CBT Reveiw 2018

2018
FULL EDITION
PASS THE
NMC-CBT
IN 2 WEEKS OR LESS
REVIEWER E-BOOK
NOW WITH
 500 UPDATED CBT MOCK QUESTIONS

(with RATIONALE & ANSWER KEYS)
NURSING COMPUTATION GUIDE

(with practice exercises & answer explanations)
UPDATED COMPLETE ESSENTIAL SUMMARIES

(Royal Marsden Manual and NMC Blueprint)
UPDATED STUDY GUIDE
MUST HAVE POINTERS FROM RECENT PASSERS
“See if you can score at least 70 out of 100 to

gauge your readiness to pass the exam”
NMC - CBT REVIEWER FOR NURSES
Introduction -------------------------------------------------------------------------------------------------------------4
CBT Information--------------------------------------------------------------------------------------------------------5
How To Reschedule----------------------------------------------------------------------------------------------------6
Preparation Tips And Strategies---------------------------------------------------------------------------------7-9
Study Guide------------------------------------------------------------------------------------------------------------11
TOPICS TO REVIEW
NMC Code of Conduct------------------------------------------------------------------------------------------13-29
Nursing Blueprint Essential Summaries --------------------------------------------------------------------30-38
Competency Adult Nursing -----------------------------------------------------------------------------------39-42
COMPLETE ESSENTIAL SUMMARIES FROM

THE ROYAL MARSDEN MANUAL OF CLINICAL NURSING
Part One – Managing The Patient Journey

Assessment And Discharge------------------------------------------------------------------------------------45-46
Infection Prevention And Control----------------------------------------------------------------------------47-54
Part Two – Supporting The Patient With Human Functioning

Communication---------------------------------------------------------------------------------------------------56-61
Elimination---------------------------------------------------------------------------------------------------------63-68
Moving And Position--------------------------------------------------------------------------------------------69-72
Nutrition, Fluid Balance And Blood Transfusion----------------------------------------------------------73-76
Patient Comfort And End Of Life Care---------------------------------------------------------------------------77
Respiratory Care--------------------------------------------------------------------------------------------------78-82
Part Three – Supporting The Patient Through The Diagnostic Process

Interpreting Diagnostic Tests----------------------------------------------------------------------------------84-85
Observations------------------------------------------------------------------------------------------------------86-92
Part Four - Supporting The Patient Through Treatment

Medicine Management-----------------------------------------------------------------------------------------94-98
Preoperative Care----------------------------------------------------------------------------------------------99-102
Wound Management----------------------------------------------------------------------------------------103-104
Solely intended for PERSONAL USE. Sharing or distribution of this E-book , or any of its contents via email, social
media, and other medium is strictly prohibited. The owners have the right to sue the violator once caught.
All rights reserved by PTER ™ © 2018 2
NMC - CBT REVIEWER FOR NURSES
NURSING COMPUTATION GUIDE-------------------------------------------------------------------------105-112

COMPUTATION EXERCISES----------------------------------------------------------------------------------113-117
COMPUTATION ANSWER & RATIONALE-----------------------------------------------------------------118-121
MOCK QUESTIONS – GAUGE YOUR PASSING RATE
CBT MOCK SET 1----------------------------------------------------------------------------------------------122-142

KEY ANSWERS & RATIONALE/LINKS SET 1 ------------------------------------------------------------143-146
CBT MOCK SET 2----------------------------------------------------------------------------------------------147-169
KEY ANSWERS & RATIONALE/LINKS SET 2-------------------------------------------------------------170-173
CBT MOCK SET 3----------------------------------------------------------------------------------------------174-194
CBT MOCK SET 4----------------------------------------------------------------------------------------------199-224
CBT MOCK SET 5----------------------------------------------------------------------------------------------229-251
POINTERS FROM RECENT PASSERS-----------------------------------------------------------------------256-262
INTRODUCTION
Congratulations on passing the IELTS or OET 
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 most 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 to conquer the exam with the
most efficient and updated information, together with strategies that are relevant to the
actual exam.
Finally, the mock questions are similar to what you will encounter during the actual exam.
This will make you more confident so it is important to answer and reflect on it.
Sharing or distribution of this E-book is strictly prohibited. If you have any question, or if you
have friends who need a copy, feel free to send us a message or share our FB page -
https://www.facebook.com/cbtreviewer/ We are more than happy to help and guide.
Best regards and enjoy reviewing. Rooting for your success! 

-Nurse Ynah and PASS THE EXAM REVIEWER (PTER) ™
CBT INFORMATION
WHAT IS CBT (Computer Based Test)?

• It is a computerised examination comprising 120 multiple choice questions
• It can only be booked after passing the IELTS or OET, and registering with the NMC
Also known as Nursing & Midwifery Council (NMC) Test of Competence
HOW TO REGISTER FOR CBT?

• Step 1:
Go to https://home.pearsonvue.com/
• Step 2:
Click on ‘For Test Takers’ & then ‘Test Takers Home’. In search bar, enter ‘Nursing and
Midwifery Council’
• Step 3:
Download ‘Test of Competence’ handbook
Test of Competence Part 1 - Candidate booklet
• Step 4: Make an account
• Step 5: Book your exam (8,320 PHP approximately)
ABOUT THE EXAM:
The exam lasts for 240 minutes (4 hours) giving the candidate ample time to read,
re-read, and double check each answer before submitting the exam paper.
Always keep in mind that you need not memorise everything. As long as you get yourself
familiarised with the UK practice, you will be fine.
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/
How to RESCHEDULE your CBT exam?
There are some instances when you feel like you are not yet ready to take the exam. In
this case, it is best to trust your gut and to reschedule your exam.
Rescheduling a CBT exam is at NO cost, just ensure to change the date at least a day or
two before your actual exam schedule.
Here are the steps:

•Step 1: Log-in to your Pearson Vue account https://home.pearsonvue.com/
•Step 2: Click on either “View Exams” or “My Account” as shown in the photo. There’s an
option to reschedule the date of your exam.
•Step 3: Recheck the date of your new appointment and take note of it.
Reminder: If you are not close to 100% ready, it is best to reschedule it and allot a little bit
more time for preparation.
PREPARATION TIPS AND STRATEGIES
The answer keys from this E-book were mostly based from the NMC CODE and Royal
Marsden Manual. Since not all of the answers can be found on the two reference
mentioned above, some answers were based on NICE, RCN, and policies of other NHS
Trusts. So if you have researched an answer that is different from the answer key in this
E-book, it’s OKAY and you don’t have to be confused.
*What’s important to pass the CBT is to base your

answer on updated UK guidelines.*
(This might be the most important out of all the tips and strategies that most review
centers and other reviewers do not realize, so please keep this in mind.) 
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.
IV and Drug computation is currently trending right now. Before, it used to be just about
5 or less than 10 items. Recently, it has increased to an average of 10 up to 20 items, so
we have dedicated a computation guide and a set of practice questions. Just remember
that you will be given a pen and white board. CALCULATORS ARE NOT allowed. But don’t
worry, it’s simple arithmetic, YOU CAN DO IT. 
Have a pre-test: Visit http://www.royalmarsdenmanual.com/student and answer the

110 sample multiple choice questions.
The questions here are close to what you will encounter on the exam and is arranged per
topic. This can help you determine 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.
 Read the NMC Code and Nursing blueprint summary at least twice, you don’t need to
memorize it, just absorb the concepts by heart.
Your decisions as a nurse will be based on these.
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.
Read the topic summaries of this E-book and answer the questions at the end of every
chapter using 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.
Additional tip: If you are using a computer or laptop, you can use [ctrl +F] to make it
easier to find a specific topic or keyword.
DO NOT GET OVERWHELMED, you may have to read a lot, but the exam is relatively
easy compared to other board exams. You just really have to read through and get the gist
of NMC’s Code and practice.
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 and succeeding sets of 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.
3 days before the exam, if you need to, visit the exam venue to alleviate stress of finding
the location on the day of your test.
 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. 
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. 
If you’re faced with an unfamiliar topic and you don’t really know the answer, utilize the
ELIMINATION METHOD. You can eliminate at least 1 or 2 answers immediately, those that
are obviously wrong right off the bat. Then choose between the remaining options by
remembering related concepts. After this, MOVE ON so you can focus on the succeeding
items. You can still review ALL of your answers before clicking on the “submit” button.
Be careful of questions with words such as NOT, ALL, ALWAYS. Don’t be scared, just be
mindful when selecting the answer. Focus is key. Keep calm as well. 
Do some stretching every now and then to keep you awake, don’t be shy, the invigilator
will not penalize you for it. You can do it, I’m rooting for your success! 
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
TIP: 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
https://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS78_Safeguarding_older_people_from_abuse_fcs.pdf?epslanguage=en-
GB?dtrk=true
NMC Standards for Medication Management

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf
Obtaining consent
https://www.nhs.uk/conditions/consent-to-treatment/
Infection control – See Royal Marsden Manual

Care for elderly with dementia – See Royal Marsden Manual
Additional Resource: https://www.ageuk.org.uk/information-advice/care/helping-a-loved-one/caring-dementia/
DAY 6
Assessment and Discharge
Communication
DAY 7
Elimination/Catheterization
Moving and positioning
Respiratory Care
DAY 8
Nutrition, Fluid Balance & Blood transfusion
Perioperative Care
STUDY GUIDE
DAY 9
Patient Comfort and End of Life Care
Interpreting Diagnostic Tests and Observations
DAY 10
Study the pointers from recent passers***
Review the computation guide and solve the practice questions manually***
DAY 11
Answer mock set 1 and 2
DAY 12
Answer mock set 3 and 4
DAY 13
Answer mock set 5
*If you’re hitting 70 /100 or above go for it! If not, you can reschedule*
DAY 14
Visit your exam venue if you need to, after that relax and PRAY 
SUMMARY
OF
TOPICS
TO REVIEW
THE NMC CODE
NMC provides guidance and professional standards that registered nurses and midwives
must uphold.
It is divided into four domains:
•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.
THE NMC CODE
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.
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.
THE NMC CODE
“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

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

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.
_________________________________________________________________________
THE NMC CODE
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
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
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

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 procedure and arrange for a suitably qualified
colleague to take over responsibility for that person’s care
THE NMC CODE
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.
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.nmc-uk.org/standards.
_________________________________________________________________________
THE NMC CODE
“II. Practise effectively”

You assess need and deliver or advise on treatment, or give help (including preventative
or rehabilitative care) without too much delay 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

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
7.1 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
8.1 respect the skills, expertise and contributions of your colleagues, referring
matters to them when appropriate
8.2 maintain effective communication with colleagues
THE NMC CODE
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
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.
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
THE NMC CODE
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
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
12.1 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
THE NMC CODE
“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

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
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.
THE NMC CODE
15 Always offer help if an emergency arises in your practice setting or anywhere

else
15.1 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
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 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.
“Every 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
staff, person you care for or member of the public who wants to raise a concern, and
THE NMC CODE
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/raisingconcerns
17 Raise concerns immediately if you believe a person is vulnerable or at risk and needs
extra support and protection
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.
18 Advise on, prescribe, supply, dispense or administer medicines within the limits of
your training and competence, the law, our guidance and other relevant policies,
guidance and regulations
18.1 prescribe, advise on, or provide medicines or treatment, including repeat
prescriptions (only if you are suitably qualified) if you have 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 they are
receiving, 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.
For more information, please visit: www.nmc-uk.org/standards
THE NMC CODE
19 Be aware of, and reduce as far as possible, any potential for harm associated with
your practice
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)
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 to colleagues, people receiving care and the public.
_________________________________________________________________________
Human factors refer to environmental, organisational and job factors, and human and
individual characteristics, which influence behaviour 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
_________________________________________________________________________
THE NMC CODE
“IV. Promote professionalism and trust”

You uphold the reputation of your profession at all times. You should display a personal
commitment to the standards of practice and behaviour set out in the Code. You 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

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 upset or distress
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
times.
For more guidance on using social media and networking sites, please visit: www.nmc-
uk.org/guidance
THE NMC CODE
21 Uphold your position as a registered nurse or midwife

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 relationship with, including people in your care
21.4 make sure that any advertisements, publications or published material you
produce or have produced for your professional services are accurate, responsible,
ethical, do not mislead or 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

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
THE NMC CODE
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.
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 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

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
25.1 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
THE NMC CODE
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.
_________________________________________________________________________
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
• 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)
THE NMC CODE
The 6 Fundamental Values
Care - the care we deliver helps the individual person and improves the health of the whole
community. People receiving care expect it to be right for them, consistently, throughout
every stage of their life.
Compassion - Compassion is how care is given through relationships based on empathy, respect
and dignity - it can also be described as intelligent kindness
Commitment - A commitment to our patients and populations is a cornerstone of what we do.

We need to build on our commitment to improve the care and experience of our patients
Courage - Courage enables us to do the right thing for the people we care for, to speak up when
we have concerns and to have the personal strength and vision to innovate and to
embrace new ways of working.
Competence - Competence means all those in caring roles must have the ability to understand
an individual’s health and social needs and the expertise, clinical and technical knowledge
to deliver effective care and treatments based on research and evidence.
Communication - Communication is central to successful caring relationships and to effective

team working.
NURSING BLUEPRINT 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.
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 non-discriminatory 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 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
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 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 in-
depth 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, 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
self- care 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.
•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.
•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 cares for transfer and transition through effective dialogue
and accurate information
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.
and Long term conditions.
as they near end of life.
Section 2:
3.1 Adult nurses must promote the concept, knowledge and practice of self- care 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 disabilities, older people, and people with long term problems such as
cognitive impairment.

•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.
•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.

Invasive and non-invasive procedures
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:
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*
COMPLETE ESSENTIAL SUMMARIES FROM
THE ROYAL MARSDEN MANUAL OF CLINICAL NURSING
COMPLETE ESSENTIAL
SUMMARIES
FROM
THE
ROYAL MARSDEN
MANUAL
OF CLINICAL NURSING
PART ONE – MANAGING
THE PATIENT JOURNEY
ASSESSMENT AND DISCHARGE
Assessment
→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
→ Must be done within 24 – 48 hours upon admission
ASSESSMENT AND DISCHARGE
10 STEPS TO DISCHARGE PLANNING
1. Start planning for discharge before or on admission

2. Identify if simple or complex discharge plan
3. Coordinate
4. 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
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, regardless of what is known of the patient’s status with respect to infection.
It includes:
•Hand hygiene (5 moments of hand washing)
•Correct disposal of sharps
•PPE
•Clean environment 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)

-respiratory tract
-urinary tract
-surgical site infections
CAUSES OF INFECTION
→normally caused by micro-organisms
→infections 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 more susceptible to alcohol; with lipid exchange
→ex. 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 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 wrist 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 encephalopathy's (TSE’s)
→Creutzfeldt-Jakob disease (CJD) *E* - associated with bovine spongiform
encephalopathy (BSE)
→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 human 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
PARENTERAL Blood/body fluids come into contact with
mucous membranes or exposed tissue
Ex. 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. Gastroenteritis
Solution: hand hygiene with soap and water,

use of PPE and good food hygiene
Isolate the patient until symptoms such as
vomiting and diarrhoea 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
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
→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:
→diarrhoea
→vomiting
>serious airborne infection
ATTENDING TO PATIENT IN ISOLATION
MEALS
→cutlery and crockery should be washed disinfected with a final rinse of 80C 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
→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 incineration
ORANGE Wastes which may be treated
PURPLE Cytotoxic wastes
YELLOW/BLACK Offensive/hygienic waste
RED Anatomical Waste
BLACK Domestic wastes
BLUE Medicinal wastes
WHITE Amalgam wastes
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 information given to 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 wishes or choices by any means
Four Key areas by Brady Wagner – in order to have the capacity to make a decision:
1. Understanding
2. Manipulating those options
3. Reasoning through a decision
4. Communication the preference/decision
Remember SAGE & THYME for communicating patients who are worried or distressed:
S – setting
A – ask
G – gather
E – empathy
T-talk
H-help
Y-you
M-me
E-end
COMMUNICATION
Denial and Collusion
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 shared sometimes secret understanding
Supporting a person in :
Denial
→provide honest information
→listening, reflecting, summarizing
→be gentle in challenging by either questioning any inconsistencies in the patient’s 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’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 eye, and hold them if appropriate
Pharmacological support:
-benzodiazepines
-antipsychotics
-sedating antihistamines
-TCA/SSRI antidepressants
COMMUNICATION
Depression
→encourage the patient to identify their own abilities to cope with the situation
→low mood that persists for more the 2 weeks
→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 affect the underlying disease
MAOI – can affect blood pressure especially when certain food types are eaten.
*antidepressant treatment should continue for at least 6 months after a response to a
treatment
ANGER, AGGRESSION AND VIOLENCE MANAGEMENT

→prevention is the most effective method of managing anger
→communicate openly, honestly and frequently (NHS 2013)
“Remain Calm” AND “Maintain safety for all”
COMMUNICATION
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

•hypoactive delirium – patient is quiet
•hyperactive delirium – heightened arousal
•mixed delirium – combination
→delirium is frequently iatrogenic

→end of life management of delirium focuses on alleviating symptoms
→if risk factors are identified, should focus on minimizing hyper arousal from the
environment
Physical restrain:
→last resort if patient is putting himself/others at risk
→shortest possible time/minimum force
COMMUNICATION
Continuation: delirium
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

•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
COMMUNICATION
ACQUIRED COMMUNICATION DISORDERS
•APHASIA/DYSPHASIA-> affect how someone uses language; may be temporary or

permanent
•DYSARTHRIA – slurred speech
•DYSPRAXIA – jumbled words
•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
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
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)
→needs verbal consent
*Most effective way to check for placement of NGT is through X-ray

→ testing if ph level is between 1 - 5.5 means gastric acid (ok)
→if ph is more than 5.5 may be pulmonary aspirate (wrong placement)
ELIMINATION
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
*Avoid contact between the drainage bag and the catheter to prevent infection.
*Ensure that the drainage bag is placed lower than the patients bladder to prevent back
flow which may lead to infection.
ELIMINATION
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 chloride 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
•Urinary diversion
•Access for therapeutic interventions
ELIMINATION
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

