gloves, goggles, and face shields. 57. What is the purpose of clamping a chest tube? A. To prevent further lung collapse and entry of air B. To minimize the feeling of pain on drain insertion C. To aid the drain into the correct position. D. To minimize risk of infection 58. What is not true about compartment syndrome? A. is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles B. it occurs when pressure within a compartment increases and affects the function of the muscle and tissues C. is defined by a critical pressure increase within a confined compartmental space, causing a decline in the perfusion pressure to the compartment tissue D. Compartment syndrome most commonly occurs in compartments in the leg or thigh. 59. What is the best site of buttock injections? A. Ventrogluteal site B. Dorsogluteal site C. Rectus Femoris D. Greater trochanter area 60. What are the steps for the proper urine collection? A. Clean meatus with soap and water B. Catch midstream C. Dispatch sample to laboratory immediately (within 6 hours) D. Ask the patient to void her remaining urine into the toilet or bedpan. A. A, B, & C

B. B, C, & D

C. A, B, & D


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61. The doctor is about to insert an IV cannula when he was called to assist in an emergency. The nurse is not experienced in peripheral cannulation. What should the nurse do? A. Inform the supervisor that the doctor left you to do it. B. Apply the canula since you have seen it done before. C. Do not gi ve because you’re not trained and assessed as competent. D. Have a friend help you apply it. 62. What is the purpose of NPO after surgery? A. To prevent a blood clot B. To prevent aspiration C. To facilitate respiration D. To prevent embolism 63. Nurses are not using a hoist to transfer patient. They said it was not well maintained. What would you do? A. make a written report B. complain verbally C. take a picture for evidence D. Do nothing 64. What is not included in the care package in a nursing home? A. Laundry B. Food C. Nursing Care D. Social Activities 65. What is abduction? A. any motion of the limbs or other body parts that pulls away from the midline of the body B. the bending of a joint so as to bring together the parts it connects C. the straightening of a joint D. the movement of a body part toward the body’s midline 66. What is compassion? A. It means that individuals are responsible for their actions and maybe asked to justify them. B. It is intelligent kindness and is central to how people perceive their care. C. It means all those in caring roles must have the ability to understand an individual’s health and social needs. D. It enables us to do the right thing for the people we care for.


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67. What is an intermediate care home? A. It is the day-to-day health care given by a health care provider. B. It includes a range of short-term treatment or rehabilitative services designed to promote independence. C. It is a system of integrated care. D. It is a means of organising work, that is patient allocation. 68. Which statement is not correct about the nursing process? A. An organised, systematic and deliberate approach to nursing with the aim of improving standards in nursing care. B. It uses a systematic, holistic, problem solving approach in partnership with the patient and their family. C. It is a form of documentation. D. It requires collection of objective data. 69. Why are support stockings used? A. To help relieve the pain and discomfort B. To promote venous flow C. To prevent new varicose veins from appearing D. For cosmetic reasons 70. What is the best site to check for oedema? A. Ankle or foot B. Eyes C. Lungs D. Abdomen 71. All but one describes holistic care: A. A system of comprehensive or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person; his or her response to illness; and the effect of the illness on the ability to meet self-care needs. B. It embraces all nursing practice that has enhancement of healing the whole person from birth to death as it’s goals. C. An all nursing practice that has healing the person as its goal. D. It involves understanding the individual as a unitary whole in mutual process with the environment. 72. A patient suffered from CVA and is now affected with dysphagia. What should not be an intervention to this type of patient? A. Place the patient in a sitting position / upright during and after eating. B. Water or clear liquids should be given. C. Instruct the patient to use a straw to drink liquids. D. Review the patient’s ability to swallow, and note the extent of facial paralysis. Please do not share or distribute the contents of this Ebook.

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73. Which is not a sign or symptom of baby born with meconium stain? A. Baby with a loud cry B. barrel-shaped chest C. slow heartbeat D. rapid or labored breathing 74. A patient underwent an abdominal surgery and will be unable to meet nutritional needs through oral intake. A patient was placed on enteral feeding. How would you position the patient when feeding is being administered? A. Sitting upright at 30 to 45° B. Sitting upright at 60 to 75° C. Sitting upright at 45 to 60 D. Sitting upright at 75 to 90° 75. A patient is being prepared for a surgery and was placed on NPO. What is the purpose of NPO? A. Prevention of aspiration pneumonia B. To facilitate induction of pre-op meds C. For abdominal procedures D. To decrease production of fluids 76. It is a condition in which you wake up during the night because you have to urinate. A. Polyuria B. Oliguria C. Nocturia D. Dysuria 77. You were administering a pre-operative medication to a patient via IM route. Suddenly, you developed a needle-stick injury. Which of the ff interventions will not be appropriate for you to do? A. Prevent the wound to bleed B. Wash the wound using running water and plenty of soap C. Do not suck the wound D. Dry the wound and over it with a waterproof plaster or dressing 78. Why is pyrexia not evident in the elderly? A. Due to lesser body fat B. Due to immature T cells C. Due to aged hypothalamus D. Due to biologic changes


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79. When do we need to document? A. As soon as possible after an event has happened to provide current up to date information about the care and condition of the patient or client) B. Every hour C. When there are significant changes to the patient’s condition D. At the end of the shift 80. All should be seen in a good documentation except: A. legible handwriting B. Name and signature, position, date and time C. Abbreviations, jargon, meaningless phrases, irrelevant speculation and offensive subjective statements D. A correct, consistent, and factual data 81. A patient is scheduled to undergo an Elective Surgery. What is the least thing that should be done? A. Assess/Obtain the patient’s understanding of, and consent to, the procedure, and a share in the decision making process. B. Ensure pre-operative fasting, the proposed pain relief method, and expected sequelae are carried out anddiscussed. C. Discuss the risk of operation if it won’t push through. D. The documentation of details of any discussion in the anaesthetic record. 82. A patient experienced sensation of fluttering in his chest, light headedness, & chest pain. The doctor diagnosed him with atrial fibrillation. What is atrial fibrillation? A. a rare, rapid and disorganised rhythm of heartbeats that rapidly leads to loss of consciousness and sudden death if not treated immediately B. episodes of abnormally fast heart rate at rest C. the heart beats more slowly than normal and can cause people to collapse D. a heart condition that causes an irregular and often abnormally fast heart rate 83. Patient manifests phlebitis in his IV site, what must a nurse do? A. Re-site the cannula B. Inform the doctor C. Apply warm compress D. Discontinue infusion 84. Which statement is not true about acute illness? A. A disease with a rapid onset and/or a short course one. B. It will eventually resolve without any medical supervision. C. It is rapidly progressive and in need of urgent care. D. It is prolonged, do not resolve spontaneously, and is rarely captured completely.


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85. Taking a nursing history prior to the physical examination allows a nurse to establish a rapport with the patient and family. Elements of the history include all of the ff except: A. the client’s health status B. the course of the present illness C. social history D. Cultural beliefs and practices 86. Which is not a sign or symptom of speed shock? A. Headache B. A tight feeling in the chest C. Irregular pulse D. Cyanosis 87. What is not included in Palliative Care? A. Psychological support B. Spiritual support C. Resuscitation D. Pain management 88. All but one is an indication for pleural tubing: A. Pneumothorax B. Abnormal blood clotting screen or low platelet count C. Malignant pleural effusion. D. Post-operative, for example thoracotomy, cardiac surgery 89. Which is not considered in an oxygen prescription? A. It should be prescribed. B. Regular pulse oximetry monitoring must be available in all clinical environments. C. Can be given to patients who are not hypoxaemic. D. It must be signed and dated. 90. What is accountability? A. It means that individuals are responsible for their actions and maybe asked to justify them. B. It is intelligent kindness and is central to how people perceive their care. C. It means all those in caring roles must have the ability to understand an individual’s health and social needs. D. It enables us to do the right thing for the people we care for. 91. What is primary care? A. It is the day-to-day health care given by a health care provider. B. It includes a range of short-term treatment or rehabilitative services designed to Please do not share or distribute the contents of this Ebook.

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promote independence. C. It is a system of integrated care. D. It is a means of organising work, that is patient allocation. 92. What is Advocacy according to NHS Trust? A. It is taking action to help people say what they want, secure their rights, represent their interests and obtain the services they need. B. This is the divulging or provision of access to data. C. It is the response to the suffering of others that motivates a desire to help. D. It is a set of rules or a promise that limits access or places restrictions on certain types of information. 93. The nurse monitors the serum electrolyte levels of a client who is taking digoxin (Lanoxin). Which of the following electrolyte imbalances is common cause of digoxin toxicity? A. Hypocalcemia B. Hyponatremia C. Hypomagnesemia D. Hypokalemia 94. You were the nurse on duty and it’s time to take your patient’s vital signs. Upon checking, you noted that the patient was given Digoxin and now has a heart rate of 50 BPM. What will you do with the next dose of Digoxin? A. Omit then document B. Omit then double the next dose; document C. Administer then document D. Administer then recheck VS 95. A patient had been suffering from severe diarrheoa and is now showing signs of dehydration. Which of the following is not a classic symptom? A. passing small amounts of urine frequently B. dizziness or light-headedness C. dark-coloured urine D. thirst 96. Signs and symptoms of early fluid volume deficit, except. A. Decreased urine output B. Decreased pulse rate C. Concentrated urine D. Decreased skin turgor 97. Which is not an indication for lumbar tap? A. For patients with increased ICP Please do not share or distribute the contents of this Ebook.

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B. For diagnostic purposes C. Introduction of spinal anaesthesia for surgery D. Introduction of contrast medium 98. Correct position for abdominal paracentesis. A. Lie the patient supine in bed with the head raised 45–50 cm with a backrest B. Sitting upright at 45 to 60 C. Sitting upright at 60 to 75° D. Sitting upright at 75 to 90° 99. MRSA means A. Methilinase – Resistant Streptococcus Aureus B. Methicillin-Resistant Streptococcus Aureus C. Methilinase – Resistant Staphylococcus Aureus D. Methicillin-Resistant Staphylococcus Aureus 100. Among the following values incorporated in NMC’s 6 C’s, which is not included? A. Care B. Courage C. Confidentiality D. Communication


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MOCK QUESTIONS SET 3

A. B. C.

1. What is the purpose of The NMC Code? It outlines specific tasks or clinical procedures It ascertains in detail a nurse's or midwife's clinical expertise It is a tool for educating prospective nurses and midwives

A. B. C.

2. When do you gain consent from a patient and consider it valid? Only if a patient has the mental capacity to give consent Only before a clinical procedure None of the above

A. B. C. D.

3. At what stage of the nursing process does the revision of the care plan occur? Assessment Planning Implementation Evaluation

A. B. C.

4. You can delegate medication administration to a student if: The student was assessed as competent Only under close, direct supervision The patient has only oral medication

A. B. C.

A. B. C.

5. A patient recently admitted to hospital, requesting to self administer the medication, has been assessed for suitability at Level 2 This means that: The registrant is responsible for the safe storage of the medicinal products and the supervision of the administration process ensuring the patient understands the medicinal product being administered The patient accepts full responsibility for the storage and administration of the medicinal products None of the above - The registrant is responsible for the safe storage of the medicinal products. At administration time, the patient will ask the registrant to open the cabinet or locker. The patient will then self-administer the medication under the supervision of the registrant 6. In a patient with hourly monitoring, when does a nurse formally document the monitoring? Every hour When there are significant changes to the patient’s condition At the end of the shift


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A. B. C.

7. What is primary care? The Accident and Emergency Room GP practices, dental practices, community pharmacies and high street optometrists First aid provided on the street

C. D. E.

8. What infection control steps should not be taken in a patient with diarrhoea caused by Clostridium Difficile? Isolation of the patient All staff must wear aprons and gloves while attending the patient All staff will be required to wash their hands before and after contact with the patient, their bed linen and soiled items Oral administration of metronidazole, vancomycin, fidaxomicin may be required None of the above

A. B. C. D. E.

9. Independent Advocacy is: Providing general advice Making decisions for someone Care and support work Agreeing with everything a person says and doing anything a person asks you to do None of the above *

A. B. C. D.

10. Which of the following are not signs of a speed shock? Flushed face Headache and dizziness Tachycardia and fall in blood pressure Peripheral oedema

A. B. C.

11. Recommended preoperative fasting times are: 2-4 hours 6-12 hours 12-14 hours

A. B. C. D.

12. Compassion in Practice – the culture of compassionate care encompasses: Care, Compassion, Competence, Communication, Courage, Commitment - DoH – “Compassion in Practice” Care, Compassion, Competence Competence, Communication, Courage Care, Courage, Commitment

A. B. C.

13. Hospital discharge planning for a patient should start: When the patient is medically fit On the admission assessment When transport is available

A. B.

14. Examples of offensive/hygiene waste which may be sent for energy recovery at energy from waste facilities can include: Stoma or catheter bags - The Management of Waste from health, social and personal care -RCN Unused non-cytotoxic/cytostatic medicines in original packaging

A. B.


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C. D.

Used sharps from treatment using cytotoxic or cytostatic medicines Empty medicine bottles

A. B. C. D.

15. Patient usually urinates at night Nurse identifies this as: Polyuria Oliguria Dysuria Nocturia

A. B. C.

16. An overall risk of malnutrition of 2 or higher signifies: Low risk of malnutrition Medium risk of malnutrition High risk of malnutrition

A. B. C. D.

17. The signs and symptoms of ectopic pregnancy except: Vaginal bleeding Positive pregnancy test Shoulder tip pain Protein excretion exceeds 2 g/day

B. C.

18. The use of an alcohol-based hand rub for decontamination of hands before and after direct patient contact and clinical care is recommended when: Hands are visibly soiled Caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn Immediately after contact with body fluids, mucous membranes and non-intact skin

A. B.

19. In DVT TEDS stockings affect circulation by: increasing blood flow velocity in the legs by compression of the deep venous system thromboembolism-deterrent hose decreasing blood flow velocity in legs by compression of the deep venous system

A. B. C. D.

20. What medications would most likely increase the risk for fall? Loop diuretic Hypnotics Betablockers Nsaids

A.

A. B. C. D.

21. Causes of diarrhoea in Clostridium Difficile are: Ulcerative colitis - Ulcerative Colitis is a condition that causes inflammation and ulceration of the inner lining of the rectum and colon Hashimotos disease - Hashimoto’s disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease Pseudomembranous colitis -pseudomembranous colitis (PMC) is an acute, exudative colitis usually caused by Clostridium difficile. PMC can rarely be caused by other bacteria, Crohn’s disease - Crohn’s Disease is one of the two main forms of Inflammatory Bowel Disease, so may also be called ‘IBD’. The other main form of IBD is a condition known as Ulcerative Colitis 22. What do you expect to manifest with fluid volume deficit?


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A. B. C. D.

Low pulse, Low Bp High pulse, High BP High Pulse, low BP Low Pulse, high BP

A. B. C.

23. Wound care management plan should be done with what type of wound? Complex wound Infected wound Any type of wound

A. B. C.

24. Wound proliferation starts after? 1-5 days 3-24 days 24 days

A. B. C. D.

25. Barrier Nursing for C.diff patient what should you not do? Use of hand gel/ alcohol rub Use gloves Patient has his own set of washers Strict disinfection of pt’s room after isolation

A. B.

26. When will you consider giving out information of the patient to a police officer? If he has a rank of an inspector If safety of the public is at risk

A. B. C. D.

A. B. C. D.

A.

27. When should adult patients in acute hospital settings have observations taken? When they are admitted or initially assessed, A plan should be clearly documented which identifies which observations should be taken and how frequently subsequent observations should be done. When they are admitted and then once daily unless they deteriorate. As indicated by the doctor. Temperature should be taken daily, respirations at night, pulse and blood pressure 4 hourly. 28. Why are physiological scoring systems or early warning scoring systems used in clinical practice? They help the nursing staff to accurately predict patient dependency on a shift by shift basis. The system provides an early accurate predictor of deterioration by identifying physiological criteria that alert the nursing staff to a patient at risk. These scoring systems are carried out as part of a national audit so we know how sick patients are in the United Kingdom. They enable nurses to call for assistance from the outreach team or the doctors via an electronic communication system. 29. You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions? Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and


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B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D. A. B.

C. D.

document clearly. This is a medical emergency. Basic airway, breathing and circulation should be attended to urgently and senior help should be sought. Refer to the neurology team. Break down the patient's Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX. Use this when you hand over. 30. What are the professional responsibilities of the qualified nurse in medicines management? Making sure that the group of patients that they are caring for receive their medications on time. If they are not competent to administer intravenous medications, they should ask a competent nursing colleague to do so on their behalf. The safe handling and administration of all medicines to patients in their care. This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects. Making sure they know the names, actions, doses and side effects of all the medications used in their area of clinical practice. To liaise closely with pharmacy so that their knowledge is kept up to date. 31. On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do? Check the cupboard, record book and order book. If the missing drugs aren't found, contact pharmacy to resolve the issue. You will also complete an incident form. Document the discrepancy on an incident form and contact the senior pharmacist on duty. Check the cupboard, record book and order book. If the missing drugs aren't found the police need to be informed. Check the cupboard, record book and order book and inform the registered nurse or person in charge of the clinical area. If the missing drugs are not found then inform the most senior nurse on duty. You will also complete an incident form. 32. It is important that patients are effectively fasted prior to surgery in order to: reduce the risk of vomiting. reduce the risk of reflux and inhalation of gastric contents. prevent vomiting and chest infections. prevent the patient gagging. 33. What are the principles of gaining informed consent prior to a planned surgery? Gaining permission for an imminent procedure by providing information in medical terms, ensuring a patient knows the potential risks and intended benefits. Gaining permission from a patient who is competent to give it, by providing information, both verbally and with written material, relating to the planned procedure, for them to read on the day of planned surgery. Gaining permission from a patient who is competent to give it, by informing them about the procedure and highlighting risks if the procedure is not carried out. Gaining permission from a patient who is competent to give it, by providing information in understandable terms prior to surgery, allowing time for answering questions, and inviting voluntary participation.


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A. B. C. D.

34. Anti-embolic stockings an effective means of reducing the potential of developing a deep vein thrombosis because: They promote arterial blood flow. They promote venous blood flow. They reduce the risk of postoperative swelling. They promote lymphatic fluid flow, and drainage.

A. B. C. D.

35. What functions should a dressing fulfil for effective wound healing? High humidity, insulation, gaseous exchange, absorbent. Anaerobic, impermeable, conformable, low humidity. Insulation, low humidity, sterile, high adherence. Absorbent, low adherence, anaerobic, high humidity.

A. B. C. D.

36. When would it be beneficial to use a wound care plan? (CHOOSE 3 ANSWERS) on initial assessment of wound during pre-assessment admission after surgery during wound infection, dehiscence or evisceration

A. B. C. D.

37. Which of the following displays the proper use of Zimmer frame? using a 1 point gait using a 2 point gait using a 3 point gait using a 4 point gait

A. B. C. D.

38. What are the signs and symptoms of shock during early stage (stage 1-3)? ( CHOOSE 3 ANSWERS) hypoxemia tachycardia and hyperventilation hypotension Acidosis

A. B. C. D.

39. A patient just had just undergone lumbar laminectomy, what is the best nursing intervention? move the body as a unit move one body part at a time move the head first and the feet last never move the patient at all

A. B. C. D.

40. Which of the following is a sign of dehydration in the elderly? diminished skin turgor hypertension anxiety attacks pyrexia

A.

