CBT Mock Test 5 - NMC Part 1 Test of Competence

NOTE: This is a “mock” test based on some of the references given in the NMC Blue Print. The test covers 4 Domains and 1 field specific competency relating to your specialism – in this case ‘Adult Nursing’. The questions provided is only a guide, individuals should review the all study material and modules provided in MMA Recruitment CBT guide.

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* 1. Why should healthcare professionals take extra care when washing and drying an elderly patient's skin?

As the older generation deserve more respect and tender loving care (TLC).

As the skin of an elder person has reduced blood supply, is thinner, less elasticand has less natural oil. This means the skin is less resistant to shearing forces and wound healing can be delayed.

All elderly people lose dexterity and struggle to wash effectively so they need support with personal hygiene.

As elderly people cannot reach all areas of their body, it is essential to ensure all body areas are washed well so that the colonization of Gram positive and negative micro organisms on the skin is avoided.

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* 2. What would you do if a patient with diabetes and peripheral neuropathy requires assistance cutting his toe nails?

Document clearly the reason for not cutting his toe nails and refer him to a chiropodist.

Document clearly the reason for not cutting his nails and ask the ward sister to do it.

Have a go and if you run into trouble, stop and refer to the chiropodist.

Speak to the patient's GP to ask for referral to the chiropodist, but make a start while the patient is in hospital.

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* 3. A patient is agitated and is unable to settle. She is also finding it difficult to sleep, reporting that she is in pain. What would you do at this point?

Ask her to score her pain, describe its intensity, duration, the site, any relieving measures and what makes it worse, looking for non verbal clues, so you can determine the appropriate method of pain management.

Give her some sedatives so she goes to sleep.

Calculate a pain score, suggest that she takes deep breaths, reposition her pillows, return in 5 minutes to gain a comparative pain score.

Give her any analgesia she is due. If she hasn't any, contact the doctor to get some prescribed. Also give her a warm milky drink and reposition her pillows. Document your action.

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* 4. On which step of the WHO analgesic ladder would you place tramadol and codeine?

Step 1: Non Opioid Drugs

Step 2: Opioids for Mild to Moderate Pain

Step 3: Opioids for Moderate to Severe Pain

Herbal medicine

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* 5. Your patient has a bulky oesophageal tumour and is waiting for surgery. When he tries to eat, food gets stuck and gives him heartburn. What is the most likely route that will be chosen to provide him with the nutritional support he needs?

Nasogastric tube feeding

Feeding via a percutaneous endoscopic gastrostomy (PEG)

Feeding via a radiologically inserted gastrostomy (RIG)

Continue oral food

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* 6. What is the best way to prevent a patient who is receiving an enteral feed from aspirating?

Lie them flat

Sit them at least at a 45° angle

Tell them to lie on their side

Check their oxygen saturations

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* 7. Which of the following medications are safe tobe administered via a nasogastric tube?

Enteric coated drugs to minimize the impact of gastric irritation.

A cocktail of all medications mixed together, to save time and prevent fluid overloading the patient.

Any drugs that can be crushed.

Drugs that can be absorbed via this route, can be crushed and given diluted or dissolved in 10-15 ml of water.

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* 8. Which check do you need to carry out before setting up an enteral feed via a nasogastric tube?

That when flushed with red juice, the red juice can be seen when the tube is aspirated.

That air cannot be heard rushing into the lungs by doing the ‘whoosh test.

That the pH of gastric aspirate is <5.5, and the measurement on the NG tube is the same length as the time insertion.

That pH of gastric aspirate is >6.0, and the measurement on the NG tube is the same length as the time insertion

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* 9. Fred is going to receive a blood transfusion. How frequently should we do his observations?

Temperature and pulse before the blood transfusion begins, then every hour, and at the end of bag/unit.

Temperature, pulse, blood pressure and respiration before the blood transfusion begins, then after 15 minutes, then as indicated in local guidelines, and finally at the end of the bag/unit.

Temperature, pulse, blood pressure and respiration and urinalysis before the blood transfusion, then at end of bag.

