NMC CBT SCENARIO-BASED QUESTIONS WITH ANSWERS

1. As the nurse on duty, you have noted that there has been an increasing number of cases of pressure sore in your nursing home. Which of the following is the best intervention?
a. Collaboration with the Multidisciplinary Team
b. Patient Advocacy
c. Reduce fragmentation and costs
d. Identify opportunities and develop policies to improve nursing practice

Answer
a. Collaboration with the Multidisciplinary Team

2. You are dispending Morphine Sulphate in the treatment room, which has been witnessed by another qualified nurse. Your patient refuses the medication when offered. What will you do next?
a. Go back to the treatment room and write a line across your documentation on the CD book; sign it as refused
b. Dispose of the medication using the denaturing kit, document it as refused and disposed of on the MARS, and write it on the nurse’s notes.
c. Dispose of the medication and document it on the patient’s care plan
d. Store the medication in the CD pod for an hour, and then ask your patient again if he/she wants to take his medication

Answer
b. Dispose of the medication using the denaturing kit, document it as refused and disposed of on the MARS, and write it on the nurse’s notes.

3 Mr Smith has been diagnosed with Multiple Sclerosis 20 years ago. Due to impaired mobility, he has developed a Grade 4 pressure sore on his sacrum. Which health professional can provide you with prescriptions for his dressing?
a. Dietician
b. Tissue Viability Nurse
c. Social Worker
Answer
b. Tissue Viability Nurse

4. A resident is due for discharge from your nursing home. You have been his keyworker for the last five years, and his family has been appreciative of the care you have provided. One of the relatives has offered you cash in an envelope after saying goodbye. What should you do?
a. Say thank you, but refuse the offer politely.
b. Say thank you and accept the offer.
c. Accept the offer, and share it with your colleagues.
d. Accept the offer and keep it to yourself.
Answer
a. Say thank you, but refuse the offer politely.

4. 1067. One of your residents has been transferred from the hospital to your nursing home after having been admitted for a week due to a chest infection. On transfer, you have noted that he had several dressings on his thighs, which he has not had before. What should you do?
a. If the dressings are intact, document it on the nursing notes and indicate that the dressings need to be changed after 48 hours.
b. Change the dressings if they look soiled and document this on the wound assessment form.
c. Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form, and redress the wounds.
d. All of the above.

Answer

c. Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form, and redress the wounds.

5. 1068. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every two hours. Which of the following outcome criteria would the nurse use?
A. Body temperature of 99°F or less
B. Toes moved in an active range of motion
C. Sensation reported when soles of feet are touched
D. Capillary refill of < 3 seconds
Answer
D. Capillary refill of < 3 seconds

6. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?
A. Side-lying with knees flexed
B. Knee-chest
C. High Fowler’s with knees flexed
D. Semi-Fowler’s with legs extended on the bed
Answer
D. Semi-Fowler’s with legs extended on the bed

7. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?
A. Taking hourly blood pressures with mechanical cuff
B. Encouraging fluid intake of at least 200mL per hour
C. Position in high Fowler’s with knee gatch raised
D. Administering Tylenol as ordered
Answer
C. Position in high Fowler’s with knee gatch raised

8. A newly admitted client has a sickle cell crisis. He is complaining of pain in his feet and hands. The nurse’s assessment findings include a pulse oximetry of 92. Assuming that all the following interventions are ordered, which should be done first?
A. Adjust the room temperature
B. Give a bolus of IV fluids
C. Start O2
D. Administer meperidine (Demerol) 75mg IV push
Answer
C. Start O2

9. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the nurse expect the client to select?
A. Roast beef, gelatin salad, green beans, and peach pie
B. Chicken salad sandwich, coleslaw, French fries, ice cream
C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
D. Pork chop, creamed potatoes, corn, and coconut cake
Answer
C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie

10. The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300mL. The nurse should give priority to:
A. Turning the client to the left side
B. Milking the tube to ensure patency
C. Slowing the intravenous infusion
D. Notifying the physician
Answer
D. Notifying the physician

11. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:
A. Using oil- or cream-based soaps
B. Flossing between the teeth
C. The intake of salt
D. Using an electric razor
Answer
B. Flossing between the teeth

12. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
A. Perform the Valsalva maneuver as the catheter is advanced
B. Turn his head to the left side and hyperextend the neck
C. Take slow, deep breaths as the catheter is removed
D. Turn his head to the right while maintaining a sniffing position
Answer
A. Perform the Valsalva maneuver as the catheter is advanced

13. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
A. Perform the Valsalva maneuver as the catheter is advanced
B. Turn his head to the left side and hyperextend the neck
C. Take slow, deep breaths as the catheter is removed
D. Turn his head to the right while maintaining a sniffing position
Answer
A. Perform the Valsalva maneuver as the catheter is advanced

14. A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the:
A. Head of the pancreas
B. Proximal third section of the small intestine
C. Stomach and duodenum
D. Esophagus and jejunum
Answer
A. Head of the pancreas

15. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?
A. “The pain will go away in a few days.”
B. “The pain is due to peripheral nervous system interruptions. I will get you some pain medication.”
C. “The pain is psychological because your foot is no longer there.”
D. “The pain and itching are due to the infection you had before the surgery.”
Answer
B. “The pain is due to peripheral nervous system interruptions. I will get you some pain medication.”