41. You walk onto one of the bay on your ward and noticed a colleague wrongly using a hoist in transferring their patient. As a nurse you will: let them continue with their work as you are not in charge of that bay


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B. C. D.

report the event to the unit manager call the manual handling specialist nurse for training inform the relatives of the mistake

A. B. C. D.

42. Which of the following is not a component of end of life care? resuscitation resuscita tion and defibrillation reduce pain maintain dignity provide family support

A. B. C. D.

43. You are the named nurse of Mr Corbyn who has just undergone an abdominal surgery 4 hours ago. You have administered his regular analgesia 2 hours ago and he is still complaining of pain. Your most immediate, most appropriate nursing action? (CHOOSE 2 ANSWERS) call the doctor assist patient in a comfortable position give another dose look for a heating pad

A. B. C. D.

44. Which of the following is a severe complication during 24 hrs post liver biopsy? pain at insertion site nausea and vomiting back pain bleeding

A. B. C. D.

45. Which of the following are signs of anaphylaxis? (CHOOSE 3 ANSWERS) swelling of tongue and rashes dyspnoea, hypotension and tachycardia hypertension and hyperthermia cold and clammy skin

A. B. C. D.

46. Which of the following senses is to fade last when a person dies? hearing smelling seeing speaking

A. B. C. D.

47. Mr Green, a COPD patient was sent home with oxygen prescription at 2 litres per minute. He is dyspnoeic, anxious and panicking when you visited him. What is your most immediate nursing action to relieve dyspnoea? Call the emergency department for ambulanc ambulancee Increase O2 rate Tell patient to calm down in a loud voice Calmly instruct patient to do deep breathing

A.

48. You have observed an IV catheter insertion site w/ erythema, swelling, pain and warm? What VIP score score would you document document on his notes? 5


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B. C. D.

2 3 4

A. B. C. D.

49. What is the best nursing action for this insertion site (Q49. You have observed an IV catheter insertion site w/ erythema, swelling, pain and warm..) (CHOOSE 2 ANSWERS) start antibiotics re-site cannula call doctor elevate

A. B. C.

50. How do you remove a negative pressure dressing? Remove pressure then detach dressing gently Get TVN nurse to remove dressing remove in a quick fashion

A. B. C. D.

51. What position should you prepare prepare the patient in pre-op for abdominal Paracentesis? Paracentesis? Supine Supine with head of bed elevated to 40-50cm Prone Side-lying

A. B. C.

52. Lumbar post op patient moving and handling Move patient as a unit Move patient close to side rails so he/she could assist herself Move with leg raised/flex raised/flexed ed

53. What is not a sign of meconium aspiration A. Floppy in appearance B. Apnoea C. Crying

A. B. C.

54. A suicidal Patient is admitted to psychiatric facility for 3 days when suddenly he is showing signs of cheerfulness and motivation. The nurse should see this as: That treatment and medication is working She has made new friends That she has finalize suicide plan

A. B. C.

55. Patient has next dose of Digoxin but has a CR=58 Omit dose, record why, and inform the doctor Give dose and tell the doctor Give dose as prescribed

56. Patient is in for oxygen therapy A. A prescription prescription is required including including route, method method and how long B. No prescription prescription is required unless he will use it at home. C. Prescripti Prescription on not required for oxygen therapy Please do not share or distribute the contents of this Ebook.

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B. C. D. E. F. G.

57. Adequate record keeping for a medical device should provide evidence of: A unique identifier identifier for the device, where where appropriate A full history, including including date of purchase purchase and where where appropriate when when it was put into use, use, deployed or installed Any specific legal requirements requirements and whether whether these have been met met Proper installation and where it was deployed Schedule and details of maintenance and repairs The end-of-life date, if specified All of the above

A. B. C.

58. The doctor prescribes a dose of 9 mg of an anticoagulant for a patient being treated for thrombosis.. The drug is being supplied in 3mg tablets. How many tablets should you thrombosis administer? 3 tablets 1.5 tablets 6 tablets

A. B. C.

59. The doctor prescribes 25mg of a drug to be given by injection. It is a drug dispensed in a solution of strength 50mg/ml. How many ml should you administer? 2ml 1.5 ml 0.5 ml – Dose Prescribed: Dose /ml - 25:50=0.5

A. B. C.

60. A doctor prescribes an injection of 200 micrograms of drug. The stock bottle contains 1mg/ml. How many ml will you administer? Bear in mind: The 2 dose values must be in the same unit 1mg=1000mc 1mg=1000mcg g , 200mcg=0 200mcg=0.2mg .2mg then dose prescribed:dose/m prescribed:dose/mll – 0.2:1=0.2 20ml 2ml 0.2ml

A. B. C. D. E. F.

61. If you witness or suspect there is a risk to the safety of people in your care and you consider that there is an immediate risk of harm, you should: Report your concerns concerns immediately, immediately, in writing to the appropriate person - Escalating concerns NMC Ask for advice from your professional professional body if unsure on what actions to take Protect client confidential confidentiality ity Refer to your employer’s whistleblowing whistleblowing policy Keep an accurate record of your concerns and action taken All of the above

A.

62. In interpreting ECG results if there is clear evidence of atrial disruption this is interpreted as? A. Cardiac Arrest B. Ventricula Ventricularr tach C. Atrial Fibrillation Fibrillation Please do not share or distribute the contents of this Ebook.

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D.

Complete blockage of the heart

A. B. C. D. E.

63. Common signs and symptoms of a hypoglycaemia exclude: Feeling hungry Sweating Anxiety or irritability irritability Blurred vision Ketoacidosis

E.

64. Select 4 Common causes for hyperglyca hyperglycaemia emia include: (CHOOSE 4 ANSWERS) Not eating enough protein Eating too much carbohydrate Over-treating Over-treati ng a hypoglycaemi hypoglycaemia a Stress Infection (for example, colds, bronchitis, flu, vomiting, diarrhoea, urinary infections, and skin infections

A. B. C. D.

65. Safeguarding is the responsi responsibility bility of: health care assistants registered nurses doctors all of the above

A. B. C.

66. Normal heart rate for 1 to 2 years old? 80 - 140 beats per minute 80 - 110 beats per minute 75 - 115 beats per minute

A. B. C. D.

67. In the News observation system, what is AVUP ? A. A replacement replacement for GCS B. An assessment assessment for confusion confusion C. Assessm Assessment ent for the level of consciousnes consciousnesss 68. Which bag do you place infected linen? water-soluble alginate polythene polythene bag before being being placed in the appropriate appropriate linen bag, bag, no A. more than ¾ full B. orange waste bag, before being placed in the appropriate linen bag, no more than ¾ full C. white linen bag, bag, after sorting, no more more than ¾ full

A. B. C. D.

69. Which one of these notifiable diseases needs to be reported on a national level? (Select x 2 correct answers) Chicken pox Tuberculosis Whooping cough Influenza 70. Patient is post of repair of tibia and fibula possible signs of compartment syndrome


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include A. Numbness and tingling B. Cool dusky toes C. Pain D. Toes swelling E. All of the above

A. B.

71. Patient developed elevated temperature and pain in the loin during blood transfusion. This is indicative of: Severe blood transfusion reaction Common blood transfusion reaction

A. B. C.

72. What is the best position in applying eye medications? Sitting position with head tilt to the right Sitting position with head tilt backwards Prone position with head tilt to the left

A. B.

73. Which of the following is at a greater risk for developing coronary artery disease? Male, obese, sedentary lifestyle Female, obese, non sedentary lifestyle

A. B. C. D.

74. Most commonly aneurysms can develop on? (CHOOSE 2 ANSWERS) Abdominal aorta Circle of Willis Intraparechymal aneurysms Capillary aneurysms

A. B. C. D.

75. On assessment of the abdomen of a patient with peritonitis you would expect to find Rebound tenderness and guarding Hyperactive, high-pitched bowel sounds and a firm abdomen A soft abdomen with bowel sounds every 2 to 3 seconds Ascites and increased vascular pattern on the skin

C. D.

76. Patients with gastric ulcers typically exhibit the following symptoms: Epigastric pain worsens before meals, pain awakening patient from sleep an melena Decreased bowel sounds, rigid abdomen, rebound tenderness, and fever Boring epigastric pain radiating to back and left shoulder, bluish-grey discoloration of periumbilical area and ascites Epigastric pains worsens after eating and weight loss

A. B. C.

77. Under the Yellow Card Scheme you must report the following: ( Select x 2 correct answers) Faulty brakes on a wheelchair Suspected side effects to blood factor, except immunoglobulin products Counterfeit or fake medicines or medical devices

A. B.


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A. B. C.

78. The degree of injection when giving subcutaneous insulin injection on a site where you can grasp 1 inch of tissue? 45 degrees 40 degrees 25 degrees

79. A patient suffered from stroke and is unable to read and write. This is called A. Aphasia (sometimes called dysphasia B. Dysphagia C. Partial aphasia

A. B. C. D.

80. Hypoglycaemia in patients with diabetes is more likely to occur when the patients take: (Select x 3 correct answers) Insulin Sulphonylureas Prandial glucose regulators Metformin

A. B. C. D.

81. Patients with gastrointestinal bleeding may experience acute or chronic blood loss. Your patient is experiencing hematochezia. You recognise this by: Red or maroon- coloured stool rectally Coffee ground emesis Black, tarry stool Vomiting of bright red or maroon blood

A. B. C. D.

82. The worst advice you can give a student nurse with regards to the use of social networking sites like Facebook? Select x 2 correct answers. Do not identify yourself as a nurse Do not engage in a personal discussion or relationship with a patient or former patient Do not post a picture of a patient's child even if they allow you to You can rely on the sites privacy settings

A. B. C. D. E.

83. It is unsafe for a spinal tap to be undertaken if the patient: Has bacterial meningitis Papilloedema Intracranial mass is suspected Site skin infection All the above

84. On physical examination of a 16 year old female patient, you notice partial erosion of her tooth enamel and callus formation on the posterior aspect of the knuckles of her hand. This is indicative of: A. Self-induced vomiting and she likely has bulimia nervosa B. A genetic disorder and her siblings should also be tested C. Self-mutilation and correlates with anxiety Please do not share or distribute the contents of this Ebook.

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D. A connective tissue disorder and she should be referred to dermatology

A. B. C. D.

85. In a community hospital, an elderly man approaches you and tells you that his neighbour has been stealing his money, saying "sometimes I give him money to buy groceries but he didn't buy groceries and he kept the money" what is your best course of action for this? Raise a safeguarding alert Just listen but don't do anything Ignore the old man, he is just having delusions Refer the old man to the community clergy who is giving him spiritual support

86. Prothrombin time is essential during anticoagulation therapy. In oral anticoagulation therapy which test is essential? Activated Thromboplastin Time - The partial thromboplastin time (PTT) test is a blood test that is done to investigate bleeding disorders and to monitor patients taking ananticlotting A. drug (heparin). International Normalized Ratio - The Prothrombin time (PT) test, standardised as the INR B. test is most often used to check how well anticoagulant tablets such as warfarin and phenindione are working A. B. C. D. E. F.

87. Conditions producing orthostatic hypotension in the elderly: Aortic stenosis Arrhythmias Diabetes Pernicious anaemia Advanced heart failure All of the above

A. B. C.

88. Waterlow score of 20 indicates what type of mattress to use? Select x 2 Standard-specification foam mattresses High-specification foam mattresses Dynamic support surface

A. B. C. D.

89. Enteral feeding patient checks patency of tube placement by: x 2 correct answers Pulling on the tube and then pushing it back in place Aspirating gastric juice and then checking for ph <4 Infusing water or air and listening for gurgles X-ray

A. B. C. D.

90. A patient is assessed as lacking capacity to give consent if they are unable to: Understand information about the decision and remember that information Use that information to make a decision Communicate their decision by talking, using sign language or by any other means All the above

A.

91. Proper Dressing for wound care should be? (Select x 3 correct answers) High humidity


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B. Low humidity C. Non Permeable/ Conformable D. Adherent E. Absorbent / Provide thermal insulation

A. B. C.

92. You are monitoring a patient in the ICU when suddenly his consciousness drops and the size of one his pupil becomes smaller what should you do? Refer to neurology team Continue to monitor patient using GCS and record Consider this as an emergency, prioritize abc & Call the doctor

A. B. C. D.

93. Patient is post op liver biopsy which is a sign of serious complication? (Select x 2 correct answers) CR of 104, RR=24, Temp of 37.5 Nausea and vomiting Pain Bleeding 94. Enteral feeding patient checks patency of tube placement by: (Select x 2 correct answers) Pulling on the tube and then pushing it back in place Aspirating gastric juice and then checking for ph <4 Infusing water or air and listening for gurgles X-ray

A. B. C.

95. Nurse is teaching patient about crutch walking which is incorrect? Take long strides Take small strides Instruct to put weight on hands

A. B. C. D.

96. What advice do you need to give to a patient taking Allopurinol? (Select x 3 correct answers) Drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise. Store allopurinol at room temperature away from moisture and heat. Avoid being near people who are sick or have infections Skin rash is a common side effect, it will pass after a few days

A. B. C. D.

97. What do you expect patients with COPD to manifest? Inc Pco2, dec O2 Dec Pco2, inc o2 Inc pco2, inc o2 Dec pco2, dec o2

A. B. C. D.

98. As a nurse, what health teachings will you give to a COPD patient? A. Encourage to stop smoking B. Administer oxygen inhalation as prescribed C. Enroll in a pulmonary rehabilitation programme Please do not share or distribute the contents of this Ebook.

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D. All the above

B.

99. A relative of the patient was experiencing vomiting and diarrhea and wished to visit her mother who was admitted. As a nurse, what will you advise to the patient's relative? There should be 48 hours after active symptoms should disappear prior to visiting patient Inform relative it is fine to visit mother as long as she uses alcohol before entering ward premises

A. B. C. D.

100. For an average person from Uk who has non-insulin dependent diabetes, how many servings of fruits and vegetables per day should they take? 1 serving 3 servings 5 servings 7 servings

A.


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A. B. C. D.

1. A 17-year old patient who was involved in an orthopaedic accident is observed not eating the meals that she previously ordered and refuses to take a bath even if she is already in recovery stage. As a nurse what do you think is the best explanation for her reaction to the accident that happened to her? Suppression Undoing Regression Repression 2. What does AVPU mean?

A. B. C. D.

alert verbalization pain unconscious awake voice pain unconscious alert voice pain unresponsive awake verbalization pain unconscious 3. Where will you put infectious linen?

A. B. C.

red plastic bag designed to disintegrate when exposed to heat red linen bag designed to hold its integrity even when exposed to heat yellow plastic bag for disposal 4. Who is responsible in disposing sharps?

A. B. C. D.

Registered nurse Nurse assistant Whoever used the sharps Whoever collects the garbage

A. B. C. D.

5. NMC requires in the UK how many units of continuing education units a nurse should have in 3 years? 35 Units 45 Units 55 Units 65 Units 6. What do you expect to assess in a grade 3 pressure ulcer?

A. B. C. D.

blistered wound on the skin open wound showing tissue open wound exposing muscles open wound exposing bones


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7. What could be the reason why you instruct your patient to retain on its original container and discard nitroglycerine meds after 8 weeks? A. B.

removing from its darkened container exposes the medicine to the light and its potency will decrease after 8 weeks it will have a greater concentration after 8weeks

A. B.

8. An 83-year old lady just lost her husband. Her brother visited the lady in her house. He observed that the lady is acting okay but it is obvious that she is depressed. 3weeks after the husband's death, the lady called her brother crying and was saying that her husband just died. She even said, "I cant even remember him saying he was sick." When the brother visited the lady, she was observed to be well physically but was irritable and claims to have frequent urination at night and she verbalizes that she can see lots of rats in their kitchen. Based on the manifestations, as a nurse, what will you consider as a diagnosis to this patient? urinary tract infection leading to delirium delayed grieving with dementia

A. B. C.

9. As you visit your patient during rounds, you notice a thin child who is shy and not mingling with the group who seemed to be visitors of the patient. You offered him food but his mother told you not to mind him as he is not eating much while all of them are eating during that time. As a nurse, what will you do? inform social service desk on suspected case of child neglect ignore incident since the child is under the responsibility of the mother raise the situation to your head nurse and discuss with her what intervention might be done to help the child

C.

10. You are to take charge of the next shift of nurses. Few minutes before your shift, the in charge of the current shift informed you that two of your nurses will be absent. Since there is a shortage of staff in your shift, what will you do? A.encourage all the staff who are present to do their best to attend to the needs of the patients B.ask from your manager if there are qualified staff from the previous shift that can cover the lacking number for your shift while you try to replace new nurses to cover C.refuse to take charge of the next shift encourage all the staff who are present to do their best to attend to the needs of the patients ask from your manager if there are qualified staff from the previous shift that can cover the lacking number for your shift while you try to replace new nurses to cover refuse to take charge of the next shift

A. B. C. D.

11. Who will you inform first if there is a shortage in supplies in your shift? Nursing assistant Purchasing personne Immediate nurse manager Supplier

A. B.

12. What do you mean by MRSA? A.

methicillin-resistant staphyloccocus aureu


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B.

multiple resistant staphylococcus antibiotic

A. B. C.

13. A young mother who delivered 48hrs ago comes back to the emergency department with post partum haemorrhage. What type of PPH is it? primary post partum haemorrhage secondary post partum haemorrhage tertiary post partum haemorrhage.

A. B. C.

14. As a registered nurse in a unit what would consider as a priority to a patient immediately post operatively? pain relief blood loss airway patency 15. Which is the most dangerous site for intramuscular injection?

A. B. C. D.

ventrogluteal deltoid rectus femoris dorsogluteal

A. B. C.

16. A solution contains 12.5 g of glucose in 0.25 l; what is the percentage concentration (%) of this solution? 5% 10% 25%

A. B. C.

17. A litre bag of 5% Glucose is prescribed over 4 hours. If a standard giving set is used, at what rate should the drip be set? 83 60 24

A. B. C. D.

A. B.

18. You believe that an adult you know and support has been a victim of physical abuse that might be considered a criminal offence. What should you do to support the police in an investigation? Question the adult thoroughly to get as much information as possible Take photographs of any signs of abuse or other potential evidence before cleaning up the victim or the crime scene Explain to the victim that you cannot speak to them unless a police officer is present Make an accurate record of what the person has said to you 19. If you suspect abuse is happening to someone, and it is not serious enough to involve the police straight away, who should you inform? A manager with safeguarding responsibility (if within an organisation) or Adult Social Care directly (if you are a member of the public) No one – it is up to the adult at risk to raise the alert


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C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D. E.

A. B.

C.

