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1. A patient with a Bipolar Disorder makes a sexually inappropriate comment to the nurse. One should take which of the following actions?
Ignore the comment because the client has a mental health disorder and cannot help it.
Report the comment to the nurse manager.
Ignore the comment, but tell the incoming nurse to be aware of the client’s propensity to make inappropriate comments.
Tell the client that is it inappropriate for clients to speak to any nurse that way.
2. A client with pancreatic cancer has an infusion of TPN (Total Parenteral Nutrition). The doctor has ordered for sliding-scale insulin. The most likely explanation for this order is:
Total Parenteral Nutrition leads to negative nitrogen balance and elevated glucose levels.
Total Parenteral Nutrition cannot be managed with oral hypoglycemics.
Total Parenteral Nutrition is a high-glucose solution that often elevates the blood glucose levels.
Total Parenteral Nutrition leads to further pancreatic disease.
3. A carer has reported that she has seen a resident fall off his bed. What initial assessment should be done?
Check the patient’s Early Warning Score along with the Glasgow Coma Scale immediately.
Ask the patient if he is in pain; if so, administer painkillers immediately.
Dial 999 and request for an ambulance to take your patient to the hospital.
Contact the out-of-hours GP and request for a home visit.
4. You were on the phone with a family member, and one of the carers has reported that one of your residents has stopped breathing and turned blue. What should you do first?
End your conversation with the family member, attend to your patient and do the CPR.
End your conversation with the family member, go to your patient’s bedroom and assess for airway, breathing and circulation.
End your conversation with the family member, and dial 999 to request for an ambulance.
Dial 111, and request for an urgent visit from the General Practitioner.
5. Karen, one of the residents in the nursing home, has not yet had her mental capacity assessment done. She has been making decisions that you personally think are not beneficial for her. Which of the following should not be implemented?
Force her to change her mind every time she makes a decision
Explain the benefits of making the right decision
Allow her to make her own decision, as she still has mental capacity
All of the above
6. You were assisting Mrs B with personal care and hygiene. She has been assessed to have mental capacity. In her wardrobe, you have seen a dress that is quite difficult to wear and a pair of trousers, which is quite easy to put on. You are trying to make a decision which one to put on her. Which of the following is a person centred intervention?
Ask her what she prefers; show her the clothes and let her choose
Let Mrs B wear her trousers
Explain to her that the dress is so difficult to put on
Tell her that the trousers will make her more comfortable if she chooses it
7. The following are ways to assess a patient’s fluid and electrolyte status except:
pulse, blood pressure, capillary refill and jugular venous pressure
presence of pulmonary or peripheral oedema
presence of postural hypertension
biomarkers
8. According to the National Institute for Health and Care Excellence (NICE) Guidelines, examples of the Personal Protective Equipment are:
9. Mr B’s mother was admitted to hospital following a fall at home and it was clearly documented that his mother suffered from diabetes. Mr B contacted the Trust concerning the Trust’s failure to make adequate discharge arrangements for his mother including the necessary arrangements to ensure that his mother would be provided with insulin following her discharge. What needs to be implemented to avoid such concern/complaint in the future?
Diabetic Liaison Nurse to work with service users in the community
On-line training for blood glucose monitoring introduced within the Trust
Diabetics to have their blood sugar recorded within four hours prior to discharge
A and C only
all of the above
10. Mary has been very physically and verbally aggressive towards other patients and staff for the last few weeks. She is now on one-to-one care, 24 hours a day. According to her person centred care plan, the nurses are looking after her very well preventing her from causing any harm. Behaviour has been discussed with the social worker, and clinical lead has applied for DoLS. Which of the following is correct?
DoLS will allow staff to intervene depriving Mary from doing something to hurt herself, other residents, and staff
DoLS refers to protecting the other patients only from Mary’s destructive behaviour.
DoLS protects the nurses and doctors only when providing care for Mary.
DoLS protects Mary only from committing suicide.
11. How do you prevent the spread on infection when nursing a patient with long term urinary catheters?
Patients and carers should be educated about and trained in techniques of hand decontamination, insertion of intermittent catheters where applicable, and catheter management before discharge from hospital.
Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor.
Bladder instillations or washouts must not be used to prevent catheter-associated infections.