Acute diarrhea – less than 2 weeks
Chronic diarrhea – more than 2 weeks
→Antimotility drugs – loperamide or codeine; must rule out any infective agent first
→fluid replacement – 1st step in managing diarrhea; additional 200ml per loose stool
Support:
•Maintain dignity, skin care
•Diet – decrease fiber, roughage
Constipation
→type 1 and 2 bristol chart
→less than 3 bowel movements per week
Support:
•Diet – increase fiber (insoluble/soluble)

•Positioning – crouch like; using bed pan
•Exercise
•Other treatment – biofeedback, rectal irrigation
ELIMINATION
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
ELIMINATION
Digital removal of feces

→beware of autonomic dysreflexia especially for patients with injury in sixth thoracic
vertebrae or above.
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
ELIMINATION
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
-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 cardio respiratory 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 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 fitted.
• 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 effort or discomfort.
Positioning the patient: sitting in bed
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 2006 ) as
it causes increased pressure in the disc (Claus et al. 2008 ).
Contraindications Post lumbar puncture, patients should lie flat to prevent dural
headache in accordance with local policy.
Spinal instability - Log rolling for suspected/confirmed cervical spinal instability).
Positioning the patient: side-lying
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 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
NUTRITION, FLUID BALANCE AND BLOOD TRANSFUSION
→Human body is 60% water
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.
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 measure height.
•SIP FEEDS – are considered as ‘complete feeds’

•Glucose polymer –unsuitable for diabetic patients
•Anti-emetics – must be given 30 minutes before meal tIme
DYSPHAGIA MANAGEMENT
→refer to speech and language therapist E
→possible need for enteral tube feeding
→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 liaison 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 (result in 10 minutes) then
transfuse the correct specific blood type
*BLOOD TRANSFUSION SET*

-changed every 12 hours or after every second unit for a continuing transfusion
-aseptic technique
*Blood warming device – maintain blood below 38⁰C
Cont: blood transfusion
POST PROCEDURE
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
HYPERKALEMIA – IF PRESENT, ASK HELP FROM MEDICAL TEAM

-anxiety
-abdominal cramps
-diarrhea
-Weakness in extremities
PATIENT COMFORT AND END OF LIFE CARE
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
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 is 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 thicken 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 stitching 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
Respiratory Care
SPEECH AND LANGUAGE THERAPIST → assessment and management of patients with

impaired swallowing and speech
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 10-15cm, 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 (CPR) - is the emergency treatment for 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
Respiratory Care
CPR - Principles of care:
Stages of assessment
•Check for safety
•Check for injury (especially cervical spine)
•Check for level of consciousness by gently shaking the shoulders asking if he’s okay
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 heart

•definitive treatment for VF and pulse less 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
Respiratory Care
METHODS OF BASIC LIFE SUPPORT – ABC
AIRWAY
•check for obstruction
•Head tilt chin lift manoeuvre
BREATHING
•Look, listen and feel for breathing for 10 seconds
>if breathing – recovery position
>if not – call for help
>artificial ventilation must commence
>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% oxygen.
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)
*F no trained nurse is available, ANY STAFF should attempt to use AED defibrillator.*
•right electrode – right sternum below clavicle

•left paddle – vertically midaxillary line
Respiratory Care
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 pulse less 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 pulse
less 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.
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 early 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)
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 of chronic renal failure

(kidneys are unable to excrete potassium)
*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 diarrhoea
UREA (2.5-6.5 MMOL/L)

-elevated levels may indicate poor kidney function
INTERPRETING DIAGNOSTIC TESTS
CREATININE (55-105MMOL/L)
-elevated levels may indicate poor 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 cardiac arrhythmia – cardiac arrest
•HYPOCALCEMIA – often associated with vitamin D deficiency; excitability and cardiac
arrhythmias; 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
*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
OBSERVATIONS
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

-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
OBSERVATIONS
BLOOD PRESSURE
•SYSTOLIC PRESSURE – peak pressure of the left ventricle

•DIASTOLIC PRESSURE – when the aortic valve closes ; aorta recoils back
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%
OBSERVATIONS
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 maximum lung inflation in LPM (litres 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
HYPOTHERMIA - occurs when body loses more heat
•35⁰C Mild
•28-32⁰C Moderate
•<28⁰C Severe
HYPERTHRMIA -fever
•38⁰C Low grade pyrexia

•38-40⁰C Moderate to high grade pyrexia
•40⁰C and above High grade pyrexia
OBSERVATIONS
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
TYPE 1 – autoimmune process; destruction of pancreases ; complete loss of insulin

•younger patients, need insulin replacement
TYPE 2 – resistance to insulin

•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)
OBSERVATIONS
RESPIRATORY RATE – is the clearest indication of brain function because it is controlled by:
-cerebral hemispheres
-cerebellum
-brainstem
*protecting the 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
CUSHING’S REFLEX –widening pulse pressure, bradycardia and decrease respiration may
indicate increasing intracranial pressure.
FREQUENCY OF OBSERVATION
-if deteriorating – as frequent as every 10-15mins then 1-2 hourly further for 48 hours.
OBSERVATIONS
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:
•SKIN COLOR
•USE OF ACCESSORY MUSCLES
•RATE, RHYTHM AND DEPTH OF RR
•SHAPE AND EXPANSION OF CHEST
Part Four - Supporting
The Patient Through
Treatment
MEDICINE MANAGEMENT
PHARMACOLOGY – study of the effects 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
MEDICINE MANAGEMENT
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 OF DRUG ADMINISTRATION

•PATIENT
•MEDICINE
•ROUTE
•TIME
•DOSE
ADVERSE DRUG REACTIONS (ADR)
TYPE A (AUGMENTED) –exaggeration of medicine’s normal effect (ex. respiratory

depression with opiods; bleeding with warfarin) ; more common
TYPE B (BIZAARE) – not predictable (ex. Anaphylaxis with beta-lactam antibiotics)
PHARMACOVIGILANCE – preventing and detecting adverse effects from medicine
YELLOW CARD SCHEME – post marketing surveillance, how medicines affect the patients.
MEDICINE MANAGEMENT
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)
-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 - 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
MEDICINE MANAGEMENT
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 organs as in an emergency
→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 and after 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

See the dedicated computation guide and answer the practice questions MANUALLY. 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
MEDICINE MANAGEMENT
COMPLICATIONS
PHLEBITIS – redness and swelling on IV site

-resite 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
PERIOPERATIVE CARE
INTRAOPERATIVE CARE (3 PHASES)

•Induction of anesthesia
•Surgery
•Recover within (PACU)
PREOPERATIVE CARE
→psychosocial preparation; prevention of peri and post op complication
→assessment aims to reduce cancellations and to reduce patient anxiety
PREOPERATIVE HISTORY
•Medical history -central nervous system

•Family history -endocrine system
•Body system review -musculoskeletal system
•Cardiovascular system -surgical and anaesthetic history
•Respiratory system -medication allergies
•Gastrointestinal system -social history -ECG
•Alcohol -Chest Xray
•Smoking
CARDIOPULMONARY EXERCISE TESTING
→2 indicators are derived from the patient’s ability to:

1. body’s maximum oxygen uptake
2. anaerobic threshold
STRESS TESTING – gold standard in measuring exercise tolerance
PERIOPERATIVE CARE
PREOPERATIVE ASSESSMENT CLINIC

Assessor roles:
•Take a comprehensive health history
•Perform physical examination
•Order appropriate investigations
*If patient is complicated – further review by an anaesthetist is needed
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 in 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.
PERIOPERATIVE CARE
PREOP PATIENT SAFETY MEASURES
•Name bands
•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
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
PERIOPERATIVE CARE
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; aseptic non touch technique using sterile
normal saline
COMPLICATION
•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 after surgery
-oliguria – 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
→withhold food unless flatus passage is positive or unless contraindicated
WOUND MANAGEMENT
Wound → an injury to living tissue
6 Basic Categories
•contusion (bruise)
•Abrasion (graze)
•Laceration (tear)
•Incision (cut)
•Puncture (stab)
•Burn
2 Main Layers of skin

•Dermis – inner
•Epidermis – outer layer
Methods of wound healing

•Primary intention – 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

•hemostastasis (5-10 mins) – clotting cascade
•inflammatory (1-5 days) – vasodilation
•proliferation or reconstructive phase (3-24 days) – healing ridge; fibroblasts; granulation
•maturation or remodelling phase (21 days onward) – may last for more than a year; re-
epithelialization; re-organization
WOUND MANAGEMENT
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
•superficial damage
•partial loss of dermis/epidermis
•damage to dermis and subcutaneous layer
•tissue necrosis and full thickness skin loss often with tunnelling sinus tracts
WOUND MANAGEMENT
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:
-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.
NURSING COMPUTATION GUIDE
COMMON EQUIVALENTS
1mg = 1000 mcg 1 kg = 1000 gm
1 gm = 1000 mg 1 lb. = 2.2 kg
1 tsp = 5 ml 1 grain = 60 mg or 65 mg
1 oz = 30 ml 1 tbsp = 3 tsp
1L = 1000 ml 1 in = 2.54 cm
Basic Steps
Step 1:
Determine the given and find out what you are looking for
Step 2:
Convert the figures to the desired unit
Step 3:
Use the correct formula and compute
TIPS
If your answer is in 1 of the test choices, it’s a good indication that you are right. If your
answer is not in the choices, analyze the question again and repeat the steps.
There will be trial and error because you are doing a manual computation. It’s totally
fine to ask for another “board” to write on. Just raise your hand and politely ask for
another one.
Remember, it’s highly possible that computation questions might be a “critical” item. So
be patient and try your best to get it right. You can do it. 
NURSING COMPUTATION
PERIOPERATIVE CAREGUIDE
DRUG CALCULATION
Drug dosage calculations are required when the amount of medication ordered (or
desired) is different from what is available on hand for the nurse to administer.
Note: When medication is given in tablets, the QUANTITY = 1 since the amount of
medication available is specified per (one) tablet.
Example 1: Toprol XL, 50 mg PO, is ordered. Toprol XL is available as 100 mg per tablets.
How many tablets would the nurse administer
Therefore, the nurse would administer 0.5 of a tablet
NURSING COMPUTATION
Cont: drug dosage calculations
Example 2: 1200 mg of Klor-Con is ordered. This medication is only available as 600 mg

per tablet. How many tablets should the nurse give?
Therefore, the nurse should give 2 tablets.
The same formula can be used for dosage calculations where the medication
is available as amount per certain volume.
In these types of calculations, the volume available on hand is the QUANTITY.
Example 3: Dilantin-125 is available as 125 mg/5 mL. Dilantin-125, 0.3 g PO, is ordered.
How much should the nurse administer to the patient?
Therefore, the nurse would administer 12 ml.
NURSING COMPUTATION
Dosage Calculations based on Body Weight
Dosage calculations based on body weight are required when the dosage ordered and
administered is dependent on the weight of the patient. For example, many pediatric
drugs are ordered and given per weight (usually in kg).
Dosage calculations based on body weight are calculated in two main stages.
Example 1: Medrol 4 mg/kg is ordered for a child weighing 64.8 lb. Medrol is available as
500 mg/4mL. How many milliliters of medication must the nurse administer?
Therefore, the nurse must administer 0.942 ml of medication.
NURSING COMPUTATION
Example 2: A doctor prescribes 250 mg of Ceftin to be taken by a 20.5 lb infant every 8

hours. The medication label indicates that 75-150 mg/kg per day is the desired dosage
range. Is this doctor's order within the desired range?
NURSING COMPUTATION
Calculation of Intravenous Drip Rates

In these types of calculations, for a given volume, time period, and drop factor (gtts/ml),
the required IV flow rate in drops per minute (gtts/min) is calculated.
Note: Since a fraction of a drop is not possible to give to a patient, it is usual to round the
answers to the nearest whole number.
Example 1: Calculate the IV flow rate for 250 mL of 0.5% dextrose to be administered over
180 minutes. The infusion set has drop factor of 30 gtts/ml
Therefore, the IV flow rate is 42 gtts/min.
NURSING COMPUTATION
Cont: Calculation of Intravenous Drip Rates
Example 2: The infusion set is adjusted for a drop factor of 15 gtts/mL. Calculate the IV
flow rate if 1500 mL IV saline is ordered to be infused over 12 hours.
Therefore, the IV flow rate is 31 gtts/min.
Calculation of Flow Rate for an Infusion Pump
Infusion pumps do not have a calibrated drop factor. The flow rate depends on the volume of
fluid ordered and the time of infusion.
Example 1: 1200 mL D5W IV is ordered to infuse in 10 hours by infusion pump.

Calculate the flow rate in milliliters per hour.
NURSING COMPUTATION
Cont: Calculation of Flow Rate for an Infusion Pump
Therefore, the IV flow rate is 120 mL/hr.
Example 2: 600 mL of antibiotic is to be infused over the 180 minutes by an infusion pump.
Calculate the flow rate (mL per hour).
Therefore, the flow rate is 200 mL/h.
Reference: George Brown College
COMPUTATION EXERCISES
PERIOPERATIVE CARE
See the answer key for rationale right after completing this exercise.
1. Doctor’s Order: Tylenol supp 1 g pr q 6 hr prn temp > 101; Available: Tylenol supp 325
mg (scored). How many supp will you administer?
A. 2 supp
B. 1 supp
C. 3 supp
D. 5 supp
2. Doctor’s Order: Nafcillin 500 mg po pc; Available: Nafcillin 1 gm tab (scored). How
many tab will you administer per day?
A.2.5 tabs
B. 2 tabs
C. 1.5 tabs
D. 1 tab
3. Doctor’s Order: Synthroid 75 mcg po daily; Available: Synthroid 0.15 mg tab

(scored). How many tab will you administer?
A. 1 tab
B. 0.5 tab
C. 2 tabs
D. 1.5 tabs
4. Doctor’s Order: Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap
will you administer for each dose to a 31 lb child?
A. 2 caps
B. 2.5 caps
C. 3 caps
D. 1.5 caps
PERIOPERATIVE CARE
5. Doctor’s Order: Cleocin Oral Susp 600 mg po qid; Directions for mixing: Add 100 mL
of water and shake vigorously. Each 2.5 mL will contain 100 mg of Cleocin. How many
tsp of Cleocin will you administer?
A. 3 tsp
B. 5 tsp
C. 3.5 tsp
D. 1 tsp
6. Doctor’s Order: Sulfasalazine Oral Susp 500 mg q 6 hr; Directions for mixing: Add 125
mL of water and shake well. Each tbsp will yield 1.5 g of Sulfasalazine. How many mL
will you give?
A. 5 ml
B. 3 ml
C. 4 ml
D. 2 ml
7. Your patient has had the following intake: 2 ½ cups of coffee (240 mL/cup), 11.5 oz
of grape juice, ¾ qt of milk, 320 mL of diet coke, 1 ¼ L of D5W IV and 2 oz of grits. What
will you record as the total intake in mL for this patient?
A. 2,325 ml
B. 3,265 ml
C. 3,325 ml
D. 2,235 ml
8. Your patient has had the following intake: 8 oz glasses of iced tea, 4 oz cartons
of grape juice, ¾ pt of ice cream, 32 oz of juice, 1 ½ L of D5W IV and 6 oz of
cottage cheese. What will you record as the total intake in mL for this patient?
A. 3,357 ml
B. 3,375 ml
C. 3,915 ml
D. 3,195 ml
PERIOPERATIVE CARE
9. Doctor’s Order: Kantamycin 7.5 mg/kg IM q 12 hr; Available: Kantamycin 0.35
Gm/mL. How many mL will you administer for each dose to a 157 lb patient?
A. 2 ml
B. 1 ml
C. 2.5 ml
D. 1.5 ml
10. Doctor’s Order: Heparin 7,855 units Sub Q bid; Available: Heparin 10,000 units per
ml. How many mL will you administer?
A. 0.79 ml
B. 1.79 ml
C. 0.17 ml
D. 1.17 ml
11. Doctor’s Order: Demerol 50 mg IVP q 6 hr prn pain; Available: Demerol75 mg/
1.3mL. How many mL will you administer?
A. 0.87 ml
B. 1.87 ml
C. 2 ml
D. 2.87 ml
12. Doctor’s Order: Streptomycin 1.75 mg/ lb IM q 12 hr; Available: Streptomycin 0.35 g
/ 2.3 mL. How many mL will you administer a day to a 59 Kg patient?
A. 1.5 ml
B. 2 ml
C. 2.5 ml
D. 3 ml
13. Doctor’s Order: Bumex 0.8 mg IV bolus bid; Reconstitution instructions: Constitute
to 1000 micrograms/3.1 mL with 4.8mL of 5% Dextrose Water for Injection. How many
mL will you administer?
A. 2 ml
B. 3.5 ml
C. 3 ml
D. 2.5 ml
PERIOPERATIVE CARE
14. Doctor’s Order: Tazidime 0.3 g IM tid; Reconstitution instructions: For IM solution
add 1.5 mL of diluent. Shake to dissolve. Provides an approximate volume of 1.8 mL
(280 mg/mL). How many mL will you give?
A. 1.9 ml
B. 2 ml
C. 3 ml
D. 1.1 ml
15. Doctor’s Order: Infuse 50 mg of Amphotericin B in 250 mL NS over 4 hr 15 min; Drop

factor: 12gtt/mL. What flow rate (mL/hr) will you set on the IV infusion pump?
A. 11.8 ml/hr
B. 58.8 ml/hr
C. 14.1 ml/hr
D. 60.2 ml/hr
16. Doctor’s Order: 1 ½ L of NS to be infused over 7 hours; Drop factor: 15 gtt/mL. What
flow rate (mL/hr) will you set on the IV infusion pump?
A. 53.6 ml/hr
B. 214.3 ml/hr
C. 35.7 ml/hr
D. 142.9 ml/hr
17. Doctor’s Order: Mandol 300 mg in 50 mL of D5W to infuse IVPB 15 minutes; Drop
factor: 10 gtt/mL. How many mL/hr will you set on the IV infusion pump?
A. 200 ml/hr
B. 87.5 ml/hr
C. 3.3 ml/hr
D. 50 ml/hr
18. Doctor’s Order: Infuse 1200 mL of 0.45% Normal Saline at 125 mL/hr; Drop Factor:
12gtt/min. How many gtt/min will you regulate the IV?
A. 2 gtt/min
B. 12 gtt/min
C. 25 gtt/min
D. 27 gtt/min
PERIOPERATIVE CARE
19. Doctor’s Order: Rocephin 0.5 grams in 250 mL of D5W to infuse IVPB 45
minutes; Drop Factor: 12gtt/min. How many gtt/ min will you regulate the IVPB?
A. 6 gtt/min
B. 30 gtt/min
C. 67 gtt/min
D. 87 gtt/min
20. Doctor’s Order: ¼ L of D5W to infuse over 2 hr 45 min; Drop factor: 60 gtt/mL. How
many gtt/min will you regulate the IV?
A. 91 gtt/min
B. 96 gtt/min
C. 125 gtt/min
D. 142 gtt/min
COMPUTATION
PERIOPERATIVE
ANSWER CARE
AND RATIONALE
1. Answer: C. 3 supp
1 g = 1000 mg
2. Answer: C. 1.5 tabs

