NMC CBT Online Practice
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1. Who is responsible in disposing sharps?
- Registered nurse
- Nurse assistant
- Whoever used the sharps
- Whoever collects the garbage
2. IV injection need to be reconsidered when?
- Medicine is available in tab form
- Poor alimentary absorption
- Drug interaction due to Gl secretions
3. It is important to read the label on every IV bag because:
- Different IV solutions are packaged similarly
- The label contains the expiration date of the IV fluid
- A and B
- A only
4. Which is the most dangerous site for intramuscular injection?
- ventrogluteal
- deltoid
- rectus femoris
- dorsogluteal
5. A suicidal Patient is admitted to psychiatric facility for 3 days when suddenly he is showing signs of cheerfulness and motivation. The nurse should see this as:
- That treatment and medication is working
- She has made new friends
- She has finalize suicide plan
6. What is the best way to avoid a haematoma forming when undertaking venepuncture?
- Tap the vein hard which will ‘get the vein up’, especially if the patient has fragile veins. This will avoid bruising afterwards.
- It is unavoidable and an acceptable consequence of the procedure. This should be explained and documented in the patient's notes.
- Choosing a soft, bouncy vein that refills when depressed and is easily detected, and advising the patient to keep their arm straight whilst firm pressure is applied.
- Apply pressure to the vein early before the needle is removed, then get the patient to bend the arm at a right angle whilst applying firm pressure
7. Which is the best site for giving IM injection on buttocks
- Upper outer quadrant
- Upper inner quadrant
- Lower outer quadrant
- Lower inner quadrant
8. Patient is given penicillin. After 12 hrs he develops itching, rash and shortness of breath, what could be the reason?
- Speed shock
- Allergic reaction
9. Why would the intravenous route be used for the administration of medications?
- It is a useful form of medication for patients who refuse to take tablets because they don’t want to comply with treatment
- It is cost effective because there is less waste as patients forget to take oral medication
- The intravenous route reduces the risk of infection because the drugs are made in a sterile environment & kept in aseptic conditions
- The intravenous route provides an immediate therapeutic effect & gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable
- more precise dose can be calculated so treatment can be more reliable
10. What do you mean by MRSA?
- methicillin-resistant staphyloccocusaureu
- multiple resistant staphylococcus antibiotic
11. Medication errors account for around a quarter of the incidents that threaten patient safety. In a study published in 2 000 it was found that 10% of all patients admitted to hospital suffer an adverse event (incident. How much of these incidents were preventable?
- 20%
- 30%
- 50%
- 60%
12. 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.
13. Pharmocokinetics can be described as:
- The study of the effects of drugs on the function of living systems
- The absorption, distribution, metabolism and excretion of drugs within ghe body: what the body does to drug
- The studyof mechanism of the action of drugs and other biochemical physiological effects: ‘what the drug does to the body’
- All of the above
14. Which drug can be given via NG tube?
- Modified release hypertensive drugs
- Crushing the tablets
- Lactulose syrup
- Insulin
15. What is not a good route for IM injection?
- upper arm
- stomach
- thigh
- buttocks
16. 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?
- “Did your company give you a severance package?”
- “Focus on the fact that you have a healthy, happy family.”
- “Losing a job is common nowadays.”
- “Tell me what happened.”
17. The medicine and Healthcare Products Regulatory Agency (MHRA) is responsible for what?
- Licensing medicinal products
- Regulating the manufacture, distribution and importation of medicines
- Regulating which medicine require a prescription and which can be available without a prescription and under what circumstances
- All of the above
18. What steps would you take if you had sustained a needlestick injury?
- Ask for advice from the emergency department, report to occupational health and fill in an incident form.
- Gently make the wound bleed, place under running water and wash thoroughly with soap and water. Complete an incident form and inform your manager. Co operate with any action to test yourself or the patient for infection with a bloodborne virus but do not obtain blood or consent for testing from the patient yourself; this should be done by someone not involved in the incident.
- Take blood from patient and self for Hep B screening and take samples and form to Bacteriology. Call your union representative for support. Make an appointment with your GP for a sickness certificate to take time off until the wound site has healed so you dont contaminate any other patients.