All of the above
12. What are the six physiological parameters incorporated into the National Early Warning Scores?
Respiratory rate, oxygen saturation, temperature, systolic blood pressure, pulse rate and level of consciousness
Biomarkers, oxygen saturation, temperature, systolic blood pressure, pulse rate and level of consciousness
Oxygen saturation, temperature, systolic blood pressure, pulse rate, level of consciousness and oedema
Temperature, systolic blood pressure, pulse rate, level of consciousness, oedema and pupillary reaction
all of the above
13. Based on the National Institute for Health and Care Excellence (NICE) Guidelines, which of the following is incorrect about sharps container?
It must be located in a safe position and height to avoid spillage.
It should be temporarily closed when not in use.
It must not be filled above the fill line.
It must not be filled below the fill line.
14. A diabetic patient with suspected Liver Tumor has been prescribed with Triphasic CT Scan. Which medication needs to be on hold after the scan?
Furosemide
Metformin
Docusate Sodium
Paracetamol
15. You are about to administer Morphine Sulfate to a paediatric patient. The information written on the controlled drug book was not clearly written - 15 mg 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 to verify the dosage
Ask a senior staff to read the medication label with you
16. You are working in a nursing home (morning shift), and one of your residents is still in the hospital. Nothing has been documented since admission. What would you do?
Ring the family and find out what happened to the resident
Speak to your manager and tell her about it
Ring the ward and request for an update from the nurse on duty
Document that the resident is still in the hospital
17. A patient in one of your bays has called for staff. She needed assistance with “spending a penny”. What will you do?
Ask her if she wants a hot or cold drink, and give her one as requested
Assist her to walk to the vending machine, and let her choose what she wants to buy
Assist her to walk to the toilet, and provide her with some privacy
Help her find her purse, and ask her what time she will be ready to go out
18. Mr B called for your assistance and wanted you to sit with him for a bit. He has disclosed confidential information about his personal life. Which of the following should you urgently deal with?
history of gall stones
presence of pacemaker
suicidal connotations
loss of appetite due to depression
19. Your patient has been recently prescribed with PEG feeding with a resting period of 4 hours. After two weeks of starting the routine, he has been having episodes of loose stool. What could be done?
Refer him to a dietician and review for a longer resting period between feeds.
Refer him to the tissue viability nurse for his peg site.
Examine his abdomen and assess for lumps.
Examine his peg site, and apply metronidazole ointment if swollen.
20. The nurse is preparing to make rounds. Which client should be seen first?
1 year old with hand and foot syndrome
69 year old with congestive heart failure
40 year old resolving pancreatitis
56 year old with Cushing’s disease
21. Adam, 26 years old, was admitted to the hospital due to multiple gunshot wounds on his abdomen. On nutritional assessment in the ICU, the patient’s height and weight were estimated to be 1.75 m and 75 kg, respectively, with a normal body mass index (BMI) of 24.5 kg/m2. He was started on Parenteral Nutrition support on day one post admission. Postoperatively, the patient developed worsening renal function and required dialysis. In critical care, what would be most likely recommended for him to meet his nutritional need?
Starting Parenteral Nutrition early in patients who are unlikely to tolerate enteral intake within the next three days
Starting with a slightly lower than required energy intake (25 kCal/kg)
A range of protein requirements (1.3-1.5 g/kg)
All of the above
None of the above
22. A patient with Leukaemia was about to receive a transfusion of blood platelets. The experiences nurse on duty in the ward noticed small clumps visible in the platelet pack and questions whether the transfusion should proceed. What should the nurse do?
Proceed with platelet transfusion and monitor for signs of rejection
Withhold platelet transfusion and document it on the patient’s chart
Ring the blood bank and enquire about the platelet pack received
All of the above
23. You are preparing a client with Acquired Immunodeficiency Syndrome (AIDS) for discharge to home. Which of the following instructions should the nurse include?
Avoid sharing things such as razors and toothbrushes.
Do not share eating utensils with family members.
Limit the time you spend in public places.
Avoid eating food from serving dishes shared with others.
24. Which of the following sets of needs should be included in your service user’s person centred care plan?
social, spiritual and academic needs
medical, psychological and financial needs
physical, medical, social, psychological and spiritual needs
a and b only
all of the above
25. Patricia has been assessed to be very confused and with impaired mobility. She wants to go to the dining room for her meal, but she wants a cardigan before doing so. What will you do?
Give her wet wipes for her hands before dinner
Disregard the cardigan and take her to the dining room
Ask her what she means by a cardigan
Make her comfortable in a wheelchair, and cover her legs with a blanket
26. During your medical rounds, you have noted that Mrs B was upset. She has verbalised that she misses her family very much, and that no one has been to visit lately. What would likely be your initial intervention?