1 g = 1,000 mg
3. Answer: B. 0.5 tab

1 mg = 1,000 mcg
4. Answer: A. 2 caps
31 lbs = 14 kg
1.8 mg/kg x 14 kg = 25.2 mg or 25 mg (per dose)
5. Answer: A. 3 tsp
COMPUTATION
PERIOPERATIVE
ANSWER CARE
AND RATIONALE
6. Answer: A. 5 ml
1 tbsp = 15 ml
7. Answer: B. 3,265 ml
1 qt = 1,000 ml
1 oz = 30 ml
600 ml + 345 ml + 750 ml + 320 ml + 1,250 ml = 3,265 ml
*Grit is not liquid at room temperature, so it is not included when

calculating intake.
8. Answer: D. 3,195 ml
1 pt = 500 ml
1 oz = 30 ml
240 ml + 120 ml + 375 ml + 960 ml + 1,500 ml = 3,195 ml
*Cottage cheese is not liquid at room temperature, so it is not included

when calculating intake.
9. Answer: D. 1.5 ml
157 lbs = 71.36 kg or 71 kg
7.5 mg/kg x 71 kg = 532.5 mg
COMPUTATION
PERIOPERATIVE
ANSWER CARE
AND RATIONALE
10. Answer: A. 0.79 ml
11. Answer: A. 0.87 ml
12. Answer: D. 3 ml
59 kg = 130 lbs
1.75 mg/lbs x 130 lbs = 227.5 mg
1.5 ml x 2 = 3 ml
13. Answer: D 2.5 ml
1 mg = 1,000 mcg
1 mg = 1,000
14. Answer: D. 1.1 ml
15. Answer: B. 58.8 ml/hr

4 hr 15 min = 4.25 hrs [4 hrs + (15 mins÷60 mins)]
COMPUTATION
PERIOPERATIVE
ANSWER CARE
AND RATIONALE
16. Answer: B. 214.3 ml/hr
17. Answer: A. 200 ml/hr

15 min = 0.25 hr
18. Answer: C. 25 gtt/min
19. Answer: C. 67 gtt/min
20. Answer: A. 91 gtt/min
CBT MOCK SETCARE
PERIOPERATIVE 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.
CBT MOCK SETCARE
PERIOPERATIVE 1
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
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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
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.
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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
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
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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
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
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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
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
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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 p34. A
patient has been confined in bed for months now and has developed pressure ulcers in the
buttocks area.
34. When you checked the waterlow it is at level 20. Which type of bed is best suited for this
patient?
A. water mattress
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.
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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
another.
D. Every four hours.
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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 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.
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.
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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
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
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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 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
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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:

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
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57.Why constipation occurs in old age?

•Anorexia and weight loss
•Increased mobility
•Decreased muscle tone and peristalsis
•Increased absorption in colon
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.
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
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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
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.
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67.In a G.P clinic when you assessing a pregnant lady you observe some bruises
on her hand. When you asked her about this she remains silent. What is your
action?
•Call her husband to know what is happening
•Tell her that you are concerned of her welfare and you may need to share this
information appropriately with the people who offer help (safeguarding
practices)
•Do nothing as she does not want to speak anything
•Call the police
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
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.
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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
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75. What is the use of protected meal time?

A. Patient get protection from visitors
B. Staff get enough time to have their bank
C. To give personal hygiene to patients who are confused
D. To allow the nurses to rest
E. Patients get enough time to eat food without distractions while staff focus on
people who needs help with eating
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
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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
B. Intake of blood thinning medications (warfarin, aspirin, and heparin)
C. Vitamin deficiency (Vitamins C and K)
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.
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
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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:

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
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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. A slow and progressive disease with no definite cure, only symptomatic
Management?
A. Acute
B. Chronic
C. Terminal
95. The best way to verify enteral tube prior to feeding:

A. Abdominal xray
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
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97. What angle to inject via subcutaneous route?

A. 90
B. 45
C. 60
D. 15
98. If a client is experiencing hypotension post operatively, the head is not tilted
in which of the following surgeries
A. Chest surgery
B. Abdominal surgery
C. Gynaecological surgery
D. Lower limb surgery
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.
KEY ANSWERS RATIONALE/LINKS
PERIOPERATIVE CARE 1
CBT MOCK SET 1
1. C→ http://www.newcastle-hospitals.org.uk/services/care-of-the-elderly_treatment-and-
medication_orthostatic-hypotension.aspx
2. D→https://www.nhs.uk/conditions/lumbar-puncture/side-effects/
3. C→https://www.nhs.uk/conditions/kidney-infection/symptoms/
4. D→https://www.biology-innovation.co.uk/pages/human-biology/respiration/
5. C→See NMC Standards for Medicine Management
6. C→http://www.clinicaladvisor.com/hospital-medicine/tachycardia/article/599572/
7. A→https://patient.info/doctor/resuscitation-in-hypovolaemic-shock
8. A→https://www.ncbi.nlm.nih.gov/pubmed/17904451
9. A→http://www.nursingprocess.org/Nursing-Process-Steps.html
10. C→https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-
copd/treatment/
11. B→https://www.bda.uk.com/improvinghealth/yourhealth/dietitians
12. B→https://www.nmc.org.uk/standards/code/
14. B→https://www.nhs.uk/conditions/consent-to-treatment/
15. C→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033612/
16. A→http://www.who.int/surgery/publications/Postoperativecare.pdf
17. C→https://www.diabetes.co.uk/diet/nhs-diet-advice.html
19. A→http://oscestop.com/ABG_interpretation.pdf
20. B→https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-
Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet
21. D→https://www.nhs.uk/conditions/coronary-heart-disease/causes/
22. D→http://www.icid.salisbury.nhs.uk/ClinicalManagement/TissueViability/Pages/WoundC
areGuidelines.aspx
23. A→See “Communication” Royal Marsden Manual
24. D→See NMC Code
25. B→http://www.newcastle-hospitals.org.uk/SpecimenTransportPolicy201301.pdf
26. D→http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/hand-hygiene
27. B→https://www.nhs.uk/conditions/diarrhoea/causes/
28. A→http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/liver-biopsy
29.B→http://www.newcastle-
hospitals.org.uk/Needlestickinjuriesandbloodbornevirus201508.pdf
30.C→http://www.health.com/health/gallery/0,,20560523,00.html#seeds-2
31.A→https://www.ncbi.nlm.nih.gov/pubmed/9421542
32.B→See “Moving and Positioning” Royal Marsden Manual
33.A→https://www.royalmarsden.nhs.uk/your-care/pain-management
34.D→http://www.judy-waterlow.co.uk/pressure_ulcer_preventative_aids.htm
35.B→https://www.nursingtimes.net/clinical-archive/nutrition/measuring-and-managing-
fluid-balance/5032614.article
36.A→https://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/lumba
r_puncture_lp_92,P07666
37.D→http://www.cmft.nhs.uk/directorates/mentor/documents/IVtherapyBS.pdf
38.C→https://www.nhs.uk/conditions/anaphylaxis/
39.A→http://www.royalmarsdenmanual.com/student/sequences/sequences9-3.asp
40.D→https://www.nhs.uk/conditions/consent-to-treatment/
41.C→See “Moving and Positioning” Royal Marsden Manual
42.D→See “Infection Control” Royal Marsden Manual
43.D→See “Medicine Management” Royal Marsden Manual
44.C→https://patient.info/doctor/resuscitation-in-hypovolaemic-shock#nav-1
45.B→See “Obtaining Consent” Royal Marsden
46.A→https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-
behavioural-conditions/dementia
47.C→http://www.wounds-uk.com/pdf/content_9506.pdf
48.D→https://www.nhs.uk/conditions/piles-haemorrhoids/
49.C→See “Communication” Royal Marsden
50.C→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886207/
51.D→http://onlinelibrary.wiley.com/doi/10.1046/j.1198-743x.2001.00287.x/full
52.A→http://www.vascularinfo.co.uk/aortic-aneurysms/abdominal-aortic-aneurysms-
explained/
53.A→https://www.alzheimers.org.uk/info/20029/daily_living/1174/urinary_tract_infection
s_utis_and_dementia/8
54.A→https://www.nhs.uk/conditions/Phlebitis/
55.C→See “Infection Control” Royal Marsden Manual
56.C→http://dailynurse.com/teach-patients-antibiotics/
57.C
58.C→See “Observations” Royal Marsden Manual
59.A→See NMC Code
61.A→https://www.hospiceuk.org/docs/default-source/What-We-Offer/Care-Support-
Programmes/benchmarking/what-is-clinical-benchmarking.pdf?sfvrsn=2
62.A→https://www.nursingtimes.net/clinical-archive/wound-care/wound-management-1-
phases-of-the-wound-healing-process/7000047.article
63.D→https://www.nhs.uk/conditions/ectopic-pregnancy/symptoms/
64.B→https://www.rcn.org.uk/professional-development/accountability-and-delegation
65.B→https://www.ncbi.nlm.nih.gov/pubmed/26048465
66.D→https://www.nhs.uk/conditions/consent-to-treatment/
67.B
68. C→https://www.medicinenet.com/loss_of_speech/symptoms.htm
69. C→http://www.who.int/gpsc/5may/background/5moments/en/
70. D→https://www.nmc.org.uk/about-us/our-role/
71. D→https://patient.info/medicine/allopurinol-zyloric
72. C→See “Medicine Management” Royal Marsden
73. D→See “NMC Standards of Medicine Management”
74. A→See “Observations” Royal Marsden
75. E
76. C→http://www.healthcentre.org.uk/dentistry/dentures-stomatitis.html
77. C→See “Assessment and Discharge” Royal Marsden
78. B→https://www.rcog.org.uk/globalassets/documents/patients/patient-information-
leaflets/pregnancy/heavy-bleeding-after-birth.pdf
79. A→http://www.firstaidforfree.com/a-guide-to-avpu-for-first-aiders/
80.A→http://www.icid.salisbury.nhs.uk/ClinicalManagement/Transfusion/Pages/SuspectedTr
ansfusionReaction-RecognitionandManagement.aspx
81. D→https://www.express.co.uk/life-style/health/799240/gum-disease-symptoms-gums-
teeth-disease-bleeding-gingivitis
82. C→https://www.nhs.uk/conditions/bronchiectasis/treatment/
83. C→https://publicdocuments.sth.nhs.uk/pil2644.pdf
84. D→https://patient.info/medicine/digoxin-lanoxin
85. C→https://patient.info/doctor/resuscitation-in-hypovolaemic-shock#nav-1
86. D→http://www.who.int/substance_abuse/information-sheet/en/
87. B→https://www.mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620
88.A→https://www.nmc.org.uk/standards/code/record-keeping/
89. C→https://patient.info/doctor/ascites-tapping
90. C→https://www.nhs.uk/conditions/first-aid/
91. D→See “Assessment and Discharge” Royal Marsden Manual
92. D→https://www.businessballs.com/managing-teams/tuckman-forming-storming-
norming-performing-model-234
93.C→http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependen
ce/CommunicationChallenges/Difficulty-Swallowing-After-Stroke-
Dysphagia_UCM_310084_Article.jsp#.WlXzh7yWbcc
94. C
95. A→See “ Nutrition, fluid balance and blood transfusion” Royal Marsden Manual
96. B→See “ Medicines management” Royal Marsden Manual
97. B→See “ Medicines management” Royal Marsden Manual
98. A
99. A→http://harmreduction.org/issues/overdose-prevention/overview/overdose-
basics/recognizing-opioid-overdose/
100.A→https://www.gov.uk/government/publications/confidentiality-nhs-code-of-practice
CBT MOCK SETCARE
PERIOPERATIVE 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
new- onset 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.
CBT MOCK SETCARE
PERIOPERATIVE 2
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 micro-organisms 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. A patient with burns is given anaesthesia using 50%oxygen and 50%nitrous

oxide to reduce pain during dressing . How long this gas is to be inhaled to be
more effective
A. 30 sec
B. 60sec
C. 1-2min
D. 3-5min
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
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.
CBT MOCK SETCARE
PERIOPERATIVE 2
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 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.
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
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.
CBT MOCK SETCARE
PERIOPERATIVE 2
20. Reason for dyspnoea in patients who diagnosed with Glomerulonephritis
patients?
A. Albumin loss increase oncotic pressure causes water retention in cells
B. Albumin loss causes decrease in oncotic pressure causes water retention
causing fluid retention in the lungs alveoli
C. Albumin loss has no effect on oncotic pressure
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 diarrhoea, 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
CBT MOCK SETCARE
PERIOPERATIVE 2
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
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. An RN is working in a team. Who is responsible for her action?

A. Herself
B. Charge nurse
C. Doctor
D. Supervisor
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 with nail polish.
B. Arterial blood gases should be sampled if the patient is receiving >60% oxygen.
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
30.When using nasal cannulae, the maximum oxygen flow rate that should be
used is 6 litres/min. Why?
A. Nasal cannulae are only capable of delivering an inspired oxygen
concentration 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 exacerbation of chronic obstructive airways 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 ulcer so place him on a
pressure relieving mattress.
CBT MOCK SETCARE
PERIOPERATIVE 2
B. Assess his risk of developing a pressure ulcer with a risk assessment tool.
If indicated, procure an appropriate 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 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
physiotherapist, 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 physiotherapist and provide her with lots of reassurance
as she 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 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.
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 to provide him with the nutritional
support he needs?
A. Nasogastric tube feeding.
B. Feeding via a percutaneous endoscopic gastrostomy (PEG).
C. Feeding via a radiologically inserted gastrostomy (RIG).
D. Continue oral food.
CBT MOCK SETCARE
PERIOPERATIVE 2
34. 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?
A. The feed. C. Food poisoning.
B. An infection. D. Being in hospital.
35. What would you do if a patient with diabetes and peripheral neuropathy
requires assistance cutting his toe nails?
A. Document clearly the reason for not cutting his toe nails 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/supplements.
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 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 can independently manage their stoma, and can get supplies.
B. That the patient has had their appliance changed regularly, and knows their
community stoma nurse.
C. That the patient knows the community stoma nurse, and has a prescription.
D. That the patient has a referral to the District Nurses for stoma care
CBT MOCK SETCARE
PERIOPERATIVE 2
39. What type of diet would you recommend to your patient who has a newly formed
stoma?
A. Encourage high-fibre foods to avoid 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 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 of effluent, type of stoma.
B. Patient preference, type of stoma, 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 of effluent, patient preference.
41. Which of these is an example of an open question?

A. Are you feeling 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
B. Unfamiliar accents
C. Overly technical language and terminology
D. Hearing problems
E. All of the above
43. Position to make breathing effective?

A. left lateral
B. Supine
C. Right Lateral
D. High sidelying
CBT MOCK SETCARE
PERIOPERATIVE 2
44. What are the most common effects of inactivity?

A. Pulmonary embolism, urinary tract infection and fear of people.
B. Deep arterial thrombosis, respiratory infection, fear of movement, loss of
consciousness, deconditioning of cardiovascular 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 of cardiovascular 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 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 and limb 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 you position a patient in a side-lying position?

A. If they are 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 muscle mass
B. Loss of muscle mass
C. A change in the shape of muscles
D. Disease of the muscle
CBT MOCK SETCARE
PERIOPERATIVE 2
49. Approximately how long is the spinal cord in an adult?

A. 30cm
B. 45cm
C. 60cm
D. 120cm
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. If a client is experiencing hypotension post operatively, the head is not tilted
in which of the following surgeries
A. Chest surgery
B. Abdominal surgery
C. Gynaecological surgery
D. Lower limb surgery
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.
CBT MOCK SETCARE
PERIOPERATIVE 2
54. 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?
B. Ask the 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. (based on royal marsden)
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 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
CBT MOCK SETCARE
PERIOPERATIVE 2
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 D. A, C, & D
61. What specifically do you need to monitor to avoid complications and ensure
optimal nutritional status in patients being enterally fed?
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
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
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.
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
CBT MOCK SETCARE
PERIOPERATIVE 2
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. An elderly client with dementia is cared by her daughter. The daughter locks
him in room to keep him safe when she goes out to work and not considering any
other options. As a nurse what is your action?
A. Explain this is a restrain. Urgently call for a safe guarding and arrange a multi-
disciplinary team conference
B. Do nothing as this is the best way of keeping him safe
C. Call police, social services to remove client immediately and refer to
safeguarding
D. Explain this is a restrain and discuss other possible options
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. An elderly client tells you that the carer is using his money when going for
shopping and not buying him any food. The client appears malnourished and
weighing only 35 kgs. As a newly qualified nurse what is your action?
A. Listen to client and raise concern with line manager
B. Do nothing as he is confused
C. Listen to the client and call safeguarding lead
D. Listen to the client and confirm with the carer
CBT MOCK SETCARE
PERIOPERATIVE 2
78. A client had fractured hand and being cared at home requiring analgesia. The
medication was prescribed under PGD. Which of the following statements are
correct relating to this:
A. A PGD can be delegated to student nurse who can administer medication with
supervision
B. PGD’s cannot be delegated to anyone
C. This type of prescription is not made under PGD
D. This can be delegated to another RN who can administer in view of a competent
person
79. Risk for health issues in a person with mental health issues
A. Increased than in normal people
B. Slightly decreased than in normal people
C. Very low as compared to normal people
D. Risk is same in people with and without mental illness
80.A Chinese woman has been admitted with fracture of wrist. When you are
helping her undress you notice some bruises on her back and abdomen of different
ages. You want to talk to her and what is your action?
A. Ask her husband about the bruises
B. Ask her son/ daughter to translate
C. Arrange for interpreter to ask questions in private
D. Do not carry any assessment and document this is not possible as the client
cannot speak English
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 and discussed.
C. Discuss the risk of operation if it won’t push through.
D. The documentation of details of any discussion in the anaesthetic record.
CBT MOCK SETCARE
PERIOPERATIVE 2
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.
85. How can a patient involved in patient centred care?