The adult's next of kin Everyone with a caring responsibility for the adult 20. If you were told by a nurse at handover to take standard precautions what would you expect to be doing? Taking precautions when handling blood and high-risk body fluids so that you dont pass on any infection to the patient. Wearing gloves, aprons and mask when caring for someone in protective isolation to protect yourself from infection. Asking relatives to wash their hands when visiting patients in the clinical setting. Using appropriate hand hygiene, wearing gloves and aprons when necessary, disposing of used sharp instruments safely and providing care in a suitably clean environment to protect yourself and the patients. 21. What would make you suspect that a patient in your care had a urinary tract infection? The doctor has requested a midstream urine specimen. The patient has a urinary catheter in situ, and the patients wife states that he seems more forgetful than usual. The patient has spiked a temperature, has a raised white cell count (WCC), has new-onset confusion and the urine in his catheter bag is cloudy. The patient has complained of frequency of faecal elimination and hasnt been drinking enough. 22. You are caring for a patient in isolation with suspected Clostridium difficile. What are the essential key actions to prevent the spread of infection? Regular hand hygiene and the promotion of the infection prevention link nurse role. Encourage the doctors to wear gloves and aprons, to be bare below the elbow and to wash hands with alcohol handrub. Ask for cleaning to be increased with soap based products. Ask the infection prevention team to review the patients medication chart and provide regular teaching sessions on the 5 moments of hand hygiene. Provide the patient and family with adequate information. Review antimicrobials daily, wash hands with soap and water before and after each contact with the patient, ask for enhanced cleaning with chlorine-based products and use gloves and aprons when disposing of body fluids. All of the above 23. What steps would you take if you had sustained a needlestick injury? Ask for advice from the emergency department, report to occupational health and fill in an incident form. Gently make the wound bleed, place under running water and wash thoroughly with soap and water. Complete an incident form and inform your manager. Cooperate with any action to test yourself or the patient for infection with a bloodborne virus but do not obtain blood or consent for testing from the patient yourself; this should be done by someone not involved in the incident. Take blood from patient and self for Hep B screening and take samples and form to Bacteriology. Call your union representative for support. Make an


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D.

appointment with your GP for a sickness certificate to take time off until the wound site has healed so you dont contaminate any other patients. Wash the wound with soap and water. Cover any wound with a waterproof dressing to prevent entry of any other foreign material

A. B. C. D.

24. What factors are essential in demonstrating supportive communication to patients? Listening, clarifying the concerns and feelings of the patient using open questions. Listening, clarifying the physical needs of the patient using closed questions. Listening, clarifying the physical needs of the patient using open questions. Listening, reflecting back the patients concerns and providing a solution.

A. B. C. D.

25. Dehydration is of particular concern in ill health. If a patient is receiving intravenous (IV) fluid replacement and is having their fluid balance recorded, which of the following statements is true of someone said to be in a positive fluid balance? The fluid output has exceeded the input. The doctor may consider increasing the IV drip rate. The fluid balance chart can be stopped as positive in this instance means good. The fluid input has exceeded the output.

A. B. C. D.

26. What specifically do you need to monitor to avoid complications and ensure optimal nutritional status in patients being enterally fed? Blood glucose levels, full blood count, stoma site and bodyweight. Eye sight, hearing, full blood count, lung function and stoma site. Assess swallowing, patient choice, fluid balance, capillary refill time. Daily urinalysis, ECG, protein levels and arterial pressure.

A. B. C. D.

27. What is the best way to prevent a patient who is receiving an enteral feed from aspirating? Lie them flat. Sit them at least at a 45° angle. Tell them to lie on their side. Check their oxygen saturations.

A. B. C. D.

28. Which check do you need to carry out before setting up an enteral feed via a nasogastric tube? That when flushed with red juice, the red juice can be seen when the tube is aspirated. That air cannot be heard rushing into the lungs by doing the whoosh test. That the pH of gastric aspirate is <5.5, and the measurement on the NG tube is the same length as the time insertion. That pH of gastric aspirate is >6.0, and the measurement on the NG tube is the same length as the time insertion. 29. Why should healthcare professionals take extra care when washing and drying an elderly patients skin?


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A. B. C. D.

A. B. C. D. A. B. C. D.

A. B. C.

As the older generation deserve more respect and tender loving care (TLC). As the skin of an elder person has reduced blood supply, is thinner, less elastic and has less natural oil. This means the skin is less resistant to shearing forces and wound healing can be delayed. All elderly people lose dexterity and struggle to wash effectively so they need support with personal hygiene. As elderly people cannot reach all areas of their body, it is essential to ensure all body areas are washed well so that the colonization of Gram-positive and negative micro-organisms on the skin is avoided. 30. What should be included in your initial assessment of your patients respiratory status? Review the patients notes and charts, to obtain the patients history. Review the results of routine investigations. Observe the patients breathing for ease and comfort, rate and pattern. Perform a systematic examination and ask the relatives for the patients history. 31. When using nasal cannulae, the maximum oxygen flow rate that should be used is 6 litres/min. Why? Nasal cannulae are only capable of delivering an inspired oxygen concentration between 24% and 40%. For any given flow rate, the inspired oxygen concentration will vary between breaths, as it depends upon the rate and depth of the patients breath and the inspiratory flow rate. Higher rates can cause nasal mucosal drying and may lead to epistaxis. If oxygen is administered at greater than 40% it should be humidified. You cannot humidify oxygen via nasal cannulae 32. Why is it essential to humidify oxygen used during respiratory therapy? Oxygen is a very hot gas so if humidification isnt used, the oxygen will burn the respiratory tract and cause considerable pain for the patient when they breathe. Oxygen is a dry gas which can cause evaporation of water from the respiratory tract and lead to thickened mucus in the airways, reduction of the movement of cilia and increased susceptibility to respiratory infection. Humidification cleans the oxygen as it is administered to ensure it is free from any aerobic pathogens before it is inhaled by the patient. 33. Which of the following would indicate an infection?

A. B. C. D.

A. B.

Hot, sweaty, a temperature of 36.5°C, and bradycardic. Temperature of 38.5°C, shivering, tachycardia and hypertensive. Raised WBC, elevated blood glucose and temperature of 36.0°C. Hypotensive, cold and clammy, and bradycardic. 34. A nurse is having trouble with doing care plans. Her team members are already noticing this problem and are worried of the consequences this may bring to the quality of nursing care delivered. The problem is already brought to the attention of the nurse. The nurse should: Accept her weakness and take this challenge as an opportunity to improve her skills by requesting lectures from her manager Ignore the criticism as this is a case of a team issue


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C.

A. B. C.

Continue delivering care as this will not affect the quality of care you are rendering your patient 35. You are in a registered nurse in a community giving health education to a patient and you notice that the student nurse is using his cell phone to t ext, what should you do? Tell the student to leave and emphasize what a disappointment she is Report the student to his Instructor after duty Politely signal the student and encourage him by actively including him in the discussion

A. B. C. D.

36. Which one of the following types of wound is NOT suitable for negative pressure wound therapy? Partial thickness burns Contaminated wounds Diabetic and neuropathic ulcers Traumatic wounds

A. B. C. D.

37. How long does the ‘inflammatory phase’ of wound healing typically last? 24 hours Just minutes 1-5 days 3-24 days

A. B. C. D.

38. Which of the following methods of wound closure is most suitable for a good cosmetic result following surgery? Skin clips Tissue adhesive Adhesive skin closure strips Interrupted suture

A. B. C. D.

39. You notice an area of redness on the buttock of an elderly patient and suspect they may be at risk of developing a pressure ulcer. Which of the following would be the most appropriate to apply? Negative pressure dressing Rapid capillary dressing Alginate dressing Skin barrier product

A. B. C. D.

40. What are the four stages of wound healing in the order they take place? Proliferative phase, inflammation phase, remodelling phase, maturation phase. Haemostasis, inflammation phase, proliferation phase, maturation phase Inflammatory phase, dynamic stage, neutrophil phase, maturation phase. Haemostasis, proliferation phase, inflammation phase, remodelling phasesupport 41. How soon after surgery is the patient expected to pass urine?


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A. B. C. D.

1-2 hours 2-4 hours 4-6 hours 6-8 hours

A. B. C. D.

42. What functions should a dressing fulfil for effective wound healing? High humidity, insulation, gaseous exchange, absorbent. Anaerobic, impermeable, conformable, low humidity Insulation, low humidity, sterile, high adherence. Absorbent, low adherence, anaerobic, high humidity 43. When would it be beneficial to use a wound care plan?

A. B. C. D.

On all chronic wounds On all infected wounds. On all complex wounds. On every wound 44. How would you care for a patient with a necrotic wound?

A. B. C. D.

Systemic antibiotic therapy and apply a dry dressing Debride and apply a hydrogel dressing. Debride and apply an antimicrobial dressing. Apply a negative pressure dressing.

A. B. C. D.

45. A new, postsurgical wound is assessed by the nurse and is found to be hot, tender and swollen. How could this wound be best described? In the inflammation phase of healing. In the haemostasis phase of healing. In the reconstructive phase of wound healing. As an infected wound

A. B. C. D.

46. When a patient is being monitored in the PACU, how frequently should blood pressure, pulse and respiratory rate be recorded? Every 5 minutes Every 15 minutes Once an hour Continuously

A. B. C. D.

47. Safe moving and handling of an anaesthetized patient is imperative to reduce harm to both the patient and staff. What is the minimum number of staff required to provide safe manual handling of a patient in theatre? 3 (1 either side, 1 at head). 5 (2 each side, 1 at head). 4 (1 each side, 1 at head, 1 at feet). 6 (2 each side, 1 at head, 1 at feet). 48. Why are anti-embolic stockings an effective means of reducing the potential of developing a deep vein thrombosis?


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A. B. C. D.

A. B. C. D.

They promote arterial blood flow. They promote venous blood flow. They reduce the risk of postoperative swelling. They promote lymphatic fluid flow, and drainage 49. You are looking after a postoperative patient and when carrying out their observations, you discover that they are tachycardic and anxious, with an increased respiratory rate. What could be happening? What would you do? The patient is showing symptoms of hypovolaemic shock. Investigate source of fluid loss, administer fluid replacement and get medical support. The patient is demonstrating symptoms of atelectasis. Administer a nebulizer, refer to physiotherapist for assessment. The patient is demonstrating symptoms of uncontrolled pain. Administer prescribed analgesia, seek assistance from medical team. The patient is demonstrating symptoms of hyperventilation. Offer reassurance, administer oxygen

A. B. C. D.

50. Who should mark the skin with an indelible pen ahead of surgery? The nurse should mark the skin in consultation with the patient A senior nurse should be asked to mark the patient's skin The surgeon should mark the skin It is best not to mark the patient's skin for fear of distressing the patient.

A. B. C. D.

51. What serious condition is a possibility for patients positioned in the Lloyd Davies position during surgery? Stroke Cardiac arrest Compartment syndrome There are no drawbacks to the Lloyd Davies position

A. B. C. D.

A.

52. You have been asked to give Mrs Patel her mid day oral metronidazole. You have never met her before. What do you need to check on the drug chart before you administer? Her name and address, the date of the prescription and dose. Her name, date of birth, the ward, consultant, the dose and route, and that it is due at 12.00. Her name, date of birth, hospital number, if she has any known allergies, the prescription for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given Her name and address, date of birth, name of ward and consultant, if she has any known allergies specifically to penicillin, that prescription is for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given and who gave it so you can check with them how she reacted. 53. Accurate postoperative observations are key to assessing a patient's deterioration or recovery. The Modified Early Warning Score (MEWS) is a scoring system that supports that aim. What is the primary purpose of MEWS? Identifies patients at risk of deterioration.


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B. C. D.

Identifies potentialrespiratory distress. Improves communication between nursing staff and doctors. Assesses the impact of pre existing conditions on postoperative recovery.

A. B. C. D.

54. Why is it important that patients are effectively fasted prior to surgery? To reduce the risk of vomiting. To reduce the risk of reflux and inhalation of gastric contents. To prevent vomiting and chest infections. To prevent the patient gagging

A. B. C. D.

A. B. C. D.

A. B. C. D.

55. What are the principles of gaining informed consent prior to planned surgery? Gaining permission for an imminent procedure by providing information in medical terms, ensuring a patient knows the potential risks and intended benefits. Gaining permission from a patient who is competent to give it, by providinginformation, both verbally and with written material, relating to the planned procedure, for them to read on the day of planned surgery. Gaining permission from a patient who is competent to give it, by informing them about the procedure and highlighting risks if the procedure is not carried out. Gaining permission from a patient who is competent to give it, by providing information in understandable terms prior to surgery, allowing time for answering questions, and inviting voluntary participation. 56. On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do? Check the cupboard, record book and order book. If the missing drugs aren't found, contact pharmacy to resolve the issue. You will also complete an incident form. Document the discrepancy on an incident form and contact the senior pharmacist on duty. Check the cupboard, record book and order book. If the missing drugs aren't found the police need to be informed. Check the cupboard, record book and order book and inform the registered nurse or person incharge of the clinical area. If the missing drugs are not found then inform the most senior nurse on duty. You will also complete an incident form 57. A patient in your care is on regular oral morphine sulphate. As a qualified nurse, what legal checks do youneed to carry out every time you administer it, which are in addition to those you would check for every other drug you administer? Check to see if the patient has become tolerant to the medication so it is no longer effective as analgesia. Check to see whether the patient has become addicted. Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; together, check the correct prescription and the identity of the patient. Check the stock of oral morphine sulphate in the CD cupboard with another


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registered nurse and record this in the control drug book; then ask the patient to prove their identity to you

A. B.

C. D.

A. B. C. D.

A. B. C. D.

58. As a newly qualified nurse, what would you do if a patient vomits when taking or immediately after taking tablets? Comfort the patient, check to see if they have vomited the tablets, and ask the doctor to prescribe something different as these obviously don't agree with the patient. Check to see if the patient has vomited the tablets and, if so, document this on the prescription chart. If possible, the drugs may be given again after the administration of antiemetics or when the patient no longer feels nauseous. It may be necessary to discuss an alternative route of administration with the doctor. In the future administer antiemetics prior to administration of all tablets.D. Discuss with pharmacy the availability of medication in a liquid form or hide the tablets in food to take the taste away Discuss with pharmacy the availability of medication in a liquid form or hide the tablets in food to take the taste away 59. Why would the intravenous route be used for the administration of medications? It is a useful form of medication for patients who refuse to take tablets because they don't want to comply with treatment. It is cost effective because there is less waste as patients forget to take oral medication. The intravenous route reduces the risk of infection because the drugs are made in a sterile environment and kept in aseptic conditions. The intravenous route provides an immediate therapeutic effect and gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable 60. What are the key reasons for administering medications to patients? To provide relief from specific symptoms, for example pain, and managing side effects as well as therapeutic purposes. As part of the process of diagnosing their illness, to prevent an illness, disease or side effect, to offer relief from symptoms or to treat a disease As part of the treatment of long term diseases, for example heart failure, and the prevention of diseases such as asthma. To treat acute illness, for example antibiotic therapy for a chest infection, and side effects such as nausea. 61. What are the most common types of medication error?

A. B. C. D.

Nurses being interrupted when completing their drug rounds, different drugs being packaged similarly and stored in the same place and calculation errors. Unsafe handling and poor aseptic technique. Doctors not prescribing correctly and poor communication with the multidisciplinary team. Administration of the wrong drug, in the wrong amount to the wrong patient, via the wrong route


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A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

62. A patient has collapsed with an anaphylactic reaction. What symptoms would you expect to see? The patient will have a low blood pressure (hypotensive) and will have a fast heart rate (tachycardia) usually associated with skin and mucosal changes. The patient will have a high blood pressure (hypertensive) and will have a fast heart rate (tachycardia). The patient will quickly find breathing very difficult because of compromise to their airway or circulation. This is accompanied by skin and mucosal changes The patient will experience a sense of impending doom, hyperventilate and be itchy all over 63. What arethe potential benefits of self-administration of medicines by patients? Nurses have more time for other aspects of patient care and it therefore reduces length of stay. It gives patients more control and allows them to take the medications on time, as well as giving them the opportunity to address any concerns with their medication before they are discharged home. Reduces the risk of medication errors, because patients are in charge of their own medication.D Creates more space in the treatment room, so there are fewer medication errors 64. What is the most accurate method of calculating a respiratory rate? Counting the number of respiratory cycles in 15 seconds and multiplying by 4. Counting the number of respiratory cycles in 1 minute. One cycle is equal to the complete rise and fall of the patient's chest. Not telling the patient as this may make them conscious of their breathing pattern and influence the accuracy of the rate. Placing your hand on the patient's chest and counting the number of respiratory cycles in 30 seconds and multiplying by 2 65. You are caring for a 17 year old woman who has been admitted with acute exacerbation of asthma. Her peak flow readings are deteriorating and she is becoming wheezy. What would you do? Sit her upright, listen to her chest and refer to the chest physiotherapist. Suggest that the patient takes her Ventolin inhaler and continue to monitor the patient. Undertake a full set of observations to include oxygen saturations and respiratory rate. Administer humidified oxygen, bronchodilators, corticosteroids and antimicrobial therapy as prescribed Reassure the patient: you know from reading her notes that stress and anxiety often trigger her asthma. 66. Why is it important to manually assess pulse rate?

A. B. C.

Amplitude, volume and irregularities cannot be detectedusing automated electronic methods Tachycardia cannot be detected using automated electronic methods Bradycardia cannot be detected using automated electronic methods


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D.

It is more reassuring to the patient

D.

67. What are the professional responsibilities of the qualified nurse in medicines management? Making sure that the group of patients that they are caring for receive their medications on time. If they are not competent to administer intravenous medications, they should ask a competent nursing colleague to do so on their behalf. The safe handling and administration of all medicines to patients in their care. This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects. Making sure they know the names, actions, doses and side effects of all the medications used in their area of clinical practice. To liaise closely with pharmacy so that their knowledge is kept up to date

A. B. C. D.

68. When would an orthostatic blood pressure measurement be indicated? If the patient has a recent history of falls. If the patient has a history of dizziness or syncope on changing position. If the patient has a history of hypertension. If the patient has a history of hypotension.

A.

B. C.

69. What do the adverse effects of hypotension include? A. B. C. D.

A. B. C. D.

A. B. C. D.

Decreased conscious level, reduced blood flow to vital organs and renal failure. The patient could become confused and not know who they are. Decreased conscious level, oliguria and reduced coronary blood flow. The patient feeling very cold 70. What are the contraindications for the use of the blood glucose meter for blood glucose monitoring? The patient has a needle phobia andprefers to have a urinalysis. If the patient is in a critical care setting, staff will send venous samples to the laboratory for verification of blood glucose level. If the machine hasn't been calibrated If peripheral circulation is impaired,collection of capillary blood is not advised as the results might not be a true reflection of the physiological blood glucose level. 71. You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions? Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and document clearly. This is a medical emergency. Basic airway, breathing and circulation should be attended to urgently and senior help should be sought. Refer to the neurology team. Break down the patient's Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX. Use this when you hand over.


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A. B. C. D.

A. B. C. D.

A. B. C. D.

72. A patient in your care is about to go for a liver biopsy. What are the most likely potential complications related to this procedure? Inadvertent puncture of the pleura, a blood vessel or bileduct Inadvertent puncture of the heart, oesophagus or spleen. Cardiac arrest requiring resuscitation. Inadvertent puncture of the kidney and cardiac arrest 73. When should adult patients in acute hospital settings have observations taken? When they are admitted or initially assessed. A plan should be clearly documented which identifies which observations should be taken and how frequently subsequent observations should be done. When they are admitted and then once daily unless they deteriorate. As indicated by the doctor. Temperature should be taken daily, respirations at night, pulse and blood pressure 4 hourly. 74. Whyare physiological scoring systems or early warning scoring systems used in clinical practice? They help the nursing staff to accurately predict patient dependency on a shift by shift basis. The system provides an early accurate predictor of deterioration by identifying physiological criteria that alert the nursing staff to a patient at risk. These scoring systems are carried out as part of a national audit so we know how sick patients are in the United Kingdom. They enable nurses to call for assistance from the outreach team or the doctors via an electronic communication system.