Contact Mrs B’s family and encourage them to visit her during the weekend.
Sit next to Mrs B and listen attentively. Allow her to talk about things that cause her anxiety.
Collaborate with the GP for a care plan review and request for antidepressants to be prescribed.
All of the above.
None of the above.
27. You have answered a phone call after receiving handover. The person you were talking to has explained that he needs to find out about his sister’s condition. What should you initially do?
Discuss about his sister’s condition and provide treatment options such as access to other resources in the community.
Check the patient’s record and verify the caller’s identity.
Refuse to divulge any information to the caller.
Discuss about his sister’s condition and book an appointment for him to attend care plan reviews.
28. Documentation confirms that Linda has MRSA. You walked into her bedroom with coffee and biscuits on a tray. Which of the following is incorrect?
Put the coffee and biscuits on her bedside table and leave the tray on the other table
Wash your hands thoroughly before leaving her room
Dispose your gloves and apron before washing your hands
Use the alcohol gel on Linda’s bedside before leaving her room
29. Which of the following is the most important in infection control and prevention?
Wearing gloves and apron at all times
Hand washing
immediate prescription of antibiotics
Use of hand rubs in the bedside
30. Donna, 50 years old, was admitted to the hospital with gastrointestinal bleed presumed to be oesophageal varices. It has been recommended that she needs to be transfused with blood; however, due to her religious and personal beliefs, she needed volume expanding agents. Unfortunately, she died a few hours after admission. Before dying, she said that it was God’s will, which she believed was right. Which of the following statements is false?
Health professionals should be aware of imposing one’s world view upon others and strive to be more receptive and sensitive to the needs of others.
Individual choice, consent and the right to refuse treatment is important.
It is important for all health professionals to do any means to keep a patient alive regardless of traditions and beliefs.
None of the Above
31. Mrs Jones has been assessed to be on nutritional deficit with a MUST Score of 1, which means that she is on medium risk. One of your interventions is to modify her diet for her to meet her nutritional needs. What should you consider?
Mrs Jones’s meal preferences.
Mrs Jones’s intake and output records.
Mrs Jones’s x-ray results.
A and B
B and C
32. You are currently working in a nursing home. One of the service users is struggling to swallow or chew his food. To whom do you make a referral to?
Tissue Viability Nurse
Social Worker
Speech and Language Therapist
Care Manager
33. There has been an outbreak of the Norovirus in your clinical area. Majority of your staff have rang in sick. Which of the following is incorrect?
Do not allow visitors to come in until after 48h of the last episode
Tally the episodes of diarrhoea and vomiting
Staff who has the virus can only report to work 48h after last episode
Ask one of the staff who is off-sick to do an afternoon shift on same day
34. You were assigned to change the dressing of a patient with diabetic foot ulcer. You were not sure if the wound has sloughy tissues or pus. How will you carry out your assessment?
Sloughy tissue is a mass of dead tissues in your wound bed, while pus is a thick yellowish/greenish opaque liquid produced in an infected wound.
Sloughy tissues are exactly the same as pus, and they both have a yellowish tinge.
Sloughy tissues and pus are similar to each other; both are found on the wound bed tissue and indicative of a dying tissue.
The presence of sloughy tissues and pus are an indication of non-surgical debridement.
All of the above
None of the above
35. Mr Brown, 21 years old, has been complaining of foul smelling urine, pain on urination and night sweats. What further assessment should be done to check if he has Urinary Tract Infection?
Assess his blood pressure.
Take a urine sample and send it to the lab.
Do the buccal swab and send the specimen to the lab.
Check his prothrombin time and signs of bleeding.
36. A complaint has been raised by one of the service user’s relatives. Which of the following should you not document?
the person’s name
the date and time of complaint made
the complaint itself
the person’s country of origin
37. A patient with a nutritional deficit and a MUST Score of 2 and above is of high risk. What should be done?
Refer the patient to the dietician, the Nutritional Support Team and implement local policy.
Observe and document dietary intake for three days.
Repeat screening weekly or monthly depending on the patient’s food intake during the last 72 hours.
All of the above.
38. Mr Evans is 89 years old with Prostate Cancer. He was advised that the only treatment available for him was palliative care after Transurethral Resection of the Prostate. What is your main task as a coordinator of care in the multidisciplinary team?
One should be able to organise the services identified in the care plan and across other agencies.
Assess the patient for respiratory complications caused by gas exchange alterations due to old age.
Sit down with the patient and ask for the frequency of his bowel elimination
Document the patient’s capability of self-care activities and the support he needs to carry out activities of daily living.
