Free Full Mock Test Part 1

✅ Correct Answer: 2 tablets

💡 Rationale: First, convert the prescribed dose to the same unit as the stock dose: 1 gram = 1000 mg. Then, use the formula: (Dose required / Dose available) = (1000 mg / 500 mg) = 2 tablets.

✅ Correct Answer: 10 ml

💡 Rationale: Use the formula: (What you want / What you've got) x Volume = (250 mg / 125 mg) x 5 ml = 2 x 5 ml = 10 ml.

✅ Correct Answer: 42 drops/min

💡 Rationale: Formula: (Total volume in ml x Drip factor) / (Total time in minutes). (1000 x 20) / (8 x 60) = 20000 / 480 = 41.66. Rounded to the nearest whole number, this is 42 drops/min.

✅ Correct Answer: 750 ml

💡 Rationale: Calculate the oral intake: 200 ml + 150 ml = 350 ml. Calculate IV intake: 100 ml/hr x 4 hours = 400 ml. Total input = 350 ml + 400 ml = 750 ml.

✅ Correct Answer: Promote commercial success

💡 Rationale: The four main themes of the NMC Code (2018) are: Prioritise people, Practise effectively, Preserve safety, and Promote professionalism and trust.

✅ Correct Answer: 30:2

💡 Rationale: The Resuscitation Council UK guidelines state that for adult Basic Life Support, the correct ratio is 30 chest compressions followed by 2 rescue breaths.

✅ Correct Answer: Washing hands thoroughly with liquid soap and water

💡 Rationale: Alcohol-based hand rubs are ineffective against C. diff spores. Handwashing with liquid soap and water is required to mechanically remove the spores from the hands.

✅ Correct Answer: Document the concern and report it to the local safeguarding lead/manager

💡 Rationale: Under the NMC Code and UK safeguarding laws, nurses have a duty to act if they suspect a vulnerable adult is at risk of financial abuse. The concern must be documented and escalated to the appropriate safeguarding lead.

✅ Correct Answer: 4 grams in 24 hours

💡 Rationale: The standard maximum daily dose of paracetamol for an adult is 4 grams in a 24-hour period, typically given as 1 gram (two 500mg tablets) every 4-6 hours.

✅ Correct Answer: Inform the nurse in charge and arrange an urgent review by the ward-based doctor or acute team

💡 Rationale: A NEWS2 score of 5 or 6 represents a medium clinical risk and requires an urgent response, including a minimum of hourly observations and urgent assessment by a clinician with core competencies in acute illness.

✅ Correct Answer: At the patient's bedside

💡 Rationale: To prevent wrong-blood-in-tube and administration errors, UK guidelines strictly mandate that the final bedside check must take place next to the patient, verifying their identity band against the blood product.

✅ Correct Answer: Draw a single clear line through the error, sign, date, and write 'written in error'

💡 Rationale: The NMC guidelines on record keeping dictate that errors must remain legible. A single line should be drawn through the text, followed by a signature, date, and clarification that it is an error.

✅ Correct Answer: Checking the pH of the gastric aspirate, expecting a result between 1 and 5.5

💡 Rationale: The NPSA and UK guidelines dictate that testing the pH of gastric aspirate (pH 1-5.5) is the safe, first-line method. The 'whoosh test' and bubbling tests are outdated and unsafe.

✅ Correct Answer: Intramuscular adrenaline (epinephrine) 1:1000

💡 Rationale: Intramuscular adrenaline (1:1000) is the life-saving, first-line treatment for anaphylaxis to rapidly reverse bronchospasm and cardiovascular collapse.

✅ Correct Answer: A breach of the NMC Code as it damages the reputation of the profession and breaches confidentiality

💡 Rationale: The NMC Code strictly states that nurses must use social media responsibly. Posting about patients or workplace grievances, even anonymously, compromises professionalism, public trust, and potential confidentiality.