16. A client with an abdominal cholecystectomy returns from surgery with a Jackson-Pratt drain. The chief purpose of the Jackson-Pratt drain is to:
A. Prevent the need for dressing changes
B. Reduce edema at the incision
C. Provide for wound drainage
D. Keep the common bile duct open
Answer
C. Provide for wound drainage

17. The nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will use:
A. Mydriatics to facilitate removal
B. Miotic medications such as Timoptic
C. A laser to smooth and reshape the lens
D. Silicone oil injections into the eyeball
Answer
A. Mydriatics to facilitate removal

18. A client with pancreatic cancer has an infusion of TPN (Total Parenteral Nutrition). The doctor has ordered sliding-scale insulin. The most likely explanation for this order is:

A. Total Parenteral Nutrition leads to negative nitrogen balance and elevated glucose levels.
B. Total Parenteral Nutrition cannot be managed with oral hypoglycemics.
C. Total Parenteral Nutrition is a high-glucose solution that often elevates blood glucose levels.
D. Total Parenteral Nutrition leads to further pancreatic disease.
Answer
C. Total Parenteral Nutrition is a high-glucose solution that often elevates blood glucose levels.

19. A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:
A. Is the opening on the client’s left side
B. Is the opening on the distal end on the client’s left side
C. Is the opening on the client’s right side
D. Is the opening on the distal right side
Answer
C. Is the opening on the client’s right side

20. You have answered a phone call after receiving the handover. The person you were talking to has explained that he needs to find out about his sister’s condition. What should you initially do?
a) Discuss about his sister’s condition and provide treatment options such as access to other resources in the community.
b) Check the patient’s record and verify the caller’s identity.
c) Refuse to divulge any information to the caller.
d) Discuss his sister’s condition and book an appointment for him to attend care plan reviews.
Answer
b) Check the patient’s record and verify the caller’s identity.

21. A carer has reported that she has seen a resident fall off his bed. What initial assessment should be done?
a. Check the patient’s Early Warning Score along with the Glasgow Coma Scale immediately.
b. Ask the patient if he is in pain; if so, administer painkillers immediately.
c. Dial 999 and request for an ambulance to take your patient to the hospital.
d. Contact the out-of-hours GP and request for a home visit.
Answer
a. Check the patient’s Early Warning Score along with the Glasgow Coma Scale immediately.

22. During your medical rounds, you have noted that Mrs X was upset. She has verbalized that she misses her family very much and that no one has been to visit lately. What would likely be your initial intervention?
a. Contact Mrs X’s family and encourage them to visit her during the weekend.
b. Sit next to Mrs X and listen attentively. Allow her to talk about things that cause her anxiety.
c. Collaborate with the GP for a care plan review and request for antidepressants to be prescribed.
d. All of the above.
e. None of the above.
Answer
b. Sit next to Mrs X and listen attentively. Allow her to talk about things that cause her anxiety.

23. On admission of a service user, you have done an informal risk assessment for pressure sores, and you have noted that the patient is currently not at risk. What will be your next step?
a) Include the Repositioning Chart on your patient’s daily notes, and instruct your carers/HCA’s to turn your patient every two hours. b) Alert the General Practitioner about your patient’s condition.
c) Reassess your patient on a regular basis and document your observations.
d) Modify your patient’s diet to maintain intact skin integrity.
Answer
c) Reassess your patient on a regular basis and document your observations.

24. You were on the phone with a family member, and one of the carers reported that one of your residents had stopped breathing and turned blue. What should you do first?
a) End your conversation with the family member, attend to your patient, and do the CPR.
b) End your conversation with the family member, go to your patient’s bedroom, and assess for airway, breathing, and circulation.
c) End your conversation with the family member, and dial 999 to request an ambulance.
d) Dial 111, and request an urgent visit from the General Practitioner.
Answer
b) End your conversation with the family member, go to your patient’s bedroom, and assess for airway, breathing, and circulation.
25. Mr Smith has just been certified dead by the General Practitioner. However, no arrangements have been made by the family. What should you do first?
a) Check the patient’s records for the next of kin details, and contact them to discuss funeral services.
b) Ring the co-operative and arrange for the undertaker to pick up Mr Smith as soon as possible.
c) Contact the GP and discuss how to deal with Mr Smith.
d) Contact your manager and enquire about dealing with Mr Smith.
Answer
c) Contact the GP and discuss how to deal with Mr Smith.

26. Mr Marriott, 21 years old, has been complaining of foul-smelling urine, pain on urination, and night sweats. What further assessment should be done to check if he has Urinary Tract Infection?
a) Assess his blood pressure.
b) Take a urine sample and send it to the lab.
c) Do the buccal swab and send the specimen to the lab.
d) Check his prothrombin time and signs of bleeding.
Answer
b) Take a urine sample and send it to the lab.

27. A patient with a nutritional deficit and a MUST Score of 2 and above is of high risk. What should be done?
a. Refer the patient to the dietician, and the Nutritional Support Team and implement local policy.
b. Observe and document dietary intake for three days.
c. Repeat screening weekly or monthly depending on the patient’s food intake during the last 72 hours.
d. All of the above.
Answer
a. Refer the patient to the dietician, and the Nutritional Support Team and implement local policy.

28. According to the National Institute for Health and Care Excellence (NICE) Guidelines, examples of the Personal Protective Equipment are:
a. Tunic top, vascular access devices, surgical scissors
b. Gloves, aprons, face mask, and goggles
c. Gloves, cannula, aprons and syringes
d. All of the above
e. None of the above
Answer
b. Gloves, aprons, face mask, and goggles

29. Based on the National Institute for Health and Care Excellence (NICE) Guidelines, which of the following is incorrect about sharps container?
a. It must be located in a safe position and height to avoid spillage.
b. It should be temporarily closed when not in use.
c. It must not be filled above the fill line.
d. It must not be filled below the fill line.
Answer
d. It must not be filled below the fill line.