Pulse, blood pressure and respiration every hour, and at the end of the bag.

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* 10. Approximately how long is the spinal cord in an adult?

30 cm

45 cm

60 cm

120 cm

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* 11. Dehydration is of particular concern in ill heath. If a patient is receiving intravenous (IV) fluid replacement and is having their fluid balance recorded, which ofthe following statements is true of someone said to be in a ‘positive fluid balance'?

The fluid output has exceeded the input.

The doctor may consider increasing the IV drip rate

The fluid balance chart can be stopped as ‘positive’ in this instance means good

The fluid input has exceeded the output

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* 12. What specifically do you need to monitor to avoid complications and ensure optimal nutritional status in patients being enterally fed?

Blood glucose levels, fullblood count, stoma site and bodyweight

Eye sight, hearing, full blood count, lung function and stoma site

Assess swallowing, patient choice, fluid balance, capillary refill time

Daily urinalysis, ECG, protein levels and arterial pressure

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* 13. Apatient needs weighing, as he is due a drug that is calculated on bodyweight. He experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do?

Document clearly in the patient's notes that a weightcannot be obtained.

Offer the patient pain relief and either use bed scales or a hoist with scales built in

Discuss the case with your colleagues and agree to guess his body weight until he agrees to stand and use the chair scales.

Omit the drug as it is not safe to give it without this information; inform the doctor and document your actions

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* 14. If the prescribed volume is taken, which of the following types of feed will provide all protein, vitamins, minerals and trace elements to meet a patient's nutritional requirements?

Protein shakes/supplement

Sip feeds

Energy drinks

Mixed fat and glucose polymer solutions/powders

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* 15. A patient has been admitted for nutritional support and started receiving a hyperosmolar feed yesterday. He presents with diarrhoea but has no pyrexia. What is likely to be the cause?

The feed

An infection

Food poisoning

Being in hospital

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* 16. Mrs Jones has had a cerebral vascular accident, so her left leg is increasedin tone, very stiff and difficult to position comfortably when she is in bed. What would you do?

Give Mrs Jones analgesia and suggest she sleeps in the chair.

Try to diminish increased tone by avoiding extra stimulation by ensuring herfoot doesn't come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed.

Give Mrs Jones diazepam and tilt the bed.

Suggest a warm bath before she lies on the bed. Then use pillows to support the stiff limb.

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* 17. Which of the following is a behavioural risk factor when assessing the potential risks of falling in an older person?

Poor nutrition/fluid intake

Poor heating

Foot problems

Fear of falling

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* 18. When positioning the supine patient in bed, why should you ensure the patient is lying centrally in the bed?

To ensure spinal and limb alignment

To ensure patient comfort

To ensure the airway is patent

To minimize the risk of injury to the practitioner

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* 19. In what instances shouldn't you position a patient in a side-lying position?

If they are pregnant

If they have a spinal fracture

If they have pressure sore

If they have lower limb pain

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* 20. What does ‘muscle atrophy’ mean?

None

Loss of muscle mass

A change in the shape of muscles

Disease of the muscle

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* 21. How do the structures of the human body work together to provide support and assist inmovement?

The skeleton provides a structural framework. This is moved by the muscles that contract or extend and in order to function, cross at least one joint and are attached to the articulating bones.

The muscles provide a structural framework and are moved by bones to which they are attached by ligaments.

The skeleton provides a structural framework; this is moved by ligaments that stretch and contract.

The muscles provide a structural framework, moving by contracting or extending, crossing at least one joint and attached to the articulating bones.

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* 22. What are the most common effects of inactivity?

Pulmonary embolism, urinary tract infection and fear of people

Deep arterial thrombosis, respiratory infection, fear of movement, loss of consciousness, deconditioning of cardiovascular system leading to an increased risk of angina.

Loss of weight, frustration and deep vein thrombosis.

Social isolation, loss of independence, exacerbation of symptoms, rapid loss of strength in leg muscles, deconditioning of cardiovascular system leading to increased risk of chest infection, and pulmonary embolism

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* 23. What do you need to consider when helping a patient with shortness of breath sit out in a chair?