✅ Correct Answer: 0.9% Sodium Chloride or warm tap water

💡 Rationale: NICE guidelines recommend using tap water or 0.9% Sodium Chloride for cleaning a wound. Antiseptics like iodine or hydrogen peroxide can damage healthy granulating tissue and delay healing.

✅ Correct Answer: Give 15-20g of fast-acting carbohydrate (e.g., fruit juice or glucose gel)

💡 Rationale: For a conscious patient experiencing mild to moderate hypoglycaemia (BM < 4.0 mmol/L), the immediate treatment is 15-20g of fast-acting carbohydrate to rapidly raise blood sugar levels.

✅ Correct Answer: You, the registered nurse, as you retain accountability for the delegation and patient outcome

💡 Rationale: Under the NMC Code, while you can delegate tasks, the registered nurse remains accountable for the appropriateness of the delegation and ensuring the task has been completed and reported correctly.

✅ Correct Answer: It must be checked by two trained personnel, one of whom must be a registered nurse, and recorded in the CD register

💡 Rationale: The Misuse of Drugs Regulations and standard UK trust policies require Schedule 2 controlled drugs to be checked and administered by two authorized practitioners, and meticulously recorded in a specific CD register.

✅ Correct Answer: A person must be assumed to have capacity unless it is established that they lack it

💡 Rationale: A fundamental principle of the Mental Capacity Act 2005 is the presumption of capacity. Every adult has the right to make their own decisions unless it is proven they lack the capacity to do so.

✅ Correct Answer: An individualised manual handling risk assessment

💡 Rationale: To comply with Health and Safety regulations and the Royal Marsden, an individual patient risk assessment must be completed and documented before attempting any moving and handling tasks to ensure safety and select the correct equipment.

✅ Correct Answer: Remove the cannula immediately and consider treatment for phlebitis

💡 Rationale: Pain, erythema, and swelling are classic signs of phlebitis (VIP score 3 or higher). The cannula must be removed immediately, and the event documented to prevent further complications like infection or thrombosis.

✅ Correct Answer: Waterlow score

💡 Rationale: The Waterlow score (along with the Braden scale) is widely used in the UK to assess pressure ulcer risk, evaluating factors like mobility, continence, and nutritional status. MUST is for malnutrition, NEWS2 for deterioration, and GCS for consciousness.

✅ Correct Answer: 88 - 92%

💡 Rationale: British Thoracic Society (BTS) guidelines state that for patients with a known risk of type 2 respiratory failure (like COPD), the target saturation should be 88-92% pending arterial blood gas results to avoid carbon dioxide retention.

✅ Correct Answer: Anterior nares (nose) and groin

💡 Rationale: Standard routine MRSA screening in the UK usually involves taking swabs from the anterior nares (nose) and the groin, as these are common sites for colonisation. Additional sites may be swabbed if wounds or devices are present.

✅ Correct Answer: Be open and honest with patients when something goes wrong with their treatment or care

💡 Rationale: The professional Duty of Candour mandates that healthcare professionals must be open and honest with patients and their families when something goes wrong that causes, or has the potential to cause, harm or distress.

✅ Correct Answer: Positioned below the level of the bladder without touching the floor

💡 Rationale: Drainage bags must be kept below the level of the bladder to prevent backflow of urine (which can cause infection), but should not rest on the floor to prevent environmental contamination. The system should remain closed.

✅ Correct Answer: Abbey Pain Scale or PAINAD

💡 Rationale: For patients with cognitive impairment who cannot self-report pain, behavioral pain assessment tools such as the Abbey Pain Scale or PAINAD (Pain Assessment in Advanced Dementia) are recommended by UK guidelines.

✅ Correct Answer: To ensure medications are readily available in the home or ward for rapid relief of common end-of-life symptoms

💡 Rationale: Anticipatory prescribing ensures that medications for common symptoms (pain, breathlessness, nausea, agitation, respiratory secretions) are written up and available ahead of time, preventing delays in symptom management.

✅ Correct Answer: Dispose of the syringe and attached needle as a single unit directly into a designated sharps bin

💡 Rationale: To prevent needle-stick injuries, used sharps must not be recapped or disassembled. The needle and syringe must be disposed of immediately at the point of use as a single unit into an approved sharps container.