30. How do you prevent the spread of infection when nursing a patient with long-term urinary catheters?
a) Patients and carers should be educated about and trained in techniques of hand decontamination, insertion of intermittent catheters where applicable, and catheter management before discharge from the hospital.
b) Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor. c) Bladder instillations or washouts must not be used to prevent catheter-associated infections.
d) All of the above.
Answer
d) All of the above.

31. Mrs Hannigan has been assessed to be on nutritional deficit with a MUST Score of 1, which means that she is at medium risk. One of your interventions is to modify her diet for her to meet her nutritional needs. What should you consider?
a. Mrs Hannigan’s meal preferences.
b. Mrs Hannigan’s intake and output records.
c. Mrs Hannigan’s x-ray results.
d. A and B
Answers
d. A and B

32. Your patient has been recently prescribed PEG feeding with a resting period of 4 hours. After two weeks of starting the routine, he has been having episodes of loose stool. What could be done?
a) Refer him to a dietician and review for a longer resting period between feeds.
b) Refer him to the tissue viability nurse for his peg site.
c) Examine his abdomen and assess for lumps.
d) Examine his peg site, and apply metronidazole ointment if swollen.
Answer
a) Refer him to a dietician and review for a longer resting period between feeds.

33. You are preparing a client with Acquired Immunodeficiency Syndrome (AIDS) for discharge to home. Which of the following instructions should the nurse include?
a) Avoid sharing things such as razors and toothbrushes.
b) Do not share eating utensils with family members.
c) Limit the time you spend in public places.
d) Avoid eating food from serving dishes shared with others.
Answer
a) Avoid sharing things such as razors and toothbrushes.

34. A patient with Bipolar Disorder makes a sexually inappropriate comment to the nurse. One should take which of the following actions?
a. Ignore the comment because the client has a mental health disorder and cannot help it.
b. Report the comment to the nurse manager.
c. Ignore the comment, but tell the incoming nurse to be aware of the client’s propensity to make inappropriate comments.
d. Tell the client that is it inappropriate for clients to speak to any nurse that way.
Answer
d. Tell the client that is it inappropriate for clients to speak to any nurse that way.

35. You are nursing an adult patient with a long bone fracture. You encourage your patient to move fingers and toes hourly, to change positions slightly every hour, and to eat high-iron foods as part of a balanced diet. Which of the following foods or beverages should you advise the client to avoid whilst on bed rest?
a) Fruit juices
b) Large amounts of milk or milk products
c) Cranberry juice cocktail
d) No need to avoid any foods while on bed rest
Answer
b) Large amounts of milk or milk products

36. The nurse is preparing to make rounds. Which client should be seen first?
a) 1-year-old with hand and foot syndrome
b) 69-year-old with congestive heart failure
c) 40-year-old resolving pancreatitis
d) 56-year-old with Cushing’s disease
Answer
b) 69-year-old with congestive heart failure

37. The nurse sat an older man on the toilet in a six-bed hospital bay. Using her judgment, she recognized that he was at risk of falling and so left the toilet door ajar. In the meantime, the nurse went to make his bed on the other side of the bay. On turning around, she noticed that the patient had fallen onto the toilet floor. What should be her initial intervention?
a) Immobilise the patient and conduct a thorough assessment, checking for injuries
b) Call for help immediately
c) Press the emergency call button immediately
d) Check the patient for injuries and transfer him to the wheelchair
Answer
b) Call for help immediately

38. A patient with Leukaemia was about to receive a transfusion of blood platelets. The experienced nurse on duty in the ward noticed small clumps visible in the platelet pack and questioned whether the transfusion should proceed. What should the nurse do?
a. Proceed with platelet transfusion and monitor for signs of rejection
b. Withhold platelet transfusion and document it on the patient’s chart
c. Ring the blood bank and enquire about the platelet pack received
d. All of the above
Answer
c. Ring the blood bank and enquire about the platelet pack received

39. You are about to administer Morphine Sulfate to a pediatric patient. The information written in the controlled drug book was not clearly written – 15 mg or 0.15 mg. What will you do first?
a. Not administer the drug, and wait for the General Practitioner to do his rounds
b. Administer 0.15 mg, because 15 mg is quite a big dose for a pediatric patient
c. Double check the medication label and the information on the controlled drug book; ring the chemist to verify the dosage
d. Ask a senior staff to read the medication label with you
Answer
c. Double check the medication label and the information on the controlled drug book; ring the chemist to verify the dosage

40. Mr Smith is 89 years old with Prostate Cancer. He was advised that the only treatment available for him was palliative care after Transurethral Resection of the Prostate. What is your main task as a coordinator of care in the multidisciplinary team?
a.) One should be able to organise the services identified in the care plan and across other agencies.
b.) Assess the patient for respiratory complications caused by gas exchange alterations due to old age.
c.) Sit down with the patient and ask for the frequency of his bowel elimination
d.) Document the patient’s capability of self-care activities and the support he needs to carry out activities of daily living.
Answer
a.) One should be able to organise the services identified in the care plan and across other agencies.