They shouldn't sit out in a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure on the lungs.

Sitting in a reclining position with the legs elevated toreduce the use of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don't expend any unnecessary energy.

The patient needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others.

There are two possible positions, either sitting upright or side lying. Which is used is determined by the age of the patient. It is also important to remember that they will always need a nebulizer and oxygen and the air temperature must be below 20° C

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* 24. Your patient has bronchitis and has difficulty in clearing his chest. What position would help to maximize the drainage of secretions?

Lying flat on his back while using a nebulizer.

Sitting up leaning on pillows and inhaling humidified oxygen

Lying on his side with the area to be drained uppermost after the patient has had humidified air.

Standing up in fresh air taking deep breath

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* 25. Perdue categorizes constipation as primary, secondary or iatrogenic. What could be some of the causes of iatrogenic constipation?

Inadequate diet and poor fluid intake

Anal fissures, colonic tumours or hypercalcaemia.

Lifestyle changes and ignoring the urge to defaecate.

Antiemetic or opioid medication

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* 26. A patient is admitted to the ward with symptoms of acute diarrhoea. What should your initial management be?

Assessment, protective isolation, universal precautions.

Assessment, source isolation, antibiotic therapy.

Assessment, protective isolation, antimotility medication.

Assessment, source isolation, universal precautions

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* 27. Your patient has undergone a formation of a loop colostomy. What important considerations should be borne in mind when selecting an appropriate stoma appliance for your patient?

Dexterity of the patient, consistency of effluent, type of stoma

Patient preference, type of stoma,consistence of effluent, state of peristomal skin, dexterity of patient.

Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, dexterity of patient, type of stoma

Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency of effluent, patient preference.

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* 28. What type of diet would you recommend to your patient who has a newly formed stoma?

Encourage high fibre foods to avoid constipation.

Encourage lots of vegetables and fruit to avoid constipation.

Encourage a varied diet as people can react differently.

Avoid spicy foods because they can cause erratic function.

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* 29. What would be your main objectives in providing stomaeducation when preparing a patient with a stoma for discharge home?

That the patient can independently manage their stoma, and can get supplies

That the patient has had their appliance changed regularly, and knows their community stoma nurse.

That the patient knows the community stoma nurse, and has a prescription.

That the patient has a referral to the District Nurses for stoma care.

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

Using a translator

Use short, precise sentences

Relying on their family or friends to help explain what you mean

Write things down

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* 31. When should a penile sheath be considered as a means of managing incontinence?

When other methods of continence management have failed

Following the removal of a catheter.

When the patient has a small or retracted penis.

When a patient requests it.

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* 32. What is the most important guiding principle when choosing the correct size of catheter?

The biggest size tolerable

The smallest size necessary.

The potential length of use of the catheter

The build of the patient

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* 33. When carrying out a catheterization, on which patients would you use anaesthetic lubricating gel prior to catheter insertion?

Male patients to aid passage, as the catheter is longer.

Female patients as there is an absence of lubricating glands in the female urethra, unlike the male urethra.

Male and female patients require anaesthetic lubricating gel

The use of anaesthetic lubricating gel is not advised due to potential adverse reactions

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* 34. On removing your patient's catheter, what should you encourage your patient to do?

Rest and drink 2-3 litres of fluid per day.

Rest and drink in excess of 5 litres of fluid per day.

Exercise and drink 2-3 litres of fluid per day.

Exercise and drink their normal amount of fluid intake.

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* 35. What are the principles of positioning a urine drainage bag?

Above the level of the bladder to improve visibility and access for the health professional.

Above the level of the bladder to avoid contact with the floor.

Below the level of the patient's bladder to reduce back flow of urine

Where the patient finds it most comfortable

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* 36. What are the principles of communicating with a patient with delirium?

Use short statements and closed questions in a well lit, quiet, familiar environment.

Use short statements and open questions in a well lit, quiet, familiar environment

Write down all questions for the patient to refer back to.