✅ Correct Answer: 125 ml/hr

💡 Rationale: To calculate the rate in ml/hr for an infusion pump, divide the total volume by the total time in hours. 500 ml / 4 hours = 125 ml/hr.

✅ Correct Answer: 150 mg

💡 Rationale: Multiply the patient's weight by the prescribed dose per kg: 75 kg x 2 mg/kg = 150 mg.

✅ Correct Answer: 0.5 ml

💡 Rationale: Use the formula: (Dose required / Dose available) x Volume. (5,000 / 10,000) x 1 ml = 0.5 x 1 ml = 0.5 ml.

✅ Correct Answer: 40 ml

💡 Rationale: Multiply the minimum acceptable volume per kg by the patient's weight: 0.5 ml x 80 kg = 40 ml per hour.

✅ Correct Answer: Voluntary, informed, and the patient must have capacity

💡 Rationale: Under UK law, valid consent requires that the patient has the mental capacity to make the decision, has been fully informed about the risks and benefits, and has made the decision voluntarily without coercion.

✅ Correct Answer: Give up to 5 back blows

💡 Rationale: According to the Resuscitation Council UK algorithm for a conscious adult with severe choking, you should immediately give up to 5 back blows, assessing between each. If this fails, proceed to 5 abdominal thrusts.

✅ Correct Answer: Encourage the wound to gently bleed under warm running water and wash with soap

💡 Rationale: UK Health and Safety guidelines mandate that following a sharps injury, you should immediately encourage bleeding (do not suck the wound), wash thoroughly with soap and warm running water (do not scrub), dry, cover, and then report it immediately.

✅ Correct Answer: Stop the blood transfusion immediately and maintain IV access with 0.9% Sodium Chloride

💡 Rationale: These are signs of an acute severe transfusion reaction. Immediate action is to stop the transfusion to prevent further administration of the incompatible or contaminated blood, and keep the vein open with normal saline while calling for urgent medical help.

✅ Correct Answer: Situation, Background, Assessment, Recommendation

💡 Rationale: SBAR is a standardized communication framework used widely in the NHS to effectively communicate critical information: Situation, Background, Assessment, and Recommendation.

✅ Correct Answer: Red or pink, moist, and slightly protruding tissue

💡 Rationale: A healthy stoma should appear red or pink (similar to the inside of the mouth), moist, and slightly protruding. Purple, black, pale, or dry tissue indicates ischemia or necrosis and requires urgent medical intervention.

✅ Correct Answer: 3

💡 Rationale: The minimum score on the GCS is 3 (Eye opening = 1, Verbal response = 1, Motor response = 1). A score of 0 does not exist.

✅ Correct Answer: Assess the patient for injuries on the floor before attempting to move them

💡 Rationale: Following a fall, the immediate priority is to assess the patient on the floor for potential injuries (e.g., fractures, head injury) to prevent exacerbating any trauma. Moving them before assessment is unsafe.

✅ Correct Answer: Delay the conversation until an official, trained professional interpreter is available

💡 Rationale: To ensure accurate, unbiased translation of medical information and valid consent, professional interpreters must be used. Relying on family members (especially minors) breaches NHS guidelines and risks misinterpretation or emotional trauma.

✅ Correct Answer: Cheyne-Stokes respiration

💡 Rationale: Cheyne-Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing (apnea). It is frequently seen at the end of life.

✅ Correct Answer: Respect their decision, document the refusal using the correct code on the drug chart, and inform the prescriber

💡 Rationale: A patient with capacity has the right to refuse treatment. Covert administration is illegal in this context. The refusal must be respected, documented properly on the MAR chart, and escalated to the medical team.

✅ Correct Answer: Evisceration; cover the exposed bowel with sterile dressings soaked in sterile 0.9% Sodium Chloride and call for urgent medical help

💡 Rationale: Evisceration is a surgical emergency. The protruding organs must not be pushed back in. They must be covered with sterile, saline-soaked dressings to prevent tissue drying and necrosis while urgent surgical help is summoned.