D.

75. A patient on your ward complains that her heart is ‘racing’ and you find that the pulse is too fast to manually palpate. What would your actions be? Shout for help and run to collect the crash trolley. Ask the patient to calm down and check her most recent set of bloods and fluid balance. A full set of observations: blood pressure, respiratory rate, oxygen saturation and temperature. It is essential to perform a 12 lead ECG. The patient should then be reviewed by the doctor. Check baseline observations and refer to the cardiology team.

A. B. C. D.

76. If a patient feels a cramping sensation in their abdomen after a colonoscopy, it is advisable that they should do/have which of the following? Eat and drink as soon as sedation has worn off. Drink 500 mL of fluid immediately to flush out any gas retained in the abdomen. Have half hourly blood pressure performed for 12 hours. Be nursed flat and kept in bed for 12 hours.

A. B. C.

77. How do you ensure the correct blood to culture ratio when obtaining a blood culture specimen from an adult patient? Please do not share or distribute the contents of this Ebook.

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A. B. C. D.

Collect at least 10 mL of blood. Collect at least 5 mL of blood. Collect blood until the specimen bottle stops filling. Collect as much blood as the vein will give you

A. B. C. D.

78. If blood is being taken for other tests, and a patient requires collection of blood cultures, which should come first to reduce the risk of contamination? Inoculate the aerobic culture first Take the other blood tests first. Inoculate the anaerobic culture first. The order does not matter as long as the bottles are clean 79. Which of the following would indicate an infection?

A. B. C. D.

Hot, sweaty, a temperature of36.5°C, and bradycardic Temperature of 38.5°C, shivering, tachycardia and hypertensive. Raised WBC, elevated blood glucose and temperature of 36.0°C. Hypotensive, cold and clammy, and bradycardic

C. D.

80. Which of the following techniques is advisable when obtaining a urine specimen in order to minimize the contamination of a specimen? Clean around the urethral meatus prior to sample collectionand get a midstream/clean catch urine specimen. Clean around the urethral meatus prior to sample collection and collect the first portion of urine as this is where the most bacteria will be. Do not clean the urethral meatus as we want these bacteria to analyse as well. Dip the urinalysis strip into the urine in a bedpan mixed with stool

A. B. C. D.

81. If a patient is experiencing dysphagia, which of the following investigations are they likely to have? Colonoscopy Gastroscopy Cystoscopy Arthroscopy

A. B. C. D.

82. Which of the following can a patient not have if they have a pacemaker in situ? MRI X ray Barium swallow CT

A. B. C. D.

83. In a fully saturated haemoglobin molecule, responsible for carrying oxygen to the body's tissues, how many of its haem sites are bound with oxygen? 2 4 6 8

A. B.


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A. B. C. D.

84. Which of the following is NOT a cause of Type 1 (hypoxaemic) respiratory failure? Asthma Pulmonary oedema Drug overdose Granulomatous lung disease

A. B. C. D.

85. Prior to sending a patient home on oxygen, healthcare providers must ensure the patient and family understand the dangers of smoking in an oxygen-rich environment. Why is this necessary? It is especially dangerous to the patient's health to smoke while using oxygen Oxygen is highly flammable and there is a risk of fire Oxygen and cigarette smoke can combine to produce a poisonous mixture Oxygen can lead to an increased consumption of cigarette

A. B. C. D.

A. B. C. D.

A. B. C. D.

86. What action would you take if a specimen had a biohazard sticker on it? Double bag it, in a self-sealing bag, and wear gloves ifhandling the specimen. Wear gloves if handling the specimen, ring ahead and tell the laboratory the sample is on its way. Wear goggles and underfill the sample bottle. Wear appropriate PPE and overfill the bottle. 87. What isthe best way to avoid a haematoma forming when undertaking venepuncture? Tap the vein hard which will ‘get the vein up’, especially if the patient has fragile veins. This will avoid bruising afterwards. It is unavoidable and an acceptable consequence of the procedure. This should be explained and documented in the patient's notes. Choosing a soft, bouncy vein that refills when depressed and is easily detected, and advising the patient to keep their arm straight whilst firm pressure is applied. Apply pressure to the vein early before the needle is removed, then get the patient to bend the arm at a right angle whilst applying firm pressure 88. You are caring for a patient with a history of COAD who is requiring 70% humidified oxygen via a facemask. You are monitoring his response to therapy by observing his colour, degree of respiratory distress and respiratory rate. The patient's oxygen saturations have been between 95% and 98%. In addition, the doctor has been taking arterial blood gases. What is the reason for this? Oximeters may be unreliable under certain circumstances, e.g. if tissue perfusion is poor, if the environment is cold and if the patient's nails are covered with nail polish. Arterial blood gases should be sampled if the patient is receiving >60% oxygen. Pulse oximeters provide excellent evidence of oxygenation, but they do not measure the adequacy of ventilation. Arterial blood gases measure both oxygen and carbon dioxide levels and therefore give an indication ofboth ventilation and oxygenation


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A. B. C. D.

A. B. C. D.

89. When using nasal cannulae, the maximum oxygen flow rate that should be used is 6 litres/min. Why? Nasal cannulae are only capable of delivering an inspired oxygen concentration between 24% and 40% Forany given flow rate, the inspired oxygen concentration will vary between breaths, as it depends upon the rate and depth of the patient's breath and the inspiratory flow rate. Higher rates can cause nasal mucosal drying and may lead to epistaxis If oxygen is administered at greater than 40% it should be humidified. You cannot humidify oxygen via nasal cannulae 90. You are currently on placement in the emergency department (ED). A 55 year old city worker is bluelighted into the ED having had a cardiorespiratory arrest at work. The paramedics have been resuscitating him for 3 minutes. On arrival, he is in ventricular fibrillation. Your mentor asks you the following question prior to your shift starting: What will be the most important part of the patient's immediate advanced life support? Early defibrillation to restart the heart Early cardiopulmonary resuscitation Administration of adrenaline every 3 minutes Correction of reversible causes of hypoxia 91. Why is it essential to humidify oxygen used during respiratory therapy?

A. B. C. D.

Oxygen is a very hot gas so if humidification isn't used, the oxygen will burn the respiratory tract and cause considerable pain for the patient when they breathe. Oxygen is a dry gas which can cause evaporation of water from the respiratory tract and lead to thickened mucus in the airways, reduction of the movement of cilia and increased susceptibility to respiratory infection. Humidification cleans the oxygen as it is administered to ensure it is free from any aerobic pathogens before it is inhaled by the patient. Humidifying oxygen adds hydrogen to it, which makes it easier for oxygen to be absorbed to the blood in the lungs. This means the cells that need it for intracellular function have their needs met in a more timely manner 92. Which of the following is NOT a symptom of impacted earwax?

A. B. C. D.

Dizziness Dull hearing Reflux cough Sneezing

A. B. C. D.

93. After death, who can legally give permission for a patient's body to be donated to medical science? Only the patient, if they left instructions for this The patient's spouse or next-of-kin The patient's GP The doctor in charge at the time of death 94. What should be included in your initial assessment of your patient's


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respiratory status? A. B. C. D.

Review the patient's notes and charts, to obtain the patient's history. Review the results of routine investigations. Observe the patient's breathing for ease and comfort, rate and pattern. Perform a systematic examination and ask the relatives for the patient's history 95. What should be included in a prescription for oxygen therapy?

A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

You don't need a prescription for oxygen unless in an emergency. The date it should commence, the doctor's signature and bleep number. The type of oxygen delivery system, inspired oxygen percentage and duration of the therapy. You only need a prescription if the patient is going to have home oxygen 96. You are caring for a patient with a tracheostomy in situ who requires frequent suctioning. How long should you suction for? If you preoxygenate the patient, you can insert the catheter for 45 seconds. Never insert the catheter for longer than 10-15 seconds. Monitor the patient's oxygen saturations and suction for 30 seconds Suction for 50 seconds and send a specimen to the laboratory if the secretions are purulent 97. What does the term ‘breakthrough pain’ mean, and what type of prescription would you expect for it? A patient who has adequately controlled pain reliefwith short lived exacerbation of pain, with a prescription that has no regular time of administration of analgesia. Pain on movement which is short lived, with a q.d.s. prescription, when necessary. Pain that is intense, unexpected, in a location that differs from that previously assessed, needing a review before a prescription is written. A patient who has adequately controlled pain relief with short lived exacerbation of pain, with a prescription that has 4 hourly frequency of analgesia if necessary 98. A patient has just returned from theatre following surgery on their left arm. They have a PCA infusion connected and from the admission, you remember that they have poor dexterity with their right hand. They are currently pain free. What actions would you take? A. Educate the patient's family to push the button when the patient asks for it. Encourage them to tell the nursing staff when they leave the ward so that staff can take over. Routinely offer the patient a bolus and document this clearly. Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed. The patient has paracetamol q.d.s. written up, so this should be adequate pain relief 99. In which of the following situations might nitrous oxide (Entonox) be considered?


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A. B. C. D.

A. B. C. D.

A wound dressing change for short term pain relief or the removal of a chest drain for reduction of anxiety. Turning a patient who has bowel obstruction because there is an expectation that they may have pain from pathological fractures For pain relief during the insertion of a chest drain for the treatment of a pneumothorax. For pain relief during a wound dressing for a patient who has had radical head and neck cancer that involved the jaw. 100. What are the key nursing observations needed for a patient receiving opioids frequently? Respiratory rate, bowel movement record and pain assessment and score. Checking the patent is not addicted by looking at their blood pressure. Lung function tests, oxygen saturations and addiction levels Daily completion of a Bristol stool chart, urinalysis, and a record of the frequency with which the patient reports breakthrough pain


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A. B. C. D.

A. B. C. D.

A.

B. C. D.

A.

1. Why should healthcare professionals take extra care when washing and drying an elderly patient's skin? As the older generation deserve more respect and tender loving care (TLC). As the skin of an elder person has reduced blood supply, is thinner, less elastic and has less natural oil. This means the skin is less resistant to shearing forces and wound healing can be delayed. All elderly people lose dexterity and struggle to wash effectively so they need support with personal hygiene. As elderly people cannot reach all areas of their body, it is essential to ensure all body areas are washed well so that the colonization of Gram positive and negative micro organisms on the skin is avoided. 2. What would you do if a patient with diabetes and peripheral neuropathy requires assistance cutting his toe nails? Document clearly the reason for not cutting his toe nails and refer him to a chiropodist. Document clearly the reason for not cutting his nails and ask the ward sister to do it. Have a go and if you run into trouble, stop and refer to the chiropodist. Speak to the patient's GP to ask for referral to the chiropodist, but make a start while the patient is in hospital. 3. A patient is agitated and is unable to settle. She is also finding it difficult to sleep, reporting that she is in pain. What would you do at this point? Ask her to score her pain, describe its intensity, duration, the site, any relieving measures and what makes it worse, looking for non verbal clues, so you can determine the appropriate method of pain management. Give her some sedatives so she goes to sleep. Calculate a pain score, suggest that she takes deep breaths, reposition her pillows, return in 5 minutes to gain a comparative pain score. Give her any analgesia she is due. If she hasn't any, contact the doctor to get some prescribed. Also give her a warm milky drink and reposition her pillows. Document your action. 4. On which step of the WHO analgesic ladder would you place tramadol and codeine? Step 1: Non Opioid Drugs


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B. C. D.

Step 2: Opioids for Mild to Moderate Pain Step 3: Opioids for Moderate to Severe Pain Herbal medicine

A. B. C. D.

5. Your patient has a bulky oesophageal tumour and is waiting for surgery. When he tries to eat, food gets stuck and gives him heartburn. What is the most likely route that will be chosen to provide him with the nutritional support he needs? Nasogastric tube feeding Feeding via a percutaneous endoscopic gastrostomy (PEG) Feeding via a radiologically inserted gastrostomy (RIG) Continue oral food

A. B. C. D.

6. What is the best way to prevent a patient who is receiving an enteral feed from aspirating? Lie them flat Sit them at least at a 45° angle Tell them to lie on their side Check their oxygen saturations

A. B. C. D.

A. B. C. D.

A. B. C.

7. Which of the following medications are safe tobe administered via a nasogastric tube? Enteric coated drugs to minimize the impact of gastric irritation. A cocktail of all medications mixed together, to save time and prevent fluid overloading the patient. Any drugs that can be crushed. Drugs that can be absorbed via this route, can be crushed and given diluted or dissolved in 10-15 ml of water. 8. Which check do you need to carry out before setting up an enteral feed via a nasogastric tube? That when flushed with red juice, the red juice can be seen when the tube is aspirated. That air cannot be heard rushing into the lungs by doing the ‘whoosh test. That the pH of gastric aspirate is <5.5, and the measurement on the NG tube is the same length as the time insertion. That pH of gastric aspirate is >6.0, and the measurement on the NG tube is the same length as the time insertion 9. Fred is going to receive a blood transfusion. How frequently should we do his observations? Temperature and pulse before the blood transfusion begins, then every hour, and at the end of bag/unit. Temperature, pulse, blood pressure and respiration before the blood transfusion begins, then after 15 minutes, then as indicated in local guidelines, and finally at the end of the bag/unit. Temperature, pulse, blood pressure and respiration and urinalysis


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D.

before the blood transfusion, then at end of bag. Pulse, blood pressure and respiration every hour, and at the end of the bag. 10. Approximately how long is the spinal cord in an adult?

A. B. C. D.

30 cm 45 cm 60 cm 120 cm

D.

11. Dehydration is of particular concern in ill heath. If a patient is receiving intravenous (IV) fluid replacement and is having their fluid balance recorded, which ofthe following statements is true of someone said to be in a ‘positive fluid balance'? The fluid output has exceeded the input. The doctor may consider increasing the IV drip rate The fluid balance chart can be stopped as ‘positive’ in this instance means good The fluid input has exceeded the output

A. B. C. D.

12. What specifically do you need to monitor to avoid complications and ensure optimal nutritional status in patients being enterally fed? Blood glucose levels, fullblood count, stoma site and bodyweight Eye sight, hearing, full blood count, lung function and stoma site Assess swallowing, patient choice, fluid balance, capillary refill time Daily urinalysis, ECG, protein levels and arterial pressure

A. B. C.

A. B. C. D.

A. B. C. D.

13. A patient needs weighing, as he is due a drug that is calculated on bodyweight. He experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do? Document clearly in the patient's notes that a weight cannot be obtained. Offer the patient pain relief and either use bed scales or a hoist with scales built in Discuss the case with your colleagues and agree to guess his body weight until he agrees to stand and use the chair scales. Omit the drug as it is not safe to give it without this information; inform the doctor and document your actions 14. If the prescribed volume is taken, which of the following types of feed will provide all protein, vitamins, minerals and trace elements to meet a patient's nutritional requirements? Protein shakes/supplement Sip feeds Energy drinks Mixed fat and glucose polymer solutions/powders


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A. B. C. D.

A. B.

C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

15. A patient has been admitted for nutritional support and started receiving a hyperosmolar feed yesterday. He presents with diarrhoea but has no pyrexia. What is likely to be the cause? The feed An infection Food poisoning Being in hospital 16. Mrs Jones has had a cerebral vascular accident, so her left leg is increasedin tone, very stiff and difficult to position comfortably when she is in bed. What would you do? Give Mrs Jones analgesia and suggest she sleeps in the chair. Try to diminish increased tone by avoiding extra stimulation by ensuring herfoot doesn't come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed. Give Mrs Jones diazepam and tilt the bed. Suggest a warm bath before she lies on the bed. Then use pillows to support the stiff limb. 17. Which of the following is a behavioural risk factor when assessing the potential risks of falling in an older person? Poor nutrition/fluid intake Poor heating Foot problems Fear of falling 18. When positioning the supine patient in bed, why should you ensure the patient is lying centrally in the bed? To ensure spinal and limb alignment To ensure patient comfort To ensure the airway is patent To minimize the risk of injury to the practitioner 19. In what instances shouldn't you position a patient in a side-lying position? If they are pregnant If they have a spinal fracture If they have pressure sore If they have lower limb pain 20. What does ‘muscle atrophy’ mean?

A. B. C. D.

Loss of muscle mass Loss of muscle mass A change in the shape of muscles Disease of the muscle 21. How do the structures of the human body work together to provide support and assist inmovement?


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A. B. C. D.

The skeleton provides a structural framework. This is moved by the muscles that contract or extend and in order to function, cross at least one joint and are attached to the articulating bones. The muscles provide a structural framework and are moved by bones to which they are attached by ligaments. The skeleton provides a structural framework; this is moved by ligaments that stretch and contract. The muscles provide a structural framework, moving by contracting or extending, crossing at least one joint and attached to the articulating bones. 22. What are the most common effects of inactivity?

A. B. C. D.

A. B.

C.

D.

A. B. C. D.

Pulmonary embolism, urinary tract infection and fear of people Deep arterial thrombosis, respiratory infection, fear of movement, loss of consciousness, deconditioning of cardiovascular system leading to an increased risk of angina. Loss of weight, frustration and deep vein thrombosis. Social isolation, loss of independence, exacerbation of symptoms, rapid loss of strength in leg muscles, deconditioning of cardiovascular system leading to increased risk of chest infection, and pulmonary embolism 23. What do you need to consider when helping a patient with shortness of breath sit out in a chair? They shouldn't sit out in a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure on the lungs. Sitting in a reclining position with the legs elevated toreduce the use of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don't expend any unnecessary energy. The patient needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others. There are two possible positions, either sitting upright or side lying. Which is used is determined by the age of the patient. It is also important to remember that they will always need a nebulizer and oxygen and the air temperature must be below 20° C 24. Your patient has bronchitis and has difficulty in clearing his chest. What position would help to maximize the drainage of secretions? Lying flat on his back while using a nebulizer. Sitting up leaning on pillows and inhaling humidified oxygen Lying on his side with the area to be drained uppermost after the patient has had humidified air. Standing up in fresh air taking deep breath


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A. B. C. D.

25. Perdue categorizes constipation as primary, secondary or iatrogenic. What could be some of the causes of iatrogenic constipation? Inadequate diet and poor fluid intake Anal fissures, colonic tumours or hypercalcaemia. Lifestyle changes and ignoring the urge to defaecate. Antiemetic or opioid medication

A. B. C. D.

26. A patient is admitted to the ward with symptoms of acute diarrhoea. What should your initial management be? Assessment, protective isolation, universal precautions. Assessment, source isolation, antibiotic therapy. Assessment, protective isolation, antimotility medication. Assessment, source isolation, universal precautions

A. B. C. D.

A. B. C. D.

27. Your patient has undergone a formation of a loop colostomy. What important considerations should be borne in mind when selecting an appropriate stoma appliance for your patient? Dexterity of the patient, consistency of effluent, type of stoma Patient preference, type of stoma,consistence of effluent, state of peristomal skin, dexterity of patient. Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, dexterity of patient, type of stoma Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency of effluent, patient preference. 28. What type of diet would you recommend to your patient who has a newly formed stoma? Encourage high fibre foods to avoid constipation. Encourage lots of vegetables and fruit to avoid constipation. Encourage a varied diet as people can react differently. Avoid spicy foods because they can cause erratic function.