41. An 82-year-old lady was admitted to the hospital for assessment of her respiratory problems. She has been a long-term smoker despite her daughter advising her to stop. Based on your assessment, she has lost a substantial amount of weight. How will you assess her nutritional status?
a) Check her height and weight, so you can determine her BMI, BMI Score, and Nutritional Care Plan
b) Use the respiratory and perfusion assessment chart on admission
c) Check if she is struggling to chew and swallow, and make a referral to the Speech and Language Therapist
d) All of the above
Answer
a) Check her height and weight, so you can determine her BMI, BMI Score, and Nutritional Care Plan

42. John, 26 years old, was admitted to the hospital due to multiple gunshot wounds on his abdomen. On nutritional assessment in the ICU, the patient’s height and weight were estimated to be 1.75 m and 75 kg, respectively, with a normal body mass index (BMI) of 24.5 kg/m2. He was started on Parenteral Nutrition support on day one post-admission. Postoperatively, the patient developed worsening renal function and required dialysis. In critical care, what would be most likely recommended for him to meet his nutritional needs?
a) Starting Parenteral Nutrition early in patients who are unlikely to tolerate enteral intake within the next three days
b) Starting with a slightly lower than required energy intake (25 kCal/kg)
c) A range of protein requirements (1.3-1.5 g/kg)
d) All of the above
e) None of the above
Answer
d) All of the above

43. You are currently working in a nursing home. One of the service users is struggling to swallow or chew his food. To whom do you make a referral to?
a) Tissue Viability Nurse
b) Social Worker
c) Speech and Language Therapist
d) Care Manager
Answer
c) Speech and Language Therapist

44. Mr C’s mother was admitted to hospital following a fall at home and it was clearly documented that his mother suffered from diabetes. Mr C contacted the Trust concerning the Trust’s failure to make adequate discharge arrangements for his mother including the necessary arrangements to ensure that his mother would be provided with insulin following her discharge. What needs to be implemented to avoid such concerns/complaints in the future?
a.) Diabetic Liaison Nurse to work with service users in the community
b.) Online training for blood glucose monitoring introduced within the Trust
c.) Diabetics are to have their blood sugar recorded within four hours prior to discharge
d.) A and C only
e.) all of the above
Answer
d.) A and C only

45. Julie, 50 years old, was admitted to the hospital with a gastrointestinal bleed presumed to be oesophageal varices. It has been recommended that she needs to be transfused with blood; however, due to her religious and personal beliefs, she needed volume-expanding agents. Unfortunately, she died a few hours after admission. Before dying, she said that it was God’s will, which she believed was right. Which of the following statements is false?
a) Health professionals should be aware of imposing one’s worldview upon others and strive to be more receptive and sensitive to the needs of others.
b) Individual choice, consent, and the right to refuse treatment is important.
c) It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs.
d) None of the Above
Answer
c) It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs.

46. Paulena, 57 years old, suffered from a very dense left-sided Cerebrovascular Accident / Stroke. She was unconscious and unresponsive for several days with IV fluids for hydration. Since her recovery from stroke, she has been prescribed to commence enteral feeding through a fine-bore nasogastric tube, in which she signed her consent in front of her who has always been supportive of her decisions. However, she tends to pull out her NGT when she is by herself in her room. She died of malnutrition after a few days. Which of the following statements is true?
a) Nurses should have the empathy to listen to more than just the spoken word.
b) Nurses should practice in accordance with Pauleena’s best interest while providing support to the family and listening to their concerns and wishes.
c) Paulena needs to be supported with questions related to mortality and the meaning of life. Therapeutic communication is also essential. d) All of the above
Answer
d) All of the above

47. An adult patient with Nasogastric Tube died in a medical ward due to aspiration of fluids. The staff nurse on duty believes that she has flushed the tube and believes it is patent. What should NOT have been done?
a) Nothing should be introduced down the tube before gastric placement is confirmed.
b) Internal guidewires should not be lubricated before gastric placement is confirmed.
c) Auscultate the patient’s stomach as you push some air in, and if you cannot hear anything, flush it.
d) It is important to check the position of the tube by measuring the pH value of stomach contents.
Answer
c) Auscultate the patient’s stomach as you push some air in, and if you cannot hear anything, flush it.

48. You were assigned to change the dressing of a patient with a diabetic foot ulcer. You were not sure if the wound had sloughy tissues or pus. How will you carry out your assessment?
a.) Sloughy tissue is a mass of dead tissues in your wound bed, while pus is a thick yellowish/greenish opaque liquid produced in an infected wound.
b.) Sloughy tissues are exactly the same as pus, and they both have a yellowish tinge.
c.) Sloughy tissues and pus are similar to each other; both are found on the wound bed tissue and are indicative of dying tissue.
d.) The presence of sloughy tissues and pus is an indication of non-surgical debridement.
e.) All of the above
f.) None of the above
Answer
a.) Sloughy tissue is a mass of dead tissues in your wound bed, while pus is a thick yellowish/greenish opaque liquid produced in an infected wound.

49. Which of the following sets of needs should be included in your service user’s person-centered care plan?
a.) social, spiritual, and academic needs
b.) medical, psychological, and financial needs
c.) physical, medical, social, psychological and spiritual needs
d.) a and b only
e.) all of the above
f.) None of the above
Answer
c.) physical, medical, social, psychological and spiritual needs

50. Annie, one of the residents in the nursing home, has not yet had her mental capacity assessment done. She has been making decisions that you personally think are not beneficial for her. Which of the following should not be implemented?
a.) Force her to change her mind every time she makes a decision
b.) Explain the benefits of making the right decision
c.) Allow her to make her own decision, as she still has mental capacity
d.) All of the above
Answer
a.) Force her to change her mind every time she makes a decision

51. Mr Z called for your assistance and wanted you to sit with him for a bit. He has disclosed confidential information about his personal life. Which of the following should you urgently deal with?
a.) history of gall stones
b.) presence of pacemaker
c.) suicidal connotations
d.) loss of appetite due to depression
Answer
c.) suicidal connotations

52. You were on duty, and you have noticed that the syringe driver is not working properly. What should you do?
a.) ask someone to fix it
b.) report this to your supervisor immediately
c.) leave this for the senior staff to sort out
d.) recommend a person to repair it
Answer
b.) report this to your supervisor immediately

