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Test of Competence part One (CBT) Practice Questions compiled by Ali Jones 2016 Question 1 What are the steps of the nursing Process? A. Assessing, diagnosing, planning, implementing, and evaluating B. Assessing, planning, implementing, evaluating, documenting C. Assessing, observing, diagnosing, planning, evaluating D. Assessing, reacting, implementing, planning, evaluating Question 1 Answer A. Assessing, diagnosing, planning, implementing, and evaluating B. Assessing, planning, implementing, evaluating, documenting C. Assessing, observing, diagnosing, planning, evaluating D. Assessing, reacting, implementing, planning, evaluating The correct answer is A. Assessing, diagnosing, planning, implementing & evaluating. www.nursing process.org (2016) Nursing standard. June 25. Vol28 no.43 2014 Question 2 What is clinical benchmarking? A. The practice of being humble enough to admit that someone else is better at something and being wise enough to try to learn how to match and even surpass them at it. B. A systematic process in which current practice and care are compared to, and amended to attain, best practice and care C. A system that provides a structured approach for realistic and supportive practice development D. All of the above Question 2 Answer What is clinical benchmarking? A. The practice of being humble enough to admit that someone else is better at something and being wise enough to try to learn how to match and even surpass them at it. B. A systematic process in which current practice and care are compared to, and amended to attain, best practice and care C. A system that provides a structured approach for realistic and supportive practice development D. All of the above The correct answer is D. All of the above. Essence of care- Gov.uK 2010 https://www.gov.uk/government/uploads/system/...data/.../dh_119978.pdf Question 3 What is nocturia? A. Urinary frequency B. Urination at night C. Poor urine output D. Non passage of urine Question 3 Answer What is nocturia? A. B. C. D. Urinary frequency Urination at night Poor urine output Non passage of urine Nocturia is urination at night. It often increases with age. It is normal to get up twice a night from the age of 70 onwards, but more frequent visits to the toilet may indicate a problem that can be treated. These may include hormonal changes, prostate problems, urge incontinence, bladder infections or heart problems and diabetes. www.guysandstthomas.nhs.uk/resources/patient...care/nocturia.pdf 2013 Question 4 What is the name given to a decreased pulse rate or heart rate? A. Tachycardia B. Hypotension C. Bradycardia D. Arrhythmia Question 4 Answer What is the name given to a decreased pulse rate or heart rate? • A. Tachycardia • B. Hypotension • C. Bradycardia • D. Arrhythmia The correct answer is bradycardia. This is a heart rate of less than 60 beats per minute with a normal sinus rhythm. . A patient with unstable bradycardia is at risk of inadequate perfusion of the vital organs, decreased myocardial function, heart block and cardiac arrest. Nursing Standard June 25, vol. 28,no. 43 2014 Question 5 How do we handle a specimen container labelled with a yellow hazard sticker? A. Wear gloves and apron and inform the laboratory that you are sending the specimen. B. Wear gloves and apron, mark it high risk and send the specimen to the laboratory with your other specimens C. Wear gloves and apron, Inform the infection control team and complete a datix form. D. Wear gloves and apron, place specimen in a blue bag & complete a datix form. Question 5 Answer How do we handle a specimen container labelled with a yellow hazard sticker? A. Wear gloves and apron and inform the laboratory that you are sending the specimen. B. Wear gloves and apron, mark it high risk and send the specimen to the laboratory with your other specimens C. Wear gloves and apron, Inform the infection control team and complete a datix form. D. Wear gloves and apron, place specimen in a blue bag & complete a datix form. • • • • • A senior member of the receiving laboratory staff must be contacted before any high-risk specimen is sent. The request form and container must be properly labelled and both marked with a yellow hazard-warning sticker. The specimen should then be placed in the transport bag which is sealed. The biohazard sticker must be clearly visible on the request form (e.g. on the outside of fold over forms) Specimens must not be placed in the sealed container with other samples, which are not categorised as high www.ouh.nhs.uk/services/referrals/laboratories/.../specimens-safe-handling.ppt Question 6 To whom should you delegate a task? A. Someone who you trust B. Someone who is competent C. Someone who you work with regularly D. All of the above Question 6 Answer To whom should you delegate a task? A. Someone who you trust B. Someone who is competent C. Someone who you work with regularly D. All of the above You need to be accountable for your decisions to delegate tasks and duties to others. You should only delegate tasks and duties to those that are practising within their scope of competence, making sure that they fully understand your instructions and who to report any changes to. Ensure that they are supported and supervised as necessary in order to provide safe and compassionate care. Ensure that any task you delegate meets the required standard. The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition 2015 Question 7 Where is revision on the nursing process done? During: A. Diagnosis B. Planning C. Implementation D. Evaluation Question 7 Answer Where is revision on the nursing process done? During: A. Diagnosis B. Planning C. Implementation D. Evaluation The correct answer is D, during evaluation. Evaluation takes place at designated points during the patient/clients period of receiving health care. This is determined by the nursing assessment which identifies the specific needs of each individual and the subsequent plan for delivering the required nursing care. Evaluation is ongoing and leads directly back to the assessment phase of the nursing process, culminating in further planning of care or discontinuation of the need, want or desire for intervention. www2.rcn.org.uk/development/learning/transcultural.../sectionthree Question 8 Why are support stockings used? A. To aid mobility B. To promote arterial flow C. To aid muscle strength D. To promote venous flow Question 8 Answer Why are support stockings used? A. To aid mobility B. To promote arterial flow C. To aid muscle strength D. To promote venous flow Correct answer is D. To promote venous flow. Stockings can help to correct the underlying problem of poor venous blood return and also reduce leg pain and swelling. When lying down very little extra power is necessary as blood does not have to go uphill and the movements we make in our sleep are enough to keep the blood flowing. Valves in the veins stop the blood flowing backwards when the muscles relax. If the valves are damaged or weakened the veins can become over-stretched and develop into varicose veins. If the valves are severely damaged by a blood clot or injury and the condition is neglected, leg ulcers might result. (December 2014) http://www.buckshealthcare.nhs.uk/Downloads/cancer/CISS%20-%2036%20Compression%20stockings.pdf Question 9 How do you test the placement of an enteral tube? A. Monitoring bubbling at the end of the tube B. Testing the acidity/alkalinity of aspirate using blue litmus paper C. Interpreting absence of respiratory distress as an indicator of correct positioning D. Have an abdominal x-ray Question 9 Answer How do you test the placement of an enteral nasogastric tube? A. Monitoring bubbling at the end of the tube B. Testing the acidity/alkalinity of aspirate using blue litmus paper C. Interpreting absence of respiratory distress as an indicator of correct positioning D. Have an abdominal x-ray The correct answer is B. Correct NG tube placement must be confirmed by aspiration on the initial placement prior to all episodes of administration to feed, water or medications. CE marked PH indicator paper should be used to test for human gastric aspirate. The PH should be between 1 and 5.5. The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition 2015 NHS National Patient Safety Agency march 2016 Question 10 What is meant by an advocate? A. Someone who develops opportunities for the patient B. Someone who has the same beliefs as the patient C. Someone who does something on behalf of the patient D. Someone who has the same values as the patient Question 10 Answer What is meant by an advocate? A. Someone who develops opportunities for the patient B. Someone who has the same beliefs as the patient C. Someone who does something on behalf of the patient D. Someone who has the same values as the patient The correct answer is c. The role of an advocate is concerned with working on behalf of self and/or others to raise awareness of a concern and to promote solutions to an issue. It often requires achieving a desired outcome working through formal, decision-making bodies. This process could include the 'chain of command' within a healthcare organization, a commission, a state legislature, or other groups at the healthcare system's policy