Communicate only through the family using short statements and closed questions.

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* 37. Which of the following is NOT an example of non-verbal communication?

Dress

Facial expression

Postur

Tone

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* 38. Which of these is an example of an open question?

Are you feeling better today?

When you said you are hurt, what do you mean?

Can you tell me what is concerning you?

Is that what you are looking for?

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

90%

50%

23%

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* 40. What factors are essential in demonstrating supportive communication to patients?

Listening, clarifying the concerns and feelings of the patient using open questions.

Listening, clarifying the physical needs of the patient using closed questions

Listening, clarifying the physical needs of the patient using open questions.

Listening, reflecting back the patient's concerns and providing a solution.

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* 41. Which behaviours will encourage a patient to talk about their concerns?

Giving reassurance and telling them not to worry.

Asking the patient about their family and friends.

Tell the patient you are interested in what is concerning them and that you are available to listen.

Tell the patient you are interested in what is concerning them and if they tell you, they will feel better.

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* 42. When communicating with someone who isn't a native English speaker, which of the following is advisable?

Using an official translator

Ask the doctor

Relying on their family or friends

Ask the receptionist

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* 43. Dehydration is of particular concern in ill health. If a patient is receiving intravenous (IV) fluid replacement and is having their fluid balance recorded, which of the following statements is true of someone said to be in a ‘positive fluid balance’?

The fluid output has exceeded the input.

The doctor may consider increasing the IV drip rate.

The fluid balance chart can be stopped as ‘positive’ in this instance means ‘good’.

The fluid input has exceeded the output.

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* 44. What is the best way to prevent a patient who is receiving an enteral feed from aspirating?

Lie them flat.

Sit them at least at a 45° angle.

Tell them to lie on their side.

Check their oxygen saturations

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* 45. Which check do you need to carry out every time before setting up a routine enteral feed via a nasogastric tube?

That when flushed with red juice, the red juice can be seen when the tube is aspirated.

That air cannot be heard rushing into the lungs by doing the ‘whoosh test’.

That the pH of gastric aspirate is <4, and the measurement on the NG tube is the same length as the time insertion.

abdominal x-ray

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* 46. What should be included in your initial assessment of your patient's respiratory status?

Review the patient's notes and charts, to obtain the patient's history.

Review the results of routine investigations.

Observe the patient's breathing for ease and comfort, rate and pattern.

check for any drains

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* 47. What should be included in a prescription for oxygen therapy?

You don't need a prescription for oxygen unless in an emergency.

The date it should commence, the doctor's signature and bleep number.

The type of oxygen delivery system, inspired oxygen percentage and

You only need a prescription if the patient is going to have home oxygen.

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* 48. What action would you take if a specimen had a biohazard sticker on it?

Double bag it, in a self-sealing bag, and wear gloves if handling the specimen.

Wear gloves if handling the specimen, ring ahead and tell the laboratory the sample is on its way.

Wear goggles and underfill the sample bottle.

Wear appropriate PPE and overfill the bottle.

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* 49. Which of the following would indicate an infection?

Hot, sweaty, a temperature of 36.5°C, and bradycardic.

Temperature of 38.5°C, shivering, tachycardia and hypertensive.

Raised WBC, elevated blood glucose and temperature of 36.0°C.

Hypotensive, cold and clammy, and bradycardic.

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* 50. Which of the following techniques is advisable when obtaining a urine specimen in order to minimize the contamination of a specimen?

Clean around the urethral meatus prior to sample collection and get a midstream/clean catch urine specimen.

Clean around the urethral meatus prior to sample collection and collect the first portion of urine as this is where the most bacteria will be.

Do not clean the urethral meatus as we want these bacteria to analyse as well.

Dip the urinalysis strip into the urine in a bedpan mixed with stool.

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* 51. We are always striving to improve our service and support to overseas nurses. Any feedback or suggestions that you might have can be made in the comment box below. If you are not registered with MMA Healthcare Recruitment and would like to receive a copy of our free CBT study guide, please provide your name and e-mail address.
http://www.mmarecruitment.com/

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