✅ Correct Answer: It increases the proportion of the drug that reaches the lungs and reduces deposition in the mouth

💡 Rationale: Spacers overcome the need for complex hand-breath coordination required for MDIs. They slow down the aerosol spray, allowing more of the drug to be inhaled into the lower airways rather than hitting the back of the throat.

✅ Correct Answer: To ensure that people who lack mental capacity are only deprived of their liberty when it is in their best interests and is the least restrictive option

💡 Rationale: DoLS are an amendment to the Mental Capacity Act 2005. They provide a legal framework to protect vulnerable adults who lack capacity to consent to care arrangements that deprive them of their liberty, ensuring it is necessary and proportionate.

✅ Correct Answer: Make the patient 'Nil By Mouth' (NBM) until assessed by SALT

💡 Rationale: If a patient exhibits signs of aspiration (coughing/choking) and has not been assessed, they must be made Nil By Mouth to prevent aspiration pneumonia until a formal SALT assessment dictates the safe consistency of fluids and diet.

✅ Correct Answer: Continue taking their basal insulin, monitor blood glucose closely, and adjust fast-acting insulin based on readings

💡 Rationale: During illness, counter-regulatory hormones cause blood glucose to rise, increasing the risk of Diabetic Ketoacidosis (DKA) in Type 1 diabetics. Insulin must never be stopped. Frequent monitoring and adjustment are required.

✅ Correct Answer: Weak opioids (e.g., codeine) +/- non-opioids

💡 Rationale: The WHO analgesic ladder progresses from Step 1: non-opioids, to Step 2: weak opioids (like codeine or tramadol) often combined with non-opioids, to Step 3: strong opioids (like morphine).

✅ Correct Answer: Type 1 (Separate hard lumps, like nuts)

💡 Rationale: The Bristol Stool Chart classifies human faeces into 7 categories. Type 1 represents severe constipation (hard, difficult to pass lumps), Type 4 is normal, and Type 7 represents severe diarrhoea.

✅ Correct Answer: Category 1

💡 Rationale: A Category 1 pressure ulcer is defined as intact skin with non-blanchable erythema (redness that does not turn white when pressed). This signals early tissue damage.

✅ Correct Answer: 60 - 100 beats per minute

💡 Rationale: The normal resting heart rate for an adult is between 60 and 100 beats per minute. Below 60 is considered bradycardia, and above 100 is tachycardia.

✅ Correct Answer: Up to 2 hours before

💡 Rationale: Modern anaesthetic guidelines (AAGBI) state that fasting from food should be 6 hours, but clear fluids can be safely consumed up to 2 hours before anaesthesia to prevent dehydration.

✅ Correct Answer: Severe peripheral arterial disease (PAD)

💡 Rationale: TED stockings apply compression. If a patient has severe peripheral arterial disease (impaired arterial blood flow to the limbs), applying compression can further restrict blood supply, causing ischemia or gangrene.

✅ Correct Answer: Refuse to disclose information until their identity is verified and there is a legal justification or patient consent

💡 Rationale: Patient confidentiality must be maintained. Identity must be verified (e.g., calling back via a police switchboard), and information can only be shared if there is patient consent, a court order, or a clear public interest justification (e.g., prevention of serious crime).

✅ Correct Answer: Delirium

💡 Rationale: Delirium is an acute, fluctuating syndrome of altered attention and awareness, often triggered by a medical condition like an infection (e.g., UTI). Unlike dementia, which is chronic and progressive, delirium has a sudden onset.

✅ Correct Answer: Ensure their safety by removing dangerous objects and placing something soft under their head

💡 Rationale: During a seizure, the primary goal is patient safety. You should never put anything in their mouth or restrain them, as this can cause severe injury. Cushion the head and clear the area.

✅ Correct Answer: They must not be touched directly or indirectly

💡 Rationale: The core principle of ANTT is that 'Key Parts' (the critical parts of the equipment that must remain sterile) must not be touched directly or indirectly at any point during the procedure to prevent the introduction of pathogens.

