Platform 1: Being an Accountable Professional

A nursing associate makes a medication error that causes no harm. According to the NMC Code, what should they do?

• AReport it only if the patient later shows signs of harm from the error
• BTell a colleague informally so that someone else is aware of what happened
• CRecord it privately and monitor the patient in case a problem develops
• DReport it promptly, be open with the patient and take action to put matters right✓

Answer: The Code requires registrants to be open and candid about errors, act immediately to put matters right, and report them through the proper route regardless of whether harm resulted. An error that reaches the patient but causes no harm is still reported, as is a near miss, so that the system can learn from it.

Which of these best describes accountability for a task that a registered nurse has delegated to a nursing associate?

• AThe nursing associate is accountable for their own practice in carrying it out, and the nurse for the decision to delegate✓
• BAccountability rests with the ward manager, who is responsible for all staff on the shift
• CThe registered nurse remains accountable for every aspect of the task once it has been delegated
• DAccountability passes entirely to the nursing associate at the moment the task is accepted

Answer: Delegation splits accountability: the person delegating is accountable for deciding the task is appropriate and the person is competent, and the person accepting it is accountable for how they perform it. The Code requires both to be satisfied that the delegation is safe.

A patient with capacity refuses a routine blood pressure check. What should the nursing associate do?

• ARespect the refusal, explain the reasons for the check, and record the refusal and the discussion✓
• BTake the reading anyway, since observations are part of the prescribed care plan
• CAsk a colleague to take the reading later without telling the patient why
• DReport the patient to the doctor as non-compliant and withhold other elements of care until they agree to the observation

Answer: An adult with capacity may refuse any intervention, however routine. The right response is to respect the decision, make sure the person understands the purpose of the check, and document the refusal and conversation accurately.

Which of these is one of the five statutory principles of the Mental Capacity Act 2005?

• ADecisions for a person who lacks capacity should be made in the family's interests
• BCapacity is assessed once, and the outcome applies to all future decisions
• CA person must be assumed to have capacity unless it is established that they lack it✓
• DA person who makes an unwise decision can be assumed to lack capacity

Answer: The Act's first principle is the presumption of capacity. The others contradict the Act: an unwise decision does not by itself show a lack of capacity, capacity is decision-specific and time-specific, and decisions must be made in the person's own best interests.

What is the standard for a written record in a patient's notes under the NMC Code?

• ADetailed and written up at the end of the shift from memory of the day's events
• BBrief, using personal shorthand so that the record can be completed quickly
• CWritten only when something unusual has happened during the period of care
• DClear, accurate, factual and completed at the time or as soon as possible afterwards✓

Answer: The Code requires records to be clear, accurate and contemporaneous, without falsification, and completed at the time or as soon as possible after the event. Retrospective entries from memory, private shorthand and gaps for 'normal' care all make the record unreliable.

A nursing associate overhears a colleague discussing a patient's diagnosis in a lift. Which principle has the colleague breached?

• AConfidentiality — patient information must be shared only with those who need it for care✓
• BDelegation — clinical information about a patient should be discussed only by senior members of staff
• CAutonomy — the patient should have been asked before the diagnosis was made
• DCandour — the colleague should have told the patient what was being said

Answer: Discussing identifiable patient information in a public place breaches confidentiality, a core requirement of the Code and of data protection law. The problem is where and to whom the information was disclosed, not who was talking.

How often must a nursing associate revalidate with the NMC, and what practice-hours requirement applies?

• AEvery three years, with at least 450 hours of registered practice✓
• BEvery five years, with at least 750 hours of registered practice
• CEvery year, with at least 150 hours of registered practice
• DEvery three years, with at least 900 hours of registered practice

Answer: Revalidation is every three years for all NMC registrants, including nursing associates, and requires 450 practice hours over the three years along with 35 hours of CPD, feedback, reflective accounts and a confirmer. 900 hours applies to anyone holding two registrations — nurse and midwife, or nurse and nursing associate — made up of 450 hours for each.

A 15-year-old asks a nursing associate for advice about contraception and does not want their parents told. Which principle guides whether the young person's confidentiality can be respected?