D.

29. What would be your main objectives in providing stoma education when preparing a patient with a stoma for discharge home? That the patient can independently manage their stoma, and can get supplies That the patient has had their appliance changed regularly, and knows their community stoma nurse. That the patient knows the community stoma nurse, and has a prescription. That the patient has a referral to the District Nurses for stoma care.

A.

30. When communicating with someone who isn't a native English speaker, which of the following is NOT advisable? Using a translator

A. B. C.


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B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

Use short, precise sentences Relying on their family or friends to help explain what you mean Write things down 31. When should a penile sheath be considered as a means of managing incontinence? When other methods of continence management have failed Following the removal of a catheter. When the patient has a small or retracted penis. When a patient requests it. 32. What is the most important guiding principle when choosing the correct size of catheter? The biggest size tolerable The smallest size necessary. The potential length of use of the catheter The build of the patient 33. When carrying out a catheterization, on which patients would you use anaesthetic lubricating gel prior to catheter insertion? Male patients to aid passage, as the catheter is longer. Female patients as there is an absence of lubricating glands in the female urethra, unlike the male urethra. Male and female patients require anaesthetic lubricating gel The use of anaesthetic lubricating gel is not advised due to potential adverse reactions 34. On removing your patient's catheter, what should you encourage your patient to do? Rest and drink 2-3 litres of fluid per day. Rest and drink in excess of 5 litres of fluid per day. Exercise and drink 2-3 litres of fluid per day. Exercise and drink their normal amount of fluid intake. 35. What are the principles of positioning a urine drainage bag?

A. B. C. D.

A. B. C. D.

Above the level of the bladder to improve visibility and access for the health professional. Above the level of the bladder to avoid contact with the floor. Below the level of the patient's bladder to reduce back flow of urine Where the patient finds it most comfortable 36. What are the principles of communicating with a patient with delirium? Use short statements and closed questions in a well lit, quiet, familiar environment. Use short statements and open questions in a well lit, quiet, familiar environment Write down all questions for the patient to refer back to. Communicate only through the family using short statements and closed questions.


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A. B. C. D.

37. Which of the following is NOT an example of non-verbal communication? Dress Facial expression Posture Tone 38. Which of these is an example of an open question?

A. B. C. D.

Are you feeling better today? When you said you are hurt, what do you mean? Can you tell me what is concerning you? Is that what you are looking for?

A. B. C. D.

39. According to Argyle (1988), when two people communicate what percentage of what is communicated is actually in the words spoken? 90% 50% 23% 7%

A. B. C. D.

A. B. C. D.

A. B. C. D.

40. What factors are essential in demonstrating supportive communication to patients? Listening, clarifying the concerns and feelings of the patient using open questions. Listening, clarifying the physical needs of the patient using closed questions Listening, clarifying the physical needs of the patient using open questions. Listening, reflecting back the patient's concerns and providing a solution. 41. Which behaviours will encourage a patient to talk about their concerns? Giving reassurance and telling them not to worry. Asking the patient about their family and friends. Tell the patient you are interested in what is concerning them and that you are available to listen. Tell the patient you are interested in what is concerning them and if they tell you, they will feel better. 42. When communicating with someone who isn't a native English speaker, which of the following is advisable? Using an official translator Ask the doctor Relying on their family or friends Ask the receptionist 43. Dehydration is of particular concern in ill health. If a patient is


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A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D. E.

receiving intravenous (IV) fluid replacement and is having their fluid balance recorded, which of the following statements is true of someone said to be in a ‘positive fluid balance’? The fluid output has exceeded the input. The doctor may consider increasing the IV drip rate. The fluid balance chart can be stopped as ‘positive’ in this instance means ‘good’. The fluid input has exceeded the output. 44. What is the best way to prevent a patient who is receiving an enteral feed from aspirating? Lie them flat. Sit them at least at a 45° angle. Tell them to lie on their side. Check their oxygen saturations 45. Which check do you need to carry out every time before setting up a routine enteral feed via a nasogastric tube? That when flushed with red juice, the red juice can be seen when the tube is aspirated. That air cannot be heard rushing into the lungs by doing the ‘whoosh test’. That the pH of gastric aspirate is <4, and the measurement on the NG tube is the same length as the time insertion. abdominal x-ray 46. What should be included in your initial assessment of your patient's respiratory status? Review the patient's notes and charts, to obtain the patient's history. Review the results of routine investigations. Observe the patient's breathing for ease and comfort, rate and pattern. check for any drains all of the above 47. What should be included in a prescription for oxygen therapy?

A. B. C. D.

A. B.

You don't need a prescription for oxygen unless in an emergency. The date it should commence, the doctor's signature and bleep number. The type of oxygen delivery system, inspired oxygen percentage and You only need a prescription if the patient is going to have home oxygen. 48. What action would you take if a specimen had a biohazard sticker on it? Double bag it, in a self-sealing bag, and wear gloves if handling the specimen. Wear gloves if handling the specimen, ring ahead and tell the laboratory the sample is on its way.


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C. D.

Wear goggles and underfill the sample bottle. Wear appropriate PPE and overfill the bottle. 49. Which of the following would indicate an infection?

A. B. C. D.

A. B. C. D.

A. B. C. D. E.

A. B. C. D.

Hot, sweaty, a temperature of 36.5°C, and bradycardic. Temperature of 38.5°C, shivering, tachycardia and hypertensive. Raised WBC, elevated blood glucose and temperature of 36.0°C. Hypotensive, cold and clammy, and bradycardic. 50. Which of the following techniques is advisable when obtaining a urine specimen in order to minimize the contamination of a specimen? Clean around the urethral meatus prior to sample collection and get a midstream/clean catch urine specimen. Clean around the urethral meatus prior to sample collection and collect the first portion of urine as this is where the most bacteria will be. Do not clean the urethral meatus as we want these bacteria to analyse as well. Dip the urinalysis strip into the urine in a bedpan mixed with stool.

51. Which of the following are barriers to effective communication? Cultural differences Unfamiliar accents Overly technical language and terminology Hearing problems All of the above 52. Which behaviours will encourage a patient to talk about their concerns? Giving reassurance and telling them not to worry. Asking the patient about their family and friends. Tell the patient you are interested in what is concerning them and that you are available to listen. Tell the patient you are interested in what is concerning them and if they tell you, they will feel better. 53. What is the difference between denial and collusion?

A.

Denial is when a healthcare professional refuses to tell a patient their diagnosis for the protection of the patient whereas collusion is when healthcare professionals and the patient agree on the information to be told to relatives and friends. B. Denial is when a patient refuses treatment and collusion is when a patient agrees to it. C. Denial is a coping mechanism used by an individual with the intention of protecting themselves from painful or distressing information whereas collusion is the withholding of information from the patient with the intention of ‘protecting them’.


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A. B. C. D.

A. B. C. D.

54. If you were explaining anxiety to a patient, what would be the main points to include? Signs of anxiety include behaviours such as muscle tension, palpitations, a dry mouth, fast shallow breathing, dizziness and an increased need to urinate or defaecate. Anxiety has three aspects: physical -bodily sensations related to flight and fight response, behavioural -such as avoiding the situation, and cognitive (thinking) -such as imagining the worst. Anxiety is all in the mind, if they learn to think differently, it will go away. Anxiety has three aspects: physical -such as running away, behavioural -such as imagining the worse (catastrophizing),and cognitive (thinking) -such as needing to urinate. 55. What factors are essential in demonstrating supportive communication to patients? Listening, clarifying the concerns and feelings of the patient using open questions. Listening, clarifying the physical needs of the patient using closed questions Listening, clarifying the physical needs of the patient using open questions. Listening, reflecting back the patient's concerns and providing a solution. 56. What infection is thought to be caused by prions?

A. B. C. D. E.

Leprosy Pneumocystis jirovecii Norovirus Creutzfeldt Jakob disease None of the above

A. B. C. D. E.

57. If a patient requires protective isolation, which of the following should you advise them to drink? Filtered water only Fresh fruit juice and filtered water Bottled water and tap water Tap water only Long-life fruit juice and filtered water

A. B. C. D. E.

58. All individuals providing nursing care must be competent at which of the following procedures? Hand hygiene and aseptic technique Aseptic technique only Hand hygiene, use of protective equipment, and disposal of waste Disposal of waste and use of protective equipment All of the above 59. For which type of waste should orange bags be used?


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A. Waste that requires disposal by incineration B. Offensive/hygiene waste C. Waste which may be ‘treated D. Offensive waste

A. B. C. D.

60. What percentage of patients in hospital in England, at the time of the 2011 National Prevalence survey, had an infection? 4.60% 6.40% 14% 16%

A. B. C. D.

61. The night after an exploratory laparotomy, a patient who has a nasogastric tube attached to low suction reports nausea. A nurse should take which of the following actions first? Administer the prescribed antiemetic to the patient. Determine the patency of the patient's nasogastric tube. Instruct the patient to take deep breaths. Assess the patient for pain

A. B. C. D.

62. Which of the following nursing theorists developed a conceptual model based on the belief that all persons should strive to achieve selfcare? Martha Rogers Dorothea Orem Florence Nightingale Cister Callista Roy 63. The term gavage indicates

A. Administration of a liquid feeding into the stomach B. Visual examination of the stomach C. irrigation of the stomach with solution D. A surgical opening through the abdomen to stomach

A. B. C. D.

64. Sue’s passed away. Sue handled this death by crying and withdrawing from friend and family. As A nurse you would notice that sue’s intensified grief is most likely a sign of which type of grief? Distorted or exaggerated Grief Anticipatory Grief Chronic or Prolonged Grief Delayed or Inhibited Grief

65. Missy is 23 years old and looking forward to being married the following day. Missy’s mother feels happy that her daughter is starting a new phase in her life but is feeling a little bit sad as well. When talking to Missy’s mother you would explain this feeling to her as a sign of what? A. Anticipated Grief Please do not share or distribute the contents of this Ebook.

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B. Lifestyle Loss C. Situational Loss D. Maturational Loss E. Self Loss F. All of the above

A. B. C. D.

66. After the suicide of her best friend Marry feels a sense of guilt, shame and anger because she had not answered the phone when her friend called shortly before her death. Which of the following statements is the most accurate when talking about Mary’s feelings? Marry’s feelings are normal and are a form of perceived loss Marry’s feelings are normal and are a form of situational loss. Marry’s feelings are not normal and are a form of situational loss. Marry's feelings are not normal and are a form of physical loss.

67. What law should be taken into consideration when a patient has hearing difficulties and would need hearing aids? (CHOOSE 2 ANSWERS) A. Mental capacity Act B. Equality act C. Communication law

A. B. C. D.

68. While having lunch at the cafeteria, your co-worker suddenly collapsed. As a nurse, what would you do? You are on lunch, no actions should be taken Assess for any danger Tap the patient to check for consciousness Call for help 69. During cardiopulmonary resuscitation:

A. B. C. D.

chest compression should be 5-6 cm deep at a rate of 100-120 compression per minute a ratio of 2 ventilation to 15 cardiac compression is required the hands should be placed over the lower third of the sternum to do chest compression check for normal breathing for 1 full minute to diagnose cardiac arrest 70. In hospitalised patients:

A. B. C. D.

cardiac arrest is usually sudden and unexpected event pulse oximetry is a reliable indicator of ventilation urine output is a good predictor of cardiac output ECG monitoring is always required 71. National Early Warning Scoring systems:

A. B. C. D.

can help detect deteriorating patients must not be calculated before referring to another team use the patient’s subjective complaints to calculate a score is a tool to measure patient’s comfort level


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B. C. D.

72. The correct management of an adult patient in ventricular fibrillation (VF) cardiac arrest includes: an initial shock with a manual defibrillator or when prompted by an automated external defibrillator (AED) atropine 3 mg IV adenosine 500 mcg IV adrenaline 1 mg IV before first shock

A. B. C. D.

73. Which of the following indicates signs of severe Chronic Obstructive Pulmonary disease (COPD)? high p02 and high pC02 low p02 and low pC02 low p02 and high pC02 high p02 and low pC02

A.

74. Severe bleeding is best characterised by: A. B. C. D.

moist skin and pinkish nailbeds dry skin and pinkish nailbeds moist skin and bluish nailbeds dry skin and bluish nailbeds 75. In doing neurological assessment, AVPU means:

A. B. C. D.

awake, voice, pain, unresponsive alert, voice, pain, unresponsive awake, verbalizes, pain, unresponsive alert, verbalizes, pain, unresponsive

A. B. C. D.

76. When doing your shift assessment, one of your patient has a waterlow score of 20. Which of the following mattress is appropriate for this score? water bed fluidized airbed low air loss alternating pressure

A. B. C. D.

77. Mrs. Smith is receiving blood transfusion after a total hip replacement operation. After 15 minutes, you went back to check her vital signs and she complained of high temperature and loin pain. This may indicate: Renal Colic Urine Infection Common adverse reaction Serious adverse reaction 78. After the handover, you noticed that the outgoing nurse documented an intervention on a wrong patient chart. What should you do to correct it, maintain safety and continuation of care?


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A. B. C. D.

Discard the paper/ document Cross the wrong entry with a line, indicated it is an error, write the date, time, name & signature, document the care correctly. Leave it, never alter pt record Inform the nurse manager, let her draw a line on the entry and place her name & signature

A. B. C. D.

79. Mr Khan, is visiting his son in London when he was admitted in accident and emergency due to abdominal pain. Mr. Khan is from Pakistan and does not speak the English language. As his nurse, what is your best action: Ask the relative Ask a cleaner who speaks the same Ask for an official interpreter Transfer him to another hospital who can communicate with him

A. B. C. D.

80. Adam, 46 years old is of Jewish descent. As his nurse, how will you plan his dietary needs? Assume he strictly needs Jewish food Ask relatives to bring food from kosher market Ask a rabbi to help you plan Ask the patient about his diet preferences

A. B. C. D.

81. Barbara, an elderly patient with dementia, wishes to go out of the hospital. What will be you appropriate action? Call the police, make sure she does not leave Encourage the patient to stay for his well being Inform the police to arrest the patient Allow her to leave, she is stable and not at risk of anything

A. B. C. D.

82. Jenny was admitted to your ward with severe bleeding after 48 hours following her labour. What stage of post partum haemorrhage is she experiencing? Primary Secondary Tertiary Emergency

A. B. C. D.

83. o effectively plan the therapy for Jenny, which of the following indicator will you consider checking together with prothrombin time (PT)? Activated prothrombin time Bleeding time Thrombin time INR 84. Who is responsible for the strict disposal of sharps?

A.

Registered Nurse


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B. C. D.

Nurse assistant Doctor The one who used the sharps

A. B. C. D.

85. As an infection prevention and control protocol, linens soiled with infectious bodily fluids should be disposed of in what means? Placed in yellow plastic bag to be disposed of Placed in dissolvable red linen bag and washed at high temperature Placed in yellow linen bag, and washed at high temperature Placed in red plastic bag to be incinerated at high temperature 86. In the UK, safeguarding is the responsibility of:

A. Nurse assistant B. Doctor C. Registered Nurse D. All of the above

A. B. C. D.

87. Which of the following is a potential complication of putting an oropharyngeal airway adjunct: Retching, vomiting Bradycardia Obstruction Nasal injury

D.

88. John, 18 years old is for discharge and will require further dose of oral antibiotics. As his nurse, which of the following will you advise him to do? Take with food or after meals and ensure to take all antibiotics as prescribed Take all antibiotics and as prescribed Take medicine during the day and ensure to finish the course of medication Take medicine and stop when he feels better

A. B. C. D.

89. John is also prescribed some medications for his Gout. Which of the following health teaching will you advise him to do? Increase fluid intake 2 - 3 liters per day Have enough sunshine Avoid paracetamol (first line analgesic) avoid dairy products

A. B. C. D.

90. Jim is to receive his eyedrops after his cataract operation. What is the best position for Jim to assume when instilling the eyedrops? sitting position, head tilted backwards supine position for comfort standing position to facilitate drainage recovery position

A. B. C.


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A. B. C. D.

A. B. C. D.

91. The current Chief Nursing Officer of England called for all nurses to be care- makers and encouraged to embed the 6 Cs in their practice. 6 Cs mean: care, compassion, competence, communication, courage, commitment care, cure, compassion, competence, communication, commitment care, competence, compassion, communication, commitment, cohesion care, collaboration, communication, compassion, commitment, competence 92. Which of the following is an average heart rate of a 1-2 year old child? 110-120 bpm 60-100 bpm 140-160 bpm 80-120 bpm 93. The following are qualities of a good leader, except:

A. Shows empathy to members B. His behaviour contributes to the team C. Acknowledges and accepts members mistakes - without any corrections D. Does not accept criticisms from members 94. Clinical audit is best described as: A. B. C. D.

a tool to evaluate the effectiveness of interventions, and to know what needs to be improved a tool used to identify the weakest link within the system a standard of which performance is based upon a tool to set a guidelines or protocol in clinical practice

A. B. C. D.

95. Breid, 76 years old, developed a pressure ulcer whilst under your care. On assessment, you saw some loss of dermis, with visible redness, but not sloughing off. Her pressure ulcer can be categorised as: moisture lesion 2nd stage partial skin thickness 3rd stage 4th stage

A. B. C. D.

96. Joshua, son of Breid went to the station to see the nurse as she was complaining of severe pain on her pressure ulcer. What will be your initial action? Check analgesia on the chart Tell you will come as soon as you can Find the nurse in charge Go immediately to see the patient 97. Which is not a stage in the Tuckman Theory of contingency?


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A. Forming B. Storming C. Norming D. Analyzing

A. B. C. D.

98. Joy, a COPD patient is to be discharged in the community. As her nurse, which of the following interventions will you encourage him to do to prevent progression of disease. Oxygen therapy Breathing exercise Cessation of smoking coughing exercise

A. B. C. D.

99. Which of the following population group is at risk of developing cardiovascular disease? (CHOOSE 3 ANSWERS) Obese, male, diabetic, hypertensive, sedentary lifestyle female, forty, fertile smoker, diabetic and alcoholic drug user, male, hypertensive

A. B. C. D.

100. In reporting contagious diseases, which of the following will need attention at national level: (CHOOSE 2 ANSWERS) Measles Tuberculosis Chicken pox Swine flu


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A. B. C. D.

1. A patient approached you to give his medications now but you are unable to give the medicine. What is your initial action? Inform the doctor Inform your team leader Inform the pharmacist Routinely document meds not given

A. B. C. D.

2. When looking after a patient in a side room requiring reverse isolation precautions, you have noticed the lack of PPE supplies. Who will you escalate it at initially? Immediate nurse manager Head of the department The one in charge of supplies Infection Control Team

A. B. C. D.

3. Tony is prescribed Lanoxin 500 mcg PO. What vital sign will you asses prior to giving the drug? heart rate and rhythm respiration rate and depth temperature urine output 4. If Tony’s heart rate slows down, this is referred to as:

A. B. C. D.

hypertension hypotension bradycardia tachycardia 5. The word 'accountability' means:

A. B. C. D.

care responsibility love peace

A.