A. Assessing patient health care needs with the other members of the health care
team
B. Engaging patient in conversation assessing and identifying needs by involving
client focusing on preferences and formulating plan accordingly.
C. Engaging patients in discussion and focusing care based on his medical condition
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
CBT MOCK SETCARE
PERIOPERATIVE 2
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. B. Abnormal blood clotting screen or low platelet count
C. C. Malignant pleural effusion.
D. D. Post-operative, for example thoracotomy, cardiac surgery
89. Which drug can be given via NG tube?

A. Modified release hypertensive drugs
B. Crushing the tablets
C. Lactulose syrup
D. Insulin
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. A client is diagnosed with hepatitis A. Which of the following statements made
by client indicates understanding of the disease
A. Sexual intimacy and kissing is not allowed
B. Transmitted only through blood transfusions
C. Any planned surgery need to be postponed
D. The disease is incurable and not preventable
CBT MOCK SETCARE
PERIOPERATIVE 2
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. Clinical practice is based on evidence based practice. Which of the following
statements is true about this
A. Clinical practice based on clinical expertise and reasoning with the best
knowledge available
B. Provision of computers at every nursing station to search for best evidence
while providing care
C. Practice based on ritualistic way
D. Practice based on what nurse thinks is the best for patient
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
CBT MOCK SETCARE
PERIOPERATIVE 2
96. During a busy shift, a nurse loads medication and asks you to administer it. What is
your action?
A. Ask student nurse to help you administer medication
B. Ask another staff nurse to help you with administering medication
C. Accept to administer the medication
D. Refuse to administer the medication
97. Which is not an indication for lumbar tap?

A. For patients with increased ICP
B. For diagnostic purposes
C. Introduction of spinal anaesthesia for surgery
D. Introduction of contrast medium
98. when breaking bad news over phone which of the following statement is appropriate
A. I am sorry to tell you that your mother passed away
B. I am sorry to tell you that your mother died
C. I am sorry to tell you that your mother has gone to heaven
D. I am sorry to tell you that your mother is no more
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
KEY ANSWERS & RATIONALE/LINKS
PERIOPERATIVE CARE SET 2
1. D→See “Infection Control” Royal Marsden Manual
2. C→http://www.royalmarsdenmanual.com/student/mcqs/mcq.asp?I=1444334433&chap
ter=09&q=0001
3. C→http://www.bmj.com/content/321/7265/864
4. C→https://www.alzheimers.org.uk/download/downloads/id/3622/urinary_tract_infecti
ons_utis_and_dementia.pdf
5. B→See “Infection Control” Royal Marsden Manual
6. B→See “Wound Management” Royal Marsden Manual
7. A→See NMC Code
8. C→http://www.icid.salisbury.nhs.uk/ClinicalManagement/Pain/Pages/GuidelinesfortheA
dministrationofEntonox.aspx)
9. C→See “Perioperative Care” Royal Marsden Manual
10. A→http://gut.bmj.com/content/52/suppl_7/vii1
11. D→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325863/
12. A→http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/entonox-ward-
administration
13. B→See “Respiratory Care” Royal Marsden Manual
14. B→https://www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-
automated-external-defibrillation/
15. A→https://www.rch.org.au/anaes/pain_management/Opioid_Infusion/#Nurse_compet
encies
16. B→See “Pain Management” Royal Marsden Manual
17. B→http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Falls%20poli
cy%20%20procedure%20Final%2025.08.pdf
18. B→See “Respiratory Care” Royal Marsden Manual
19. D→http://www.newcastle-
hospitals.org.uk/downloads/policies/Infection%20Control/CDifficilePolicy201512.pdf
20. B→ http://www.kidneyabc.com/nephritis-symptoms/1647.html
21. B→See “Moving and Positioning” Royal Marsden Manual
22. B→https://www.transfusionguidelines.org/transfusion-handbook/4-safe-transfusion-
right-blood-right-patient-right-time-and-right-place/4-11-monitoring-the-transfusion-
episode
23. B→https://www.nhs.uk/conditions/diarrhoea/
24. B →https://www.fairview.org/patient-education/82956
25.B→https://www.nhs.uk/conditions/social-care-and-support/equality-act-disability-
discrimination/?
26.A→https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1858797543
27.A→ See NMC Code
28.D→https://patient.info/doctor/arterial-blood-gases-indications-and-interpretation
29.C→See “Perioperative Care” Royal Marsden Manual
30.C→See “Respiratory Care” Royal Marsden Manual
33.C→http://www.ouh.nhs.uk/patient-guide/leaflets/files/100510rig.pdf
34.A →See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marsden Manual
35.A→http://www.cuhk.edu.hk/med/nur/nnpru/doc/FootCareProtocol.pdf
36.B→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marsden Manual
37.B→https://www.openanesthesia.org/who_analgesic_ladder/
38.A→See “ Elimination” Royal Marsden Manual
39.C→See “ Elimination” Royal Marsden Manual
40.D→See “ Elimination” Royal Marsden Manual
41.B→See “Communication” Royal Marden Manual
42.E→See “Communication” Royal Marden Manual
43.D →See “Moving and Positioning” Royal Marsden Manual
44.D →See “ Patient Comfort And End Of Life Care” Royal Marden Manual
45.D→https://www.ncbi.nlm.nih.gov/books/NBK235613/
46.A→See “Moving and Positioning” Royal Marden Manual
47.B→See “Moving and Positioning” Royal Marden Manual
48.B→See “Moving and Positioning” Royal Marden Manual
49.B →https://www.dartmouth.edu/~humananatomy/part_7/chapter_41.html
50.A→See “Wound Management” Royal Marden Manual
51.D→http://nursing411.org/Courses/MD0916_Nursing_Care_Related_to_the_Musculoskeleta
l_system/1-13_Nursing_Care_related_to_the_musculoskeletal_system.html
52.A→See “Moving and Positioning” Royal Marsden Manual
53.B→https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/20014
6/Confidentiality_-_NHS_Code_of_Practice.pdf
54. C→ See “Observations” Royal Marsden Manual
55. B→See “Assessment and Discharge” Royal Marsden Manual
56. B→See “Infection Control” Royal Marden Manual
57. C→https://www.dbth.nhs.uk/wp-content/uploads/2017/07/PAT-T-29-v.1-Chest-Drains-
Guidance-incl-changes-TJN-review-date-extended.pdf
58. D→https://www.nhs.uk/conditions/compartment-syndrome/
59. A→See “Medicine Management” Royal Marden Manual
60. C→See “Elimination” Royal Marden Manual
61. A→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marsden Manual
62. B→See “Perioperative Care” Royal Marden Manual
63. A→See NMC Code
64. D→https://caretobedifferent.co.uk/nhs-continuing-healthcare/
65. A→See “Moving and Positioning” Royal Marden Manual
66. B→https://rcni.com/revalidation/6cs-nursing-32156
67. B→https://www.nhs.uk/conditions/social-care-and-support/hospital-discharge-care/?
68.D→http://www.cmft.nhs.uk/directorates/mentor/documents/Assessingplanningimplementi
ngandevaluatingcare_001.pdf
69. B→See “Perioperative Care” Royal Marden Manual
70. A→https://www.nhs.uk/conditions/oedema/#symptoms-of-oedema
71. C→https://www.ukessays.com/essays/nursing/holistic-care-holistic-therapies-and-nursing-
nursing-essay.php
72. B→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marden Manual
73.A→https://babylink.scot.nhs.uk/CommonProblemsAndConditions/RespiratorySystem/Pages
/MeconiumAspirationSyndrome.aspx
74. A→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marden Manual
75.A→See “NMC Safeguarding”
76. C →See “Elimination” Royal Marden Manual
77.A→See “NMC Safeguarding”
78. D→https://www.gov.uk/government/publications/patient-group-directions-pgds/patient-
group-directions-who- can-use-them
79.A → See “Communication” Royal Marsden Manual
80.C→See “Communication” Royal Marsden Manual
81. C→See “Perioperative Care” Royal Marden Manual
82. D →https://www.nhs.uk/conditions/atrial-fibrillation/
83. D→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marden Manual
84. D→See “Observations” Royal Marden Manual
85.B – See “NMC Code”
86. D→https://medical-dictionary.thefreedictionary.com/speed+shock
87. C→See “ Patient Comfort And End Of Life Care” Royal Marden Manual
88. B→See “Respiratory Care” Royal Marden Manual
89.C
A. Modified release hypertensive drugs (Sustained release or anti-neoplastic tablets must
not be crushed or dissolved either, as there is a risk of increased toxicity)
B. Crushing the tablets (Enteric-coated tablets must not be crushed or dissolved because
there is a risk of gastric irritation)
C. Lactulose syrup
D. Insulin (this is via SQ)
90. A→http://rcnhca.org.uk/46-2/accountability-and-delegation/accountability/
91.A→ A client is diagnosed with hepatitis A. which of the following statements made by client
indicates understanding of the disease
A. Sexual intimacy and kissing is not allowed (https://www.mayoclinic.org/diseases-
conditions/hepatitis-a/basics/causes/con- 20022163)
B. Does require hospitalization
C. Transmitted only through blood transfusions
D. Any planned surgery need to be postponed
92. A→https://www.nhs.uk/conditions/social-care-and-support/advocacy-services/?#advocacy-
and-mental-capacity
93. D→https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1321926632
94. A→See Royal Marsden Manual
95. A→https://www.nhs.uk/conditions/dehydration/
96. D→See “NMC Standards on Medicine Management”
97. A→https://emedicine.medscape.com/article/80773-overview#a4
98. A→ Professional and with empathy
99. D→https://www.nhs.uk/conditions/mrsa/
100. C →https://rcni.com/revalidation/6cs-nursing-32156
CBT MOCK SETCARE
PERIOPERATIVE 3
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
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
3. which of the following statements made by client diagnosed with hepatitis A needs further
understanding of the disease.
A. Washing hands before cooking food
B. Practice hand hygiene
C. Refraining from sexual intimacy and kissing while symptoms still present
D. Towels and flannels can be shared with children
4. Gurgling sound from airway in a postoperative client indicates:

A. Complete obstruction of lower airway
B. Partial obstruction of upper airway
C. Common sign of a post-operative patient
D. Indicates immediate insertion of laryngeal airway
5. A patient recently admitted to hospital, requesting to self administer the medication, has
been assessed for suitability at Level 2 This means that:
A. 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
B. The patient accepts full responsibility for the storage and administration of the medicinal
products
C. 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
CBT MOCK SETCARE
PERIOPERATIVE 3
6.Nurse is caring for a confused client who’s not taking fluids, staff on previous shift tried to
make him drink but were unsuccessful. Now it is the visitors time, the patient’s wife is
waiting outside. What should the nurse do?
A. Ask the wife to give him fluid, and enquire about his fluid preferences and usual drinking
time
B. Tell her to wait and you need some time to make him drink
C. Inform doctor to start fluids to prevent dehydration
7. What is primary care?

A. The Accident and Emergency Room
B. GP practices, dental practices, community pharmacies and high street optometrists
C. First aid provided on the street
8. A new RN have problems with making assumptions. Which part of the code she should focus
to deliver fundamentals of care effectively
A. Prioritise people
B. Practice effectively
C. Preserve safety
D. Commitment
E. Promote professionalism and trust
9. Independent Advocacy is:

A. Providing general advice
B. Making decisions for someone
C. Care and support work
D. Agreeing with everything a person says and doing anything a person asks you to do
E. None of the above
10. You are mentoring a 3rd year student nurse, the student request that she want to assist a
procedure with tissue viability nurse, how can you deal with this situation?
A. Tell her it is not possible
B. Call to the college and ask whether it is possible for a 3rd student to assist the procedure
C. Allow her as this is the part of her learning
D. Tell her it is possible if you provide direct supervision
CBT MOCK SETCARE
PERIOPERATIVE 3
11. Recommended preoperative fasting times are:
A.2-4 hours
B.6-12 hours
C.12-14 hours
12. CVP line measures?

A. Pressure in right atrium
B. Pulmonary arteries
C. Left ventrivle
D. Vena cava
13. Hospital discharge planning for a patient should start:

A. When the patient is medically fit
B. On the admission assessment
C. When transport is available
14. Examples of offensive/hygiene waste which may be sent for energy recovery at energy from
waste facilities can include:
A. Stoma or catheter bags - The Management of Waste from health, social and personal
care -RCN
B. Unused non-cytotoxic/cytostatic medicines in original packaging
C. Used sharps from treatment using cytotoxic or cytostatic medicines
D. Empty medicine bottles
15. According to law in England, UK when you faced with a situation of emergency what is your
action?
A. Should not assist when it is outside of work environment
B. Law insists you to stop and assist
C. Do not involve in the situation
D. You are not obliged in any way but as a professional duty advises you to stop and assist
CBT MOCK SETCARE
PERIOPERATIVE 3
16. An overall risk of malnutrition of 2 or higher signifies:
A. Low risk of malnutrition
B. Medium risk of malnutrition
C. High risk of malnutrition
17. Which of the following actions jeopardise the professional boundaries

between patient and nurse:
A. Focusing on effective communication
B. Focusing on needs of patient related to illness
C. Focusing on withholding value opinions related to the decisions
D. Focusing on social relationship outside working environment
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:
A. Hands are visibly soiled
B. Caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves
have been worn
C. Immediately after contact with body fluids, mucous membranes and non-intact skin
19. Independent and supplementary nurse and midwife are those who are?
A. Registrants who completed a programme to prescribe under community nurse
practitioner’s drug formulary
B. Nurse and midwife student who cleared medication administration exam
C. nurses and midwives educated in appropriate medication prescription for certain
pharmaceuticals
D. nurses and midwives whose name is entered in the register
20. What medications would most likely increase the risk for fall?
A. Loop diuretic
B. Hypnotics
C. Betablockers
D. Nsaids
CBT MOCK SETCARE
PERIOPERATIVE 3
21.An unmarried young female admitted with ectopic pregnancy with her friend to hospital
with complaints of abdominal pain. Her friend assisted a procedure and became aware of
her pregnancy and when the family arrives to hospital, she reveals the truth. The family
reacts negatively. What could the nurse have done to protect the confidentiality of the
patient information?
A. should tell the family that they don’t have any rights to know the patient information
B. that the friend was mistaken and the doctor will confirm the patient’s condition
C. should have asked another staff nurse to be a chaperone while assisting a procedure
D. should insist friend on confidentiality
22. What do you expect to manifest with fluid volume deficit?

A. Low pulse, Low Bp
B. High pulse, High BP
C. High Pulse, low BP
D. Low Pulse, high BP
23. You have assigned a new student to an experienced health care assistant to gain some
knowledge in delivering patient care. The student nurse tells you that the HCA has pushed
the client back to the chair when she was trying to stand up. What is your action?
A. Suspend HCA immediately
B. Ask the client later on what has happened
C. Intervene on spot and raise concern immediately to the manager on duty
D. Ignore the student as she is new and does not have any experience
24. Wound proliferation starts after?

A. 1-5 days
B. 3-24 days
C. 24 days
25. Barrier Nursing for C.diff patient what should you not do?
A. Use of hand gel/ alcohol rub
B. Use gloves
C. Patient has his own set of washers
D. Strict disinfection of pt’s room after isolation
CBT MOCK SETCARE
PERIOPERATIVE 3
26. You are transcribing medications from prescription chart to a discharge letter. Before
sending this letter what action must be taken?
A. A registrant should sign this letter
B. The letter has to be checked by a nurse in charge
C. Transcribing is not allowed in any circumstances
D. Letter can be sent directly to the patient after transcribing
27. When explaining about travellers’ diarrhoea which of the following is correct?
A. Travellers’ diarrhoea is mostly caused by Rotavirus
B. Oral rehydration in adults and children is not useful
C. Adsorbents such as kaolin is ineffective and not advised
D. Antimotility drugs like loperamide is ineffective management
28. Why are physiological scoring systems or early warning scoring systems used in clinical
practice?
A. They help the nursing staff to accurately predict patient dependency on a shift by shift
basis.
B. The system provides an early accurate predictor of deterioration by identifying physiological
criteria that alert the nursing staff to a patient at risk.
C. These scoring systems are carried out as part of a national audit so we know how sick
patients are in the United Kingdom.
D. 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?
A. Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and
document clearly.
B. This is a medical emergency. Basic airway, breathing and circulation should be attended to
urgently and senior help should be sought.
C. Refer to the neurology team.
D. 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.
CBT MOCK SETCARE
PERIOPERATIVE 3
30. What are the professional responsibilities of the qualified nurse in medicines
management?
A. 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.
B. 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.
C. Making sure they know the names, actions, doses and side effects of all the medications
used in their area of clinical practice.
D. 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?
A. 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.
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. You will also complete an incident form.
32. Most of the s/s are common in both type1 and type 2 diabetes. Which of the following
symptom is more common in typ1 than type2?
A. Thirst
B. Ketones
C. Weight loss
D. Poly urea
CBT MOCK SETCARE
PERIOPERATIVE 3
33. What are the principles of gaining informed consent prior to a 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.
34. Anti-embolic stockings an effective means of reducing the potential of developing a deep
vein thrombosis because:
A. They promote arterial blood flow.
B. They promote venous blood flow.
C. They reduce the risk of postoperative swelling.
D. They promote lymphatic fluid flow, and drainage.
35. What functions should a dressing fulfil for effective wound healing?
A. High humidity, insulation, gaseous exchange, absorbent.
B. Anaerobic, impermeable, conformable, low humidity.
C. Insulation, low humidity, sterile, high adherence.
D. Absorbent, low adherence, anaerobic, high humidity.
36. When would it be beneficial to use a wound care plan? (CHOOSE 3 ANSWERS)
A. on initial assessment of wound
B. during pre-assessment admission
C. after surgery
D. during wound infection, dehiscence or evisceration
CBT MOCK SETCARE
PERIOPERATIVE 3
37. Which of the following displays the proper use of Zimmer frame?
A. using a 1 point gait
B. using a 2 point gait
C. using a 3 point gait
D. using a 4 point gait
38. What are the signs and symptoms of shock during early stage (stage 1-3)? (CHOOSE 3
ANSWERS)
A. hypoxemia
B. tachycardia and hyperventilation
C. hypotension
D. Acidosis
39. A patient just had just undergone lumbar laminectomy, what is the best nursing
intervention?
A. move the body as a unit
B. move one body part at a time
C. move the head first and the feet last
D. never move the patient at all
40. Which of the following is a sign of dehydration in the elderly?