- Wash the wound with soap and water. Cover any wound with a waterproof dressing to prevent entry of any other foreign material
19. A patient is on Inj. Fentanyl skin patch common side effect of the fentanyl overdose is
- Fast and deep breathing, dizziness, sleepiness
- Slow and shallow breathing, dizziness, sleepiness
- Noisy and shallow breathing, dizziness, sleepiness
- Wheeze and shallow breathing, dizziness, sleepiness
20. As a registered nurse, you are expected to calculate fluid volume balance of a patient whose input is 2437 ml and output is 750 ml
- 1887 (Negative Balance)
- 1197 (Negative Balance)
- 1887 (Positive Balance)
- 1197 (Positive Balance)
21. Your patient has been prescribed Tramadol 50 mgs tablet for pain relief. Upon receipt of the tablets from the pharmacist you will:
- Record this in the controlled drug register book with the pharmacist witnessing
- Put it in the patient’s medicine pod
- Store it in ward medicine cupboard
- Ask the pharmacist to give it to the patient
22. You have observed an IV catheter insertion site w/ erythema, swelling, pain and warm? What VIP score would you document on his notes?
- 5
- 2
- 3
- 4
23. 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.
24. Tom was admitted because of acute asthma attack, later on in your shift he complained of abdominal pain and vomited. He asked for pain relief. Which of the following prescribed analgesia will you give him?
- Fetanyl buccal patch
- Ibuprofen enteric coated capsule
- Paracetamol suppositories
- Oromorphine
25. Which is the first drug to be used in cardiac arrest of any aetiology?
- Adrenaline
- Amiodarone
- Atropine
- Calcium chloride
26. The nurse is admitting a client, on initial assessment the nurse tries to inquire the patient if he has been taking alternative therapies and OTC drugs but the client becomes angry and refuses to answer saying thenurse is doing so because he belongs to an ethnic minority group, what is the nurse’s best response?
- The nurse will stop asking questions as it is upsetting to the patient
- Wait and give some time for the client to get adjusted to modern ways of hospitalisation
- The nurse will politely explain to the patient about alternative therapies such as St.Johns Wort which interact with drugs
- The nurse will assign another nurse to ask questions
27. A nursing assistant would like to know what a patient group directive means. Your best reply will be:
- they are specific written instructions for the supply and administration of a licensed named medicine
- can be used by any registered nurse or midwife caring for the patient
- drugs can be used outside the terms of their licence (“off label”),
- it is an alternative form of prescribing
28. Which color card is used to report adverse drug reaction?
- Green Card
- Yellow Card
- White Card
- Blue Card
29. You have just administered an antibiotic drip to you patient. After few minutes, your patient becomes breathless and wheezy and looks unwell. What is your best action on this situation?
- Stop the infusion, call for help, anaphylactic kit in reach, monitor closely
- continue the infusion and observe further
- check the vital signs of the patient and call the doctor
- stop the infusion and prepare a new set of drip
30. You have discovered that the last dose of intravenous antibiotic administered to service user was the wrong dose. Which of the following should you do?
- Document the event in the service user’s medical record only.
- File an incident report, and document the event in the service user’s medical record.
- Document in the service user’s medical record that an incident report was filed.
- File an incident report, but don’t document the even on the service user’s record, because information about the incident is protected.
31. After having done your medication round, you have realised that your patient has experienced the adverse effect of the drug. What will be your initial intervention?
- You must do the physical observations and notify the General practitioner
- You must ring the General Practitioner and request for a home visit
- You must administer medication from the Homely Remedy Pod after having spoken to the General Practitioner.
- You must observe your patient until the General Practitioner arrives at your nursing home
32. The degree of injection when giving subcutaneous insulin injection on a site where you can grasp 1 inch of tissue?
- 45degrees
- 40degrees
- 25degrees
33. What is the most common complication of venepuncture?
- Nerve injury
- Arterial puncture
- Haematoma
- Fainting
34. A nurse is not trained to do the procedure of IV cannulation , still she tries to do the procedure . You are the colleague of this nurse. What will be your action?
- You should tell that nurse to not to do this again
- You should report the incident to someone in authority
- You must threaten the nurse, that you will report this to the authority
- You should ignore her act
35. A patient with burns is given anesthesia using 50% oxygen and 50% nitrous oxide to reduce pain during dressing, how long this gas is to be inhaled to be more effective?
- 30 sec
- 60sec
- 1-2min
- 3-5min
36. You are about to administer Morphine Sulphate to a paediatric patient. The information written on the control drug book was not clearly written - 15mg or 0.15 mg. What will you do first?
- Not administer the drug, and wait for the General Practitioner to do his rounds
- Administer 0.15 mg, because 15 mg is quite a big dose for a paediatric patient
- Double check the medication label and the information on the controlled drug book; ring the chemist the verify the dosage
- Ask a senior staff to read the medication label for you
37. How should we transport controlled drugs? Select which does not apply:
- Controlled drugs should be transferred in a secure, locked or sealed, tamper- evident container.
- A person collecting controlled drugs should be aware of safe storage and security and the importance of handing over to an authorized person to obtain a signature.