6. When administering injection in the buttocks, it should be given: (CHOOSE 2 ANSWERS) right upper quadrant


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B. C. D.

left upper quadrant right lower quadrant left lower quadrant

A. B. C. D.

7. What is an indication that a suicidal patient has an impending suicide plan: (CHOOSE 2 ANSWERS) She/he is cheerful and seems to have a happy disposition talk or write about death, dying or suicide threaten to hurt or kill themselves actively look for ways to kill themselves, such as stockpiling tablets 8. Patient-centred care is best defined as:

A. B. C. D.

care is focused on the doctor care is focused on the health team care is focused on the patient care is focused on the environment 9. The nurse can divulge patient's information, only when:

A. B. C. D.

it can pose as a threat to the public and when it is ordered by the court requested by family members asked by media personnel for broadcast and publication required by employer 10. Covert communication may include the following except:

A. B. C. D.

Body language tone of voice appearance eye contact

A. B. C. D.

11. Which of the following conditions can be observed in a proper wound dressing: absorbent, humid, aerated non absorbent, humid, aerated non humid, absorbent, aerated non humid, non absorbent, aerated

A. B. C. D.

12. What stage of pressure ulcer includes tissue involvement and crater formation? (CHOOSE 2 ANSWERS) stage 1 stage 2 stage 3 stage 4 13. One of the main responsibilities of an employer should be:

A. B. C. D.

provide a safe place for the employees provide entertainment to employees create opportunities for growth create ways to make networks


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14. Respiratory protective equipment include: A. B. C. D.

gloves mask apron paper towels 15. Clostridium difficile (C- diff) infections can be prevented by:

A. B. C. D.

using hand gels washing your hands with soap and water using repellent gowns limit visiting times

A. B. C. D.

16. In case of a needle stick injury, what should the nurse do initially: (CHOOSE 2 ANSWERS) encourage wound to bleed and wash with water report to occupational health visit Accident and Emergency for treatment make an incident report

A. B. C. D.

17. Which of the following agency set the standards of education, training and conduct and performance for nurses and midwives in the UK? NMC DH CQC RCN 18. A person supervising a nursing student in the clinical area is called as:

A. B. C. D.

mentor preceptor interceptor supervisor

A. B. C. D.

19. In supervising a student nurse perform a drug rounds, the NMC expects you to do the following at all times: supervise the entire procedure and the sign the chart allow student to give drugs and sign the chart at the end of shift delegate the supervision of the student to a senior nursing assistant and ask for feedback allow the student to observe but not signing on the chart

A. B. C. D.

20. You are a new and inexperienced staff, which of the following actions will you do during your first day on the clinical area? Acknowledge your limitations, seek supervision from your team leader volunteer to do the drug rounds help in admitting the patients answer all enquiries from the patients


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C. D.

21. You are the nurse on Ward C with 14 patients. Your fellow incoming nurses called in sick and cannot come to work on your shift. What will be your best action on this situation? Review patient intervention, set priorities, ask the supervisor to hand over extra staff continue with your shift and delegate some responsibilities to the nursing assistant fill out an incident form about the staffing condition ask the colleague to look for someone to cover

A. B. C. D.

22. Mr. James, 72 years old, is a registered blind admitted on your ward due to dehydration. He is encouraged to drink and eat to recover. How will you best manage this plan of care? Ask the patient the assistance he needs delegate someone to feed him ask the relatives to assist in feeding him look for volunteer to assist with his needs

A. B.

23. Early ambulation prevents all complications except: A. B. C. D.

Chest infection and lung collapse Muscle wasting Thrombosis Surgical site infection

D.

24. An adult woman asks for the best contraception in view of her holiday travel to a diarrhoea prone areas. She is currently taking oral contraceptives. What advice will you give her? Tell her to abstain from having sex because of HIV Tell her to bring lots of contraceptives because it will be expensive Tell her to use other methods like condom because diarrhoea lessens the effects of OCP tell her to continue taking her usual contraceptives

A. B. C. D.

25. You are the nurse assigned in recovery room or post anaesthetic care unit. The main priority of care in such area is: keeping airway intact keeping patient pain free keeping neurological condition stable keeping relatives informed of patient’s condition

A. B. C. D.

26. Leonor, 72 years old patient is being treated with antibiotics for her UTI. After three days of taking them, she developed diarrhoea with blood stains. What is the most possible reason for this? Antibiotics causes chronic inflammation of the intestine An anaphylactic reaction Antibiotic alters her GI flora which made Clostridium-difficile to multiply she is not taking the antibiotics with food

A. B. C.


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B. C. D.

27. One of your young patient displayed an overt sexual behaviour directly to you. How will you best respond to this? Talk to the patient about the situation, to reestablish and maintain professional boundaries and relationship ignore the behaviour as this is part of the development process report the patient to their relatives inform line manager of the incident

A. B. C. D.

28. You have just administered an antibiotic drip to you patient. After few minutes, your patient becomes breathless and wheezy and looks unwell. What is your best action on this situation? Stop the infusion, call for help, anaphylactic kit in reach, monitor closely continue the infusion and observe further check the vital signs of the patient and call the doctor stop the infusion and prepare a new set of drip

A. B. C. D.

29. Mr James, a patient in the community phoned you asking for advise as he i s experiencing some side effects of the medications he was given. What will be your best action on this situation? Call the doctor and wait for advice Tell the patient to stop taking the drug Attend to the patient and make necessary intervention for the side effect ask the patient to call the emergency service/ambulance

A.

30. Which of the following is the most dangerous site for IM injection? A. B. C. D.

Deltoid Thigh Abdominal area Buttocks

A. B. C. D.

31. In using social media like Facebook, how will you best adhere to your Code of Conduct as a nurse? (CHOOSE 2 ANSWERS) Never have relationship with previous patient Never post pictures concerning your practice Never tell you are a nurse Always rely SOLELY in your FBs privacy setting

A. B. C. D.

A.

32. Which of the following is not a usual sign and symptom associated with depression? Feeling of sadness, hopelessness Anorexia Increased energy reserved and isolated 33. A 16 year old patient had recently undergone an orthopaedic surgery due to an accident. She is stable and can care for herself. Few days after, she started not to feed and wash herself even though she is physically able to. What could be the reason for this behaviour? She wants to displace her experience by not taking care of herself.


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B. C. D.

She wants to repress her feeling to forget the accident. she is depressed She went to an earlier state which is very dependent. She wants the same attention she had before when she was ill. 34. Nursing process is best illustrated as:

A. B. C. D.

Patient with medical diagnosis task oriented care Individualized approach to care All of the above

A. B. C. D.

35. Which of the following best describes the Contingency Theory of Leadership? (CHOOSE 3 ANSWERS) Leaders behaviour influence team members Leaders grasp the whole picture and their respective roles The plan is influenced by the outside force The leader sees the kind of situation, the setting, and their roles

D.

36. The nurse-in-charge or Head nurse wanted to follow a task-oriented model of care. Se wanted everything to be done before 10 am. How will you best approach the situation? tell other nurses to follow Inform the patient about the goal Discuss to her that this has a negative impact on meeting patient care and outcomes disregard her method and do it your way

A. B. C. D.

37. In a community setting, an elderly patient reported to you that he gives shopping money to his neighbours but failed to bring groceries on frequent occasions. What is your best response on this situation? Confront the neighbour Ignore, maybe he is very old and does not think clearly Fill up a raising a concern/ safeguarding form, and escalate ask patient to report neighbour to police

A. B. C. D.

38. When the IV route of medicine administration is favoured against the oral route, the nurse should consider the following reasons, except: Cannot be absorbed in the alimentary tract GI secretions lessens effect Need immediate effect There is an oral alternative

A. B. C.

39. The early signs of phlebitis included: A. B. C. D.

redness and pain at site increase in temperature swelling of surrounding tissue resistance when administering intravenous fluid and drug


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A. B. C. D.

40. Mrs Red is complaining of shortness of breath. On assessment, her legs are swollen indicative of tissue oedema. What do you think is the possible cause of this? left side heart failure right side heart failure renal failure liver failure

A. B. C. D.

41. Mrs Red’s doctor is suspecting an aortic aneurysm after her chest x -ray. Which of the most common type of aneurysm? cerebral abdominal femoral thoracic

A. B. C. D.

42. Mr Bond, 72 years old, complains of difficulty of chewing his food. He normally wears upper dentures daily. On assessment, you noticed some signs of gingivitis. Which of the following signs will you expect? redness of soft palate and tissues surrounding the teeth haemo-serous discharges around the gums loosening of teeth presence of pockets deep in the gums

A. B. C. D.

43. Mr Bond also shared with you that his gums also bleed during brushing. Which of the following statement will best explain this? lack of vitamin C in his diet he is brushing too hard he is not using proper toothbrush to remove the plaque he is flossing wrongly

A. B. C. D.

44. Mr Bond’s daughter rang and wanted to visit him. She told you of her diarrhoea and vomiting in the last 24 hours. How will you best respond to her about visiting Mr Bond? allow her to visit and use alcohol gel before contact with him visit him when she feels better visit him when she is symptom free after 48 hours allow her to visit only during visiting times only

A. B. C. D.

45. One of the government initiative in promoting good healthy living is eating the right and balanced food. Which of the following can achieve this? 24/7 exercise programme 5-a-day fruits and vegetable portions low calorie diet high protein diet

A.

46. Mr Bond will require 10 mgs of oromorph. The stock comes in 5 mg/2ml. How much will you draw up from the bottle? 4 ml


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B. C. D.

10 ml 6 ml 8 ml 47. The nursing process involves the following:

A. B. C. D.

assessment, diagnosis, planning, intervention and evaluation assessment, differentiation, planning, intervention, evaluation assessment, planning, intervention, evaluation assessment, planning, referring, evaluation

A.

48. Wendy, 18 years old, was admitted on Medical Ward because of recurrent urinary tract infection (UTI). She disclosed to you that she had unprotected sex with her boyfriend on some occasions. You are worried this may be a possible cause of the infection. How will best handle the situation? tell her that any information related to her well being will need to be share to the health care team inform her parents about this so she can be advised appropriately keep the information a secret in view of confidentiality report her boyfriend to social services

B. C. D.

A. B. C. D.

49. If you were told by a nurse at handover to take ‘standard precautions’, what would you expect to be doing? Taking precautions when handling blood and ‘high risk’ body fluids so as not to pass on any infection to the patient Wearing gloves, an apron and a mask when caring for someone in protect Asking relatives to wash their hands when visiting patients in the clinical setting Using appropriate hand hygiene, wearing gloves and an apron when necessary, disposing of used sharp instruments safely, and providing care in a suitably clean environment to protect yourself and the patients.

A. B. C. D. E.

50. All individuals providing nursing care must be competent at which of the following procedures? Hand hygiene and aseptic technique Aseptic technique only Hand hygiene, use of protective equipment, and disposal of waste Disposal of waste and use of protective equipment All of the above

A. B. C. D.

51. How long does proliferative phase of wound healing occur? 3-24 days 24-26 days 1-7 days 24 hours 52. Compassion is best described as:

A. B. C.

showing empathy when delivering care not answering relatives queries giving patient some monies to buy unhealthy food


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D.

providing care without gaining consent 53. In caring for a patient, the nurse should? (CHOOSE 3 ANSWERS)

A. B. C. D.

whenever possible provide care that is culturally sensitive and according to patients preference ask the patient and their family about their culture be aware of the patient’s culture disregard the patient’s culture 54. For which type of waste should orange bags be used?

A. B. C. D.

Waste that requires disposal by incineration Offensive/hygiene waste Waste which may be "treated" Offensive waste

A. B. C. D.

55. If a patient requires protective isolation, which of the following should you advise them to drink? Filtered water only Fresh fruit juice and filtered water Bottled water and tap water Long-life fruit juice and filtered water

A. B. C. D.

56. A nurse assists the physician is performing liver biopsy. After the biopsy the nurse places the patient in which position? Supine Prone Left-side lying Right-side lying

A. B. C. D.

A. B. C. D.

57. A Registered nurse is new to the diagnosis of her patient. What is the best response of the nurse? The nurse should come early for her shift & spend more time to care for the patient The nurse should spend an hour in library, learn about the new diagnosis & then take care of the patient The nurse should clarify her doubts with her senior on duty & with the doctors about the diagnosis & plan nursing care accordingly The nurse should request the other staff to continue with the shift as she lacks knowledge about the diagnosis 58. Certain infectious diseases should be notified at international level. Though it is doctor's responsibility, as a registered nurse you should be aware about the diseases that require national notification. Which among the following is notifiable infectious disease at a national level? Tuberculosis Influenza Chicken pox Swine flu


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59. The first techniques used examining the abdomen of a client is: A. B. C. D.

Palpation Auscultation Percussion Inspection

A. B. C. D.

60. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client's vital sign hereafter. What phrase of nursing process is being implemented here by the nurse? Assessment Diagnosis Planning Implementation

A. B. C. D.

61. When communicating with children, what most important factor should the nurse take into consideration? Developmental level Physical development Non verbal cues Parental involvement

A. B. C. D.

62. Which of the following would be an appropriate strategy in reorienting a confused patient to where her room is? Place picture of her family on the bedside stand Put her name in a large letters on her forehead Remind the patient where her room is Let the other residents know where the patient's room is

A. B. C. D.

63. A nurse has been told that a client's communications are tangential. The nurse would expect that the clients verbal responses to questions would be: Long and wordy Loosely related to the questions Rational and logical Simplistic, short and incomplete

A. B. C. D.

64. A nurse delegates duties to a health assistant, what NMC standard she should keep in mind while doing this? She transfers the accountability to care assistant RN is accountable for care assistants actions No need to assess the competency, as the care assistant is expert in her care area Healthcare assistant is accountable to only her senior 65. Which of the following approaches creates a barrier to communication?

A. B. C. D.

Using to many different skills during a single interaction Giving advise rather than encouraging the patient to problem solve Allowing the patient to become too anxious before changing the subject Focusing on what the patient is saying rather than on the skill used


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A. B. C. D.

A. B. C. D.

66. A client diagnosed of cancer visits the OPD and after consulting the doctor breaks down in the corridor and begins to cry. What would the nurses best action? Ignore the client and let her cry in the hallway Inform the client about the preparing to come forth next appointment for further discussion on the treatment planned Take her to a room and try to understand her worries and do the needful and assist her with further information if required Explain her about the list of cancer treatments to survive 67. An example of a positive outcome of a nurse-health team relationship would be: Receiving encouragement and support from co-workers to cope with the many stressors of the nursing role Becoming an effective change agent in the community An increased understanding of the family dynamics that affect the client An increased understanding of what the client perceives as meaningful from his or her perspective 68. A patient has sexual interest in you. What would you do?

A. B. C. D.

A. B. C. D.

A. B. C. D.

Just avoid it, because the problem can be the manifestation of the underlying disorder, and it will be resolved by its own as he recovers Never attend that patient Try to re-establish the therapeutic communication and relationship with patient and inform the manager for support Inform police 69. Communication is not the message that was intended but rather the message that was received. The statement that best helps explain this is Clean communication can ensure the client will receive the message intended Sincerity in communication is the responsibility of the sender and the receiver Attention to personal space can minimize misinterpretation of communication Contextual factors, such as attitudes, values, beliefs, and self-concept, influence communication 70. When communicating with someone who isn't a native English speaker, which of the following is NOT advisable? Using a translator Use short, precise sentences Relying on their family or friends to help explain what you mean Write things down 71. Which of the following is NOT an example of non-verbal communication?

A. B. C. D.

Dress Facial expression Posture Tone


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A. B. C. D.

72. The nurse is discussing problem-solving strategies with a client who recently experienced the death of a family member and the loss of a full -time job. The client says to the nurse. 'I hear what you're saying to me, but it just isn't making any sense to me. I can't think straight now." The client is expressing feelings of: Rejection Overload Disqualification Hostility

A. B. C. D.

73. The supervisor reprimands the charge nurse because the nurse has not adhered to the budget. Later the charge nurse accuses the nursing staff of wasting supplies. This is an example of Denial Repression Suppression Displacement

A. B. C. D.

74. You are assisting a doctor who is trying to assess and collect information from a child who does not seem to understand all that the doctor is telling and is restless. What will be your best response? Stay quiet and remain with the doctor Interrupt the doctor and ask the child the questions Remain with the doctor and try to gain the confidence of the child and politely assess the child's level of understanding and help the doctor with the information he is looking for Make the child quiet & ask his mother to stay with him

D.

75. As an RN in charge you are worried about a nurse's act of being very active on social media site, that it affect the professionalism. Which one of these is the worst advice you can give her? Do not reveal your profession of being a Nurse on social site Do not post any pictures of client's even if they have given you permission Do not involve in any conversions with client's or their relatives through a social site Keep your profile private

A. B. C. D.

76. According to NMC Standards code and conduct, a registered nurse is EXCLUDED from legal action in which one of these? Fixed penalty for speeding Possessing stock medications Convicted for fraud Convicted for theft

A. B. C.

77. A client is brought to the emergency room by the emergency medical services after being hit by car. The name of the client is not known. The client has sustained a severe head injury, multiple fractures and is unconscious. An emergency craniotomy is required, regarding informed consent for the surgical Please do not share or distribute the contents of this Ebook.

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procedure, which of the following is the best action? A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

Call the police to identify the client and locate the family Obtain a court order for the surgical procedure Ask the emergency medical services team to sign the informed consent Transport the victim to the operating room for surgery 78. A nurse educator is providing in-service education to the nursing staff regarding transcultural nursing care. A staff member asks the nurse educator to describe the concept of acculturation. The most appropriate response in which of he following? It is subjective perspective of the person's heritage and sense of belonging to a group It is a group of individuals in a society that is culturally distinc and has a unique identity It is a process of learning, a different culture to a dapt to a new or change in environment It is a group that share some of the characteristics of the larger population group of which it is a part 79. A client is diagnosed with cancer and is told by surgery followed by chemotherapy will be necessary, the client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try it?". The nurse responds by making which most appropriate statement? "It is a tendency to view one's own ways as best" "You need to ask your physician about it" "I would try anything that I could if I had cancer" "There are many different forms of complementary therapies, let's talk about these therapies" 80. A nurse is preparing to deliver a food tray to a client whose religion is Jewish. The nurse checks the food on the tray and notes that the food on the tray and notes that the client has received a roast beef dinner with whole milk as a beverage. Which action will the nurse take? Deliver the food tray to the client Call the dietary department and ask for a new meal tray Replace the whole milk with fat free milk Ask the dietary department to replace the roast beef with pork 81. When would an orthostatic blood pressure measurement be indicated?

A. B. C. D.

If the patient has a recent history of falls If the patient has a history of dizziness or syncope on changing position If the patient has a history of hypertension If the patient has a history of hypotension 82. A registered nurse had a very busy day as her patient was sick, got intubated & had other life saving procedures. She documented all the events & by the end of the shift recognized that she had documented in other patient's record. What is best response of the nurse?


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A.

D.