A. diminished skin turgor
B. hypertension
C. anxiety attacks
D. Pyrexia
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:
A. let them continue with their work as you are not in charge of that bay
B. report the event to the unit manager
C. call the manual handling specialist nurse for training
D. inform the relatives of the mistake
CBT MOCK SETCARE
PERIOPERATIVE 3
42. Which of the following is not a component of end of life care?
A. resuscitation and defibrillation
B. reduce pain
C. maintain dignity
D. provide family support
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)
A. call the doctor
B. assist patient in a comfortable position
C. give another dose
D. look for a heating pad
44. Which of the following is a severe complication during 24 hrs post liver biopsy?
A. pain at insertion site
B. nausea and vomiting
C. back pain
D. bleeding
45. Which of the following are signs of anaphylaxis? (CHOOSE 3 ANSWERS)

A. swelling of tongue and rashes
B. dyspnoea, hypotension and tachycardia
C. hypertension and hyperthermia
D. cold and clammy skin
46. Which of the following senses is to fade last when a person dies?
A. hearing
B. smelling
C. seeing
D. speaking
CBT MOCK SETCARE
PERIOPERATIVE 3
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?
A. Call the emergency department for ambulance
B. Increase O2 rate
C. Tell patient to calm down in a loud voice
D. Calmly instruct patient to do deep breathing
48. You have observed an IV catheter insertion site w/ erythema, swelling, pain and
warm? What VIP score would you document on his notes?
A. 5
B. 2
C. 3
D. 4
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)
A. start antibiotics
B. re-site cannula
C. call doctor
D. elevate
50. How do you remove a negative pressure dressing?

A. Remove pressure then detach dressing gently
B. Get TVN nurse to remove dressing
C. remove in a quick fashion
51. What position should you prepare the patient in pre-op for abdominal Paracentesis?
A. Supine
B. Supine with head of bed elevated to 40-50cm
C. Prone
D. Side-lying
CBT MOCK SETCARE
PERIOPERATIVE 3
52. Lumbar post op patient moving and handling
A. Move patient as a unit
B. Move patient close to side rails so he/she could assist herself
C. Move with leg raised/flexed
53. What is not a sign of meconium aspiration

A. Floppy in appearance
B. Apnoea
C. Crying
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:
A. That treatment and medication is working
B. She has made new friends
C. That she has finalize suicide plan
55. Patient has next dose of Digoxin but has a CR=58

A. Omit dose, record why, and inform the doctor
B. Give dose and tell the doctor
C. Give dose as prescribed
56. Patient is in for oxygen therapy

A. A prescription is required including route, method and how long
B. No prescription is required unless he will use it at home.
C. Prescription not required for oxygen therapy
57. Adequate record keeping for a medical device should provide evidence of:
A. A unique identifier for the device, where appropriate
B. A full history, including date of purchase and where appropriate when it was put into
use, deployed or installed
C. Any specific legal requirements and whether these have been met
D. Proper installation and where it was deployed
CBT MOCK SETCARE
PERIOPERATIVE 3
E. Schedule and details of maintenance and repairs
F. The end-of-life date, if specified
G. All of the above
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
administer?
A. 3 tablets
B. 1.5 tablets
C. 6 tablets
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?
A. 2ml
B. 1.5 ml
C. 0.5 ml – Dose Prescribed: Dose /ml - 25:50=0.5
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=1000mcg , 200mcg=0.2mg then dose prescribed:dose/ml – 0.2:1=0.2
A. 20ml
B. 2ml
C. 0.2ml
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:
A. Report your concerns immediately, in writing to the appropriate person - Escalating

concerns NMC
B. Ask for advice from your professional body if unsure on what actions to take
C. Protect client confidentiality
D. Refer to your employer’s whistleblowing policy
E. Keep an accurate record of your concerns and action taken
F. All of the above
CBT MOCK SETCARE
PERIOPERATIVE 3
62. In interpreting ECG results if there is clear evidence of atrial disruption this is interpreted
as?
Cardiac Arrest
Ventricular tach
Atrial Fibrillation
Complete blockage of the heart
63. Common signs and symptoms of a hypoglycaemia exclude:

A. Feeling hungry
B. Sweating
C. Anxiety or irritability
D. Blurred vision
E. Ketoacidosis
64. Select 3 Common causes for hyperglycaemia: (CHOOSE 3 ANSWERS)

A. Not eating enough protein
B. Eating too much carbohydrate
C. Over-treating a hypoglycaemia
D. Stress
E. Infection (for example, colds, bronchitis, flu, vomiting, diarrhoea, urinary infections, and
skin infections
65. Safeguarding is the responsibility of:

A. health care assistants
B. registered nurses
C. doctors
D. all of the above
66. Normal heart rate for 1 to 2 years old?

A. 80 - 140 beats per minute
B. 80 - 110 beats per minute
C. 75 - 115 beats per minute
CBT MOCK SETCARE
PERIOPERATIVE 3
67. In the News observation system, what is AVUP ?
A. A replacement for GCS
B. An assessment for confusion
C. Assessment for the level of consciousness
68. Which bag do you place infected linen?

A. water-soluble alginate polythene bag before being placed in the appropriate linen bag, no
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, after sorting, no more than ¾ full
69. Which one of these notifiable diseases needs to be reported on a national level? (Select x 2
correct answers)
A. Chicken pox
B. Tuberculosis
C. Whooping cough
D. Influenza
70. Possible signs of compartment syndrome include

A. Numbness and tingling
B. Cool dusky toes
C. Pain
D. Toes swelling
E. All of the above
71. Patient developed elevated temperature and pain in the loin during blood transfusion. This
is indicative of:
A. Severe blood transfusion reaction
B. Common blood transfusion reaction
CBT MOCK SETCARE
PERIOPERATIVE 3
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
73. Which of the following is at a greater risk for developing coronary artery disease?
A. Male, obese, sedentary lifestyle
B. Female, obese, non sedentary lifestyle
74. Most commonly aneurysms can develop on? (CHOOSE 2 ANSWERS)

A. Abdominal aorta
B. Circle of Willis
C. Intraparechymal aneurysms
D. Capillary aneurysms
75. On assessment of the abdomen of a patient with peritonitis you would expect to find
A. Rebound tenderness and guarding
B. Hyperactive, high-pitched bowel sounds and a firm abdomen
C. A soft abdomen with bowel sounds every 2 to 3 seconds
D. Ascites and increased vascular pattern on the skin
76. Patients with gastric ulcers typically exhibit the following symptoms:
A. Epigastric pain worsens before meals, pain awakening patient from sleep an melena
B. Decreased bowel sounds, rigid abdomen, rebound tenderness, and fever
C. Boring epigastric pain radiating to back and left shoulder, bluish-grey discoloration of
periumbilical area and ascites
D. Epigastric pains worsens after eating and weight loss
CBT MOCK SETCARE
PERIOPERATIVE 3
77. Under the Yellow Card Scheme you must report the following: ( Select x 2 correct answers)
A. Faulty brakes on a wheelchair
B. Suspected side effects to blood factor, except immunoglobulin products
C. Counterfeit or fake medicines or medical devices
78. The degree of injection when giving subcutaneous insulin injection on a site where you can
grasp 1 inch of tissue?
A. 45 degrees
B. 40 degrees
C. 25 degrees
79. As a nurse you are responsible for looking after patient’s nutritional needs and to
maintain good weight during hospitalization. How would you achieve this?
A. Assessing nutritional status, client preferences and needs, making individual food choices
available, checking daily weight and documentation
B. Providing all clients with liquid nutritional supplements
C. Assessing all patients using MUST screening tool and by taking patients preferences into
consideration
D. Checking daily weigh and documenting
80. Hypoglycaemia in patients with diabetes is more likely to occur when the patients take:
(Select x 3 correct answers)
A. Insulin
B. Sulphonylureas
C. Prandial glucose regulators
D. Metformin
81. Patients with gastrointestinal bleeding may experience acute or chronic blood loss. Your
patient is experiencing hematochezia. You recognise this by:
A. Red or maroon- coloured stool rectally
B. Coffee ground emesis
C. Black, tarry stool
D. Vomiting of bright red or maroon blood
CBT MOCK SETCARE
PERIOPERATIVE 3
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.
A. Do not identify yourself as a nurse
B. Do not engage in a personal discussion or relationship with a patient or former patient
C. Do not post a picture of a patient's child even if they allow you to
D. You can rely on the sites privacy settings
83. It is unsafe for a spinal tap to be undertaken if the patient:

A. Has bacterial meningitis
B. Papilloedema
C. Intracranial mass is suspected
D. Site skin infection
E. 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
D. A connective tissue disorder and she should be referred to dermatology
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?
A. Raise a safeguarding alert
B. Just listen but don't do anything
C. Ignore the old man, he is just having delusions
D. Refer the old man to the community clergy who is giving him spiritual support
CBT MOCK SETCARE
PERIOPERATIVE 3
86. Prothrombin time is essential during anticoagulation therapy. In oral anticoagulation
therapy which test is essential?
A. 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 drug (heparin).
B. International Normalized Ratio - The Prothrombin time (PT) test, standardised as the INR
test is most often used to check how well anticoagulant tablets such as warfarin and
phenindione are working
87. Conditions producing orthostatic hypotension in the elderly:

A. Aortic stenosis
B. Arrhythmias
C. Diabetes
D. Pernicious anaemia
E. Advanced heart failure
F. All of the above
88. When do you wear clean gloves?

A. Assisting with bathing
B. Feeding a client
C. When there is broken skin on hand
D. Any activity which includes physical touch of a client
89. Enteral feeding patient checks patency of tube placement by: x 2 correct answers
A. Pulling on the tube and then pushing it back in place
B. Aspirating gastric juice and then checking for ph <4
C. Infusing water or air and listening for gurgles
D. X-ray
CBT MOCK SETCARE
PERIOPERATIVE 3
90. A patient is assessed as lacking capacity to give consent if they are unable to:
A. Understand information about the decision and remember that information
B. Use that information to make a decision
C. Communicate their decision by talking, using sign language or by any other means
D. All the above
91. Proper Dressing for wound care should be? (Select x 3 correct answers)
A. High humidity
B. Low humidity
C. Non Permeable/ Conformable
D. Adherent
E. Absorbent / Provide thermal insulation
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?
A. Refer to neurology team
B. Continue to monitor patient using GCS and record
C. Consider this as an emergency, prioritize ABC & Call the doctor
93 When delegating any task to anyone what you must need to consider?
A. Delegating according to job description
B. Delegating tasks to student nurses they can be able to do
C. Delegating tasks only to health care assistans
D. Before delegating tasks to anyone, assess if that person is competent and able to carry
the task
94. after breaking bad news of expected death to a relative over phone , she says thanks for
letting us know and becomes silent. Which of the following statements made by nurse
would be more empathetic
A. Say I will ask the doctor to call you
B. You seem stunned. You want me to help you think what you want to do next
C. Call me back if you have got any questions
CBT MOCK SETCARE
PERIOPERATIVE 3
95. Nurse is teaching patient about crutch walking which is incorrect?
A. Take long strides
B. Take small strides
C. Instruct to put weight on hands
96. What advice do you need to give to a patient taking Allopurinol?

.(Select x 3 correct answers)
A. Drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
B. Store allopurinol at room temperature away from moisture and heat.
C. Avoid being near people who are sick or have infections
D. Skin rash is a common side effect, it will pass after a few days
97. Signs and symptoms of septic shock:

A. Tachycardia, hypertension, normal WBC, non pyrexial
B. Tachycardia, hypotension, increased WBC, pyrexial
C. Tachycardia, , increased WBC, normotension, non pyrexial
D. Decreased heart rate, decreased blood pressure, normal WBC and pyrexial
98. which solution use minimum tissue damage while providing wound care
A. Hydrogen peroxide
B. Povidine iodine
C. Saline
D. Gention violet
99. Normal value of oxygen saturation:

A. 95 to 100 percent.
B. under 90 percent
C. Above 80 percent
100. Normal range of blood PH:

A. 7.35 to 7.45
B. 5.5 to 6.5
PERIOPERATIVE
KEY ANSWERS CARE
& RATIONALE/LINKS SET 3
1.C→See “NMC Code”
2.A→https://www.nhs.uk/conditions/consent-to-treatment/
4.B→See “Perioperative Care” Royal Marsden Manual
5.C→See “Standards for Medicine Management”
6.A→See “Communication” Royal Marsden Manual
7.B→http://content.digital.nhs.uk/primary-care
8.E→See “NMC Code”
9.E→http://www.nhslothian.scot.nhs.uk/HealthInformation/Advocacy/Pages/default.aspx
10.D→See “NMC Code”
11.B→https://www.nhs.uk/chq/Pages/1019.aspx?CategoryID=69
12.A→ (The central venous pressure (CVP) is the pressure measured in the central veins close
to the heart. It indicates mean right atrial pressure and is frequently used as an estimate
of right ventricular preload.)
13.B→See “Assessment and Discharge” Royal Marsden Manual
14.A→https://www.gov.uk/how-to-classify-different-types-of-waste/healthcare-and-related-
wastes
15.D. →https://www.rcn.org.uk/get-help/rcn-advice/duty-of-care
17.D→See “Communication” Royal Marsden Manual
19.A→See “NMC Standards for Medicine Management”
21.C→(providing patient confidentiality)
22.C→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marsden Manual
23.C→ safeguarding
24.B→See “Wound Management” Royal Marsden Manual
25.A→See “Infection Control” Royal Marsden Manual
26.B→See “NMC Standards for Medicine Management”
PERIOPERATIVE
KEY ANSWERS CARE
27.D→ when explaining about travellers’ diarrhoea which of the following is correct?
A. Travellers’ diarrhoea is mostly caused by Rotavirus (The most common cause of
traveler's diarrhea is enterotoxigenic Escherichia coli (ETEC) bacteria)
B. Oral rehydration in adults and children is not useful
C. Adsorbents such as kaolin is ineffective and not advised
D. Antimotility drugs like loperamide is ineffective management (as they can delay
clearance of the infectious organisms and make the illness worse.)
28.B→See “Observations” Royal Marsden Manual
29.B→See “Observations” Royal Marsden Manual
30.B→See “Medicine Management” Royal Marsden Manual
30.B→See “Medicine Management” Royal Marsden Manual
31.D→See “NMC Standards for Medicine Management”
32.B→See Royal Marsden Manual
33.D→See “Perioperative Care” Royal Marsden Manual
34.B→https://www.nursingtimes.net/clinical-archive/patient-safety/anti-embolism-
stockings/5028392.article
35.A→See “Wound Management” Royal Marsden Manual
36.A,C,D→See “Wound Management” Royal Marsden Manual
38.A,B,C→ See Royal Marsden Manual
40.A→See “Fluid and Nutrition” Royal Marsden Manual
41.B→See “NMC Code”
42.A →See Royal Marsden Manual
43.A, B→ See “Perioperative Care” Royal Marsden Manual
44.D→http://www.surgeryencyclopedia.com/La-Pa/Liver-Biopsy.html
45.A,B,D→https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/33-
anaphylaxis-and-severe-allergic-reaction
46.A→See “ Patient Comfort And End Of Life Care” Royal Marsden Manual
47.D→ See Royal Marsden Manual
48.A→http://www.bhs.org.au/airapps/Services/au/org/bhs/govdoc/files/references/5663.pdf
PERIOPERATIVE
KEY ANSWERS CARE
49.B,D→See Royal Marsden Manual
51.B→ See Royal Marsden Manual
52.A→ See Royal Marsden Manual
53.C→ See Royal Marsden Manual
54.C→ See Royal Marsden Manual
55.A→ See Royal Marsden Manual
56.A → See Royal Marsden Manual
57.G→https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/42102
8/Managing_medical_devices_-_Apr_2015.pdf
58.A→9mg/3mg
59.C→25mg/50mg/ml
60.C→0.2mg/1mg per ml
61.F→See “NMC Code”
62.C→https://heartresearch.org.uk/grants/atrial-fibrillation
63.E→http://www.nhsdirect.wales.nhs.uk/encyclopaedia/h/article/hypoglycaemia/
64.B,C,D,→https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/#what-causes-
high-blood
sugar
65.D→https://www.gov.uk/government/publications/safeguarding-children-and-young-
people/safeguarding-children-and-young-people
66.A→See “Observations” Royal Marsden Manual
67.C→https://www.nursingtimes.net/clinical-archive/neurology/neurological-assessment-1-
assessing-level-of-consciousness/1703021.article
68.A→https://www.infectionpreventioncontrol.co.uk/content/uploads/2015/05/13-Laundry-
May-2015-Version-1.01.pdf
69.B,C→https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-
report
70.E→https://www.nhs.uk/conditions/compartment-syndrome/#symptoms-of-compartment-
syndrome
71.A→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260299/
72.B →http://www.ouh.nhs.uk/patient-guide/leaflets/files/100322instileyedrops.pdf
73.A →https://heartuk.org.uk/healthcare-professionals/resources-and-publications/risk-charts
PERIOPERATIVE
KEY ANSWERS CARE
74.A,B→https://www.nhs.uk/conditions/brain-aneurysm/
75.A →https://www.mayoclinic.org/diseases-conditions/peritonitis/symptoms-causes/syc-
20376247
76.D→https://www.nhs.uk/conditions/stomach-ulcer/symptoms/
77.B,C→https://yellowcard.mhra.gov.uk/
78.A→See “Medicine Management” Royal Marsden Manual
79.A→See “Nutrition and Fluid Management” Royal Marsden Manual
80.A,B,C→https://www.diabetes.co.uk/diabetes-and-hypoglycaemia.html
81.A →http://www.healthhype.com/what-is-melena-and-hematochezia-signs-of-bleeding-in
the-stool.html
82.A,D→https://www.nmc.org.uk/standards/guidance/social-media-guidance/
83.E→https://emedicine.medscape.com/article/80773-overview#a4
84.A→http://www.bulimiahelp.org/article/signs-bulimia
85.A→https://www.nmc.org.uk/standards/safeguarding/
86.B→https://www.utmb.edu/LSG/Pages/ORAL_ANTICOAG_THERAPY.aspx
87.F→https://patient.info/doctor/hypotension#nav-0
88.C→ to protect yourself
89.B,D→See “ Nutrition, Fluid Balance And Blood Transfusion” Royal Marsden Manual
90.D→https://www.legislation.gov.uk/ukpga/2005/9/section/2
91.A,C,E→See “Wound Management” Royal Marsden Manual
94.B→ (with empathy and offering to help)
96.A,B,C→https://www.rxlist.com/zyloprim-side-effects-drug-center.htm
97.B→ (https://www.healthline.com/health/septic-shock#symptoms2)
98.C→ (because mimics your body's internal pH.)
100.A→ See “Observations” Royal Marsden Manual
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
A. Suppression
B. Undoing
C. Regression
D. Repression
2. What does AVPU mean?

