Nursing Practice & Decision-making

A 16-year-old who fully understands a proposed treatment wishes to consent to it. Under UK law, how should the nurse regard this?

• AA 16-year-old is presumed able to consent to their own treatment✓
• BConsent has to be approved by a court before treatment can begin
• CA parent's consent is needed alongside their own
• DThe young person cannot give valid consent until they reach the age of 18

Answer: In the UK, people aged 16 and 17 are presumed to have the capacity to consent to their own medical treatment. Younger children may also consent if assessed as Gillick competent.

A patient's NEWS2 score has risen sharply with a new score of 7. What does this indicate the nurse should do?

• AReduce the frequency of observations to avoid disturbing the patient
• BTrigger an urgent clinical review and escalate as per protocol✓
• CWait for the next scheduled medication round
• DContinue routine 12-hourly observations

Answer: A NEWS2 score of 7 or more is a high score that triggers an emergency response, including urgent clinical review and continuous monitoring. Prompt escalation reduces the risk of deterioration and cardiac arrest.

An unconscious patient is brought to hospital after an accident and needs immediate life-saving treatment. There is no advance decision. What is the legal basis for treating them?

• ATreatment may be given in the patient's best interests under the doctrine of necessity✓
• BA court order is required before treatment can be given
• CTreatment cannot be given without written consent
• DA relative's consent is needed before treatment can be given

Answer: When a patient lacks capacity and there is no valid advance decision, urgent life-saving treatment may lawfully be given in their best interests under the principle of necessity. Waiting for consent would risk serious harm.

A nurse suspects an older patient is being financially abused by a family member. What is the correct action?

• ARaise a safeguarding concern following local policy✓
• BIgnore it as it is a private family matter
• CWait until the patient complains formally
• DConfront the family member directly without evidence

Answer: Nurses have a duty to safeguard adults at risk and must raise a safeguarding concern through local procedures when abuse is suspected. Acting promptly protects the patient from further harm.

Before administering a medicine, which of the following must the nurse check as one of the 'rights' of medicines administration?

• AThe right patient, drug, dose, route and time✓
• BThe right ward stock level
• CThe right colour of the packaging and the right size of box
• DThe right pharmacy supplier

Answer: Safe medicines administration requires confirming the right patient, drug, dose, route and time, along with documentation. These checks reduce the risk of medication errors and patient harm.

A patient's aggregate NEWS2 score is 7. What clinical response is recommended?

• ARoutine 4-hourly observations
• BA repeat of the observations the next day
• CAn emergency response✓
• DA review by a nurse within 12 hours

Answer: Under NEWS2, an aggregate score of 7 or more triggers an emergency response from a team with critical care competencies, and usually continuous monitoring of vital signs.

A patient's NEWS2 aggregate score is 2, but one parameter alone scores 3. What does NEWS2 recommend?

• ADischarge planning to begin that day
• BNo change, as the aggregate score is low
• CObservations once every 12 hours
• DAn urgent review on the ward✓

Answer: A score of 3 in any single parameter is a trigger in its own right, calling for an urgent ward-based response by a clinician, whatever the aggregate score.

Under NEWS2, how many points does new-onset confusion score?

• A0
• B1
• C3✓
• D2

Answer: New confusion (the 'C' in ACVPU) scores 3, the same as responding only to voice or pain or being unresponsive, because it can signal serious illness such as sepsis.

A patient has hypercapnic respiratory failure and is on NEWS2 SpO2 Scale 2. What is their usual oxygen saturation target?

• A85 to 88%
• B94 to 98%
• C96 to 100%
• D88 to 92%✓

Answer: Scale 2 is used for patients with a prescribed target range of 88 to 92%, usually because of hypercapnic respiratory failure. Most other acutely ill patients have a target of 94 to 98%.

In the ABCDE assessment of a deteriorating patient, what does 'D' stand for?

• ADrugs
• BDiet
• CDiagnosis
• DDisability✓

Answer: ABCDE stands for Airway, Breathing, Circulation, Disability and Exposure. Disability covers the level of consciousness, pupils and blood glucose.