✅ Correct Answer: 25 grams

💡 Rationale: A 5% solution means there are 5 grams of the substance in every 100 ml of fluid. Therefore, in 500 ml, there are 5 x 5 = 25 grams of dextrose.

✅ Correct Answer: 0.75 ml/hr

💡 Rationale: To find the hourly rate, divide the total volume by the total time in hours: 18 ml / 24 hours = 0.75 ml/hr.

✅ Correct Answer: 20

💡 Rationale: BMI is calculated as weight in kilograms divided by height in meters squared (kg/m²). Calculation: 80 / (2.0 x 2.0) = 80 / 4.0 = 20.

✅ Correct Answer: 0.5 tablet

💡 Rationale: Use the formula: (Dose required / Dose available) = (62.5 / 125) = 0.5 (half a tablet). Scored tablets can be broken to achieve this dose safely.

✅ Correct Answer: 6 Litres per minute

💡 Rationale: Standard nasal cannulae are designed to deliver low-flow oxygen, typically between 1 to 6 Litres per minute. Flow rates above 6 L/min can cause discomfort, drying, and bleeding of the nasal mucosa without significantly increasing oxygen saturation.

✅ Correct Answer: Implement continuous 1:1 observation and escalate urgently to the medical and psychiatric liaison teams

💡 Rationale: A patient with active suicidal ideation and a specific plan is at imminent risk. Immediate continuous 1:1 observation (eyesight level) must be initiated to ensure their safety, followed by urgent escalation for psychiatric assessment.

✅ Correct Answer: Adopt a calm, non-confrontational stance, maintain a safe distance, and use active listening

💡 Rationale: De-escalation focuses on verbal and non-verbal communication to calm the situation. This involves maintaining personal space, using a calm tone, avoiding direct confrontation, and listening to the patient's concerns to defuse anxiety and anger.

✅ Correct Answer: Report the discovery directly to the local police via the 101 non-emergency number within one month

💡 Rationale: Nurses, midwives, and teachers have a mandatory, personal legal duty to report 'known' cases of FGM in girls under 18 directly to the police. This is not a choice and overrides standard confidentiality.

✅ Correct Answer: Ruptured ectopic pregnancy

💡 Rationale: The combination of missed period, lower abdominal pain, vaginal bleeding, and especially 'shoulder tip pain' (caused by diaphragmatic irritation from internal bleeding) are classic red-flag signs of a ruptured ectopic pregnancy, which is a surgical emergency.

✅ Correct Answer: 10,000 parts per million (ppm) available chlorine

💡 Rationale: For large blood spills, UK infection prevention guidelines mandate the use of a chlorine-releasing agent at a concentration of 10,000 ppm available chlorine (often supplied as granules or specific hypochlorite solutions) to ensure the destruction of blood-borne viruses.

✅ Correct Answer: Act without delay to raise concerns appropriately, prioritizing patient safety over professional loyalty

💡 Rationale: The NMC Code states that you must 'act without delay if you believe that there is a risk to patient safety or public protection'. Loyalty to colleagues must never be prioritized over the safety of those receiving care.

✅ Correct Answer: Cushing's Triad, indicating raised intracranial pressure (ICP)

💡 Rationale: Cushing's Triad consists of hypertension (specifically a widening pulse pressure), bradycardia, and irregular respirations. It is a late and life-threatening sign of severely elevated intracranial pressure and imminent brain herniation.

✅ Correct Answer: Sit or lie down, place the tablet under the tongue, and allow it to dissolve completely

💡 Rationale: GTN causes rapid vasodilation, which can lead to a sudden drop in blood pressure and fainting. The patient must be advised to sit or lie down. Sublingual medications must be placed under the tongue to bypass first-pass metabolism for rapid absorption.