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

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

A. Registered nurse
B. Nurse assistant
C. Whoever used the sharps
D. Whoever collects the garbage
5. NMC requires in the UK how many units of continuing education units a nurse should have in
3 years?
A. 35 Units
B. 45 Units
C. 55 Units
D. 65 Units
CBT MOCK SETCARE
PERIOPERATIVE 4
6. What do you expect to assess in a grade 3 pressure ulcer?
A. blistered wound on the skin
B. open wound showing tissue
C. open wound exposing muscles
D. open wound exposing bones
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. removing from its darkened container exposes the medicine to the light and its potency
will decrease after 8 weeks
B. it will have a greater concentration after 8weeks
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?
A. urinary tract infection leading to delirium
B. delayed grieving with dementia
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?
A. inform social service desk on suspected case of child neglect
B. ignore incident since the child is under the responsibility of the mother
C. raise the situation to your head nurse and discuss with her what intervention might be done
to help the child
CBT MOCK SETCARE
PERIOPERATIVE 4
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
11. Who will you inform first if there is a shortage in supplies in your shift?
A. Nursing assistant
B. Purchasing personne
C. Immediate nurse manager
D. Supplier
12. What do you mean by MRSA?

A. methicillin-resistant staphyloccocus aureu
B. multiple resistant staphylococcus antibiotic
13. A young mother who delivered 48hrs ago comes back to the emergency department
with post partum haemorrhage. What type of PPH is it?
A. primary post partum haemorrhage
B. secondary post partum haemorrhage
C. tertiary post partum haemorrhage.
14. As a registered nurse in a unit what would consider as a priority to a patient

immediately post operatively?
A. pain relief
B. blood loss
C. airway patency
CBT MOCK SETCARE
PERIOPERATIVE 4
15. Which is the most dangerous site for intramuscular injection?
A. ventrogluteal
B. deltoid
C. rectus femoris
D. dorsogluteal
16. A solution contains 12.5 g of glucose in 0.25 l; what is the percentage concentration
(%) of this solution?
A. 5%
B. 10%
C. 25%
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?
A. 83
B. 60
C. 24
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?
A. Question the adult thoroughly to get as much information as possible
B. Take photographs of any signs of abuse or other potential evidence before cleaning up the
victim or the crime scene
C. Explain to the victim that you cannot speak to them unless a police officer is present
D. 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. A manager with safeguarding responsibility (if within an organisation) or Adult Social Care
directly (if you are a member of the public)
B. No one – it is up to the adult at risk to raise the alert
C. The adult's next of kin
D. Everyone with a caring responsibility for the adult
CBT MOCK SETCARE
PERIOPERATIVE 4
20. 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 that you dont pass
on any infection to the patient.
B. Wearing gloves, aprons and mask when caring for someone in protective isolation to
protect yourself from infection.
C. Asking relatives to wash their hands when visiting patients in the clinical setting.
D. 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?
A. The doctor has requested a midstream urine specimen.
B. The patient has a urinary catheter in situ, and the patients wife states that he seems more
forgetful than usual.
C. 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.
D. 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?
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 patients 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.
E. All of the above
CBT MOCK SETCARE
PERIOPERATIVE 4
23. 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 dont
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
24. 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 patients concerns and providing a solution.
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?
A. The fluid output has exceeded the input.
B. The doctor may consider increasing the IV drip rate.
C. The fluid balance chart can be stopped as positive in this instance means good.
D. The fluid input has exceeded the output.
CBT MOCK SETCARE
PERIOPERATIVE 4
26. What specifically do you need to monitor to avoid complications and ensure optimal
nutritional status in patients being enterally fed?
27. What is the best way to prevent a patient who is receiving an enteral feed from aspirating?
Lie them flat.
A. Sit them at least at a 45° angle.
B. Tell them to lie on their side.
C. Check their oxygen saturations.
28. Which check do you need to carry out before setting up an enteral feed via a nasogastric
tube?
A. That when flushed with red juice, the red juice can be seen when the tube is
aspirated.
B. That air cannot be heard rushing into the lungs by doing the whoosh test.
C. That the pH of gastric aspirate is <5.5, and the measurement on the NG tube is the
same length as the time insertion.
D. 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?
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 micro-
organisms on the skin is avoided.
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
A. Nasal cannulae are only capable of delivering an inspired oxygen concentration 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 patients 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

A. 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.
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.
33. Which of the following would indicate an infection?

A. Hot, sweaty, a temperature of 36.5°C, and bradycardic.
B. Temperature of 38.5°C, shivering, tachycardia and hypertensive.
C. Raised WBC, elevated blood glucose and temperature of 36.0°C.
D. Hypotensive, cold and clammy, and bradycardic.
CBT MOCK SETCARE
PERIOPERATIVE 4
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:
A. Accept her weakness and take this challenge as an opportunity to improve her skills by
requesting lectures from her manager
B. Ignore the criticism as this is a case of a team issue
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 text, what should you do?
A. Tell the student to leave and emphasize what a disappointment she is
B. Report the student to his Instructor after duty
C. Politely signal the student and encourage him by actively including him in the discussion
36. Which one of the following types of wound is NOT suitable for negative pressure wound
therapy?
A. Partial thickness burns
B. Contaminated wounds
C. Diabetic and neuropathic ulcers
D. Traumatic wounds
37. How long does the ‘inflammatory phase’ of wound healing typically last?
A. 24 hours
B. Just minutes
C. 1-5 days
D. 3-24 days
CBT MOCK SETCARE
PERIOPERATIVE 4
38. Which of the following methods of wound closure is most suitable for a good cosmetic
result following surgery?
A. Skin clips
B. Tissue adhesive
C. Adhesive skin closure strips
D. Interrupted suture
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?
A. Negative pressure dressing
B. Rapid capillary dressing
C. Alginate dressing
D. Skin barrier product
40. What are the four stages of wound healing in the order they take place?
A. Proliferative phase, inflammation phase, remodelling phase, maturation phase.
B. Haemostasis, inflammation phase, proliferation phase, maturation phase
C. Inflammatory phase, dynamic stage, neutrophil phase, maturation phase.
D. Haemostasis, proliferation phase, inflammation phase, remodelling phasesupport
41. How soon after surgery is the patient expected to pass urine?
A. 1-2 hours
B. 2-4 hours
C. 4-6 hours
D. 6-8 hours
42. What functions should a dressing fulfil for effective wound healing?
A. High humidity, insulation, gaseous exchange, absorbent.
B. Anaerobic, impermeable, conformable, low humidity
C. Insulation, low humidity, sterile, high adherence.
D. Absorbent, low adherence, anaerobic, high humidity
CBT MOCK SETCARE
PERIOPERATIVE 4
43. When would it be beneficial to use a wound care plan?
A. On all chronic wounds
B. On all infected wounds.
C. On all complex wounds.
D. On every wound
44. How would you care for a patient with a necrotic wound?
A. Systemic antibiotic therapy and apply a dry dressing
B. Debride and apply a hydrogel dressing.
C. Debride and apply an antimicrobial dressing.
D. Apply a negative pressure dressing.
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?
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
46. When a patient is being monitored in the PACU, how frequently should blood pressure,
pulse and respiratory rate be recorded?
A. Every 5 minutes
B. Every 15 minutes
C. Once an hour
D. Continuously
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).
CBT MOCK SETCARE
PERIOPERATIVE 4
48. Why are anti-embolic stockings an effective means of reducing the potential of developing a
deep vein thrombosis?
A. They promote arterial blood flow.
B. They promote venous blood flow.
C. They reduce the risk of postoperative swelling.
D. 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?
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
50. Who should mark the skin with an indelible pen ahead of surgery?
A. The nurse should mark the skin in consultation with the patient
B. A senior nurse should be asked to mark the patient's skin
C. The surgeon should mark the skin
D. It is best not to mark the patient's skin for fear of distressing the patient.
51. What serious condition is a possibility for patients positioned in the Lloyd Davies position
during surgery?
A. Stroke
B. Cardiac arrest
C. Compartment syndrome
D. There are no drawbacks to the Lloyd Davies position
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
A. Her name and address, the date of the prescription and dose.
B. Her name, date of birth, the ward, consultant, the dose and route, and that it is due at
12.00.
C. 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
D. 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?
A. Identifies patients at risk of deterioration.
B. Identifies potentialrespiratory distress.
C. Improves communication between nursing staff and doctors.
D. Assesses the impact of pre existing conditions on postoperative recovery.
54. Why is it important that patients are effectively fasted prior to surgery?
A. To reduce the risk of vomiting.
B. To reduce the risk of reflux and inhalation of gastric contents.
C. To prevent vomiting and chest infections.
D. To prevent the patient gagging
55. 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 providinginformation,
both verbally and with written material, relating to the planned procedure, for them to
read on the day of planned surgery.
CBT MOCK SETCARE
PERIOPERATIVE 4
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.
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?
A. 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.
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 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?
A. Check to see if the patient has become tolerant to the medication so it is no longer
effective as analgesia.
B. Check to see whether the patient has become addicted.
C. 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.
D. Check the stock of oral morphine sulphate in the CD cupboard with another registered
nurse and record this in the control drug book; then ask the patient to prove their identity
to you
CBT MOCK SETCARE
PERIOPERATIVE 4
58. As a newly qualified nurse, what would you do if a patient vomits when taking or
immediately after taking tablets?
A. 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.
B. 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.
C. 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
D. 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?
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
60. What are the key reasons for administering medications to patients?
A. To provide relief from specific symptoms, for example pain, and managing side effects as
well as therapeutic purposes.
B. 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
C. As part of the treatment of long term diseases, for example heart failure, and the
prevention of diseases such as asthma.
D. To treat acute illness, for example antibiotic therapy for a chest infection, and side effects
such as nausea.
CBT MOCK SETCARE
PERIOPERATIVE 4
61. What are the most common types of medication error?
A. Nurses being interrupted when completing their drug rounds, different drugs being
packaged similarly and stored in the same place and calculation errors.
B. Unsafe handling and poor aseptic technique.
C. Doctors not prescribing correctly and poor communication with the multidisciplinary
team.
D. Administration of the wrong drug, in the wrong amount to the wrong patient, via the
wrong route
62. A patient has collapsed with an anaphylactic reaction. What symptoms would you expect to
see?
A. The patient will have a low blood pressure (hypotensive) and will have a fast heart rate
(tachycardia) usually associated with skin and mucosal changes.
B. The patient will have a high blood pressure (hypertensive) and will have a fast heart rate
(tachycardia).
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
63. What arethe potential benefits of self-administration of medicines by patients?

A. Nurses have more time for other aspects of patient care and it therefore reduces length
of stay.
B. 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.
C. Reduces the risk of medication errors, because patients are in charge of their own
medication.D
D. Creates more space in the treatment room, so there are fewer medication errors
CBT MOCK SETCARE
PERIOPERATIVE 4
64. What is the most accurate method of calculating a respiratory rate?
A. Counting the number of respiratory cycles in 15 seconds and multiplying by 4.
B. Counting the number of respiratory cycles in 1 minute. One cycle is equal to the complete
rise and fall of the patient's chest.
C. Not telling the patient as this may make them conscious of their breathing pattern and
influence the accuracy of the rate.
D. 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?
A. Sit her upright, listen to her chest and refer to the chest physiotherapist.
B. Suggest that the patient takes her Ventolin inhaler and continue to monitor the patient.
C. Undertake a full set of observations to include oxygen saturations and respiratory rate.
Administer humidified oxygen, bronchodilators, corticosteroids and antimicrobial therapy
as prescribed
D. 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. Amplitude, volume and irregularities cannot be detectedusing automated electronic
methods
B. Tachycardia cannot be detected using automated electronic methods
C. Bradycardia cannot be detected using automated electronic methods
D. It is more reassuring to the patient
CBT MOCK SETCARE
PERIOPERATIVE 4
67. What are the professional responsibilities of the qualified nurse in medicines management?
A. 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.
B. 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.
C. Making sure they know the names, actions, doses and side effects of all the medications
used in their area of clinical practice.
D. To liaise closely with pharmacy so that their knowledge is kept up to date
68. When would an orthostatic blood pressure measurement be indicated?

A. If the patient has a recent history of falls.
B. If the patient has a history of dizziness or syncope on changing position.
C. If the patient has a history of hypertension.
D. If the patient has a history of hypotension.
69. What do the adverse effects of hypotension include?

A. Decreased conscious level, reduced blood flow to vital organs and renal failure.
B. The patient could become confused and not know who they are.
C. Decreased conscious level, oliguria and reduced coronary blood flow.
D. The patient feeling very cold
70. What are the contraindications for the use of the blood glucose meter for blood glucose
monitoring?
A. The patient has a needle phobia andprefers to have a urinalysis.
B. If the patient is in a critical care setting, staff will send venous samples to the laboratory
for verification of blood glucose level.
C. If the machine hasn't been calibrated
D. 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.
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
A. Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS)
and document clearly.
B. This is a medical emergency. Basic airway, breathing and circulation should be attended to
urgently and senior help should be sought.
C. Refer to the neurology team.
D. 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.
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?
A. Inadvertent puncture of the pleura, a blood vessel or bileduct
B. Inadvertent puncture of the heart, oesophagus or spleen.
C. Cardiac arrest requiring resuscitation.
D. Inadvertent puncture of the kidney and cardiac arrest
73. When should adult patients in acute hospital settings have observations taken?
A. 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.
B. When they are admitted and then once daily unless they deteriorate.
C. As indicated by the doctor.
D. Temperature should be taken daily, respirations at night, pulse and blood pressure 4
hourly.
CBT MOCK SETCARE
PERIOPERATIVE 4
74. Whyare physiological scoring systems or early warning scoring systems used in clinical
practice?
A. They help the nursing staff to accurately predict patient dependency on a shift by shift
basis.
B. The system provides an early accurate predictor of deterioration by identifying
physiological criteria that alert the nursing staff to a patient at risk.
C. These scoring systems are carried out as part of a national audit so we know how sick
patients are in the United Kingdom.
D. They enable nurses to call for assistance from the outreach team or the doctors via an
electronic communication system.
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?
B. Ask the 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.
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?
A. Eat and drink as soon as sedation has worn off.
B. Drink 500 mL of fluid immediately to flush out any gas retained in the abdomen.
C. Have half hourly blood pressure performed for 12 hours.
D. Be nursed flat and kept in bed for 12 hours.
77. How do you ensure the correct blood to culture ratio when obtaining a blood culture
specimen from an adult patient?
A. Collect at least 10 mL of blood.
B. Collect at least 5 mL of blood.
C. Collect blood until the specimen bottle stops filling.
D. Collect as much blood as the vein will give you
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
A. Inoculate the aerobic culture first
B. Take the other blood tests first.
C. Inoculate the anaerobic culture first.
D. The order does not matter as long as the bottles are clean
79. Which of the following would indicate an infection?

A. Hot, sweaty, a temperature of36.5°C, and bradycardic
B. Temperature of 38.5°C, shivering, tachycardia and hypertensive.
C. Raised WBC, elevated blood glucose and temperature of 36.0°C.
D. Hypotensive, cold and clammy, and bradycardic
80. Which of the following techniques is advisable when obtaining a urine specimen in order to
minimize the contamination of a specimen?
A. Clean around the urethral meatus prior to sample collectionand get a midstream/clean
catch urine specimen.
B. 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.
C. Do not clean the urethral meatus as we want these bacteria to analyse as well.
D. Dip the urinalysis strip into the urine in a bedpan mixed with stool
81. If a patient is experiencing dysphagia, which of the following investigations are they likely to
have?
A. Colonoscopy
B. Gastroscopy
C. Cystoscopy
D. Arthroscopy
CBT MOCK SETCARE
PERIOPERATIVE 4
82. Which of the following can a patient not have if they have a pacemaker in situ?
A. MRI
B. X ray
C. Barium swallow
D. CT
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?
A. 2
B. 4
C. 6
D. 8
84. Which of the following is NOT a cause of Type 1 (hypoxaemic) respiratory failure?
A. Asthma
B. Pulmonary oedema
C. Drug overdose
D. Granulomatous lung disease
85. Prior to sending a patient home on oxygen, healthcare providers must ensure the patient
and family understand the dangers of smoking in an 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?
A. It is especially dangerous to the patient's health to smoke while using oxygen
B. Oxygen is highly flammable and there is a risk of fire
C. Oxygen and cigarette smoke can combine to produce a poisonous mixture
D. Oxygen can lead to an increased consumption of cigarette
86. What action would you take if a specimen had a biohazard sticker on it?
A. Double bag it, in a self-sealing bag, and wear gloves ifhandling the specimen.
B. Wear gloves if handling the specimen, ring ahead and tell the laboratory the sample is on
its way.
C. Wear goggles and underfill the sample bottle.
D. Wear appropriate PPE and overfill the bottle.
CBT MOCK SETCARE
PERIOPERATIVE 4
87. What isthe best way to avoid a haematoma forming when undertaking venepuncture?
A. Tap the vein hard which will ‘get the vein up’, especially if the patient has fragile veins.
This will avoid bruising afterwards.
B. It is unavoidable and an acceptable consequence of the procedure. This should be
explained and documented in the patient's notes.
C. 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.
D. 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?
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 with 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 ofboth ventilation and oxygenation
89. When using nasal cannulae, the maximum oxygen flow rate that should be used is 6
litres/min. Why?
A. Nasal cannulae are only capable of delivering an inspired oxygen concentration between
24% and 40%
B. 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.
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
CBT MOCK SETCARE
PERIOPERATIVE 4
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?
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

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
92. Which of the following is NOT a symptom of impacted earwax?