According to Resuscitation Council UK, what is the ratio of chest compressions to rescue breaths in adult CPR?

• A30 compressions to 2 breaths✓
• B15 compressions to 2 breaths
• C30 compressions to 1 breath
• D5 compressions to 1 breath

Answer: Adult basic life support uses 30 compressions to 2 rescue breaths, with compressions 5 to 6 cm deep at 100 to 120 a minute.

Where should intramuscular adrenaline be given in an adult with anaphylaxis?

• AThe back of the upper arm
• BThe upper outer buttock
• CThe abdomen, below the navel
• DThe anterolateral thigh✓

Answer: Resuscitation Council UK advises giving IM adrenaline into the anterolateral aspect of the middle third of the thigh.

A conscious adult with diabetes has a blood glucose of 3.2 mmol/L. What should the nurse give first?

• AA large meal, then recheck in 4 hours
• BNothing, as 3.2 mmol/L is within normal range
• C15 to 20 g of fast-acting carbohydrate✓
• DTheir next dose of insulin early, then recheck

Answer: Hypoglycaemia is a blood glucose below 4 mmol/L. A conscious patient who can swallow should have 15 to 20 g of quick-acting carbohydrate, with glucose rechecked after about 10 to 15 minutes.

In NICE's sepsis risk criteria for settings outside acute hospitals, which of these is a high-risk criterion in an adult with suspected sepsis?

• AA systolic blood pressure of 130 mmHg
• BA temperature of 37.2 degrees Celsius
• CA heart rate above 130 beats per minute✓
• DA respiratory rate of 18 breaths per minute

Answer: NICE NG51 lists a heart rate over 130 beats per minute as a high-risk criterion, along with others such as a respiratory rate of 25 or more and a systolic blood pressure of 90 mmHg or less. Since 2024 NICE advises using NEWS2 to assess adults in acute hospital settings.

How often does NICE recommend repositioning an adult who is at high risk of developing a pressure ulcer?

• AAt least every 8 hours
• BAt least every 4 hours✓
• CAt least every 12 hours
• DAt least once a day

Answer: NICE CG179 recommends repositioning adults at high risk at least every 4 hours, and adults at risk at least every 6 hours.

How is a category 2 pressure ulcer described?

• AIntact skin with redness that does not blanch when pressed
• BPartial-thickness skin loss, such as a shallow open ulcer✓
• CFull-thickness tissue loss with bone or tendon exposed
• DDeep tissue injury under intact, dark or purple skin

Answer: A category 2 pressure ulcer involves partial-thickness loss of the dermis, seen as a shallow open ulcer with a red-pink wound bed or a blister. Non-blanching redness of intact skin is category 1.

What is the Malnutrition Universal Screening Tool (MUST) used for?

• AScreening patients for swallowing problems
• BMeasuring a patient's daily fluid intake
• CAssessing the risk of developing pressure ulcers
• DIdentifying adults at risk of malnutrition✓

Answer: MUST, developed by BAPEN, uses BMI, unplanned weight loss and the effect of acute illness to identify adults who are malnourished or at risk of malnutrition.

According to NICE, which inpatients should have a multifactorial falls risk assessment?

• APatients of any age who have been admitted following a fall at home
• BPatients who walk with a frame, a stick or another walking aid
• CAll patients aged 80 or over, and only if they have fallen in hospital
• DEveryone aged 65 or over, and those aged 50 to 64 at higher risk✓

Answer: NICE advises that all inpatients aged 65 or over, and those aged 50 to 64 judged to be at higher risk of falling because of an underlying condition, should have a multifactorial falls risk assessment.

Which feature best helps distinguish delirium from dementia?

• ADelirium starts suddenly and fluctuates✓
• BDelirium affects memory but not attention
• CDelirium is a normal part of ageing
• DDelirium develops slowly over many years

Answer: Delirium has an acute onset, a fluctuating course and marked inattention, and often has a treatable cause such as infection. Dementia usually develops gradually.

What is the first principle of the Mental Capacity Act 2005?