53. A patient in one of your bays has called for staff. She needed assistance with “spending a penny”. What will you do?
a.) Ask her if she wants a hot or cold drink, and give her one as requested
b.) Assist her to walk to the vending machine, and let her choose what she wants to buy
c.) Assist her to walk to the toilet, and provide her with some privacy
d.) Help her find her purse, and ask her what time she will be ready to go out
Answer
c.) Assist her to walk to the toilet, and provide her with some privacy

54. Betty has been assessed to be very confused and with impaired mobility. She wants to go to the dining room for her meal, but she wants a cardigan before doing so. What will you do?
a.) Give her wet wipes for her hands before dinner
b.) Disregard the cardigan and take her to the dining room
c.) Ask her what she means by a cardigan
d.) Make her comfortable in a wheelchair, and cover her legs with a blanket
Answer
c.) Ask her what she means by a cardigan
55. Mrs A is 90 years old and has been admitted to the nursing home. The staff seem to have difficulty dealing with her family. One day, during your shift, Mrs A fell off a chair. You have assessed her, and no injuries have been noted. Which of the following is a principle of the Duty of Candour?
a.) You will not ring the family since there is no injury caused by the fall.
b.) You have liaised with the lead nurse, and she decided not to ring the family due to no harm.
c.) Observe the patient, take her physical observations, and ask if you must call the family.
d.) All of the above
e.) None of the above
Answer
e.) None of the above

56. Maggie has been very physically and verbally aggressive towards other patients and staff for the last few weeks. She is now on one-to-one care, 24 hours a day. According to her person centred care plan, the nurses are looking after her very well preventing her from causing any harm. Behaviour has been discussed with the social worker, and clinical lead has applied for DoLS. Which of the following is correct?
a.) DoLS will allow staff to intervene depriving Maggie from doing something to hurt herself, other residents, and staff
b.) DoLS refers to protecting the other patients only from Maggie’s destructive behaviour.
c.) DoLS protects the nurses and doctors only when providing care for Maggie.
d.) DoLS protects Maggie only from committing suicide.
Answer
a.) DoLS will allow staff to intervene depriving Maggie from doing something to hurt herself, other residents, and staff

57. 1126. You were assisting Mrs X with personal care and hygiene. She has been assessed to have mental capacity. In her wardrobe, you have seen a dress that is quite difficult to wear and a pair of trousers, which is quite easy to put on. You are trying to make a decision on which one to put on her. Which of the following is a person-centred intervention?
a.) Ask her what she prefers; show her the clothes and let her choose
b.) Let Mrs. X wear her trousers
c.) Explain to her that the dress is so difficult to put on
d.) Tell her that the trousers will make her more comfortable if she chooses it
Answer
a.) Ask her what she prefers; show her the clothes and let her choose

58. Documentation confirms that Amy has MRSA. You walked into her bedroom with coffee and biscuits on a tray. Which of the following is incorrect?
a.) Put the coffee and biscuits on her bedside table and leave the tray on the other table
b.) Wash your hands thoroughly before leaving her room
c.) Dispose of your gloves and apron before washing your hands
d.) Use the alcohol gel on Amy’s bedside before leaving her room
Answer
d.) Use the alcohol gel on Amy’s bedside before leaving her room

59. Which of the following is the most important in infection control and prevention?
a.) Wearing gloves and apron at all times
b.) Hand washing
c.) immediate prescription of antibiotics
d.) Use of hand rubs in the bedside
Answer
b.) Hand washing

60. There has been an outbreak of the Norovirus in your clinical area. The majority of your staff have rang in sick. Which of the following is incorrect?
a.) Do not allow visitors to come in until after 48hrs of the last episode
b.) Tally the episodes of diarrhea and vomiting
c.) Staff who have the virus can only report to work 48hrs after the last episode
d.) Ask one of the staff who is off-sick to do an afternoon shift on the same day
Answer
d.) Ask one of the staff who is off-sick to do an afternoon shift on the same day

61. Alan appears to be very confused today. He seems to be quite verbally aggressive towards staff. His urine has also got a bit of a foul smell. How would you assess this resident?
a.) Check his papillary response to light
b.) Collect a urine sample for MSU
c.) Carry out the urine dipstick
d.) b and c
e.) None of the above
Answers
d.) b and c

62. You are working in a nursing home (morning shift), and one of your residents is still in the hospital. Nothing has been documented since admission. What would you do?
a.) Ring the family and find out what happened to the resident
b.) Speak to your manager and tell her about it
c.) Ring the ward and request for an update from the nurse on duty
d.) Document that the resident is still in the hospital
Answer
c.) Ring the ward and request for an update from the nurse on duty

63. A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weightgain of 30 pounds in four months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?
A. Impaired physical mobility related to decreased endurance
B. Hypothermia r/t decreased metabolic rate
C. Disturbed thought processes r/t interstitial edema
D. Decreased cardiac output r/t bradycardia
Answer
D. Decreased cardiac output r/t bradycardia

64. A client with leukemia is receiving Trimetrexate. After reviewing the client’s chart, the physician orders Wellcovorin (leucovorin calcium). The rationale for administering leucovorin calcium to a client receiving Trimetrexate is to:
A. Treat iron-deficiency anemia caused by chemotherapeutic agents
B. Create a synergistic effect that shortens treatment time
C. Increase the number of circulating neutrophils
D. Reverse drug toxicity and prevent tissue damage
Answer
D. Reverse drug toxicity and prevent tissue damage

65. A client is admitted to the hospital with a temperature of 99.8°F, complaints of blood tinged hemoptysis, fatigue, and night sweats. The client’s symptoms are consistent with a Diagnosis of:
A. Pneumonia
B. Reaction to antiviral medication
C. Tuberculosis
D. Superinfection due to low CD4 count
Answer
C. Tuberculosis

66. The client with confusion says to the nurse, “I haven’t had anything to eat all day long. When are they going to bring breakfast?” The nurse saw the client in the day room eating breakfast with other clients 30 minutes before this conversation. Which response would be best for the nurse to make?
A. “You know you had breakfast 30 minutes ago.”
B. “I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse.”
C. “I’ll get you some juice and toast. Would you like something else?”
D. “You will have to wait a while; lunch will be here in a little while.”
Answer
C. “I’ll get you some juice and toast. Would you like something else?”