A.Dizziness
B.Dull hearing
C.Reflux cough
D.Sneezing
93. After death, who can legally give permission for a patient's body to be donated to medical
science?
A.Only the patient, if they left instructions for this
B.The patient's spouse or next-of-kin
C.The patient's GP
D.The doctor in charge at the time of death
CBT MOCK SETCARE
PERIOPERATIVE 4
94. 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
95. 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
96. 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
97. 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 reliefwith 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
CBT MOCK SETCARE
PERIOPERATIVE 4
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.
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
99. 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.
100. 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
2.C
3.A→http://www.bcpft.nhs.uk/documents/policies/i/875-infection-prevention-and-control-
assurance-sop-1-standard-infection-prevention-and-control-
precautions/filehttp://www.wales.nhs.uk/sites3/Documents/739/RCN%20infection%20co
ntrol.doc.pdf
4.C
5.A→http://revalidation.nmc.org.uk/what-you-need-to-do/continuing-professional-
development
7.A→See “Medicine Management” Royal Marsden Manual
8.A
9.C→https://www.nspcc.org.uk/preventing-abuse/safeguarding/
12.A
13.B
15.D→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562949/
16.A→(convertion:0.25Lx1000ml=250ml)
12.5g/250ml x 100 = 5%
17.A↓
(standard giving set: 20gtt)
(convertion: 1 liter = 1000 ml)
1000ml/4 hours = 250ml/hr
250ml per hr / 60 mins x 20gtt = 83.33 or 83
18.D→https://www.nmc.org.uk/standards/safeguarding/
19.A→https://www.nmc.org.uk/standards/safeguarding/
21.C
22.E
23.B→http://www.nhsemployers.org/~/media/Employers/Documents/Retain%20and%20impro
ve/Needlestick20injury.pdf
24.A
25.D
26.A
27.B
29.B
30.C
31.C
32.B
33.B
34.A
35.C
36.B
37.C
38.B
39.B
40.B
43.D
46.A
47.C
48.B
52.C→See “Medicine Management” Royal Marsden Manual
53.A→https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963767/
54.B
55.D
56.D
57.C
See “NMC Standards for Medicine Management”
58.B
See “Medicine Managemet” Royal Marsden Manual
59.D
60.B
61.D
62.C
https://www.nhs.uk/conditions/anaphylaxis/
63.B
See “Medicines Management” Royal Marsden Manual
64.B
See “Observations” Royal Marsden Manual
65.C
See “Respiratory Care” Royal Marsden Manual
66.A
67.B
See “NMC Standards in Medicine Management”
68.B
See “Moving and Positioning” Royal Marsden Manual
69.C
70.D→See “ Interpreting Diagnostic Tests” Royal Marsden Manual
71.B
72.
73.A
74.B→https://www.england.nhs.uk/nationalearlywarningscore/
76.A→https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/colo
noscopy_92,P07693
77.A→See “ Interpreting Diagnostic Tests” Royal Marsden Manual
79.B
82.A→See “ Interpreting Diagnostic Tests” Royal Marsden Manual
83.B→See “Respiratory Care” Royal Marsden Manual
84.C→See “Respiratory Care” Royal Marsden Manual
85.B→See “Respiratory Care” Royal Marsden Manual
88.D
89.C
90.A
91.B
92.D→See “Observations” Royal Marsden Manual
94.C
95.C
96.B
97.A
98.C
99.A
100.A→https://www.rch.org.au/anaes/pain_management/Opioid_Infusion/#Observations
CBT MOCK SETCARE
PERIOPERATIVE 5
1. A patient approached you to give his medications now but you are unable to give the
medicine. What is your initial action?
A. Inform the doctor
B. Inform your team leader
C. Inform the pharmacist
D. Routinely document meds not given
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?
A. Immediate nurse manager
B. Head of the department
C. The one in charge of supplies
D. Infection Control Team
3. Tony is prescribed Lanoxin 500 mcg PO. What vital sign will you asses prior to giving the
drug?
A. heart rate and rhythm
B. respiration rate and depth
C. temperature
D. urine output
4. If Tony’s heart rate slows down, this is referred to as:

A. hypertension
B. hypotension
C. bradycardia
D. tachycardia
5. The word 'accountability' means:

A. care
B. responsibility
C. love
D. peace
CBT MOCK SETCARE
PERIOPERATIVE 5
6. When administering injection in the buttocks, it should be given: (CHOOSE 2 ANSWERS)
A. right upper quadrant
B. left upper quadrant
C. right lower quadrant
D. left lower quadrant
7. What is an indication that a suicidal patient has an impending suicide plan: (CHOOSE 2
ANSWERS)
A. She/he is cheerful and seems to have a happy disposition
B. talk or write about death, dying or suicide
C. threaten to hurt or kill themselves
D. actively look for ways to kill themselves, such as stockpiling tablets
8. Patient-centred care is best defined as:

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

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

A. Body language
B. tone of voice
C. appearance
D. eye contact
CBT MOCK SETCARE
PERIOPERATIVE 5
11. Which of the following conditions can be observed in a proper wound dressing:
A. absorbent, humid, aerated
B. non absorbent, humid, aerated
C. non humid, absorbent, aerated
D. non humid, non absorbent, aerated
12. What stage of pressure ulcer includes tissue involvement and crater formation? (CHOOSE 2
ANSWERS)
A. stage 1
B. stage 2
C. stage 3
D. stage 4
13. One of the main responsibilities of an employer should be:

A. provide a safe place for the employees
B. provide entertainment to employees
C. create opportunities for growth
D. create ways to make networks
14. Respiratory protective equipment include:

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

A. using hand gels
B. washing your hands with soap and water
C. using repellent gowns
D. limit visiting times
CBT MOCK SETCARE
PERIOPERATIVE 5
16. In case of a needle stick injury, what should the nurse do initially: (CHOOSE 2 ANSWERS)
A. encourage wound to bleed and wash with water
B. report to occupational health
C. visit Accident and Emergency for treatment
D. make an incident report
17. Which of the following agency set the standards of education, training and conduct and
performance for nurses and midwives in the UK?
A. NMC
B. DH
C. CQC
D. RCN
18. A person supervising a nursing student in the clinical area is called as:
A. mentor
B. preceptor
C. interceptor
D. supervisor
19. In supervising a student nurse perform a drug rounds, the NMC expects you to do the
following at all times:
A. supervise the entire procedure and the sign the chart
B. allow student to give drugs and sign the chart at the end of shift
C. delegate the supervision of the student to a senior nursing assistant and ask for feedback
D. allow the student to observe but not signing on the chart
20. You are a new and inexperienced staff, which of the following actions will you do during
your first day on the clinical area?
A. Acknowledge your limitations, seek supervision from your team leader
B. volunteer to do the drug rounds
C. help in admitting the patients
D. answer all enquiries from the patients
CBT MOCK SETCARE
PERIOPERATIVE 5
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?
A. Review patient intervention, set priorities, ask the supervisor to hand over extra staff
B. continue with your shift and delegate some responsibilities to the nursing assistant
C. fill out an incident form about the staffing condition
D. ask the colleague to look for someone to cover
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?
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
23. Early ambulation prevents all complications except:

A. Chest infection and lung collapse
B. Muscle wasting
C. Thrombosis
D. Surgical site infection
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?
A. Tell her to abstain from having sex because of HIV
B. Tell her to bring lots of contraceptives because it will be expensive
C. Tell her to use other methods like condom because diarrhoea lessens the effects of OCP
D. tell her to continue taking her usual contraceptives
25. You are the nurse assigned in recovery room or post anaesthetic care unit. The main priority
of care in such area is:
A. keeping airway intact
B. keeping patient pain free
C. keeping neurological condition stable
D. keeping relatives informed of patient’s condition
CBT MOCK SETCARE
PERIOPERATIVE 5
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?
A. Antibiotics causes chronic inflammation of the intestine
B. An anaphylactic reaction
C. Antibiotic alters her GI flora which made Clostridium-difficile to multiply
D. she is not taking the antibiotics with food
27. One of your young patient displayed an overt sexual behaviour directly to you. How will you
best respond to this?
A. Talk to the patient about the situation, to re- establish and maintain professional
boundaries and relationship
B. ignore the behaviour as this is part of the development process
C. report the patient to their relatives
D. inform line manager of the incident
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?
A. Stop the infusion, call for help, anaphylactic kit in reach, monitor closely
B. continue the infusion and observe further
C. check the vital signs of the patient and call the doctor
D. stop the infusion and prepare a new set of drip
29. Mr James, a patient in the community phoned you asking for advise as he is experiencing
some side effects of the medications he was given. What will be your best action on this
situation?
A. Call the doctor and wait for advice
B. Tell the patient to stop taking the drug
C. Attend to the patient and make necessary intervention for the side effect
D. ask the patient to call the emergency service/ambulance
CBT MOCK SETCARE
PERIOPERATIVE 5
30. Which of the following is the most dangerous site for IM injection?
A. Deltoid
B. Thigh
C. Abdominal area
D. Buttocks
31. In using social media like Facebook, how will you best adhere to your Code of Conduct as a
nurse? (CHOOSE 2 ANSWERS)
A. Never have relationship with previous patient
B. Never post pictures concerning your practice
C. Never tell you are a nurse
D. Always rely SOLELY in your FBs privacy setting
32. Which of the following is not a usual sign and symptom associated with depression?
A. Feeling of sadness, hopelessness
B. Anorexia
C. Increased energy
D. 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?
A. She wants to displace her experience by not taking care of herself.
B. She wants to repress her feeling to forget the accident.
C. she is depressed
D. 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. Patient with medical diagnosis
B. task oriented care
C. Individualized approach to care
D. All of the above
CBT MOCK SETCARE
PERIOPERATIVE 5
35. Which of the following best describes the Contingency Theory of Leadership? (CHOOSE 3
ANSWERS)
A. Leaders behaviour influence team members
B. Leaders grasp the whole picture and their respective roles
C. The plan is influenced by the outside force
D. The leader sees the kind of situation, the setting, and their roles
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?
A. tell other nurses to follow
B. Inform the patient about the goal
C. Discuss to her that this has a negative impact on meeting patient care and outcomes
D. disregard her method and do it your way
E.
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?
A. Confront the neighbour
B. Ignore, maybe he is very old and does not think clearly
C. Fill up a raising a concern/ safeguarding form, and escalate
D. ask patient to report neighbour to police
38. When the IV route of medicine administration is favoured against the oral route, the nurse
should consider the following reasons, except:
A. Cannot be absorbed in the alimentary tract
B. GI secretions lessens effect
C. Need immediate effect
D. There is an oral alternative
CBT MOCK SETCARE
PERIOPERATIVE 5
39. The early signs of phlebitis included:
A. redness and pain at site
B. increase in temperature
C. swelling of surrounding tissue
D. resistance when administering intravenous fluid and drug
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?
A. left side heart failure
B. right side heart failure
C. renal failure
D. liver failure
41. Mrs Red’s doctor is suspecting an aortic aneurysm after her chest x-ray. Which of the
most common type of aneurysm?
A. cerebral
B. abdominal
C. femoral
D. thoracic
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?
A. redness of soft palate and tissues surrounding the teeth
B. haemo-serous discharges around the gums
C. loosening of teeth
D. presence of pockets deep in the gums
43. Mr Bond also shared with you that his gums also bleed during brushing. Which of the
following statement will best explain this?
A. lack of vitamin C in his diet
B. he is brushing too hard
C. he is not using proper toothbrush to remove the plaque
D. he is flossing wrongly
CBT MOCK SETCARE
PERIOPERATIVE 5
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?
A. allow her to visit and use alcohol gel before contact with him
B. visit him when she feels better
C. visit him when she is symptom free after 48 hours
D. allow her to visit only during visiting times only
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?
A. 24/7 exercise programme
B. 5-a-day fruits and vegetable portions
C. low calorie diet
D. high protein diet
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?
A. 4 ml
B. 10 ml
C. 6 ml
D. 8 ml
47. The nursing process involves the following:

A. assessment, diagnosis, planning, intervention and evaluation
B. assessment, differentiation, planning, intervention, evaluation
C. assessment, planning, intervention, evaluation
D. assessment, planning, referring, evaluation
CBT MOCK SETCARE
PERIOPERATIVE 5
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?
A. tell her that any information related to her well being will need to be share to the
health care team
B. inform her parents about this so she can be advised appropriately
C. keep the information a secret in view of confidentiality
D. report her boyfriend to social services
49. 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 protect
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.
50. All individuals providing nursing care must be competent at which of the following
procedures?
A. Hand hygiene and aseptic technique
B. Aseptic technique only
C. Hand hygiene, use of protective equipment, and disposal of waste
D. Disposal of waste and use of protective equipment
E. All of the above
51. How long does proliferative phase of wound healing occur?

A. 3-24 days
B. 24-26 days
C. 1-7 days
D. 24 hours
CBT MOCK SETCARE
PERIOPERATIVE 5
52. Compassion is best described as:
A. showing empathy when delivering care
B. not answering relatives queries
C. giving patient some monies to buy unhealthy food
D. providing care without gaining consent
53. In caring for a patient, the nurse should? (CHOOSE 3 ANSWERS)

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

A. Waste that requires disposal by incineration
B. Offensive/hygiene waste
C. Waste which may be "treated"
D. Offensive waste
55. If a patient requires protective isolation, which of the following should you advise them to
drink?
A. Filtered water only
B. Fresh fruit juice and filtered water
C. Bottled water and tap water
D. Long-life fruit juice and filtered water
56. A nurse assists the physician is performing liver biopsy. After the biopsy the nurse places the
patient in which position?
A. Supine
B. Prone
C. Left-side lying
D. Right-side lying
CBT MOCK SETCARE
PERIOPERATIVE 5
57. A Registered nurse is new to the diagnosis of her patient. What is the best response of the
nurse?
A. The nurse should come early for her shift & spend more time to care for the patient
B. The nurse should spend an hour in library, learn about the new diagnosis & then take care
of the patient
C. The nurse should clarify her doubts with her senior on duty & with the doctors about the
diagnosis & plan nursing care accordingly
D. 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?
A. Tuberculosis
B. Influenza
C. Chicken pox
D. Swine flu
59. The first techniques used examining the abdomen of a client is:
A. Palpation
B. Auscultation
C. Percussion
D. Inspection
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?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
CBT MOCK SETCARE
PERIOPERATIVE 5
61. When communicating with children, what most important factor should the nurse take into
consideration?
A. Developmental level
B. Physical development
C. Non verbal cues
D. Parental involvement
62. Which of the following would be an appropriate strategy in reorienting a confused patient
to where her room is?
A. Place picture of her family on the bedside stand
B. Put her name in a large letters on her forehead
C. Remind the patient where her room is
D. Let the other residents know where the patient's room is
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:
A. Long and wordy
B. Loosely related to the questions
C. Rational and logical
D. Simplistic, short and incomplete
64. A nurse delegates duties to a health assistant, what NMC standard she should keep in mind
while doing this?
A. She transfers the accountability to care assistant
B. RN is accountable for care assistants actions
C. No need to assess the competency, as the care assistant is expert in her care area
D. Healthcare assistant is accountable to only her senior
CBT MOCK SETCARE
PERIOPERATIVE 5
65. Which of the following approaches creates a barrier to communication?
A. Using to many different skills during a single interaction
B. Giving advise rather than encouraging the patient to problem solve
C. Allowing the patient to become too anxious before changing the subject
D. Focusing on what the patient is saying rather than on the skill used
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?
A. Ignore the client and let her cry in the hallway
B. Inform the client about the preparing to come forth next appointment for further
discussion on the treatment planned
C. Take her to a room and try to understand her worries and do the needful and assist her
with further information if required
D. 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:

A. Receiving encouragement and support from co-workers to cope with the many stressors
of the nursing role
B. Becoming an effective change agent in the community
C. An increased understanding of the family dynamics that affect the client
D. 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. 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
B. Never attend that patient
C. Try to re-establish the therapeutic communication and relationship with patient and
inform the manager for support
D. Inform police
CBT MOCK SETCARE
PERIOPERATIVE 5
69. Communication is not the message that was intended but rather the message that was
received. The statement that best helps explain this is
A. Clean communication can ensure the client will receive the message intended
B. Sincerity in communication is the responsibility of the sender and the receiver
C. Attention to personal space can minimize misinterpretation of communication
D. 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?
A. Using a translator
B. Use short, precise sentences
C. Relying on their family or friends to help explain what you mean
D. Write things down
71. Which of the following is NOT an example of non-verbal communication?