- Have valid ID badge
- None of the above
38. One of your patient has challenged your recent practice of administering a subcutaneous low-molecular weight heparin (LMWH) without disinfecting the injection site. The guidelines for nursing procedures do not recommend this method. Which of the following response will support your action?
- “We were taught during our training not to do so as it is not based on evidence.”
- “Our guidelines, which are based on current evidence, recommends a non disinfection method of subcutaneous injection.”
- “I am glad you called my attention. I will disinfect your injection site next time to ensure your safety and peace of mind.”
- “Disinfecting the site for subcutaneous injection is a thing of the past. We are in an evidence-based practice now.”
39. After IV dose patient develops, rashes, itching, flushed skin
- septecimia
- adverse reaction
40. UK policy for needle prick injury includes all but one:
- Encourage the wound to bleed
- Suck the wound
- Wash the wound using running water and plenty of soap
- Don’t scrub the wound while washing it
41. An adolescent male being treated for depression arrives with his family at the Adolescent Day Treatment Centre for an initial therapy meeting with the staff. The nurse explains that one of the goals of the family meeting is to encourage the adolescent to:
- Trust the nurse who will solve his problem
- Learn to live with anxiety and tension
- Accept responsibility for his actions and choices
- Use the members of the therapeutic milieu to solve his problems
42. You were administering a pre-operative medication to a patient via IM route. Suddenly, you developed a needle-stick injury. Which of the following interventions will not be appropriate for you to do?
- Prevent the wound to bleed
- Wash the wound using running water and plenty of soap
- Do not suck the wound
- Dry the wound and over it with a waterproof plaster or dressing
43. Susan is diabetic and on PEG feed. Her blood sugar has been high during the last 3 days. She is on Nystatin Oral Drops QID, regular PEG flushes and insulin doses. Her Humulin dose has been increased from 12 iu to 14 iu. The nurse practitioner has advised you to monitor her BM’s for the next two days. What will be your initial intervention if her BM drops to 2.8 mmol after 2 morning doses of 14 iu?
- Offer her a chocolate bar and a glass of orange juice
- Flush glucose syrup through her PEG Tube
- Ring the nurse practitioner and ask if the insulin dose can be dropped to 12 iu
- Contact the General Practitioner and request for a visit
44. Hypokalemia can occur in which situation?
- Addissons disease
- When use spironolactone
- When use furosemide
45. On physical examination of a 16 year old female patient, you notice partial erosion of her tooth enamel and callus formation on the posterior aspect of the knuckles of her hand. This is indicative of:
- Self-induced vomiting and she likely has bulimia nervosa
- A genetic disorder and her siblings should also be tested
- Self-mutilation and correlates with anxiety
- A connective tissue disorder and she should be referred to dermatology
46. What does the term ‘breakthrough pain’ mean, and what type of prescription would you expect for it?
- A patient who has adequately controlled pain relief with short lived exacerbation of pain, with a prescription that has no regular time of administration of analgesia
- Pain on movement which is short lived, with a q.d.s. prescription, when necessary.
- Pain that is intense, unexpected, in a location that differs from that previously assessed, needing a review before a prescription is written.
- A patient who has adequately controlled pain relief with short lived exacerbation of pain, with a prescription that has 4 hourly frequency of analgesia if necessary
47. What is the best nursing action for this insertion site. You have observed an IV catheter insertion site w/ erythema, swelling, pain and warm.
- start antibiotics
- re-site cannula
- call doctor
- elevate
48. Mary is 86 years old, and has been in the nursing home for 5 years now. She has been complaining of burning sensation in her chest and sour taste at the back of her throat. What would she most likely to be prescribed with?
- Ranitidine
- Zantac
- Paracetamol
- Levothyroxine
- a and b
- b and c
49. A patient needs weighing, as he is due a drug that is calculated on bodyweight. He experiences a lot of pain on movement so is reluctant to move, particularly stand up. What would you do?
- Document clearly in the patient’s notes that a weight cannot be obtained
- Offer the patient pain relief and either use bed scales or a hoist with scales built in
- Discuss the case with your colleagues and agree to guess his body weight until he agrees to stand and use the chair scales
- Omit the drugs as it is not safe to give it without this information; inform the doctor and document your actions
50. What are the key nursing observations needed for a patient receiving opioids frequently?
- Respiratory rate, bowel movement record and pain assessment and score.
- Checking the patent is not addicted by looking at their blood pressure.
- Lung function tests, oxygen saturations and addiction levels.
- Daily completion of a Bristol stool chart, urinalysis, and a record of the frequency with which the patient reports breakthrough pain.