67. The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive Kernig’s sign is charted if the nurse notes:
A. Pain on flexion of the hip and knee
B. Nuchal rigidity on flexion of the neck
C. Pain when the head is turned to the left side
D. Dizziness when changing positions
Answer
A. Pain on flexion of the hip and knee

68. The client arrives in the emergency department after a motor vehicle accident. Nursing assessment findings include BP 80/34, pulse rate 120, and respirations 20. Which is the client’s most appropriate priority nursing diagnosis?
A. Alteration in cerebral tissue perfusion
B. Fluid volume deficit
C. Ineffective airway clearance
D. Alteration in sensory perception
Answer
B. Fluid volume deficit

69. To maintain Bryant’s traction, the nurse must make certain that the child’s:
A. Hips are resting on the bed, with the legs suspended at a right angle to the bed
B. Hips are slightly elevated above the bed and the legs are suspended at a right angle to the bed
C. Hips are elevated above the level of the body on a pillow and the legs are suspended parallel to the bed
D. Hips and legs are flat on the bed, with the traction positioned at the foot of the bed
Answer
B. Hips are slightly elevated above the bed and the legs are suspended at a right angle to the bed

70. The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot?
A. Application of a short inclusive spica cast
B. Stabilization with a plaster-of-Paris cast
C. Surgery with Kirschner wire implantation
D. A gauze dressing only
Answer
B. Stabilization with a plaster-of-Paris cast

71. A nurse obtains an order from a physician to restrain a client by using a jacket restraint. The nurse instructs the nursing assistant to apply the restraint. Which of the following would indicate inappropriate application of the restraint by the nursing assistant.
A) A safety knot in the restraint straps
B) Restraint straps that are safely secured to the side rails
C) The jacket restraint is secured such that two fingers can slide easily between the restraints & the client’s skin
D) Jacket restraint straps that do not tighten when force is applied against them
Answer
D) Jacket restraint straps that do not tighten when force is applied against them

72. A patient with a history of schizophrenia is admitted to the acute psychiatric care unit. He mutters to himself as the nurse attempts to take a history and yells, “I don’t want to answer any more questions! There are too many voices in this room!” Which of the following assessment questions should the nurse ask NEXT?
A. “Are the voices telling you to do things?
B. “Do you feel as though you want to harm yourself or anyone else?”
C. “Who else is talking in this room? It’s just you and me.
D. “I don’t hear any other voices
Answer
A. “Are the voices telling you to do things?

73. You were a new nurse in a geriatric ward. The son of one of your patients discussed that he has noticed his mother is not being treated well in the ward, and that she looks very dehydrated and malnourished. How do you deal with the scenario?
a.) Do not do anything, because it is not much of a concern
b.) Discuss the case with a colleague
c.) Report this to your supervisor
d.) Make a decision not to intervene – it will be dealt with by management
Answer
c.) Report this to your supervisor
74. The nurse cares for an elderly patient with moderate hearing loss. The nurse should teach the patient’s family to use which of the following approaches when speaking to the patient?
(A) Raise your voice until the patient is able to hear you.
(B) Face the patient and speak quickly using a high voice.
(C) Face the patient and speak slowly using a slightly lowered voice.
(D) Use facial expressions and speak as you would formally
Answer
(C) Face the patient and speak slowly using a slightly lowered voice.

75. An 86-year-old male with senile dementia has been physically abused & neglected for the past two years by his live-in caregiver. He has since moved & is living with his son & daughter-in-law. Which response by the client’s son would cause the nurse great concern?
A) “ How can we obtain reliable help to assist us in taking care of Dad? We can’t do it alone.”
B) “ Dad used to beat us kids all the time. I wonder if he remembered that when it happened to him?”
C) “I’m not sure how to deal with Dad’s constant repetition of words.”
D) “I plan to ask my sister & brother to help my wife & me with Dad on the weekends.”
Answer
B) “ Dad used to beat us kids all the time. I wonder if he remembered that when it happened to him?”

76. A client comes to the local clinic complaining that sometimes his heart pounds and he has trouble sleeping. The physical exam is normal. The nurse learns that the client has recently started a new job with expanded responsibilities and is worried about succeeding. Which of the following responses by the nurse is BEST?
A. “Have you talked to your family about your concerns?
B. You appear to have concerns about your ability to do your job
C. “You could benefit from counseling.
D. “It’s normal to feel anxious when starting a new job.”
Answer
B. You appear to have concerns about your ability to do your job

77. Patient has just been told by the physician that she has stage III uterine cancer. The patient says to the nurse, “I don’t know what to do. How do I tell my husband?” and begins to cry. Which of the following responses by the nurse is the MOST therapeutic?
A. “It seems to be that this is a lot to handle. I’ll stay here with you.”
B. “How do you think would be best to tell your husband?”
C. “I think this will all be easier to deal with than you think.”
D. “Why do you think this is happening to you?”
Answer
A. “It seems to be that this is a lot to handle. I’ll stay here with you.”