level. Tomajan, K., (January 31, 2012) "Advocating for Nurses and Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 1, Manuscript 4. Question 11 Which of these is not a symptom of an ectopic pregnancy? A. B. C. D. Pain Bleeding Vomiting Diarrhoea Question 11 Answer Which of these is not a symptom of an ectopic pregnancy? A. Pain B. Bleeding C. Vomiting D. Diarrhoea The correct answer is vomiting. Women may feel nauseous and vomit but it is not always a symptom of an ectopic pregnancy. An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation. In the UK, around 1 in every 80-90 pregnancies is ectopic. This is around 12,000 pregnancies a year. 9 March 2016 www.nhsdirect.wales.nhs.uk/encyclopaedia/e/article/ectopicpregnancy/? Question 12 What is atrial fibrillation? A heart condition that causes, A. An irregular and often abnormally slow heart rate B. An irregular and often abnormally fast heart rate C. A regular heart rhythm with an abnormally slow heart rate D. A regular heart rhythm with an abnormally fast heart rate Question 12 Answer What is atrial fibrillation? A heart condition that causes, A. An irregular and often abnormally slow heart rate B. An irregular and often abnormally fast heart rate C. A regular heart rhythm with an abnormally slow heart rate D. A regular heart rhythm with an abnormally fast heart rate The correct answer is B. In atrial fibrillation, the heart rate is irregular due to the heart's upper chambers (atria) contracting randomly. The heart rate can sometimes be considerably higher than 100 beats a minute. Problems including dizziness, shortness of breath and tiredness may be noticeable as well as heart palpitations. Sometimes, atrial fibrillation doesn't cause any symptoms and a person with it is completely unaware that their heart rate isn't regular. May 18th 2015 http://www.nhs.uk/Conditions/atrial-fibrillation/Pages/Introduction.aspx Question 13 What is the role of the NMC? A. To regulate hospitals or other healthcare settings in the UK B. To regulate healthcare assistants C. To represent or campaign on behalf of nurses and midwives D. To regulate nurses and midwives In the UK to protect the public Question 13 Answer What is the role of the NMC? A. To regulate hospitals or other healthcare settings in the UK B. To regulate healthcare assistants C. To represent or campaign on behalf of nurses and midwives D. To regulate nurses and midwives In the UK to protect the public The correct answer is D. The NMC regulates nurses in England, Wales, Scotland & Northern Ireland. It exists to protect the public. It set standards of education, training, conduct and performance so that nurses and midwives can deliver high quality healthcare throughout their careers. It ensures that nurses and midwives keep their skills and knowledge up to date and uphold our professional standards. It has clear and transparent processes to investigate nurses and midwives who fall short of our standards. The NMC maintains a register of nurses and midwives allowed to practise in the UK. 5th February 2016 https://www.nmc.org.uk/about-us/our-role/ Question 14 During enteral feeding in adults, at what degree angle should the patient be nursed at to reduce the risk of reflux and aspiration? A. B. C. D. 25 35 45 55 Question 14 Answer During enteral feeding in adults, at what degree angle should the patient be nursed at to reduce the risk of reflux and aspiration? A. B. C. D. 25 35 45 55 The correct answer is C. Aspiration may occur due to regurgitation of feed, poor gastric emptying or incorrect placement of the NG tube. The risk can be reduced by, A. B. C. The use of prokinetics to encourage gastric emptying e.g. metoclopramide Checking the position of the tube before feeding Ensuring the patient has their head at a 45 degree angle during feeding. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 15 When using crutches, what part of the body should absorb the patient’s weight? A. B. C. D. Armpits Hands Back Shoulders Question 15 Answer When using crutches, what part of the body should absorb the patient’s weight? A. B. C. D. Armpits Hands Back Shoulders The correct answer is B. Proper Positioning: • When standing up straight, the top of your crutches should be about 1-2 inches below your armpits. • The handgrips of the crutches should be even with the top of your hip line. • Your elbows should be slightly bent when you hold the handgrips. • To avoid damage to the nerves and blood vessels in your armpit, your weight should rest on your hands, not on the underarm supports. February2015 Question 16 The CQC describes compassion as what? A. B. C. D. Intelligent Kindness Smart confidence Creative commitment Gifted courage Question 16 Answer The CQC describes compassion as what? A. B. C. D. Intelligent Kindness Smart confidence Creative commitment Gifted courage The correct answer is A. Compassion is how care is given through relationships based on empathy, respect and dignity - it can also be described as intelligent kindness, and is central to how people perceive their care. https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf Question 17 What is abduction? A. Division of the body into front and back B. Movement of a body part towards the body’s midline C. Division of the body into left and right D. Movement of a body part away from the body’s midline Question 17 Answer What is abduction? A. Division of the body into front and back B. Movement of a body part towards the body’s midline C. Division of the body into left and right D. Movement of a body part away from the body’s midline The correct answer is D. Abduction and adduction are two terms that are used to describe movements towards or away from the midline of the body. Abduction is a movement away from the midline – just as abducting someone is to take them away. For example, abduction of the shoulder raises the arms out to the sides of the body. Adduction is a movement towards the midline. Adduction of the hip squeezes the legs together. In fingers and toes, the midline used is not the midline of the body, but of the hand and foot respectively. Therefore, abducting the fingers spreads them out. http://teachmeanatomy.info/the-basics/anatomical-terminology/terms-of-movement/ Question 18 What does intermediate care not consist of? A. Maximise dependent living B. Prevent unnecessary acute hospital admission C. Prevent premature admission to long-term residential care D. Support timely discharge from hospital Question 18 Answer What does intermediate care not consist of? A. Maximise dependent living B. Prevent unnecessary acute hospital admission C. Prevent premature admission to long-term residential care D. Support timely discharge from hospital The correct answer is A. Intermediate care maximises independent living The Department of Health (2001) introduced intermediate care in the United Kingdom's NHS Plan and refined it in the national service framework for older people. The concept seems to arise out of a policy imperative, rather than an analysis of the scientific evidence about effective models of care. Objectives such as “promotion of independence” and “prevention of unnecessary hospital admission” were to be achieved through providing a new range of services between hospital and home. Specific targets (for example, the number of service users, prevented admissions) accompanied these objectives . 14 Aug 2004 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC509331/ Question 19 How many cups of fluid do we need everyday to keep us well hydrated? A. 1 to 2 B. 2 to 4 C. 4 to 6 D. 6 to 8 Question 19 Answer How many cups of fluid do we need everyday to keep us well hydrated? A. 1 to 2 B. 2 to 4 C. 4 to 6 D. 6 to 8 The Eat well Guide shows the different types of food we should eat, and in what proportions in to have a healthy, balanced diet. It says we should drink six to eight glasses of fluid a day. Water, lower fat milk and sugar-free drinks including tea and coffee all count. 