✅ Correct Answer: A spare tracheostomy tube of the same size, and one a size smaller, along with suction equipment

💡 Rationale: National Patient Safety Agency (NPSA) guidelines state that emergency equipment must be at the bedside of any patient with a tracheostomy. This critically includes spare tubes (same size and one size smaller in case of stoma closure during accidental decannulation) and working suction.

✅ Correct Answer: A registered nurse who has been specifically trained and assessed as competent in VoED, provided the death was expected

💡 Rationale: While certification of death is typically done by a doctor, the *verification* of an expected death (confirming the fact of death) can be carried out by a registered nurse who has completed specific local Trust training and competency assessments.

✅ Correct Answer: Three attempts, recording the highest (best) score

💡 Rationale: To obtain an accurate peak flow reading, the patient should be instructed to blow as hard and fast as possible into the meter three separate times. The highest of these three readings (the 'best' blow) is the one recorded on the chart.

✅ Correct Answer: A Mid-Stream Specimen of Urine (MSSU)

💡 Rationale: An MSSU (Mid-Stream Specimen of Urine) is the standard technique for obtaining urine for C&S. The patient voids the first portion of urine into the toilet (flushing out distal urethral flora), catches the middle portion in the sterile pot, and finishes in the toilet.

✅ Correct Answer: 1 minute

💡 Rationale: Clinical guidelines dictate that a tourniquet should not be left on for longer than 1 minute. Prolonged application causes blood stasis and hemoconcentration, which can falsely elevate levels of potassium, proteins, and lipids.

✅ Correct Answer: Perform a portable ultrasound bladder scan to measure urine volume

💡 Rationale: Post-operative urinary retention is common. Before performing an invasive procedure (catheterization) which carries an infection risk, a non-invasive bladder scan should be used to confirm retention and determine the volume of urine in the bladder.

✅ Correct Answer: Via a dedicated lumen of a Central Venous Access Device (e.g., PICC or Central Line)

💡 Rationale: TPN is highly concentrated and hyperosmolar. If given through a small peripheral vein, it will quickly cause severe phlebitis and tissue damage. It must be infused into a large, high-flow central vein via a central line or PICC.

✅ Correct Answer: Clusters of bruises in different stages of healing on the inner thighs, upper arms, and torso

💡 Rationale: Bruises on bony prominences (shins, knees, elbows) are common accidental injuries. Bruises on soft tissue areas (inner thighs, back, torso), bruises shaped like objects/hands, and clusters of bruises in various stages of healing raise high suspicion for physical abuse.

✅ Correct Answer: Gloves, Apron/Gown, Eye protection, Mask

💡 Rationale: The most contaminated items should be removed first. Gloves are removed first, followed by hand hygiene. Then the apron/gown, then eye protection. The mask/respirator is always removed last, ideally outside the patient room, followed by final hand hygiene.

✅ Correct Answer: Completely offload the heels by placing a pillow under the length of the calves so the heels 'float' over the mattress

💡 Rationale: The gold standard for preventing heel pressure ulcers is total offloading (making the heels 'float'). Massaging bony prominences causes deep tissue damage. Ring cushions restrict blood flow and are contraindicated.

✅ Correct Answer: 4 hours

💡 Rationale: Blood must be transfused within 4 hours of removal from controlled temperature storage. Beyond 4 hours, the risk of dangerous bacterial proliferation in the blood bag increases significantly.

✅ Correct Answer: Document 'Penicillin' in the allergy box, explicitly detail the reaction ('mild nausea'), and classify it as a side effect/intolerance rather than true anaphylaxis

💡 Rationale: It is critical to distinguish between a true immune-mediated allergy (e.g., rash, anaphylaxis) and an adverse drug reaction/intolerance (e.g., nausea, diarrhea). The exact nature of the reaction must be clearly documented to allow prescribers to make safe, informed clinical decisions.

✅ Correct Answer: Up to 6 hours

💡 Rationale: Section 5(4) allows a registered mental health or learning disability nurse to hold a patient for up to 6 hours. This time allows a doctor (or Approved Mental Health Professional) to attend and assess whether a Section 5(2) doctor's holding power (up to 72 hours) is required.