78. As a nurse, you make sure that the patient and public safety is protected. Thus, 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. Which is the least effective way to protect a patient’s safety?
A) Support the exchange of information at all levels without fear and against authority gradients – is known to be associated with constant awareness to the possibility of hazard or harm
B) Support for continual learning, growth and adaptation even under stress by valuing relevant knowledge, skills and observations even at the lowest levels of hierarchy
C) Support the willingness and capacity to look beyond first impressions, labels and old beliefs – organisations must remain closely in touch with activities and facts on the ground in the daily operations
D) Support the openness culture that encourages clear lines to report concerns and reinforces the attitudes that prevent safeguarding concerns from scrutiny where staff at all levels feel confident that they can voice their concerns without fear of victimization
Answer
D) Support the openness culture that encourages clear lines to report concerns and reinforces the attitudes that prevent safeguarding concerns from scrutiny where staff at all levels feel confident that they can voice their concerns without fear of victimization
79. 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?
A) Ask the patient the assistance he needs
B) Delegate someone to feed him
C) Ask the relatives to assist in feeding him
D) Look for volunteer to assist with his needs
Answer
A) Ask the patient the assistance he needs
80. A nurse should be able to show awareness of his/her role in health promotion and supporting a healthy lifestyle. Whilst providing health education to a group of patients with cancer about management of their non-healing wounds, it is important for one to:
A) Consider individual wound management priorities
B) Review the patient’s treatment plan
C) Determine the locations of the wounds
D) Verify the types of cancer
Answer
A) Consider individual wound management priorities
81. Julie, 50 years old, was admitted to the hospital with gastrointestinal bleed presumed to be oesophageal varices. It has been recommended that she needs to be transfused with blood; however, due to her religious and personal beliefs, she needed volume expanding agents. Unfortunately, she died a few hours after admission. Before dying, she said that it was God’s will, which she believed was right. Which of the following statements is false?
A) Health professionals should be aware of imposing one’s world view upon others and strive to be more receptive and sensitive to the needs of others
B) Individual choice, consent and the right to refuse treatment is important
C) It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs
D) None of the Above
Answer
C) It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs
82. Pauleena, 57 years old, suffered from a very dense left sided Cerebrovascular Accident / Stroke. She was unconscious and unresponsive for several days with IV fluids for hydration. Since her recovery from stroke, she has been prescribed to commence enteral feeding through a fine bore nasogastric tube, in which she signed her consent in front of her who have always been supportive of her decisions. However, she tends to pull out her NGT when she is by herself in her room. She died of malnutrition after a few days. Which of the following statements is true?
A) Nurses should have the empathy to listen to more than just the spoken word
B) Nurses should practice in accordance to Pauleena’s best interest while providing support to the family and listening to their concerns and wishes
C) Pauleena needs to be supported with questions related to mortality and meaning of life Therapautic communication is also essential
D) All of the above
Answer
D) All of the above
83. Barbara, a 75-year old patient from a nursing home was admitted on your ward because of fractured neck of femur after a trip. She will require an open-reduction and internal fixation (ORIF) procedure to correct the injury. Which of the following statements will help her understand the procedure?
A) You are going to have an ORIF done to correct your fracture
B) Some metal screws and pins will be attached to your hip to help with the healing of your broken bone
C) The operation will require a metal fixator implanted to your femur and adjacent bones to keep it secured
D) The ORIF procedure will be done under general anaesthesia by an orthopaedic surgeon
Answer
B) Some metal screws and pins will be attached to your hip to help with the healing of your broken bone

84. Lisa, a working mother of 3, has approached you during a recent attendance of her daughter in Accident and Emergency because of an acute asthma attack about smoking cessation. What is your most appropriate response to her?
A) Smoking cessation will help prevent further asthma attack
B) Referral can be made to the local NHS Stop Smoking Service
C) Discuss with her the NICE recommendations on smoking cessation
D) It is not common for people like her to stop smoking
Answer
B) Referral can be made to the local NHS Stop Smoking Service

85. Margaret has been diagnosed with Hepatic Adenoma. Her results are as follows – benign tumor as shown on triphasic CT Scan and alpha feto proteins within normal range. She is asymptomatic and does not appear jaundice, but she appears to be very anxious. As a nurse, what will you initially do?
A) Sit down with Margaret and discuss about her fears; use therapeutic communication to alleviate anxiety
B) Refer her to a psychiatrist for treatment
C) Discuss invasive procedure with patient, and show her videos of the operation
D) Take her to the surgeon’s clinic and discuss about consent for invasive procedure
Answer
A) Sit down with Margaret and discuss about her fears; use therapeutic communication to alleviate anxiety

86. One of your residents has been transferred from the hospital to your nursing home after having been admitted for a week due to a chest infection. On transfer, you have noted that he had several dressings on his thighs, which he has not had before. What should you do?
A) If the dressings are intact, document it on the nursing notes and indicate that the dressings need to be changed after 48 hours
B) Change the dressings if they look soiled and document this on the wound assessment form
C) Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form and redress the wounds
D) All of the above
Answer
C) Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form and redress the wounds

87. During your medical rounds, you have noted that Mrs X was upset. She has verbalised that she misses her family very much, and that no one has been to visit lately. What would likely be your initial intervention?
A) Contact Mrs X’s family and encourage them to visit her during the weekend
B) Sit next to Mrs X and listen attentively Allow her to talk about things that cause her anxiety
C) Collaborate with the GP for a care plan review and request for antidepressants to be prescribed
D) All of the above
E) None of the above
Answer
B) Sit next to Mrs X and listen attentively Allow her to talk about things that cause her anxiety

88. On admission of a service user, you have done an informal risk assessment for pressure sores, and you have noted that the patient is currently not at risk. What will be your next step?
A) Include the Repositioning Chart on your patient’s daily notes, and instruct your carers/HCA’s to turn your patient every two hours
B) Alert the General Practitioner about your patient’s condition
C) Reassess your patient on a regular basis and document your observations
D) Modify your patient’s diet to maintain intact skin integrity