39. John appears to be very confused today. He seems to be quite verbally aggressive towards staff. His urine has also got a bit of foul smell. How would you assess this resident?
Check his papillary response to light
Collect a urine sample for MSU
Carry out the urine dipstick
b and c
None of the above
40. A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:
Is the opening on the client’s left side
Is the opening on the distal end on the client’s left side
Is the opening on the client’s right side
Is the opening on the distal right side
41. Mrs B is 90 years old and has been admitted to the nursing home. The staff seem to have difficulty dealing with her family. One day, during your shift, Mrs B fell off a chair. You have assessed her, and no injuries have been noted. Which of the following is a principle of the Duty of Candour?
You will not ring the family since there is no injury caused by the fall.
You have liaised with the lead nurse, and she decided not to ring the family due to no harm.
Observe the patient, take her physical observations, and ask if you must call the family.
All of the above
None of the above
42. You were on duty, and you have noticed that the syringe driver is not working properly. What should you do?
ask someone to fix it
report this to your supervisor immediately
leave this for the senior staff to sort out
recommend a person to repair it
43. Mr Bond has just been certified dead by the General Practitioner. However, no arrangements have been made by the family. What should you do first?
Check patient’s records for the next of kin details, and contact them to discuss about funeral services.
Ring the co-operative and arrange for the undertaker to pick up Mr Bond as soon as possible.
Contact the GP and discuss about how to deal with Mr Bond.
Contact your manager and enquire about dealing with Mr Bond.
44. Maria, 57 years old, suffered from a very dense left sided Cerebrovascular Accident/ Stroke. She was unconscious and unresponsive for several days with IV fluids for hydration. Since her recovery from stroke, she has been prescribed to commence enteral feeding through a fine bore nasogastric tube, in which she signed her consent in front of her who have always been supportive of her decisions. However, she tends to pull out her NGT when she is by herself in her room. She died of malnutrition after a few days. Which of the following statements is true?
Nurses should have the empathy to listen to more than just the spoken word.
Nurses should practice in accordance to Pauleena’s best interest while providing support to the family and listening to their concerns and wishes.
Maria needs to be supported with questions related to mortality and meaning of life. Therapeutic communication is also essential.
All of the above
45. An 82 year old lady was admitted to the hospital for assessment of her respiratory problems. She has been a long term smoker in spite of her daughter advising her to stop. Based on your assessment, she has lost a substantial amount of weight. How will you assess her nutritional status?
Check her height and weight, so you can determine her BMI, BMI Score and Nutritional Care Plan
Use the respiratory and perfusion assessment chart on admission
Check if she is struggling to chew and swallow, and make a referral to the Speech and Language Therapist
All of the above
46. The nurse sat an older man on the toilet in a six-bed hospital bay. Using her judgement, she recognised that he was at risk of falling and so left the toilet door ajar. In the meantime, the nurse went to make his bed on the other side of the bay. On turning around, she noticed that the patient had fallen onto the toilet floor. What should be her initial intervention?
Immobilise the patient and conduct a thorough assessment, checking for injuries
Call for help immediately
Press the emergency call button immediately
Check the patient for injuries and transfer him to the wheelchair
47. You are nursing an adult patient with a long-bone fracture. You encourage your patient to move fingers and toes hourly, to change positions slightly every hour, and to eat high-iron foods as part of a balanced diet. Which of the following foods or beverages should you advise the client to avoid whilst on bed rest?
Fruit juices
Large amounts of milk or milk products
Cranberry juice cocktail
No need to avoid any foods while on bed rest
48. On admission of a service user, you have done an informal risk assessment for pressure sores, and you have noted that the patient is currently not at risk. What will be your next step?
Include the Repositioning Chart on your patient’s daily notes, and instruct your carers/HCA’s to turn your patient every two hours.
Alert the General Practitioner about your patient’s condition.
Reassess your patient on a regular basis and document your observations.
Modify your patient’s diet to maintain intact skin integrity.
49. An adult patient with Nasogastric Tube died in a medical ward due to aspiration of fluids. Staff nurse on duty believes that she has flushed the tube and believed it is patent. What should NOT have been done?
Nothing should be introduced down the tube before gastric placement is confirmed.
Internal guidewires should not be lubricated before gastric placement is confirmed.
Auscultate the patient’s stomach as you push some air in, and if you cannot hear anything, flush it.
It is important to check the position of the tube by measuring the pH value of stomach contents.