• AA person's family can decide whether the person has capacity
• BA person must be assumed to have capacity unless it is shown they lack it✓
• CA person who makes an unwise decision should be assessed as lacking capacity
• DA person with a diagnosis of dementia is assumed to lack capacity

Answer: The first principle is that a person must be assumed to have capacity unless it is established that they lack it.

A patient with capacity refuses a treatment that staff believe would help them. What does the Mental Capacity Act say?

• AAn unwise decision does not by itself mean they lack capacity✓
• BStaff may give the treatment if they think it is best for them
• CRefusing treatment shows the patient lacks capacity
• DThe patient's next of kin may override the refusal

Answer: Under the Act a person is not to be treated as unable to make a decision merely because they make an unwise decision. A capacitous adult may refuse treatment.

Under the Mental Capacity Act, a person is unable to make a decision if they cannot do which of these?

• AUnderstand, retain, use or weigh it, or communicate their decision✓
• BRemember the information for at least one week after it was given
• CAgree with the recommendation that the healthcare professional has made
• DRead and write the written information that they were given in English

Answer: The functional test asks whether the person can understand the relevant information, retain it long enough, use or weigh it, and communicate the decision by any means.

A 14-year-old wants to consent to treatment without their parents knowing. What principle applies?

• AThey can consent to any treatment at 14
• BThey cannot consent until the age of 16
• COnly a court can decide for anyone under 16
• DThey may consent if they are Gillick competent✓

Answer: A young person under 16 can consent to treatment if they have enough intelligence and understanding to fully understand what is proposed, known as Gillick competence.

Under section 5(4) of the Mental Health Act 1983, for how long may a nurse detain an informal inpatient?

• AUp to 28 days
• BUp to 24 hours
• CUp to 72 hours
• DUp to 6 hours✓

Answer: Section 5(4), the nurse's holding power, allows a qualified mental health or learning disability nurse to detain an informal inpatient for up to 6 hours until a doctor or approved clinician arrives.

How long can a patient be detained for assessment under section 2 of the Mental Health Act 1983?

• AUp to 72 hours
• BUp to 6 months
• CUp to 28 days✓
• DUp to 14 days

Answer: Section 2 allows detention for assessment, which may be followed by treatment, for up to 28 days. Section 3, for treatment, lasts up to 6 months initially.

A patient has a DNACPR decision in place. What does this mean for their other treatment?

• AOther treatment and care continue as needed✓
• BTheir observations no longer need to be recorded
• CAll active treatment must stop, including antibiotics
• DThey should not be given food or fluids by mouth

Answer: A DNACPR decision applies only to cardiopulmonary resuscitation. It does not mean that other treatment, care or monitoring should be withheld.

How should a patient's identity be checked before a blood transfusion?

• AAt the nurses' station, using the patient's notes and bed number
• BAt the bedside, matching their details to the blood component label✓
• CAt the bedside, by asking if they are the person named on the bag
• DIn the blood fridge area, by checking the label against the request

Answer: Positive patient identification must be carried out at the bedside, asking the patient to state their details where possible and matching them against the wristband and the component label.

During a blood transfusion the patient develops a fever, rigors and low blood pressure. What should the nurse do first?

• ASlow the transfusion down and recheck in an hour
• BGive paracetamol and let the transfusion continue
• CStop the transfusion and get an urgent medical review✓
• DFinish the unit quickly, then report the reaction

Answer: A suspected acute transfusion reaction needs the transfusion to be stopped immediately, the patient assessed using ABCDE and urgent medical help sought.

According to British Thoracic Society guidance, what is the usual target oxygen saturation for most acutely ill adults?

• A88 to 92%
• B90 to 94%
• C94 to 98%✓
• D98 to 100%

Answer: The BTS recommends a target of 94 to 98% for most acutely ill adults, and 88 to 92% for those at risk of hypercapnic respiratory failure.

According to Resuscitation Council UK, how should paediatric basic life support begin in a child who is not breathing normally?

• AWith 5 rescue breaths✓
• BWith 2 rescue breaths
• CWith 15 chest compressions
• DWith 30 chest compressions

Answer: Paediatric basic life support starts with 5 initial rescue breaths, followed by chest compressions at a ratio of 15 compressions to 2 breaths.