89. The nurse is preparing to move an adult who has right sided paralysis from the bed into a wheel chair. Which statement describes the best action for the nurse to take?
A) Position the wheelchair on the left side of the bed
B) Keep the head of the bed elevated 10 degree
C) Protect the client’s left arm with a sling during the transfer
D) Bend at the waist while helping the client into a standing position
Answer
A) Position the wheelchair on the left side of the bed

90. A client with a right arm cast for fractured humerus states, “I haven’t been able to straighten the fingers on the right hand since this morning.” What action should the nurse take?
A) Assess neurovascular status to the hand
B) Ask the client to massage the fingers
C) Encourage the client to take the prescribed analgesic
D) Elevate the arm on a pillow to reduce oedema
Answer
A) Assess neurovascular status to the hand

91. Post surgery, the doctor tells the patient that treatment is not working. The doctor instructed the nurse to stay with the patient until the nurse specialist arrive. What should the nurse do?
A) Document outcomes in the patient’s chart
B) Sit silently with patient until nurse specialist arrives
C) Ask the patient if he wants to discuss what the doctor said
D) Do not leave the patient unattended and try to answer his questions
Answer
C) Ask the patient if he wants to discuss what the doctor said

92. An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse that they would like to take an herbal substance to help lower their blood pressure. The nurse should take which action?
A) Tell the client that herbal substances are not safe and should never be used
B) Teach the client how to take their BP so that it can be monitored closely
C) Encourage the client to discuss the use of an herbal substance with the health care provider
D) Tell the client that if they take the herbal substance they will need to have their BP checked frequently
Answer
C) Encourage the client to discuss the use of an herbal substance with the health care provider

93. 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?
A) Tell her that you will arrange a meeting with a doctor after the procedure
B) Give a health education on cancer prevention
C) Ignore her question and take her for the procedure
D) Understand her feelings and tell the patient that it is normal procedure
Answer
D) Understand her feelings and tell the patient that it is normal procedure

94. You were assisting Mrs X with personal care and hygiene. She has been assessed to have mental capacity. In her wardrobe, you have seen a dress that is quite difficult to wear and a pair of trousers, which is quite easy to put on. You are trying to make a decision which one to put on her. Which of the following is a person centred intervention?
A) Ask her what she prefers; show her the clothes and let her choose
B) Let Mrs X wear her trousers
C) Explain to her that the dress is so difficult to put on
D) Tell her that the trousers will make her more comfortable if she chooses it
Answer
A) Ask her what she prefers; show her the clothes and let her choose

95. A young woman has suffered fractured pelvis in an accident, she has been hospitalized for 3 days, when she tells her primary nurse that she has something to tell her but she doesnot want the nurse to tell anyone. She says that she had tried to donate blood and tested positive for HIV. What is best action of the nurse to take?
A) Document this information on the patient’s chart
B) Tell the patient’s physician
C) Inform the healthcare team who will come in contact with the patient
D) Encourage the patient to disclose this information to her physician
Answer
D) Encourage the patient to disclose this information to her physician

96. The nurse is admitting a client, on initial assessment the nurse tries to inquire the patient if he has been taking alternative therapies and OTC drugs but the client becomes angry and refuses to answer saying the nurse is doing so because he belongs to an ethnic minority group, what is the nurse’s best response?
A) The nurse will stop asking questions as it is upsetting to the patient
B) Wait and give some time for the client to get adjusted to modern ways of hospitalization
C) The nurse will politely explain to the patient about alternative therapies such as St Johns Wort which interact with drugs
D) The nurse will assign another nurse to ask questions
Answer
C) The nurse will politely explain to the patient about alternative therapies such as St Johns Wort which interact with drugs

97. One of your patient has challenged your recent practice of administering a subcutaneous low-molecular weight heparin (LMWH) without disinfecting the injection site. The guidelines for nursing procedures do not recommend this method. Which of the following response will support your action?
A) “We were taught during our training not to do so as it is not based on evidence”
B) “Our guidelines, which are based on current evidence, recommends a non-disinfection method of subcutaneous injection”
C) “I am glad you called my attention I will disinfect your injection site next time to ensure your safety and peace of mind”
D) “Disinfecting the site for subcutaneous injection is a thing of the past We are in an evidence-based practice now”
Answer
B) “Our guidelines, which are based on current evidence, recommends a non-disinfection method of subcutaneous injection”

98. A registered nurse had a very busy day as her patient was sick, got intubated and had other life saving procedures. She documented all the events and by the end of the shift recognized that she had documented in other patient’s record. What is best response of the nurse?
A) She should continue documenting in the same file as the medical document cannot be corrected
B) She should tear the page from the file and start documenting in the correct record
C) She should put a straight cut over her documentation and write as wrong, sign it with her NMC code, date and time
D) She should write as wrong documentation in a bracket and continue
Answer
C) She should put a straight cut over her documentation and write as wrong, sign it with her NMC code, date and time

99. A patient in one of your bays has called for staff. She needed assistance with “spending a penny”. What will you do?
A) Ask her if she wants a hot or cold drink, and give her one as requested
B) Assist her to walk to the vending machine, and let her choose what she wants to buy
C) Assist her to walk to the toilet, and provide her with some privacy
D) Help her find her purse, and ask her what time she will be ready to go out
Answer
C) Assist her to walk to the toilet, and provide her with some privacy

100. 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?
A) Discard the paper/ document
B) Cross the wrong entry with a line, indicated it is an error, write the date, time, name and signature, document the care correctly
C) Leave it, never alter patient record
D) Inform the nurse manager, let her draw a line on the entry and place her name and signature
Answer
B) Cross the wrong entry with a line, indicated it is an error, write the date, time, name and signature, document the care correctly