• AParental responsibility — anyone under 18 needs a parent's consent for any treatment, so the parents must be told
• BSafeguarding — any request of this kind must be reported to the police
• CThe Mental Capacity Act — its principles apply to everyone who is asked to consent, regardless of their age
• DGillick competence — a young person under 16 with sufficient understanding may consent to their own treatment✓

Answer: A young person under 16 who has sufficient maturity and understanding to make a particular decision is Gillick competent and can consent to treatment; for contraception and sexual-health advice specifically, the Fraser guidelines set out when this can be given without parental knowledge, and confidentiality is respected unless there is a safeguarding concern. The Mental Capacity Act applies from age 16.

Which of these is one of the four themes of the NMC Code?

• AMaximise efficiency
• BPreserve safety✓
• CFollow instructions
• DPromote independence

Answer: The Code's four themes are: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. The other phrases are not Code themes.

A nursing associate is asked to carry out a procedure they have not been trained in. What should they do?

• ADo it this once under the senior colleague's direction and ask for formal training afterwards so that it can be done properly next time
• BAttempt it carefully, since refusing a task from a senior colleague would be insubordinate
• CDecline and explain that it is outside their competence, so that a competent person can do it✓
• DAttempt it after reading the procedure online, as long as a colleague is nearby

Answer: The Code requires registrants to recognise and work within the limits of their competence. Accepting a task you are not competent to perform puts the patient at risk; the safe response is to say so and ensure a competent person carries it out.

A nursing associate is asked by a patient's relative for details of the patient's diagnosis. The patient has capacity and has not said what may be shared. What should the nursing associate do?

• ARefuse and end the conversation, since relatives should not be asking staff about a patient's care
• BShare the diagnosis, since close relatives are entitled to information about a family member's care
• CShare a general outline without the specific diagnosis so that the relative is not left with nothing
• DExplain that they cannot share details without the patient's agreement, and offer to ask the patient what they are happy to share✓

Answer: Confidential information belongs to the patient, who decides what is shared and with whom. The Code requires the nursing associate to protect it while still treating the relative with courtesy — checking with the patient is the right route.

What is the purpose of the NMC Code?

• ATo list the medicines that a nursing associate may administer without supervision
• BTo set out the professional standards that nurses, midwives and nursing associates must uphold to be registered✓
• CTo describe the clinical procedures that nursing associates are permitted to carry out
• DTo set the pay bands and working hours for registered staff in the NHS

Answer: The Code is the professional standards framework for all NMC registrants and is the basis for revalidation and fitness-to-practise decisions. Scope of practice, medicines rules and pay are set elsewhere.

A patient with fluctuating capacity refuses their evening medication at a time when they appear confused. Which action is most consistent with the Mental Capacity Act?

• AReturn later when the patient may have capacity and try again, and if they still lack capacity, act in their best interests with the team✓
• BHide the medication in the patient's food or drink, since a confused patient cannot make a valid refusal and the dose must not be missed
• CRecord the refusal on the chart and withhold all further doses of the medicine until the patient asks for them of their own accord
• DAsk a relative to consent to the medication on the patient's behalf over the phone, since next of kin can decide for a confused person

Answer: Capacity is time- and decision-specific: the Act requires taking all practicable steps to help the person decide, including choosing a better time. Covert administration needs a documented best-interests decision involving the team and pharmacy, and relatives cannot consent unless they hold a relevant lasting power of attorney.

Which of these is an example of a nursing associate practising within the limits of their role?

• ADeclining to interpret an ECG and asking the registered nurse to review it✓
• BPrescribing a laxative for a constipated patient after checking the BNF
• CCertifying a patient fit for discharge without medical review
• DAdjusting an intravenous insulin infusion rate based on their own reading of the blood glucose

Answer: Nursing associates work within a defined scope and must recognise the limits of their competence. Interpreting an ECG, altering an insulin infusion, prescribing and discharging are outside that scope without the appropriate registered professional's decision.

A nursing associate notices that their own record of a patient's observations from yesterday contains an error. What should they do?

• AErase or overwrite the original entry so that the record is accurate
• BMake a new, dated entry correcting the error, leaving the original visible and signed✓
• CAsk a colleague who was on duty to rewrite the observation for them
• DLeave it, since altering records after the event is not permitted

Answer: Records must be accurate, but they must also be complete and traceable: the correct approach is a dated, signed correction that leaves the original legible. Erasing or overwriting looks like tampering, and leaving a known error uncorrected fails the accuracy duty.