A. Dress
B. Facial expression
C. Posture
D. Tone
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:
A. Rejection
B. Overload
C. Disqualification
D. Hostility
CBT MOCK SETCARE
PERIOPERATIVE 5
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:
A. Denial
B. Repression
C. Suppression
D. Displacement
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?
A. Stay quiet and remain with the doctor
B. Interrupt the doctor and ask the child the questions
C. 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
D. Make the child quiet & ask his mother to stay with him
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?
A. Do not reveal your profession of being a Nurse on social site
B. Do not post any pictures of client's even if they have given you permission
C. Do not involve in any conversions with client's or their relatives through a social site
D. Keep your profile private
76. According to NMC Standards code and conduct, a registered nurse is EXCLUDED from legal
action in which one of these?
A. Fixed penalty for speeding
B. Possessing stock medications
C. Convicted for fraud
D. Convicted for theft
CBT MOCK SETCARE
PERIOPERATIVE 5
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 procedure, which of the following is the best action?
A. Call the police to identify the client and locate the family
B. Obtain a court order for the surgical procedure
C. Ask the emergency medical services team to sign the informed consent
D. 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?
A. It is subjective perspective of the person's heritage and sense of belonging to a group
B. It is a group of individuals in a society that is culturally distinc and has a unique identity
C. It is a process of learning, a different culture to a dapt to a new or change in environment
D. 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?
A. "It is a tendency to view one's own ways as best"
B. "You need to ask your physician about it"
C. "I would try anything that I could if I had cancer"
D. "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?
A. Deliver the food tray to the client
B. Call the dietary department and ask for a new meal tray
C. Replace the whole milk with fat free milk
D. Ask the dietary department to replace the roast beef with pork
CBT MOCK SETCARE
PERIOPERATIVE 5
81. When would an orthostatic blood pressure measurement be indicated?
A. If the patient has a recent history of falls
B. If the patient has a history of dizziness or syncope on changing position
C. If the patient has a history of hypertension
D. 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?
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 & start documenting in the correct record
C. She should put a straight cut over her documentation & write as wrong, sign it with her
NMC code, date & time
D. She should write as wrong documentation in a bracket & continue
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:
A. 25 hrs
B. 35 hrs
C. 55 hrs
D. 45 hrs
84. How to give respect & dignity to the client?

A. Compassion, support & reassurance to the client
B. Communicate effectively with them
C. Behaving in a professional manner
D. Giving advice on health care issues
CBT MOCK SETCARE
PERIOPERATIVE 5
85. Which of the step is NOT involved in Tuckman's group formation theory
A. Accepting
B. Norming
C. Storming
D. Forming
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?
A. Assume it is emergency surgery & the consent is implied
B. Get the consent form & have the client sign it
C. Tell the physician that the consent form is not signed
D. Have a family member sign the consent form
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?
A. Accept the client's decision and give information on the consequences of his actions
B. Let the family decide
C. Administer the blood product against the patients decision
D. The doctor will decide
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?
A. Tell the client that herbal substances are not safe & 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
CBT MOCK SETCARE
PERIOPERATIVE 5
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:
A. The police shows his identification
B. The police officer has the right to such information
C. There is a clear risk of safety and potential harm to the public
D. The hospital manager authorized to give the information
90. When communicating with the a client who speaks a different language, which best
practice should the nurse implement?
A. Speak loudly & slowly
B. Arrange for an interpreter to translate
C. Speak to the client & family together
D. Stand close to the client & speak loudly
91. The code is the foundation of

A. Dress code
B. Personal document
C. Good nursing & midwifery practice & a key tool in safeguarding the health & well
being of the public
D. Hospital administration
92. According to the nursing code of ethics, the nurse's first allegiance is to the:
A. Client and client's family
B. Client only
C. Healthcare organization
D. Physician
CBT MOCK SETCARE
PERIOPERATIVE 5
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. A client with a cast for a fractured femur & who has numbness & discoloration of the
toes
B. A client with balanced skeletal traction & who needs assistance with morning care
C. A client who had an above-the-knee amputation yesterday & has a temperature of
101.4F
D. 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
A. Role modeling behaviors of the preceptor
B. The philosophy of the new nurse's school of nursing
C. The orientation provided to the new nurse
D. Lack of trust in the team members
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?
A.Practical Nurse
B.Registered Nurse
C.Nursing assistant
D.Volunteer
96. An RN from the women's health clinic is temporarily reassigned to a medical-surgical unit.
Which of these client assignments would be most appropriate for this nurse?
A.A newly diagnosed client with type 2 diabetes mellitus who is learning foot care
B.A client from a motor vehicle accident with an external fixation device on the leg
C.A client admitted for a barium swallow after a transient ischemic attack
D.A newly admitted client with a diagnosis of pancreatic cancer
CBT MOCK SETCARE
PERIOPERATIVE 5
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?
A.50 ml
B.150 ml
C.200 ml
D.300 ml
98. An infusion of 24 mg of Inj. Furosemide is ordered for 12 hrs. How much dose is infused in
an hour?
A.4 mg/hr
B.2 mg/hr
C.3 mg/hr
D.1 mg/hr
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
A.1887 (Negative Balance)
B.1197 (Negative Balance)
C.1887 (Positive Balance)
D.1197 (Positive Balance)
100. Which of the following is the most common aneurysm site?

A.Hepatic Artery
B.Abdominal aorta
C.Renal arch
D.Circle of Wills
1.D→See “NMC Standards for Medicine Management”
3.A→https://www.rxlist.com/lanoxin-tablets-drug.htm
4.C
6.A,B→See “Medicine Management” Royal Marsden Manual
7.A,D→See “ Patient Comfort And End Of Life Care” Royal Marsden Manual
8.C→https://rcni.com/hosted-content/rcn/first-steps/what-person-centred-care-means
12.B,C→See “Wound Management” Royal Marsden Manual
13.A→http://www.nhsemployers.org/your-workforce/retain-and-improve/managing-your-
workforce/supporting-the-armed-forces-in-the-nhs/employers-roles-and-responsibilities
14.B→See “Infection Control” Royal Marsden Manual
15.B,C
16.A,D→See “Infection Control” Royal Marsden Manual
17.A→See “NMC Code”
18.A
21.A
24.C→See “NMC Standards in Medicine Management”
25.A →See “Perioperative Care” Royal Marsden Manual
26.C→See “Elimination” Royal Marsden Manual
27.A,D→See “NMC Code”
28.A →See “NMC Standards for Medicine Management”
29.A
30.C
31.A,B→https://www.nmc.org.uk/standards/guidance/social-media-guidance/
32.C
34.C→http://www.cmft.nhs.uk/directorates/mentor/documents/Assessingplanningimplementi
ngandevaluatingcare_001.pdf
35.A,B,D→http://www.callofthewild.co.uk/library/theory/contingency-model-of-leadership/
36.C
37.C→https://www.nmc.org.uk/standards/safeguarding/
38.D
39.A,B,C
40.B→https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-
20373142
41.B
42.A
43.B
44.C
45.B
46.A→10mg / 5mg x 2 ml = 4ml
47.A
50.E
51.A
52.A
53.A,B,C
54.C
55.D
56.D→See “Moving and Positioning” Royal Marsden Manual
58.D
59.D→See “Assessment and Discharge” Royal Marsden Manual
60.A→See “Assessment and Discharge” Royal Marsden Manual
63.B→See “Communication” Royal Marsden Manual
67.A→See “Communication” Royal Marsden Manua
68.C→See “Communication” Royal Marsden Manua
69.D→See “Communication” Royal Marsden Manua
71.D
74.C→See “Communication” Royal Marsden Manua
75.A
81.B
82.C
83.B
85.A
88.C
89.C
92.B→http://www.hopeassociation.org/home/ethical-principles/
97.C→Convert: half hour (30mins) to hour 30mins/60mins = 0.5
100 ml / 0.5 hours = 200 ml
98.B→24mg / 12 hrs = 2mg/hr
99.C
100.B
POINTERS FROM RECENT
PERIOPERATIVE PASSERS
CARE
We have included the links/rationale to the answers, but you don’t have to check everything.
Just browse on these, and study those that you are not familiar with.
At least be prepared for more computation questions. More or less 20 items. Practice manual
computation. Good thing, we have 50 items in this Ebook for practice. 
Normal range of blood ph

7.35 to 7.45
http://www.southend.nhs.uk/pathology-handbook/test-directory/test-directory-b-index/blood-
gases/
Central venous pressure (CVP)

The normal range for CVP is 5-10cm H2O (2-6mmHg) when taken from the mid-axillary line
at the fourth intercostal space.
http://www.cetl.org.uk/learning/print/cvp-print.pdf
PGD (patient group directions)

Scope and who can use them
https://www.nice.org.uk/guidance/mpg2
Transcribing medicines: read “Standards of Medicine Management” start on Page 18

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-
medicines-management.pdf
Breastfeeding merits
https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx
Symptoms of chronic renal failure https://www.nhs.uk/conditions/kidney-

disease/symptoms/#later-stages-of-ckd
CARE
Hepatitis A, general knowledge
https://www.nhs.uk/conditions/hepatitis-a/
Patient education for measuring blood sugar

https://www.diabetes.co.uk/blood-glucose/how-to-test-blood-glucose-levels.html
Assumption is against which nursing code?

PRIORITISE PEOPLE
https://www.nmc.org.uk/standards/code/read-the-code-online/
How to tell patient's death to their family

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124925/
Travel diarrhoea, advice to the patients

http://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/travellers-diarrhoea.aspx
Confidentiality situational questions

CONFIDENTIALITY: NHS CODE OF PRACTICE
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confi
dentiality_-_NHS_Code_of_Practice.pdf
Wound dressing
http://www.wounds-uk.com/made-easy/postoperative-incision-management&print
Radiotherapy skin care

http://www.cancerresearchuk.org/about-cancer/cancer-in-
general/treatment/radiotherapy/side-effects/general-radiotherapy/skin
Neutropenia general knowledge

Neutrophils are a type of white blood cell. White blood cells are particularly important
in fighting infections.
https://www.lymphomas.org.uk/about-lymphoma/treatment-lymphoma/side-effects-
lymphoma-treatment/neutropenia-and-risk-infection#neutrophils-function
CARE
Delegation, situational questions
The NMC code says registrants must be accountable for their decisions to delegate tasks and
duties to other people.
Read page 10 of NMC Code
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
Advocacy for people with mental disorder and dementia

https://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/advocacy-services.aspx
If the family bring the food for the patients in hospital?

On arrival at the ward all food gifts should be declared. An appropriately trained nurse will
check to see if the food is suitable for the patient and check containers and labelling.
All packaging must be intact with the use by or best before date not exceeded. Only food that
has been sealed by the manufacturer using heat seals, tamperproof lids and bottle tops
will be allowed. Home produced items and goods sealed only with a sticker will not be
allowed
http://www.uhbristol.nhs.uk/patients-and-visitors/preparing-to-come-to-hospital/bringing-
food-into-hospital/
Physical symptoms from stress

headaches
muscle tension or pain
dizziness
sleep problems
feeling tired all the time
eating too much or too little
https://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/understanding-stress.aspx
Minor symptoms of pregnant women

https://www.nhs.uk/conditions/pregnancy-and-baby/pages/signs-and-symptoms-
pregnancy.aspx
CARE
How to treat kids in anaphylactic shock
https://www.nhs.uk/conditions/anaphylaxis/
https://www.nhs.uk/conditions/first-aid/recovery-position/
Role of translational nurse

https://www.ecmcnetwork.org.uk/sites/default/files/InnovativeRolesCambridge_presentation.
pdf
Arrhythmia and Defibrillation

https://www.nhs.uk/conditions/arrhythmia/
https://www.bhf.org.uk/heart-health/how-to-save-a-life/defibrillators
Entonox, how long in advance do they start for a good effect

If you are taking good, controlled breaths, the Entonox starts to work very quickly, usually
within 20 seconds to two minutes. The effects only last for about 2 to 5 minutes after you
have stopped breathing it in.
http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/entonox-ward-
administration#Rationale
Tilting patients with hypotension after operation

Tilt-table testing for orthostatic hypotension[1]:
Passive tilt-testing to an angle between 60° and 80° for three minutes is recommended for the
diagnosis of orthostatic hypotension.
The test is considered positive if systolic BP falls below 20 mm Hg and diastolic BP below 10
mm Hg of baseline.
If symptoms occur, the patient should be tilted back to the supine position immediately.
https://patient.info/doctor/hypotension
SpO2 normal range

in adults less than 70 years of age when awake at rest and at sea level: 96% - 98%
https://gpnotebook.co.uk/simplepage.cfm?ID=x20121011164224605084
CARE
Anemia symptoms
The most common symptoms include:
tiredness and lack of energy (lethargy)
shortness of breath
noticeable heartbeats (heart palpitations)
a pale complexion
https://www.nhs.uk/conditions/iron-deficiency-anaemia/
Sickle-cell disease management
The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders.
People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in
their red bloodcells. Hemoglobin is a protein in red blood cells that carries oxygen
throughout the body.
https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease
Source isolation clinical setting

http://www.rdehospital.nhs.uk/docs/patients/services/infection_control/source-isolation-
policy.pdf
Compensated shock symptoms

With compensated shock, the body is experiencing a state of low blood volume but is still able
to maintain blood pressure and organ perfusion by increasing the heart rate and
constricting the blood vessels. If responding to an emergency in which shock is suspected,
a quick assessment of the patient should be completed to measure the level of
consciousness, mental state and vital signs.
https://www.ems1.com/airway-management/articles/150652048-Compensated-vs-
decompensated-shock-what-you-need-to-know/
Asystole
Asystole refers to the absence of heartbeat in the absence of electrical activity from the
heart; ie a flat ECG with no pulse.
https://www.gpnotebook.co.uk/simplepage.cfm?ID=832176155
CARE
Rotavirus
Rotavirus causes gastroenteritis. The symptoms include severe watery diarrhoea, usually
with vomiting, fever, and stomach cramps.
https://www.gov.uk/government/collections/rotavirus-guidance-data-and-analysis
Cardiac Failure
Heart failure means that the heart is unable to pump blood around the body properly.
https://www.nhs.uk/conditions/heart-failure/
Chronic Renal Failure Signs

Symptoms can include:
weight loss and poor appetite.
swollen ankles, feet or hands – as a result of water retention (oedema)
shortness of breath.
tiredness.
blood in your urine.
an increased need to pee – particularly at night.
difficulty sleeping (insomnia)
itchy skin.
https://www.nhs.uk/conditions/kidney-disease/symptoms/
Septic Shock Signs

Septic shock is a life-threatening condition that happens when blood pressure drops to a
dangerously low level after an infection.
https://www.nhs.uk/conditions/septic-shock/#symptoms-of-septic-shock
CARE
Supplemental Prescribing
Supplementary prescribing (SP) represents a recent development in non-medical prescribing in
the UK, involving a tripartite agreement between independent medical prescriber,
dependent prescriber and patient, enabling the dependent prescriber to prescribe in
accordance with a patient-specific clinical management plan (CMP).
http://www.sciencedirect.com/science/article/pii/S0168851007001789
Adrenaline/Noradrenaline
Noradrenaline and adrenaline are catecholamines.
Catecholamines affect cardiovascular functions by actions at adrenoceptors on cardiovascular
cells, in the nervous system, and in the kidneys.
Norepinephrine causes vasoconstriction (a narrowing of the blood vessels) so is useful for
maintaining blood pressure and increasing it in times of acute stress.
In medicine, norepinephrine is used to increase or maintain blood pressure during acute
medical situations that cause low blood pressure and epinephrine is used in the
emergency treatment of allergic reactions, to treat low blood pressure during septic
shock, and in eye surgery to maintain dilation of the pupil.
http://www.els.net/WileyCDA/ElsArticle/refId-a0001401.html
Tissue viability nurse

Primarily considers all aspects of skin and soft tissue wounds, including acute surgical
wounds, pressure ulcers and all forms of leg ulceration (Tissue Viability Society, 2014).
However, tissue viability nurses (TVNs) have a multifaceted role, which has developed
differently in each region to reflect local requirements.
http://www.wounds-uk.com/pdf/content_11514.pdf
COPD
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions
that cause breathing difficulties.
https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/
===END===

CBT Reveiw 2018

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CBT Reveiw 2018

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2018

 500 UPDATED CBT MOCK QUESTIONS

NURSING COMPUTATION GUIDE

UPDATED COMPLETE ESSENTIAL SUMMARIES

UPDATED STUDY GUIDE

MUST HAVE POINTERS FROM RECENT PASSERS

“See if you can score at least 70 out of 100 to

COMPLETE ESSENTIAL SUMMARIES FROM

Part One – Managing The Patient Journey

Part Two – Supporting The Patient With Human Functioning

Part Three – Supporting The Patient Through The Diagnostic Process

Part Four - Supporting The Patient Through Treatment

NURSING COMPUTATION GUIDE-------------------------------------------------------------------------105-112

MOCK QUESTIONS – GAUGE YOUR PASSING RATE

CBT MOCK SET 1----------------------------------------------------------------------------------------------122-142

POINTERS FROM RECENT PASSERS-----------------------------------------------------------------------256-262

Congratulations on passing the IELTS or OET 

You are now a step closer to becoming a UKRN!

Best regards and enjoy reviewing. Rooting for your success! 

WHAT IS CBT (Computer Based Test)?

HOW TO REGISTER FOR CBT?

• Step 4: Make an account

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

ABOUT THE EXAM:

Here are the steps:

*What’s important to pass the CBT is to base your

Have a pre-test: Visit http://www.royalmarsdenmanual.com/student and answer the

ON THE DAY OF THE EXAM

NMC Standards for Medication Management

Infection control – See Royal Marsden Manual

It is divided into four domains:

PROFESSIONAL STANDARDS OF PRACTICE AND BEHAVIOUR FOR NURSES AND MIDWIVES

“I. Prioritise people”

1 Treat people as individuals and uphold their dignity

2 Listen to people and respond to their preferences and concerns

4 Act in the best interests of people at all times

5 Respect people’s right to privacy and confidentiality

“II. Practise effectively”

6 Always practise in line with the best available evidence

10 Keep clear and accurate records relevant to your practice

11 Be accountable for your decisions to delegate tasks and duties to other

12 Have in place an indemnity arrangement which provides appropriate cover

“III. Preserve safety”

13 Recognise and work within the limits of your competence

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

“IV. Promote professionalism and trust”

20 Uphold the reputation of your profession at all times

21 Uphold your position as a registered nurse or midwife

22 Fulfil all registration requirements

23 Cooperate with all investigations and audits

24 Respond to any complaints made against you professionally

The 6 Fundamental Values

Commitment - A commitment to our patients and populations is a cornerstone of what we do.

Communication - Communication is central to successful caring relationships and to effective

Domain 1: Professional Values

•Works within the legal framework when seeking consent

Competency 2. All nurses must practice in a holistic, non-judgemental, caring and

Practice Infection Prevention and Control *E*

Domain 2: Communication and Interpersonal Skills

Domain 3: Nursing Practice and Decision Making

•Demonstrates clinical confidence

Competency 3. All nurses must carry out comprehensive, systematic nursing

•Acts autonomously and appropriately when faced with sudden determination

•Different types of prescribing

Practice Infection Prevention and Control E