She should continue documenting in the same file as the medical document cannot be corrected She should tear the page from the file & start documenting in the correct record She should put a straight cut over her documentation & write as wrong, sign it with her NMC code, date & time She should write as wrong documentation in a bracket & continue

A. B. C. D.

83. According to NMC, RN must have to update their skills and knowledge throughout their professional career. On hourly basis, a minimum of how much should an RN possess in 3 years: 25 hrs 35 hrs 55 hrs 45 hrs

B. C.

84. How to give respect & dignity to the client? A. B. C. D.

Compassion, support & reassurance to the client Communicate effectively with them Behaving in a professional manner Giving advice on health care issues 85. Which of the step is NOT involved in Tuckman's group formation theory

A. B. C. D.

Accepting Norming Storming Forming

A. B. C. D.

86. An adult has been medicated for her surgery. The operating room (OR) nurse, when going through the client's chart, realizes that the consent form has not been signed. Which of the following is the best action for the nurse to take? Assume it is emergency surgery & the consent is implied Get the consent form & have the client sign it Tell the physician that the consent form is not signed Have a family member sign the consent form

B. C. D.

87. A mentally capable client in a critical condition is supposed to receive blood transfusion. But client strongly refuses the blood product to be transfused. What would be the best response of the nurse? Accept the client's decision and give information on the consequences of his actions Let the family decide Administer the blood product against the patients decision The doctor will decide

A.

88. An antihypertensive medication has been prescribed for a client with HTN. The client tells the clinic nurse that they would like to take an herbal substance to help lower their BP. The nurse should take which action? Tell the client that herbal substances are not safe & should never be used.

A.


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B. C. D.

Teach the client how to take their BP so that it can be monitored closely Encourage the client to discuss the use of an herbal substance with the health care provider Tell the client that if they take the herbal substance they will need to have their BP checked frequently

A. B. C. D.

89. A police officer approached the nurses' station asking for information on a specific client. The nurse knows that she can give the necessary information if: The police shows his identification The police officer has the right to such information There is a clear risk of safety and potential harm to the public The hospital manager authorized to give the information

A. B. C. D.

90. When communicating with the a client who speaks a different language, which best practice should the nurse implement? Speak loudly & slowly Arrange for an interpreter to translate Speak to the client & family together Stand close to the client & speak loudly 91. The code is the foundation of

A. B. C. D.

Dress code Personal document Good nursing & midwifery practice & a key tool in safeguarding the health & well being of the public Hospital administration 92. According to the nursing code of ethics, the nurse's first allegiance is to the:

A. B. C. D.

A. B. C. D.

A.

Client and client's family Client only Healthcare organization Physician 93. A nurse from Medical-surgical unit asked to work on the orthopedic unit. The medical-surgical nurse has no orthopedic nursing experience. Which client should be assigned to the medical-surgical nurse? A client with a cast for a fractured femur & who has numbness & discoloration of the toes A client with balanced skeletal traction & who needs assistance with morning care A client who had an above-the-knee amputation yesterday & has a temperature of 101.4F A client who had a total hip replacement 2 days ago & needs blood glucose monitoring 94. A nurse preceptor is working with a new nurse and notes that the new nurse is reluctant to delegate tasks to members of the care team. The nurse preceptor recognizes that this reluctance most likely is due to Role modeling behaviors of the preceptor


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B. C. D.

The philosophy of the new nurse's school of nursing The orientation provided to the new nurse Lack of trust in the team members

A. B. C. D.

95. The measurement and documentation of vital signs is expected for clients in a long term facility. Which staff type would it be a priority to delegate these tasks to? Practical Nurse Registered Nurse Nursing assistant Volunteer

A. B. C. D.

96. An RN from the women's health clinic is temporarily reassigned to a medicalsurgical unit. Which of these client assignments would be most appropriate for this nurse? A newly diagnosed client with type 2 diabetes mellitus who is learning foot care A client from a motor vehicle accident with an external fixation device on the leg A client admitted for a barium swallow after a transient ischemic attack A newly admitted client with a diagnosis of pancreatic cancer

A. B. C. D.

97. A dose of 100 ml of injection Metronidazole is to be infused over half an hour. How much amount of the medicine will be given in an hour? 50 ml 150 ml 200 ml 300 ml

A. B. C. D.

98. An infusion of 24 mg of Inj. Furosemide is ordered for 12 hrs. How much dose is infused in an hour? 4 mg/hr 2 mg/hr 3 mg/hr 1 mg/hr

A. B. C. D.

99. As a registered nurse, you are expected to calculate fluid volume balance of a patient whose input is 2437 ml and output is 750 ml 1887 (Negative Balance) 1197 (Negative Balance) 1887 (Positive Balance) 1197 (Positive Balance) 100. Which of the following is the most common aneurysm site?

A. B. C. D.

Hepatic Artery Abdominal aorta Renal arch Circle of Wills


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A. B. C. D.

1. What are the principles of communicating with a patient with delirium? Use short statements & open questions in a well-lit, quiet, familiar environment Write down all questions for the patient to refer back to Communicate only through the family using short statements & closed questions Use short statements & closed questions in a well-lit, quiet, familiar environment

A. B. C. D.

2. Which of the following statements by a nurse would indicate an understanding of intrapersonal communications? "Intrapersonal communications occurs within a person" "Intrapersonal communications occur between two ot more people" "Interpersonal communications is the same as intrapersonal communication" "Nurses should avoid using intrapersonal communications"

A. B. C. D.

3. Which therapeutic communication technique is being used in this nurseclient interaction? Formulating a plan of action Making observations Exploring Encouraging comparison

A. B. C. D.

4. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? "I notice you are wearing a new dress and you have washed your hair" "You did not attend group today. Can we talk about that?" "I'll sit with you until it is time for your family session" "I'm happy that you are now taking your medications. They will really help"

A. B.

5. The nurse asks a newly admitted client. "What can we do to help you?" What is the purpose of this therapeutic communication technique? To explore a subject, idea, experience, or relationship To communicate that the nurse is listening to the conversation


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C. D.

To reframe the client's thoughts about mental health treatment To put the client at ease

A. B. C. D.

6. Which nursing statement is good example of the therapeutic communication technique of focusing? "Your counselling session is in 30 minutes. i'll stay with you until then." "You mentioned your relationship with your father. Let's discuss that further" "I'm having a difficult time understanding what you mean." "Describe one of the best things that happened to you this week."

A. B. C. D.

7. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? "keep your chin up. I'll explain the procedure to you." "There is always an explanation for both good and bad behaviors." "Can you tell me why you said that?" "Are you not understanding the explanation I provided?"

A. B. C. D.

A. B. C. D.

8. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? "I wouldn't worry about these voices,. The medication will make them disappear." "Why not turn up the radio so that the voices are muted." "My sister has the same diagnosis as you and she also hears voices." "I understand that the voices seem real to you, but i do not hear any voices." 9. Which therapeutic statement is a good example of the therapeutic communication technique of offering self? "Would you like me to accompany you to your electroconvulsive therapy treatment?" "I think it would be great if you talked about that problem during our next group session." "After discharge, would you like to meet me for lunch to review your outpatient progress?" "I notice that you are offering help to other peers in the milieu." 10. On a psychiatric unit, the preferred milieu environment is BEST describe as:

A. B. C. D.

A. B.

Fostering a therapeutic social, cultural, and physical environment. Providing an environment that will support the patient in his or her therapeutic needs. Fostering a sense of well-being and independence in the patient. Providing an environment that is safe for the patient to express feelings. 11. A new mother is admitted to the acute psychiatric unit with severe postpartum depression. She is tearful and states, "I don't know why this happened to me I was so excited for my baby to come, but now I don't know!" Which of the following responses by the nurse is MOST therapeutic? "Maybe you weren't ready for a child after all." "Having a new baby is stressful, and the tiredness and different hormone levels don't help. It happens to many new mothers and is very treatable."


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C. D.

"What happened once you brought the baby home? Did you feel nervous?" "Has your husband been helping you with the housework at all?"

A. B. C. D.

12. A patient with antisocial personality disorder enters the private meeting room of a nursing unit as a nurse is meeting with a different patient. Which of the following statements by the nurse is BEST? "Please leave and I will speak with you when I am done." "I need you to leave us alone." "You may sit with us as long as you are quiet." "I'm sorry, but HIPPA says that you can't be here. Do you mind leaving?"

A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

13. The wife of a client with PTSD (post traumatic stress disorder) communicate to the nurse that she is having trouble dealing with her husband's condition at home. Which of the following suggestions made by the nurse is CORRECT? "Do not touch or speak to your husband during an active flashback. Wait until it is finished to give him support." "Discourage your husband from exercising, as this will worsen his condition." "Encourage your husband to avoid regular contact with outside family members." "Keep your cupboards free of high-sugar and high-fat foods." 14. A client express concern regarding the confidentiality of her medical information. The nurse assures the client that the nurse maintains client confidentiality by: Explaining the exact limits of confidentiality in the exchanges between the client and the nurse. Limiting discussion about clients to the group room and hallways. Summarizing the information the client provides during assessments and documenting this summary in the chart. Sharing the information with all members of the healthcare team 15. When caring for clients with psychiatric diagnoses, the nurse recalls that the purpose of psychiatric diagnoses or psychiatric labeling to: Identify those individuals in need of more specialized care. Identity those individuals who are at risk for harming others. Define the nursing care for individuals with similar diagnoses Enable the client's treatment team to plan appropriate and comprehensive care. 16. If you were told by a nurse at handover to take "standard precautions" what would you expect to be doing? Taking precautions when handling blood & "high risk" body fluids that you don't pass on any infection to the patient. Using appropriate hand hygiene, wearing gloves & aprons when necessary, disposing of used sharp instruments safely & providing care in a suitably clean environment to protect yourself & the patients. Wearing gloves, aprons & mask when caring for someone in protective isolation to protect yourself from infection. Asking relatives to wash their hands when visiting patients in the clinical setting .


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17. You are told a patient is in "source isolation". What would you do & why? A. B. C. D.

A. B. C. D.

A. B. C. D.

Isolating a patient so that they don't catch any infections Nursing an individual who is regarded as being particularly vulnerable to infection in such a way as to minimize the transmission of potential pathogens to that person. Nursing a patient who is carrying an infectious agent that may be risk to others in such a way as to minimize the risk of the infection spreading elsewhere in their body. Nurse the patient in isolation, ensure that you wear apprpriate personal protective equipment (PPE) & adhere to strict hygiene , for the purpose of preventing the spread of organism from that patient to others. 18. What would make you suspect that a patient in your care had a urinary tack infection? The patient has spiked a temperature, has a raised white cell count (WCC), has new-onset confusion & the urine in the catheter bag is cloudy The doctor has requested a midstream urine specimen The patient has a urinary catheter in situ & the patient's wife states that he seems more forgetful than usual The patient has complained of frequency of faecal elimination & hasn't been drinking enough 19. A new postsurgical wound is assessed by the nurse and is found to be hot, tender and swollen. How could this wound be best described? In the inflammation phase of healing In the haemostasis phase of healing In the reconstructive phase of wound healing As an infected wound 20. What are the four stages of wound healing in the order they take place?

A. B. C. D.

Haemostasis, inflammation phase, proliferative phase, maturation phase Haemostasis, proliferation phase, inflammation phase, remodeling phase Inflammatory phase, dynamic stage, neutrophil phase, maturation phase Proliferative phase, inflammatory phase, remodeling phase, maturation phase

A. B. C. D.

21. If an elderly immobile patient had a "grade 3 pressure sore", what would be your management? Film dressing, mobilization, positioning, nutritional support Foam dressing, pressure relieving mattress, nutritional support Dry dressing, pressure relieving mattress, mobilization Hydrocolloid dressing, pressure relieving mattress, nutritional support 22. How can risk be reduced in the healthcare setting?

A. B. C.

By setting targets which measure quality Healthcare professionals should be encouraged to fill in incident forms; this will create a culture of "no blame" Healthcare will always involve risks so incidents will always occur, we need to accept this


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D.

A.

B. C.

D.

By adopting a culture of openness & transparency & exploring the root causes of patient safety incidents. 23. A patient in your care knocks their head on the bedside locker when reaching down to pick up something they have dropped. What do you do? Help the patient to a safe comfortable position, commence neurological observations & ask the patient's doctor to come & review them, checking the injury isn't serious, when this taken place, write up what happened & any future care in the nursing notes Discuss the incident with the nurse in charge & contact your union representative in case you get into trouble Help the patient to a safe comfortable position, take a set of observations & report the incident to the nurse in charge who may call a doctor. Complete an incident form. At an appropriate time, discuss the incident with the patient & if they wish, their relatives Let the patient's relatives know so that they don't make a complaint & write an incident report for your self so you remember the details in case there are problems in the future

A. B. C. D.

24. The client reports nausea and constipation. Which of the following would be the priority nursing action? Complete an abdominal assessment Administer an anti-nausea a medication Notify the physician Collect a stool sample

A. B. C. D.

25. The nurse suspects that a client is withholding health-related information out of fear of discovery and possible legal problems. The nurse formulates nursing diagnoses for the client carefully, being concerned about a diagnostic error resulting from which of the following? Generalize from experience Identifying with the client Lack of clinical experience Incomplete date

A. B. C. D.

26. Which of the following descriptors is most appropriate to use when stating the "problem" part of nursing diagnosis? Oxygenation saturation 93% Output 500 ml in 8 hours Anxiety Grimacing

A. B.

27. The rehabilitation nurse wishes to make the following entry into a client's plan of care: "Client will reestablish a pattern of daily bowel movements without straining within two months." The nurse would write this statement under which section of the plan of care? Long-term goals Short-term goals


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C. D.

A. B. C. D.

Nursing orders Nursing diagnosis/problem list 28. The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? "Don't be too soft on the staff, if they make a mistake, be certain to reprimand them immediately." "Give your best nurses extra attention and rewards for their help." "Never gets into a disagreement with a staff member." "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 29. The famous 14 Principles of Management was first defined by

A. B. C. D.

James Watt Adam Smith Henri Fayol Elton Mayo

C. D.

30. The nursing staff communicates that the new manager has a focus on the "bottom line," and little concern for the quality of care. What is likely true of this nurse manager? The manager is unwilling to listen to staff concerns unless they have an impact on costs. The manager understands the organization's values and how they mesh with the manger's values. The manager is communicating the importance of a caring environment. The manager is looking at the total care picture

A. B. C. D.

31. A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? Maintain in an autocratic approach to influence results. Understand complex health care environments. Use critical thinking to solve problems on the unit Give assignments clearly, taking staff expertise into consideration.

A. B.

A. B. C. D.

32. What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit? "I can't believe you need help with such simple task. Didn't you learn that in school?" "I know I told you that you could have the weekend off, but I really need you to work." "The other work many extra shifts, why can't you?" "I'm sorry, but i do not have a nurse to spare today to help your unit. I cannot make a change now, but we should talk further about schedules and needs."


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A. B. C. D.

33. The nurse executive of a health care organization wishes to prepare and develop nurse manager for several new units that the organization will open next year. What should be the primary goal for this work? Prepare these managers so that they will focus on maintaining standards of care. Prepare these managers to oversee the entire health care organization. Prepare these managers to interact with hospital administration. Focus on rewarding current staff for doing a good job with their assigned tasks by selecting them for promotion. 34. What are the key competencies and features for effective collaboration?

A. B. C. D.

Effective communication, cooperation, and decreased competition for scarce resources. Mutual respect and open communication, critical feedback, cooperation, and willingness to share ideas and decisions. High level of trust and honest, giving and receiving feedback, and decision making. Effective communication skills, mutual respect, constructive feedback, and conflict management

A. B. C. D.

35. A registered nurse is a preceptor for a new nursing graduate and is describing critical paths and variance analysis to the new nursing graduate. The registered nurse instructs the new nursing graduate that a variance analysis is performed on all clients: Every other day of hospitalization Every third day of hospitalization Continuously Daily during hospitalization

A. B. C. D.

36. A nurse manager is planning to implement a change in the method of the documentation system for the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The initial step in the process of change for the nurse manager is which of the following? identify the inefficiency that needs improvement or correction identify potential solutions and strategies for the change process plan strategies to implement the change set goals and priorities regarding the change process

A. B. C. D.

37. Ms. Jones is newly promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? Country Club Management Organization Man Impoverished Management Team Management 38. What are essential competencies for today's nurse manager?


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A. B. C. D.

strategic planning and design Self and group awareness A vision and goals Communication and teamwork

A. B. C. D.

39. As a nurse manager achieves a higher management position in the organization, there is a need for what type of skills? Conceptual and interpersonal skills Visionary and interpersonal skills Communication and technical skills Personal and communication skills 40. The characteristic of an effective leader include:

A. B. C. D. E.

attention to detail financial motivation sound problem-solving skills and strong people skills emphasis on consistent job performance all of the above

D.

41. What is the most important issue confronting nurse manager using situational leadership? Value is placed on the accomplishment of tasks and on interpersonal relationship between leader and group members and among group members. Leadership style differ for a group whose members are at different levels of maturity. Leaders can choose one of the four leadership styles when faced with a new situation. Personality traits and leadr's power base influence the leader's choice of style.

A. B. C. D.

42. When developing a program offering for patients who are newly diagnosed with diabetes, a nurse case manager demonstrates an understanding or learning styles by: Utilizing variety of educational materials. Providing a snack with a low glycemic index. Allowing patients's time to voice their opinions. Administering a pre- and post test assessment

A. B. C.

43. Which strategy could the nurse use to avoid disparity in health care delivery? A. B. C. D.

Campaign for fixed nurse-patient ratios. Care for more patients even if quality suffers. Request more health plan options. Recognize the cultural issue related to patient care. 44. Which option best illustrates a positive outcome for managed care?

A. B. C. D.

Involvement in the political process. Reshaping current policy. Cost-benefit analysis. Increase in preventive services.


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A. B. C. D.

45. The patient is being discharged from the hospital after having a coronary artery bypass graft (CABG). Which level of the health care system will best serve the needs of this patient at this point? Public health care Primary care Secondary care Tertiary care 46. Proper technique to use walker

A. B. C. D.

A. B. C. D.

move 10 feet, take small steps move 10 feet, take large wide steps move 12 feet transform weight to walker and walk 47. After lumbar puncture, the patient experienced shock. What is the etiology behind it? Increased ICP Headache Side effect of medications CSF leakage 48. What is the preferred position for abdominal Paracenthesis?

A. B. C. D.

Supine with head slightly elevated Supine with knees bent Prone Side-lying

A. B. C. D.

49. You see a man collapsing while you are in a queue. What will you do first as BLS Certified Nurse? Start CPR Leave the patient Shout for help Check for responsiveness 50. How to act in an emergency in a health care set up?

A. B. C. D.

according to the patient's condition according to instruction according to situation according to our competence

A. B. C. D.

51. Dehydration is of particular concern in ill health. If a patient is receiving IV fluid replacement and is having their fluid balance recorded, which of the following statements is true of someone said to be in "positive fluid balance" The fluid input has exceeded the output The fluid balance chart can be stopped as "positive" means "good" The doctor may consider increasing the IV drip rate The fluid output has exceeded the input


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A. B. C. D.

52. What specifically do you need to monitor to avoid complications & ensure optimal nutritional status in patients being enterally fed? Daily urinalysis, ECG, Protein levels and arterial pressure Assess swallowing, patient choice, fluid balanc, capillary refill time Eye sight, hearing, full blood count, lung function and stoma site Blood glucose levels, full blood count, stoma site and body weight

D.