13th July 2015 www.nhs.uk/Livewell/Goodfood/Pages/water-drinks.aspx Question 20 Approximately how many people in the UK are malnourished? A. 1 million B. 3 million C. 5 million D. 7 million Question 20 Answer Approximately how many people in the UK are malnourished? A. 1 million B. 3 million C. 5 million D. 7 million BAPEN (British Association for Parenteral and Enteral Nutrition) estimates that malnourishment affects over 3 million people in Britain at any one time and if ignored, this causes real problems. Malnourished individuals go to their GP more often, are admitted to hospital more frequently, stay on the wards for longer, succumb to infections, and can even end up being admitted to long term care or dying unnecessarily. In children, it is also disastrous with profound effects on growth and development through childhood and later increased risks of major adult diseases. Malnutrition Matters Meeting Quality Standards in Nutritional Care May 2010 www.bapen.org.uk/pdfs/toolkit-for-commissioners.pdf Question 21 If a patient has been assessed as lacking capacity to make their own decisions, what government legislation or ‘act’ should be referred to ? A. Health and Social Care Act (2012) B. Mental capacity Act (2005) C. Carers (Equal opportunities) Act (2004) D. All of the above Question 21 Answer If a patient has been assessed as lacking capacity to make their own decisions, what government legislation or ‘act’ should be referred to ? A. Health and Social Care Act (2012) B. Mental capacity Act (2005) C. Carers (Equal opportunities) Act (2004) D. All of the above The Mental Capacity Act 2005 governs decision-making on behalf of adults who may not be able to make particular decisions. The Act and its codes of practice set out: • who can take particular decisions on someone else's behalf • when and how a decision can be taken • when and how people who lack capacity to take decisions about their care and welfare can be deprived of their liberty to get the care they need in a hospital or care home.in a hospital or care home. The Mental Capacity Act was fully implemented on 1 April 2009. http://www.royalmarsdenmanual.com/productinfo/pdfs/RMM_Stud_c02.pdf (cqc 2016) http://www.cqc.org.uk/content/about-mental-capacity-act Question 22 Under the Carers (Equal opportunities)Act (2004) what are carers entitled to? A. B. C. D. Their own assessment Financial support Respite care All of the above Question 22 Answer Under the Carers (Equal opportunities)Act (2004) what are carers entitled to? A. B. C. D. Their own assessment Financial support Respite care All of the above The word 'carer' refers to people who provide unpaid care to a relative, friend or neighbour who is in need of support because of mental or physical illness, old age or disability. It does not include people who work as volunteers or paid carers; these people should be referred to as 'care workers' or, better still, this confusion could be minimised by the use within the sector of the term ‘support worker’ to describe those who are paid to provide care. www.scie.org.uk/publications/guides/guide09/ Question 23 For which of the following modes of transmission is good hand hygiene a key preventative measure? A. Airborne B. Direct & indirect contact C. Droplet D. All of the above Question 23 Answer For which of the following modes of transmission is good hand hygiene a key preventative measure? A. Airborne B. Direct & indirect contact C. Droplet D. All of the above ‘Modes of transmission’ refers to the way in which infection can be passed from one person to another. ‘Modes of transmission’: Direct contact, Indirect contact, Droplet transmission, Airborne transmission, parenteral transmission, Faecal-oral transmission, Vector transmission. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 24 If you were asked to take ‘standard precautions’ what would you expect to be doing? A. Wearing gloves, aprons and mask when caring for someone in protective isolation B. Taking precautions when handling blood and ‘high risk’ body fluids so as not to pass on any infection to the patient C. Using appropriate hand hygiene, wearing gloves and aprons where necessary, disposing of used sharp instruments safely and providing care in a suitably clean environment to protect yourself and the patients D. Asking relatives to wash their hands when visiting patients in the clinical setting Question 24 Answer If you were asked to take ‘standard precautions’ what would you expect to be doing? A. Wearing gloves, aprons and mask when caring for someone in protective isolation B. Taking precautions when handling blood and ‘high risk’ body fluids so as not to pass on any infection to the patient C. Using appropriate hand hygiene, wearing gloves and aprons where necessary, disposing of used sharp instruments safely and providing care in a suitably clean environment to protect yourself and the patients D. Asking relatives to wash their hands when visiting patients in the clinical setting Standard Infection Control Precautions (SICP) are designed to prevent cross transmission from recognised and unrecognised sources of infection. These sources of (potential) infection include blood and other body fluid secretions or excretions (excluding sweat, non –intact skin or mucous membranes) and any equipment or items in the care environment which are likely to become contaminated. http://www.nhsprofessionals.nhs.uk/download/comms/cg1_nhsp_standard_infection_control_precautions_v3.pdf Question 25 When treating patient’s with clostridium difficile, how should you clean your hands? A. B. C. D. Use alcohol hand rubs Use soap & water Use hand wipes All of the above Question 25 Answer When treating patient’s with clostridium difficile, how should you clean your hands? A. B. C. D. Use alcohol hand rubs Use soap & water Use hand wipes All of the above Clostridium difficile have the capacity to surround a copy of their genetic material with a tough coating. Because this structure is created within the bacterial cell, it is known as a spore. The parent cell dies and disintegrates leaving the spore to survive and then germinate and reproduce. It cannot be destroyed by boiling or by alcohol rubs. The spores need to be removed by washing with soap and water. Hands must be dried thoroughly. https://www.royalmarsden.nhs.uk/about-royal-marsden/quality-and-safety/infection-prevention-andcontrol/c-difficile- Question 26 Except which procedure must all individuals providing nursing care must be competent at? A. B. C. D. Hand hygiene Use of protective equipment Disposal of waste Aseptic technique Question 26 Answer Except which procedure must all individuals providing nursing care must be competent at? A. B. C. D. Use of protective equipment Disposal of waste Hand hygiene Aseptic technique HCA’s are able to provide nursing care, however only registered nurses or HCA’s who have had the relevant training and been deemed competent, may undertake aseptic technique. Nurses should decline to carry out any procedures that they have not been prepared for. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 27 In non-verbal communication, what does SOLER stand for? A. Squarely, open posture, leaning slightly forward, eye contact, relaxed B. Squarely, open ended questions, leaning slightly forward, eye contact, relaxed C. Squarely, open posture, leaning forward, eye contact, rested D. Squarely, open ended questions, leaning slightly backwards, rested Question 27 Answer In non-verbal communication, what does SOLER stand for? A. Squarely, open posture, leaning slightly forward, eye contact, relaxed B. Squarely, open ended questions, leaning slightly forward, eye contact, relaxed C. Squarely, open posture, leaning forward, eye contact, rested D. Squarely, open ended questions, leaning slightly backwards, rested Non-verbal communication can have an impact on the total communication taking place. By learning an awareness of ‘SOLER’, and making this behaviour part of your normal demeanour, patients will be encouraged to talk more openly, facilitating emotional disclosure. http://www.royalmarsdenmanual.com/productinfo/pdfs/RMM_Stud_c02.pdf Question 28 Which of the following is NOT one of the six fundamental values for nursing, midwifery and care staff set out in compassion in Practice Nursing, Midwifery & care staff? A. Care B. Consideration C. Communication D. Compassion Question 28 Answer Which of the following is NOT one of the six fundamental values for nursing, midwifery and care staff set out in compassion in Practice Nursing, Midwifery & care staff? A. Care B. Consideration C. Communication D. Compassion The 6C’s reinforce the enduring values and beliefs that underpin care wherever it takes place. It gives us an easily understood and consistent way to explain our values as professionals and care staff and to hold ourselves to account for the care and services that we provide. The 6C’s all carry equal weight, and naturally focus on putting the people we care for at the heart of everything we do. The correct answer is Consideration. The 6 C’s are care, compassion, courage, communication, commitment and competence. Compassion in Practice - NHS England https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf Question 29 A patient puts out his arm so that you can take his blood pressure. What type of consent is this? A. Verbal B. Written C. Implied D. None of the above, consent is not required Question 29 Answer A patient puts out his arm so that you can take his blood pressure. What type of consent is this? A. Verbal B. Written C. Implied D. None of the above, consent is not required Consent may be expressed by a person verbally, in writing or by implying. The nurse should ensure that the person has understood what examination or treatment is intended and why for the consent to be valid. Written consent is usually obtained from the patient by the person undertaking the procedure. Sometimes a nurse who has had the necessary consent training and is competent to do so, may seek to obtain consent. e.g. Advanced Nurse Practitioner The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 30 How should eye drops be administered? A. Pulling on the lower eyelid and administering the eye drops B. Pulling on the upper eyelid and administering the eye drops C. Tip the patients head back and administer the eye drops into the cornea D. Tip the patients head to the side and administer the eye drops into the nasolacrimal system Question 30 Answer How should eye drops be administered? A. Pulling on the lower eyelid and administering the eye drops B. Pulling on the upper eyelid and administering the eye drops C. Tip the patients head back and administer the eye drops into the cornea D. Tip the patients head to the side and administer the eye drops into the nasolacrimal system Most types of drops are instilled into the pocket formed by gently pulling on the lower eyelid (inferior fornix), as the conjunctiva in this area is less sensitive than that overlying the cornea. It prevents the immediate loss of the drops into the nasolacrimal drainage system. On administration the nozzle should be held approximately 1 -2 cm above the eye to avoid contact with the eyelids and cornea. Ointments are applied to the upper rim of the inferior fornix using a similar technique to the eye drops. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 31 What fluid should ideally be used when irrigating eyes? A. B. C. D. sterile 0.9% sodium chloride Sterile water Chloramphenicol drops tap water Question 31 Answer Saline can irritate and sting the sensitive eye area, so where possible, sterile water is recommended. Lint free swabs should be used when cleaning the eye area due to discharge or encrustation. The swab should be wiped over the eyelid from the nose outward. When irrigating the eye, the patients head should be supported with their chin almost horizontal and the head inclined to the side of the eye to be treated. This is to avoid any solution running either over the nose into the other eye or to avoid cross infection, out of the affected eye and down the cheek, or down the lacrimal duct. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 32 When selecting a stoma appliance for a patient who has undergone a formation of a loop colostomy, what factors would you consider? A. Patient dexterity, consistency of effluent, type of stoma B. Patient preference, type of stoma, consistency of effluent, state of peristomal skin, dexterity of the patient C. Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, patient dexterity, type of stoma. D. Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency of effluent, patient preference. Question 32 Answer When selecting a stoma appliance for a patient who has undergone a formation of a loop colostomy, what factors would you consider? A. Patient dexterity, consistency of effluent, type of stoma B. Patient preference, type of stoma, consistency of effluent, state of peristomal skin, dexterity of the patient C. Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, patient dexterity, type of stoma. D. Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency of effluent, patient preference. Loop (temporary) colostomies may be formed to divert faecal output to allow the healing of a surgical join or repair or relieve an obstruction or bowel injury. Patient’s need to be involved in their own care as much as possible. Question 33 What is the clinical benefit of active ankle movements? A. B. C. D. To assist with circulation To lower the risk of a DVT To maintain joint range All of the above Question 33 Answer What is the clinical benefit of active ankle movements? A. B. C. D. To assist with circulation To lower the risk of a DVT To maintain joint range All of the above Deep vein thrombosis, or DVT, is caused by a blood clot in a deep vein and can be life-threatening. Symptoms may include swelling, pain, and tenderness, often in the legs. Risk factors include immobility, hormone therapy, and pregnancy. http://www.webmd.com/dvt/default.htm Question 34 In the context of assessing risks prior to moving and handling, what does T-I-L-E stand for? A. Task- individual – lift - environment B. Task- intervene – load - environment C. Task – intervene – load –equipment D. Task – individual – load - environment Question 34 Answer In the context of assessing risks prior to moving and handling, what does T-I-L-E stand for? A. Task- individual – lift - environment B. Task- intervene – load - environment C. Task – intervene – load –equipment D. Task – individual – load - environment There is an absolute requirement to assess the risks arising from moving and handling patients that cannot reasonably be avoided. Once the risk of not moving the patient is deemed greater than moving the patient, then the use of the aforementioned needs to be considered. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 35 If your patient is unable to reposition themselves, how often should their position be changed? A. 1 hourly B. 2 hourly C. 3 hourly D. As often as possible Question 35 Answer If your patient is unable to reposition themselves, how often should their position be changed? A. 1 hourly B. 2 hourly C. 3 hourly D. As often as possible Direct pressure to the skin and friction during movement of patients are two of the most common causes of injury to the skin that can lead to pressure ulcers. Any patient who has or is at risk of developing a pressure sore should be positioned with the use of pressure-relieving equipment such as a specialist mattress or cushions. The Royal Marsden manual of Clinical Nursing Procedures 9th edition (2015) Question 36 How much urine should someone void an hour? A. B. C. D. 0.5 – 1ml/Kg/hr of the patient’s body weight 2mls/KG/hr of the patient’s body weight 30mls 50mls Question 36 Answer How much urine should someone void an hour? A. B. C. D. 0.5 – 1ml/Kg/hr of the patient’s body weight 2mls/KG/hr of the patient’s body weight 30mls 50mls This is dependent on the person’s weight. On average, a person should void 0.5 – 1ml/Kg/hr of urine. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 37 In spinal cord injury patients, what is the most common cause of autonomic dysreflexia (a sudden rise in blood pressure)? A. B. C. D. Bowel obstruction Fracture below the level of the spinal lesion Pressure sore Urinary obstruction Question 37 Answer In spinal cord injury patients, what is the most common cause of autonomic dysreflexia (a sudden rise in blood pressure)? A. B. C. D. Bowel obstruction Fracture below the level of the spinal lesion Pressure sore Urinary obstruction Autonomic dysreflexia can be caused by the other factors, however urinary obstruction is the most common. If left untreated it can cause seizures, retinal haemorrhage, pulmonary oedema, renal insufficiency, myocardial infarction, cerebral haemorrhage, and death. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 38 If a patient is prescribed nebulizers, what is the minimum flow rate in litres per minute required? 2-4 4-6 6–8 8 - 10 Question 38 Answer If a patient is prescribed nebulizers, what is the minimum flow rate in litres per minute required? A. 2 - 4 B. 4 - 6 C. 6 – 8 D. 8 - 10 Once the piped air/oxygen is turned on to ensure a sufficient mist is formed, a minimum flow rate of 6 – 8 litres per minute is required. Optimal nebulization of 4ml takes approximately 10 minutes. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 39 In normal breathing, what is the main muscle(s) involved in inspiration? A. B. C. D. The diaphragm The lungs the intercostal All of the above Question 39 Answer In normal breathing, what is the main muscle(s) involved in inspiration? A. B. C. D. The diaphragm The lungs the intercostal All of the above For inspiration to occur, the pressure in the alveoli must be lower than the air pressure in the atmosphere. The diaphragm flattens and descends and the intercostal muscles lift the rib cage and sternum, causing the ribs to broaden outwards and increasing the diameter of the thoracic cavity, both from one side and front to back. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 40 The human body is made up of approximately what proportion of water? A. B. C. D. 50% 60% 70% 80% Question 40 Answer The human body is made up of approximately what proportion of water? A. B. C. D. 50% 60% 70% 80% This can vary with age, gender and percentage of fatty tissue. Total body water is distributed between intracellular fluid (within the cell) and extracellular (outside the cell) compartments. Body fluid is a composition of water and various dissolved solutes – electrolytes (potassium, sodium chloride, magnesium, bicarbonate) and non-electrolytes (glucose, lipids, creatinine, urea). The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 41 Concentration of electrolytes within the body vary depending on the compartment within which they are contained. Extracellular fluid has a high concentration of which of the following? A. B. C. D. Potassium Chloride Sodium Magnesium Question 41 Answer Concentration of electrolytes within the body vary depending on the compartment within which they are contained. Extracellular fluid has a high concentration of which of the following? A. Potassium B. Chloride C. Sodium D. Magnesium Extracellular fluid has an increase in sodium content and is relatively low in potassium. Intracellular fluid is the reverse. The movement and distribution of fluid and solutes between compartments are controlled by the semi-permeable phospholipid cellular membranes that separate them. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 42 How can patients who need assistance at meal times be identified? A. B. C. D. A red sticker A colour serviette A red tray Any of the above Question 42 Answer How can patients who need assistance at meal times be identified? A. B. C. D. A red sticker A colour serviette A red tray Any of the above Sufficient staff need to be made available to support those patients who need help. These patients can be discreetly be identified through using any of the aforementioned. Protected meal times should be in place whereby all non-essential clinical activities are discontinued. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 43 People with blood group A are able to receive blood from the following: A. B. C. D. Group A only Groups AB or B Groups A or O Groups A, B or O Question 43 Answer People with blood group A are able to receive blood from the following: A. B. C. D. Group A only Groups AB or B Groups A or O Groups A, B or O People with group O red cells don’t have either A or B surface antigens. However they do have anti A and anti B 1gM antibodies in their serum. They are only able to receive blood group O, but can donate to A,B,O & AB groups. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 44 Which layer of the skin contains blood and lymph vessels, sweat and sebaceous glands? A. B. C. D. Epidermis Dermis Subcutaneous layer All of the above Question 44 Answer Which layer of the skin contains blood and lymph vessels, sweat and sebaceous glands? A. B. C. D. Epidermis Dermis Subcutaneous layer All of the above The dermis is made up of white fibrous tissue and yellow elastic fibres which give the skin its toughness and elasticity. The dermis provides the epidermis (outer coating of the skin) with structural and nutritional support. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 45 Which of the following is no longer a recommended method of mouth care? A. B. C. D. Chlorhexidine solution and foam sticks Sodium bicarbonate Normal saline mouth wash Glycerine and lemon swabs Question 45 Answer Which of the following is no longer a recommended method of mouth care? A. B. C. D. Chlorhexidine solution and foam sticks Sodium bicarbonate Normal saline mouth wash Glycerine and lemon swabs The correct answer is glycerine and lemon swabs. Side effects include the increase in oral drying and loss of saliva due to temporary over-stimulation of the salivary glands, and osmotic effects of glycerine. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 46 What percentage of the air we breathe is made up of oxygen? A. 16% B. 21% C. 26% D. 31% Question 46 Answer What percentage of the air we breathe is made up of oxygen? A. 16% B. 21% C. 26% D. 31% The air we breathe in under normal conditions from the atmosphere is composed of the following gases: Oxygen 21% Carbon dioxide 0.03% Nitrogen 79% Rare gases 0.003% The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 47 Which of the following oxygen masks is able to deliver between 60 – 90%of oxygen when delivered at a flow rate of 10 -15L/min? A. simple semi-rigid plastic masks B. Nasal cannulas C. Venturi high flow mask D. Non-rebreathing masks Question 47 Answer Which of the following oxygen masks is able to deliver between 60 – 90%of oxygen when delivered at a flow rate of 10 -15L/min? A. simple semi-rigid plastic masks B. Nasal cannulas C. Venturi high flow mask D. Non-rebreathing masks Simple semi-rigid plastic masks – 21 – 60% used with a humidifier if used for more than 12 hours Nasal cannulas – approx. 28 – 35% oxygen. Patients needing oxygen for more than 24 hours should be given humidified oxygen to protect their airway defences Venturi high flow mask – oxygen should be given according to the venture barrel reading (24 – 60%) The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 48 Which is the first drug to be used in cardiac arrest of any aetiology? A. B. C. D. Adrenaline Amiodarone Atropine Calcium chloride Question 48 Answer Which is the first drug to be used in cardiac arrest of any aetiology? A. B. C. D. Adrenaline Amiodarone Atropine Calcium chloride Adrenaline concentrates the blood around the vital organs, specifically the brain and the heart, by peripheral vasoconstriction. These are the organs that must continue to receive blood to increase the chances of survival following cardiac arrest. Adrenaline also strengthens cardiac contractions as it stimulates the cardiac muscle. This further increases the amount of blood circulating to the vital organs, and also increases the chance of the heart returning to a normal rhythm. https://www.nursingtimes.net/clinical-archive/cardiology/understanding-the-drugs-used-during-cardiac-arrest-response/203172.article [accessesd 25/1/17] Question 49 What is the most common complication of venepuncture? A. B. C. D. Nerve injury Arterial puncture Haematoma Fainting Question 49 Answer What is the most common complication of venepuncture? A. B. C. D. Nerve injury Arterial puncture Haematoma Fainting Haematoma. This develops when blood leaks from the vein into the surrounding tissues. It may be caused by a needle penetrating the vein wall completely, needles only being partially inserted or insufficient pressure being applied when the needle is removed. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 50 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. What 4 Key areas does the code cover: A. Prioritise people, practise effectively, preserve safety, promote professionalism and trust B. Prioritise people, practise safely, preserve dignity, promote professionalism and trust C. Prioritise care, practise effectively, preserve security, promote professionalism and trust D. Prioritise care, practise safely, preserve security, promote kindness and trust Question 50 Answer 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. What 4 Key areas does the code cover: A. Prioritise people, practise effectively, preserve safety, promote professionalism and trust B. Prioritise people, practise safely, preserve dignity, promote professionalism and trust C. Prioritise care, practise effectively, preserve security, promote professionalism and trust D. Prioritise care, practise safely, preserve security, promote kindness and trust 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. It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism. https://www.nmc.org.uk/standards/code/ Question 51 • When collecting an MSU from a male patient, what should they do prior to the specimen being collected? • Clean the meatus and catch a specimen from the last of the urine voided • Clean the meatus and catch a specimen from the first stream of urine (approx. 30mls) • Clean the meatus and catch a specimen of the urine midstream • Ask the patient to void into a bottle and pour urine specimen into the specimen container. Question 51 Answer • When collecting an MSU from a male patient, what should they do prior to the specimen being collected? • Clean the meatus and catch a specimen from the last of the urine voided • Clean the meatus and catch a specimen from the first stream of urine (approx. 30mls) • Clean the meatus and catch a specimen of the urine midstream • Ask the patient to void into a bottle and pour urine specimen into the specimen container. When collecting an MSU(mid-stream specimen of urine), the patient must pass a small amount of urine before collecting the specimen. This is to reduce the risk of contamination of the specimen with naturally occurring micro-organisms/flora within the urethra. Prior to the specimen being collected, the patient should wash his hands, retract the foreskin and clean the skin surrounding the urethral meatus with soap and water, saline solution or a disinfectant-free solution. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 52 • When you tell a 3rd year student under your care to dispense medication to your patient what will you assess? • • • • A. B. C. D. Whether s/he is able to give medicine Whether s/he is under your same employment His/her competence and skills Supervise directly Question 52 Answer • When you tell a 3rd year student under your care to dispense medication to your patient what will you assess? • • • • A. B. C. D. Whether s/he is able to give medicine Whether s/he is under your same employment His/her competence and skills Supervise directly Registered practitioners supervising students are responsible for the delegation of all aspects of drug administration and accountable to ensure that the student nurse is competent to carry out drug administration under direct supervision. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) https://www.nmc.org.uk/standards/additional-standards Question 53 A nurse is caring for clients in the mental health clinic. A women comes to the clinic complaining of insomnia and anorexia. The patient tearfully tells the nurse that she was laid off from a job that she had held for 15 years. Which of the following responses, if made by the nurse, is MOST appropriate? A. “Did your company give you a severance package?” B. “Focus on the fact that you have a healthy, happy family.” C. “Losing a job is common nowadays.” D. “Tell me what happened.” Question 53 Answer A nurse is caring for clients in the mental health clinic. A women comes to the clinic complaining of insomnia and anorexia. The patient tearfully tells the nurse that she was laid off from a job that she had held for 15 years. Which of the following responses, if made by the nurse, is MOST appropriate? A. “Did your company give you a severance package?” B. “Focus on the fact that you have a healthy, happy family.” C. “Losing a job is common nowadays.” D. “Tell me what happened.” By exploring the situation you allow the patient to verbalize and give a full explanation of the facts. https://www.nursingtimes.net/roles/nurse.../good-communication.../5003004.article Question 54 The nurse is leading an in service about management issues. The nurse would intervene if another nurse made which of the following statements? A. “It is my responsibility to ensure that the consent form has been signed and attached to the patient’s chart prior to surgery.” B. “It is my responsibility to witness the signature of the client before surgery is performed.” C. “It is my responsibility to answer questions that the patient may have prior to surgery.” D. “It is my responsibility to provide a detailed description of the surgery and ask the patient to sign the consent form.” Question 54 Answer A nurse is leading a programme about management issues. The nurse would intervene if a ward nurse made which of the following statements? A. “It is my responsibility to ensure that the consent form has been signed and attached to the patient’s chart prior to surgery.” B. “It is my responsibility to witness the signature of the client before surgery is performed.” C. “It is my responsibility to answer questions that the patient may have prior to surgery.” D. “It is my responsibility to provide a detailed description of the surgery and ask the patient to sign the consent form.” Consent needs to be obtained from the patient by a Doctor or specialist nurse who has had the correct training in line with the hospital policy. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 55 Which client has the highest risk for a bacteraemia? A. Client with a peripherally inserted central catheter (PICC) line B. Client with a central venous catheter (CVC) C. Client with an implanted infusion port D. Client with a peripherally inserted intravenous line Question 55 Answer Which client has the highest risk for a bacteraemia? A. Client with a peripherally inserted central catheter (PICC) line B. Client with a central venous catheter (CVC) C. Client with an implanted infusion port D. Client with a peripherally inserted intravenous line A Central venous catheter insertion is placed into a vein in the neck or chest with the tip resting in the superior vena cava and carries the highest risk for bacterial infection of the bloodstream. A central venous access device presents a high risk of infection with an incidence of bacteraemia of between 4 – 8%. Question 56 A client with a right arm cast for fractured humerus states, “I haven’t been able to straighten the fingers on my right hand since this morning.” What action should the nurse take? A. Assess neurovascular status to the hand B. Ask the client to massage the fingers C. Encourage the client to take the prescribed analgesic D. Elevate the right arm on a pillow to reduce oedema Question 56 Answer A client with a right arm cast for fractured humerus states, “I haven’t been able to straighten the fingers on my right hand since this morning.” What action should the nurse take? A. Assess neurovascular status to the hand B. Ask the client to massage the fingers C. Encourage the client to take the prescribed analgesic D. Elevate the right arm on a pillow to reduce oedema This finding is suggestive of neurological injury as a result of pressure on nerves and soft tissue because of swelling. The Royal Marsden manual of Clinical Nursing Procedures 8th Edition. (2011) Question 57 Which finding should the nurse report to the provider prior to a magnetic resonance imaging MRI? A. History of cardiovascular disease B. Allergy to iodine and shellfish C. Permanent pacemaker in place D Allergy to dairy products Question 57 Answer • Which finding should the nurse report to the provider prior to a magnetic resonance imaging MRI? • A. History of cardiovascular disease • B. Allergy to iodine and shellfish • C. Permanent pacemaker in place • D Allergy to dairy products Patients with non-MRI compatible implanted devices such as cochlear implants and cardiac pacemakers should not be scanned. Other implanted devices such as stents must be confirmed as MR safe prior to scanning. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 58 A client experiences an episode of pulmonary oedema because the nurse forgot to administer the morning dose of furosemide (Lasix). Which legal element can the nurse be charged with? A. Assault B. Slander C. Negligence D. Tort Question 58 Answer A client experiences an episode of pulmonary oedema because the nurse forgot to administer the morning dose of furosemide (Lasix). Which legal element can the nurse be charged with? A. B. C. D. Assault Slander Negligence Tort The nurse committed an act of omission (Breach of Duty) thereby constituting an act of negligence. The Royal Marsden manual of Clinical Nursing Procedures 8th Edition. (2011) Question 59 After finding the patient, which statement would be most appropriate for the nurse to document on a datix/incident form? A. “The patient climbed over the side rails and fell out of bed.” B. “The use of restraints would have prevented the fall.” C. “Upon entering the room, the patient was found lying on the floor.” D. “The use of a sedative would have helped keep the patient in bed.” Question 59 Answer After finding the patient, which statement would be most appropriate for the nurse to document on a datix/incident form? A. “The patient climbed over the side rails and fell out of bed.” B. “The use of restraints would have prevented the fall.” C. “Upon entering the room, the patient was found lying on the floor.” D. “The use of a sedative would have helped keep the patient in bed.” The cause of the patient fall is not identified and the nurse must document the facts. All documentation should be clearly written, dated and timed, and not include unnecessary abbreviations, jargon or speculation. https://www.nmc.org.uk/standards/code/ Question 60 A nurse documents vital signs without actually performing the task. Which action should the charge nurse take after discussing the situation with the nurse? A. Charge the nurse with malpractice B. Document the incident C. Notify the board of nursing D. Terminate employment Question 60 Answer A nurse documents vital signs without actually performing the task. Which action should the charge nurse take after discussing the situation with the nurse? A. Charge the nurse with malpractice B. Document the incident C. Notify the board of nursing D. Terminate employment After discussing the situation with the nurse, the nurse in charge should document the incident. Further action may need to be taken dependent on the outcome. The Royal Marsden manual of Clinical Nursing Procedures 8th Edition. (2011) Question 61 • How many phases of korotkoff sounds are there? • A. 3 • B. 4 • C. 5 • D. 6 Question 61 Answer • • • • • How many phases of Korotkoff sounds are there? A. 3 B. 4 C. 5 D. 6 1. Clear tapping, repetitive sounds which increase in intensity and indicate the systolic pressure 2. murmuring and swishing sounds heard between the systolic and diastolic pressures 3.sharper and crisper sounds 4.distinct muffling which may sound soft and blowing 5.silence as the cuff pressure drops below the diastolic pressure. Korotkoff sounds are not dependably audible in children under 1 and many in children under 5. Therefore ultrasound, doppler or oscillometric devices are recommended. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 62 What is meant by ‘Gillick competent’? • A. Children under the age of 12 who are believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. • B. Children under the age of 16 who are believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment • C. Children under the age of 18 who are believed not to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. • D. Children under the lawful age of consent who are believed not to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment Question 62 Answer What is meant by ‘Gillick competent’? • A. Children under the age of 12 who are believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. • B. Children under the age of 16 who are believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment • C. Children under the age of 18 who are believed not to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. • D. Children under the lawful age of consent who are believed not to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Children-under-16.aspx Question 63 A patient is prescribed metformin 1000mg twice a day for his diabetes. While talking with the patient he states “I never eat breakfast so I take a ½ tablet at lunch and a whole tablet at supper because I don’t want my blood sugar to drop.” As his primary care nurse you: A. Tell him he has made a good decision and to continue B. Tell him to take a whole tablet with lunch and with supper C. Tell him to skip the morning dose and just take the dose at supper D. Tell him to take one tablet in the morning and one tablet in the evening as ordered Question 63 Answer A patient is prescribed metformin 1000mg twice a day for his diabetes. While talking with the patient he states “I never eat breakfast so I take a ½ tablet at lunch and a whole tablet at supper because I don’t want my blood sugar to drop.” As his primary care nurse you: A. Tell him he has made a good decision and to continue B. Tell him to take a whole tablet with lunch and with supper C. Tell him to skip the morning dose and just take the dose at supper D. Tell him to take one tablet in the morning and one tablet in the evening as ordered The patient should take the metformin as ordered. Metformin should not cause low blood sugars due to the way it is used in the body. https://www.diabetesselfmanagement.com/diabetes-resources/definitions/metformin/ Question 64 • After a lumbar puncture, your patient becomes unconscious. What will be the reason? • A. Increased intracranial pressure (ICP) • B. Headache • C. Side effects of medication • D. Cerebral Spinal fluid (CSF) leakage Question 64 Answer • After a lumbar puncture, your patient becomes unconscious. What will be the reason? • • • • A. B. C. D. Increased intracranial pressure (ICP) Headache Side effects of medication Cerebral Spinal fluid (CSF) leakage Cerebral spinal fluid leakage. The presence of clear fluid should be reported to a doctor immediately especially if accompanied by symptoms such as loss of consciousness, motor changes, problems voiding. ICP – Lumbar puncture should not be undertaken with raised or suspected ICP due to the risk of brain herniation. Headache – the size of the needle used may contribute to a headache. A 25 gauze blunt ended needle is recommended. Medication – patients receiving intrathecal medication should always be given the correct agent. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 65 • In what order should the four phases of wound healing be? • A. Inflammation, Proliferation, haemostasis, maturation • B. Haemostasis, Inflammation, Proliferation, maturation • C. Proliferation, haemostasis, maturation, inflammation • D. Maturation, inflammation, Proliferation, haemostasis . Question 65 Answer In what order should the four phases of wound healing be? A. Inflammation, Proliferation, haemostasis, maturation B. Haemostasis, Inflammation, Proliferation, maturation C. Proliferation, haemostasis, maturation, inflammation D. Maturation, inflammation, Proliferation, haemostasis Haemostasis (minutes) Inflammation ( 1-5 days) Proliferation (3-24 days) Maturation (21 days onwards) The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 66 The UK regulator for nursing & midwifery professions within the UK with a stated aim to protect the health & well-being of the public is: A. GMC B. NMC C. BMC D. WHC Question 66 Answer The UK regulator for nursing & midwifery professions within the UK with a stated aim to protect the health & well-being of the public is: A. GMC B. NMC C. BMC D. WHC The NMC (nursing & midwifery council) maintains a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK. https://www.nmc.org.uk/about-us/our-role/ Question 67 The nurse has made an error in documenting client care. Which appropriate action should the nurse take? A. Draw a line through error, initial, date and document correct information B. Document a late addendum to the nursing note in the client’s chart C. Tear the documented note out of the chart D. Delete the error by using whiteout Question 67 Answer The nurse has made an error in documenting client care. Which appropriate action should the nurse take? A. Draw a line through error, initial, date and document correct information B. Document a late addendum to the nursing note in the client’s chart C. Tear the documented note out of the chart D. Delete the error by using whiteout An error in documentation requires that the nurse draw a single line through the error, initial and date the line, then document the factual and correct documentation in the medical record. Question 68 The nurses on the day shift report that the controlled drug count is incorrect. What is the most appropriate nursing action? A. Report the discrepancy to the nurse manager and pharmacy immediately B. Report the incident to the local board of nursing C. Inform a doctor D. Report the incident to the NMC Question 68 Answer The nurses on the day shift report that the controlled drug count is incorrect. What is the most appropriate nursing action? A. Report the discrepancy to the nurse manager and pharmacy immediately B. Report the incident to the local board of nursing C. Inform a doctor D. Report the incident to the NMC The nurse manager and pharmacy must be alerted immediately of any discrepancy in the controlled drug count. These substances are regulated & an incident report must be completed. https://www.nmc.org.uk/standards/additional-standards/standards-for-medicines-management/ Question 69 Which of the following is not a part of the 6 rights of medication administration? A. B. C. D. Right time Right route Right medication Right reason Question 69 Answer Which of the following is not a part of the 6 rights of medication administration? A. Right time B. Right route C. Right medication D. Right reason The administration of medicines has been identified as a source of risk to patients. The National Reporting and Learning System highlights that the most frequently reported source of medication errors are wrong dose, omitted or delayed medication and administration of the wrong medicine (NPSA 2013). This has prompted many organisations to adopt the ‘5 rights’ approach to medication administration: Right patient, Right drug, Right dose, Right route, Right time. Some types of errors, such as maladministration of insulin, are now classed by the Department of Health (DH) as‘never events’. Never events are considered to be unacceptable and preventable. 4th March 2013 https://www.nhsprofessionals.nhs.uk/Download/comms/CG3%20%20Administration%20of%20Medicine%20Guidelines%20V4%20March%202013.pdf Question 70 The nurse is caring for a diabetic patient and when making rounds, notices that the patient is trembling and stating they are dizzy. The next action by the nurse would be: A. Administer patient’s scheduled Metformin B. Give the patient a glass of orange juice C. Check the patient’s blood glucose D. Call the doctor Question 70 Answer The nurse is caring for a diabetic patient and when making rounds, notices that the patient is trembling and stating they are dizzy. The next action by the nurse would be: A. Administer patient’s scheduled Metformin B. Give the patient a glass of orange juice C. Check the patient’s blood glucose D. Call the doctor Check the patient’s blood glucose. The signs and symptoms appear to be that of hypoglycaemia, but they could also represent other conditions. The first step in the nursing process is to assess and gather all the required information. Obtaining the blood glucose reading would be beneficial before giving the diabetic patient orange juice or metformin. http://www.nhs.uk/Conditions/Hypoglycaemia/Pages/Treatment.aspx Question 71 Who has the overall responsibility for the safe and appropriate management of controlled drugs within the clinical area? A. All registered nurses B. The nurse in charge C. The consultant D. All staff Question 71 Answer Who has the overall responsibility for the safe and appropriate management of controlled drugs within the clinical area? A. All registered nurses B. The nurse in charge C. The consultant D. All staff The nurse in charge of an area is responsible for the safe and appropriate management of controlled drugs in that area. Certain tasks such as holding the keys can be delegated to a registered nurse, but the overall responsibility remains with the nurse in charge. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question72 A Ibuprofen 200mg tablet has been prescribed. You only have a 400mg coated ibuprofen tablet. What should you do? A. B. C. D. Give half of the tablet crush the tablet and give half of the amount order the different dose of tablet from pharmacy omit Question 72 Answer A Ibuprofen 200mg tablet has been prescribed. You only have a 400mg coated ibuprofen tablet. What should you do? A. B. C. D. Give half of the tablet crush the tablet and give half of the amount order the different dose of tablet from pharmacy omit the tablet Enteric coatings are applied to tablets to delay the release of drugs that are inactivated by the stomach contents (pancreatin; erythromycin; omeprazole), to prevent stomach irritation (aspirin; diclofenac; naproxen; corticosteroids), or to delay the onset of action to a specific site within the gastrointestinal tract (sulphasalazine in the treatment of Crohn’s disease). Crushing enteric coated tablets may result in the drug being released too early, destroyed by stomach acid, or irritating the stomach lining. In general, manipulation of enteric coated and extended-release formulations is not, therefore, recommended. https://www.rpharms.com/support-pdfs/pharmaceuticalissuesdosageformsjune-2011.pdf Question 73 What is primary care? A. Medical care provided by a specialist or facility upon referral by a physician in the community B. A comprehensive information service that helps to put you in control of your healthcare. C. Health care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment. D. Voluntary and community organisations (both registered charities such as associations, self-help groups and community groups), social enterprises, mutuals and co-operatives. Question 73 Answer What is primary care? A. Medical care provided by a specialist or facility upon referral by a physician in the community B. A comprehensive information service that helps to put you in control of your healthcare. C. Health care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment. D. Voluntary and community organisations (both registered charities such as associations, self-help groups and community groups), social enterprises, mutuals and cooperatives. As many people's first point of contact with the NHS, around 90 per cent of patient interaction is with primary care services. In addition to GP practices, primary care covers dental practices, community pharmacies and high street optometrists. Question 74 • While giving an IV infusion your patient develops speed shock. What is not a sign and symptom of this? • • • • A. B. C. D. Circulatory collapse Peripheral oedema Facial flushing Headache Question 74 Answer While giving an IV infusion your patient develops speed shock. What is not a sign and symptom of this? • A. Circulatory collapse • B. Peripheral oedema • C. Facial flushing • D. Headache Prevention of speed shock involves the nurse having knowledge of the drug and the recommended rate of administration. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 75 Which are not the benefits of using negative pressure wound therapy? A. B. C. D. Can reduce wound odour Increases local blood flow in peri-wound area Can be used on untreated osteomyelitis Can reduce use of dressings Question 75 Answer Which are not the benefits of using negative pressure wound therapy? A. Can reduce wound odour B. Increases local blood flow in peri-wound area C. Can be used on untreated osteomyelitis D. Can reduce use of dressings Negative pressure wound therapy is contraindicated in untreated osteomyelitis The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 76 • Why is pyrexia not always evident in the elderly? • A. Due to immature T cells • B. Due to mature T cells • C. Due to immature D cells • D. Due to mature D cells Question 76 Answer • Why is pyrexia not always evident in the elderly? • A. Due to immature T cells • B. Due to mature T cells • C. Due to immature D cells • D. Due to mature D cells T cells attack infected or damaged cells directly or produce powerful chemicals that mobilize an army of other immune system substances and cells. With age, however, people produce fewer naïve T cells, which makes them less able to combat new health threats users.rcn.com/jkimball.ma.ultranet/.../B_and_Tcells.html Question 77 • What is accountability? • A. Ethical and moral obligations permeating the nursing profession • B. To be answerable to oneself and others for one's own actions.” • C. A systematic approach to maintaining and improving the quality of patient care within a health system (NHS). • D. The process of applying knowledge and expertise to a clinical situation to develop a solution Question 77Answer • What is accountability? • A. Ethical and moral obligations permeating the nursing profession • B. To be answerable to oneself and others for one's own actions.” • C. A systematic approach to maintaining and improving the quality of patient care within a health system (NHS). • D. The process of applying knowledge and expertise to a clinical situation to develop a solution. It will always be the nurse responsible for the patients on a shift who must ensure that anyone delegated with a task is competent to do so and knows what to report on completing the activity. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 78 In infection control, what is a pathogen? A. B. C. D. A micro-organism that is capable of causing infection, especially in vulnerable individuals, but not normally in healthy ones. Micro-organisms that are present on or in a person but not causing them any harm. Indigenous microbiota regularly found at an anatomical site. Antibodies recruited by the immune system to identify and neutralize foreign objects like bacteria and viruses. Question 78 Answer • In infection control, what is a pathogen? • A. A micro-organism that is capable of causing infection, especially in vulnerable individuals, but not normally in healthy ones. • B. Micro-organisms that are present on or in a person but not causing them any harm. • C. Indigenous microbiota regularly found at an anatomical site. • D. Antibodies recruited by the immune system to identify and neutralize foreign objects like bacteria and viruses. A pathogen is a micro-organism that is capable of causing infection, especially in vulnerable individuals, but not normally in healthy ones. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 79 When disposing of waste, what colour bag should be used to dispose of offensive/hygiene waste? A. Orange B. Yellow C. Yellow and black stripe D. Black Question 79 Answer When disposing of waste, what colour bag should be used to dispose of offensive/hygiene waste? A. Orange B. Yellow C. Yellow and black stripe D. Black A yellow & black bag (tiger stripe). This bag was chosen as these colours were historically used for the disposal of the sanitary/offensive/hygiene waste stream. They should be sent to landfill in a suitably permitted or licensed site. It should not be compacted in unlicensed/permitted facilities. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 80 What is the National early warning system? A. Early detection of deterioration in a patient’s vital signs B. The nurse must learn more and educate themselves C. Nurse needs to take more care and responsibility D. Early identification of own needs • • • • • Question 80 Answer What is the National early warning system? A. Early detection of deterioration in a patient’s vital signs B. The nurse must learn more and educate themselves C. Nurse needs to take more care and responsibility D. Early identification of own needs The NEWS (national early warning score) allows for early identification and referral of patients at risk of deterioration. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 81 What should you do if you sustain a needle stick injury? A. B. C. D. Suck the wound, cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Wash the wound using running water and plenty of soap, dry it and cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Encourage the wound to bleed, wash the wound using running water and plenty of soap, dry it and cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Suck the wound, wash the wound using running water and plenty of soap, complete an incident report and participate in the risk assessment to be performed by others. Question 81 Answer What should you do if you sustain a needle stick injury? A. B. C. D. Suck the wound, cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Wash the wound using running water and plenty of soap, dry it and cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Encourage the wound to bleed, wash the wound using running water and plenty of soap, dry it and cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. Suck the wound, wash the wound using running water and plenty of soap, complete an incident report and participate in the risk assessment to be performed by others. Encourage the wound to bleed, wash the wound using running water and plenty of soap, dry it and cover it with a waterproof plaster or dressing, complete an incident report and participate in the risk assessment to be performed by others. www.nhs.uk/chq/Pages/2557.aspx?CategoryID=72 Question 82 For adverse drug reactions, what colour card scheme should you use? A. Red B. Yellow C. Blue D. Pink • • • • • Question 82 Answer For adverse drug reactions, what colour card scheme should you use? Red Yellow Blue Pink The yellow card scheme is run by the medicines and health care products regulatory agency (MHRA) and the commission of human medicines (CHM) used to collect information from both health professionals and patients in suspected adverse drug reactions with prescribed medicines, over the counter medicines and herbal medicines. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 83 Orthostatic hypotension is diagnosed if the systolic blood pressure drops by how many mmHg? A. 20 B. 25 C. 30 D. 35 Question 83 Answer • Orthostatic hypotension is diagnosed if the systolic blood pressure drops by how many mmHg? • 20 • 25 • 30 • 35 It may also occur if the diastolic blood pressure reduces by at least 10mmHg within 3 minutes of the patient standing upright. Hypotension is usually compensated for by the baroreceptor reflex and the sympathetic nervous system, but this may not work as efficiently in the older person. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 84 In what quadrant should intramuscular injections be given into the buttock? A. Upper innermost quadrant B. Upper outermost quadrant C. Lower innermost quadrant D. Lower outermost quadrant Question 84 Answer In what quadrant should intramuscular injections be given into the buttock? • A. Upper innermost quadrant • B. Upper outermost quadrant • C. Lower innermost quadrant • D. Lower outermost quadrant The dorsogluteal site or upper outer quadrant is the traditional site of choice. However this site still carries a danger of the needle hitting the sciatic nerve and the superior gluteal arteries. The Royal Marsden manual of Clinical Nursing Procedures 9th Edition. (2015) Question 85