53. A patient needs weighing, as he is due to a drug that is calculated on body weight. He is experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do? Discuss the case with your colleagues and agree to guess his body weight until he agrees to stand and use the chair scales Omit the drugs as it is not safe to give it without this information; inform the doctor and document your actions Offer the patient pain relief and either use bed scales or a hoist with scales built in Document clearly in the patient's notes that a weight cannot be obtained

A. B. C. D.

54. If the prescribed volume is taken, which of the following type of feed will provide all protein, vitamins, minerals and trace elements to meet patient's nutritional requirements? Protein shakes/suplements Energy drink Mixed fat and glucose polymer solutions/powder Sip feeds

A. B. C. D.

55. A patient has been admitted for nutritional support and started receiving a hyperosmolar feed yesterday. He presents with diarrhea but no pyrexia. What is likely to be cause? An infection Food poisoning Being in hospital The feed

A. B. C. D.

56. Your patient has a bulky oesophageal tumor and is waiting for surgey. When he tries to eat, food gets stuck and gives him heart burn. What is the most likely route that will be chosen to provide him with the nutritional support he needs? Feeding via Radiologically inserted Gastostomy (RIG) Nasogastric tube feeding Feeding via a Percutaneous Endoscopic Gastrostonomy (PEG) Continue oral

A. B. C. D.

57. What is the best way to prevent who is receiving an enteral feed from aspirating? Check their oxygen saturations tell them to lie in their side Lie them flat Sit them at least 45 degrees angle

A. B. C.


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A. B. C. D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

58. Which of the following medications are safe to be administered via a nasogastric tube? Drugs that can be absorbed via this route, can be crushed and given diluted or dissolved in 10-15 ml of water Enteric-coated drugs to minimize the impact of gastric irritation A cocktail of all medications mixed together, to save time and prevent fluid over loading the patient Any drugs that can be crushed 59. Which check do you need to carry out before setting up an enteral feed via nasogastric tube? The air cannot be heard rushing into the lungs by doing the WHOOSH TEST That when flushed with red juice, the red juice can be seen when the tube is aspirated That the pH of gastric aspirate is above 6.6 and the measurements on the NG tube is the same length as the time insertion That the pH of gastric aspirate is below 5.5 and the measurements on the NG tube is the same length as the time insertion. 60. Monica is going to receive blood transfusion, How frequently should we do her observation? Temperature , pulse, blood pressure and respiration before the blood transfusion begins, then after 15-min, then as indicated in local guidelines, and finally at the end of bag/unit. Temperature and pulse before the blood transfusion begins, then every hour, and at the end of bag/unit Temperature, pulse, blood pressure and respiration and urinalysis before the blood transfusion, then at end of bag Pulse, blood pressure and respiration every hour, and at the end of the bag 61. How do the structures of human body work together to provide support and assist in movement? The muscles provide a structural framework, moving by contracting or extending crossing at least one joint and attached to the articulating bones The skeleton provides a structural framework; this is moved by ligaments that stretch and contract The muscles provide a structural framework and are moved by bones to which they are attached by ligaments The skeleton provides a structural framework. This is moved by the muscles that contract or extend and in order to function, cross at least one joint and are attached to the articulating bones. 62. What are the most common effects of inactivity?

A. B. C.

Social isolation, loss of independence, exacerbation of symptoms, rapid loss of strength in lg muscles, de-conditioning of cardiovascular system leading to an increased risk of chest infection and pulmonary embolism. Loss of weight , frustration and deep vein thrombosis Deep arterial thrombosis, respiratory infection, fears of movement, loss of


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D.

A. B.

C.

D.

A. B. C. D.

A. B. C. D.

A. B. C. D.

consciousness , de-conditioning of cardiovascular system leading to an increased risk of angina Pulmonary embolism, UTI, & fear of people 63. What do you need to consider when helping a patient with shortness of breath sit out in a chair? They should not sit out on a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure in lungs Sitting in reclining position with legs elevated to reduce the use of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don't expend any unnecessary energy there are two possible positions, either sitting upright or side lying. Which is used and is determined by the age of the patient . It is also important to remember that they will always need a nebulizer and oxygen and the air temperature must be below 20 degree Celcius The patients needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others. 64. Your patient has bronchitis and has difficulty in clearing his chest. What position would help to maximize the drainage of secretions? Lying on his side with the area to be drained uppermost after the patient has had humidified air Lying flat on his back while using a nebulizer Sitting up leaning on pillows and inhaling humidified oxygen Standing up in fresh air taking deep breaths 65. Mrs Jones has had a cerebral vascular accident, so her left leg is increased in tone, very stiff and difficult to position comfortably when she is in bed. What would you do? Try to diminish increased tone by avoiding extra stimulation by ensuring her foot does not into contact with the end of the bed;supporting with a pillow, her left leg in side lying and keeping the knee flexed Give Mrs. Jones analgesia and suggest she sleeps in chair Give Mrs. Jones diazepam and tilt the bed Suggest a warm bath before she lies on the bed. Then use pillows to support the stiff limb 66. When should adult patients in acute hospital settings have observations taken? When they are admitted & then once daily unless they deteriorate As indicated by the doctor Temperature should be taken daily, respiration at night, pulse & blood pressure 4 hourly When they are admitted or initially assessed. A plan should be clearly documented which identifies which observations should be taken & how frequently subsequent observations should be done


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A. B. C. D.

67. Why are physiological scoring systems or early warning scoring system used in clinical practice? These scoring systems are carried out as part of a national audit so we know how sick patients are in the united kingdom They enable nurses to call for assistance from the outreach team or the doctors via an electronic communication system They help the nursing staff to accurately predict patient dependency on a shift by shift basis The system provides an early accurate predictor of deterioration by identifying physiological criteria that alert the nursing staff to a patient at risk

A. B. C. D.

68. A patient is recovering from surgery has been advanced from a clear diet to a full liquid diet. The patient is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse should offer which full liquid item to the patient Custard Black Tea Gelatin Ice pop

A. B. C. D.

69. The nurse is preparing to change the parenteral nutrition (PN) solution bag & tubing. The patient's central venous line is located in the right subclavian vein. The nurse ask the client to take which essential action during the tubing change? Take a deep breath, hold it, & bear down Breathe normally Exhale slowly & evenly Turn the head to the right

A. B. C. D.

70. A 27-year old adult male is admitted for treatment of Crohn's disease. Which information is most significant when the nurse assesses his nutritional health? Facial rubor Dry skin Bleeding gums Anthropometric measurements

A. B. C. D.

71. A nurse is advised one hour vital charting of a patient, how frequently it should be recorded? Every 3 hours Every shift Whenever the vital signs show deviations from normal Every one hour

A. B. C.

72. When a patient arrives to the hospital who speaks a different language. Who is responsible for arranging an interpreter? Doctor Management Registered Nurse


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D.

Nursing assistant

A. B. C. D.

73. A COPD patient is in home care. When you visit the patient, he is dyspnoeic, anxious and frightened. He is already on 2 liter oxygen with nasal cannula. What will be your action? Increase the flow of oxygen to 5 L Ask the patient to calm down Call the emergency service Give Oramorph 5 mg medications as prescribed .

A. B. C. D.

74. A client breathes shalowlly and looks upward when listening to the nurse. Which sensory mode should the nurse plan to use with this client? Touch Auditory Kinesthetic Visual

A. B. C. D.

75. An eight year old girl with learning disabilities is admitted for a minor surgery, she is very restless ang agitated and wants her mother to stay with her, what will you do? Act according to company policy Inform the Doctor Tell her you will take care of the child Advice the mother to stay till she settles

A. B. C. D.

76. While at outside setup what care will you give as a Nurse if you are exposed to a situation? Provide care which is at expected level Above what is expected Ignoring the situation Keeping up to professional standards

A. B. C. D.

77. A newly diagnosed patient with Cancer says "I hate Cancer, why did God give it to me". Which stage of grief process is this? Denial Bargaining Depression Anger

A. B. C. D.

78. A nurse is advised one hour vital charting of a patient, how frequently it should be recorded? Whenever the vital signs show deviations from normal Every shift Every one hour Every 3 hours 79. Mrs. A is posted for CT scan. Patient is afraid cancer will reveal during her scan. She asks "why is this test". What will be your response as a nurse?


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A. B. C. D.

Tell her that you will arrange a meeting with a doctor after the procedure Give a health education on cancer prevention Ignore her question and take her for the procedure Understand her feelings and tell the patient that it is normal procedure. 80. What is the purpose of clinical audit?

A. B. C. D.

A. B. C. D.

Helps to identify areas of improvement in the system pertaining to Nursing and Medical personnel It helps to understand the functioning and effectiveness of nursing activities Helps to understand the outcomes and processes for medical and surgical procedures Helps to understand medical outcomes and process only 81. In an emergency department doctor asked you to do the procedure of cannulation and left the ward. You haven't done it before. What would you do? Don't do it as you are not competent or trained for that & write incident report & inform the supervisor Do it Ask your colleague to do it Complain to the supervisor that doctor left you in middle of the procedure 82. Which of the following client should the nurse deal with first

A. B. C. D.

A. B. C. D.

A client who needs to be suctioned A client who needs her dressing changed A client who needs to be medicated for incisional pain A client who is incontinent & needs to be cleaned 83. A client on your medical surgical unit has a cousin who is physician & wants to see the chart. Which of the following is the best response for the nurse to take Ask the client to sign an authorization & have someone review the chart with cousin Hand the cousin the client chart to review Call the attending physician & have the doctor speak with the cousin Tell the cousin that the request cannot be granted 84. How soon after surgery is the patient expected to pass urine?

A. B. C. D.

6-8 hours 4-6 hours 2-4 hours 1-2 hours 85. The most commonly injured carpal bone is:

A. B. C. D.

the scaphoid bone the triquetral bone the pisiform bone the hamate bone


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86. Glasgow Coma score (GCS) is made up of 3 component parts and these are: A. B. C. D.

eye opening response/motor response/verbal response eye opening response/verbal response/pupil reaction to light eye opening response/motor response/pupil reaction to light eye opening response/limb power/verbal response

A. B. C. D.

87. Recognition of the unwell child is crucial. The following are all signs and symptoms of respiratory distress in children EXCEPT: Lying supine Nasal flaring Intercostal and sternal recession adopting an upright position 88. Which of the following is NOT a risk factor for ectopic pregnancy

A. B. C. D.

Alcohol abuse Smoking Tubal or pelvic surgery previous ectopic pregnancy 89. Carpal tunnel syndrome is caused by compression of which nerve:

A. B. C. D.

Median nerve Axillary nerve Ulnar nerve Radial nerve

A. B. C. D.

90. 500mg of Amoxicillin is prescribed to a patient three times a day, 250mg tablets are available. How many tablets for single dose? 6 4 2 8

A. B. C. D.

91. A patient got admitted to hospital with a head injury.Within 15 minutes, GCS was assessed and it was found to be 15. After initial assessment, a nurse should monitor neurological status Every 15 minutes 30 minutes 45 minutes 60 minutes

A. B. C. D.

92. According to recent UK researh, what is the recommended amount of vegetables and fruits to be consumed per day? 3 portions per serving 5 portions per serving 7 portions per serving 4 portions per serving


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93. What instructions should you give a client receiving oral Antibiotics? A. B. C. D.

Consume it all at once take the antibiotic with glass of water Take the medication with meals and consume all the antibiotics take the medication as prescribed and complete the course 94. When will you disclose the identity of a patient under your care?

A. B. C. D.

You can disclose it anytime you want When a patient relatives wishes to When media demands for it Justified by public interest law and order

A. B. C. D.

95. An 18 year old 26 week pregnant woman who uses illicit drugs frequently, the factors in risk for which one of the following: Spina bifida Meconium aspiration Pneumonia Teratogenicity

A. B. C. D.

96. You would refer to the early phase of scar tissue formation as which of the following kinds of tissue? Granulation Fibrous Keloid Cicatrix

A. B. C. D.

97. After instructing the client on crutch walking tecnique, the nurse should evaluate the client's understanding by using which of the following methods? Have client explain produce to the family Achievement of 90 on written test Explanation Return demonstration

A. B. C. D.

98. A woman reports of per vaginal bleeding 48 hrs after normal vaginal delivery. What is this type of post partum hemorrhage classified as? Primary Secondary Tertiary All of the above

A. B. C. D.

99. A client requests you that he wants to go home against medical advice, what should you do? Inform the management Inform the local police Call the security guard Allow the client to go home as he won't pose any threat to self or others


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A. B. C. D.

100. You saw a relative of a client has come with her son, who looks very thin, shy & frightened. You serve them food, but the mother of that child says "don't give him, he eats too much". You should: Raise your concern with your nurse manager about potential for child abuse & ask for her support. Ignore the mother & ask the relative if the child is abused. Ignore the mother's advice & serve food to the child. Ignore the situation as she is the mother & knows better about her child.


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ANSWER KEY FOR MOCK QUESTIONS SET 1 1. B 2. D 3. C 4. A 5. C 6. C 7. A 8. D 9. A 10. C 11. B 12. B 13. B 14. B 15. C 16. A 17. C 18. B 19. A 20. B 21. D 22. D 23. A 24. D 25. B 26. D 27. B 28. A 29. B 30. C 31. D 32. B 33. A 34. D 35. B

36. A 37. D 38. C 39. D 40. D 41. C 42. D 43. D 44. C 45. B 46. A 47. C 48. D 49. C 50. C 51. D 52. A 53. A 54. A 55. C 56. C 57. C 58. C 59. A 60. D 61. A 62. A 63. D 64. D 65. B 66. D 67. B 68. C 69. C 70. D

71. D 72. C 73. D 74. A 75. E 76. C 77. A 78. B 79. A 80.A 81. D 82. C 83. C 84. D 85. C 86. D 87. B 88.A 89. C 90. C 91. D 92. D 93. C 94. C 95. A 96. B 97. B 98. A 99. A 100.A

ANSWER KEY FOR MOCK QUESTIONS SET 2

1. D 2. C 3. C 4. C 5. B 6. B 7. A 8. C 9. C 10. A 11. D 12. A 13. B 14. A 15. A 16. A 17. D 18. B 19. C 20. B 21. B 22. B 23. B 24. B 25. B 26. A 27. A 28. D 29. C 30. C 31. B 32. C 33. C 34. A 35. A


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36. B 37. B 38. A 39. C 40. D 41. B 42. E 43. D 44. D 45. A 46. A 47. B 48. B 49. B 50. A 51. D 52. A 53. D 54. C 55. B 56. B 57. A 58. D 59. A 60. C 61. A 62. B 63. A 64. A 65. A 66. B 67. B 68. D 69. B 70. A

71. C 72. B 73. A 74. A 75. A 76. C 77. A 78. D 79. A 80. C 81. C 82. D 83. D 84. D 85. B 86. D 87. C 88. B 89. C 90. A 91. A 92. A 93. D 94. A 95. A 96. D 97. A 98. A 99. D 100. C

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ANSWER KEY FOR MOCK QUESTIONS SET 3 1.C 2.A 3.D 4.B

36.A,C,D 37.C 38.A,B,C 39.A

71.A 72.B 73.A 74.A,B

1.C 2.C 3.A 4.C

36.B 37.C 38.A 39.D

71.B 72.A 73.A 74.B

5.C 6.A 7.B 8.E 9.E 10.D 11.B 12.A 13.B 14.A 15.D 16.C 17.D 18.C 19.A 20.B 21.C 22.C 23.C 24.B 25.A 26.B 27.D 28.B 29.B 30.B 31.D 32.B 33.D 34.B 35.A

40.A 41.C 42.A 43.B,C 44.B 45.A,B,D 46.A 47.D 48.C 49.B,D 50.A 51.B 52.A 53.C 54.C 55.A 56.A 57.G 58.A 59.C 60.C 61.F 62.C 63.E 64.B,C,D,E 65.D 66.B 67.C 68.A 69.B,C 70.E

75.A 76.D 77.A,C 78.A 79.A 80.A,B,C 81.A 82.A,D 83.E 84.A 85.A 86.B 87.F 88.B,C 89.B,D 90.D 91.A,C,E 92.C 93.B,D 94.B,D 95.A 96.A,B,C 97.A 98.D 99.A 100.C

5.A 6.B 7.A 8.A 9.C 10.B

40.B 41.D 42.A 43.D 44.B 45.A

75.C 76.A 77.A 78.A 79.B 80.A

11.C 12.A 13.B 14.C 15.D 16.A 17.A 18.D 19.A 20.D 21.C 22.E 23.B 24.A 25.D 26.A 27.B 28.D 29.B 30.C 31.C 32.B 33.B 34.A 35.C

46.A 47.C 48.B 49.A 50.C 51.C 52.C 53.A 54.B 55.D 56.D 57.C 58.B 59.D 60.B 61.D 62.C 63.B 64.B 65.C 66.A 67.B 68.B 69.C 70.D

81.B 82.A 83.B 84.C 85.B 86.A 87.C 88.D 89.C 90.A 91.B 92.D 93.A 94.C 95.C 96.B 97.A 98.C 99.A 100.A


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1.B 2.A 3.A 4.B

36.A 37.D 38.B 39.D

71.A 72.A 73.A 74.C

1.D 2.C 3.A 4.C

36.C 37.C 38.D 39.A,B,C

71.D 72.B 73.D 74.C

5.C 6.B 7.D 8.C 9.B 10.B 11.D 12.A 13.B 14.B 15.A 16.B 17.A 18.A 19.B 20.B 21.A 22.D 23.C 24.C 25.D 26.D 27.D 28.C 29.A 30.C 31.A 32.B 33.C 34.C 35.C

40.A 41.C 42.A 43.D 44.B 45.C 46.E 47.C 48.A 49.B 50.A 51.E 52.C 53.C 54.B 55.A 56.D 57.E 58.C 59.C 60.B 61.B 62.B 63.A 64.D 65.D 66.C 67.A,D 68.C 69.A 70.C

75.B 76.D 77.D 78.B 79.A 80.D 81.B 82.B 83.A 84.D 85.B 86.D 87.A 88.B 89.A 90.A 91.A 92.D 93.D 94.A 95.B 96.D 97.D 98.C 99.A,C,D 100.A,B

5.B 6.A,B 7.A,D 8.C 9.A 10.C 11.A 12.B,C 13.A 14.B 15.B,C 16.A,D 17.A 18.A 19.A 20.A 21.A 22.A 23.D 24.C 25.A 26.C 27.A,D 28.A 29.A 30.C 31.A,B 32.C 33.D 34.C 35.A,B,D

40.B 41.B 42.A 43.B 44.C 45.B 46.A 47.A 48.A 49.D 50.E 51.A 52.A 53.A,B,C 54.C 55.D 56.D 57.C 58.D 59.D 60.A 61.A 62.C 63.B 64.B 65.B 66.C 67.A 68.C 69.D 70.C

75.A 76.A 77.D 78.D 79.D 80.B 81.B 82.C 83.B 84.A 85.A 86.C 87.A 88.C 89.C 90.B 91.C 92.B 93.D 94.D 95.C 96.B 97.C 98.B 99.C 100.B


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NMC CBT 2017

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