✅ Correct Answer: The ADRT must be respected, and IV antibiotics withheld, even if this leads to the patient's death

💡 Rationale: Under the Mental Capacity Act 2005, a valid and applicable Advance Decision to Refuse Treatment (ADRT) is legally binding. If it clearly covers the current scenario and includes refusal of life-sustaining treatment, healthcare professionals must abide by it.

✅ Correct Answer: Gently pull the pinna (outer ear) upwards and backwards

💡 Rationale: In adults, the ear canal has a slight curve. To straighten the canal and give the thermometer's infrared sensor a clear view of the tympanic membrane, the pinna must be gently pulled upwards and backwards.

✅ Correct Answer: The average plasma glucose concentration over the previous 2 to 3 months

💡 Rationale: HbA1c (glycated haemoglobin) measures the amount of glucose attached to haemoglobin in red blood cells. Since red blood cells have a lifespan of about 120 days, it provides an accurate reflection of the average blood glucose levels over the preceding 8-12 weeks.

✅ Correct Answer: Within 1 hour of recognition

💡 Rationale: Sepsis is a time-critical medical emergency. The 'Sepsis Six' bundle (Give O2, IV fluids, IV antibiotics; Take blood cultures, lactate, urine output) must be initiated and completed within 1 hour of recognizing red flag sepsis to significantly reduce mortality.

✅ Correct Answer: 3 tablets

💡 Rationale: Use the formula: (Dose required / Dose available) = (150 micrograms / 50 micrograms) = 3 tablets.

✅ Correct Answer: + 450 ml

💡 Rationale: Total Input = 1000 ml (IV) + 400 ml (Oral) = 1400 ml. Total Output = 800 ml (Urine) + 150 ml (Vomit) = 950 ml. Net Balance = Input - Output = 1400 ml - 950 ml = +450 ml.

✅ Correct Answer: 21 capsules

💡 Rationale: Multiply the number of capsules per dose by the frequency per day, then by the number of days: 1 capsule x 3 times a day = 3 capsules per day. 3 capsules/day x 7 days = 21 capsules.

✅ Correct Answer: To provide protective (reverse) isolation, reducing the patient's exposure to exogenous pathogens from staff and other patients

💡 Rationale: Neutropenic patients are highly immunocompromised. Protective isolation (source isolation) is used to protect the vulnerable patient from acquiring opportunistic infections from the hospital environment, staff, or other patients.

✅ Correct Answer: 10 to 15 seconds

💡 Rationale: Suctioning removes oxygen from the airway along with secretions. To minimize the risk of severe hypoxia, arrhythmias, and mucosal trauma, suction must not be applied for longer than 10 to 15 seconds per pass.

✅ Correct Answer: Only when the patient loses the mental capacity to make those specific decisions themselves

💡 Rationale: Under the Mental Capacity Act 2005, an LPA for Health and Welfare can only be used if and when the donor (the patient) actually loses the mental capacity to make the specific health or care decision in question.

✅ Correct Answer: Naloxone

💡 Rationale: The clinical triad of central nervous system depression, respiratory depression, and pinpoint pupils is highly indicative of an opioid overdose. Naloxone is the specific opioid receptor antagonist used to rapidly reverse these life-threatening effects.

✅ Correct Answer: Face, Arms, Speech, Time

💡 Rationale: FAST is a globally recognized and UK standard tool for stroke recognition: Facial drooping, Arm weakness, Speech difficulties, and Time to call 999.

✅ Correct Answer: Assessing the groin puncture site for bleeding/haematoma and checking distal pedal pulses

💡 Rationale: Following an arterial puncture (like a femoral angiogram), the highest risks are retroperitoneal bleeding, hematoma formation at the site, and arterial occlusion. Frequent assessment of the puncture site and distal pulses (to ensure adequate blood flow to the leg) is critical.

✅ Correct Answer: Ensure the patient is Nil By Mouth (NBM), insert a nasogastric (NG) tube on free drainage, and commence IV fluids

💡 Rationale: A paralytic ileus is a temporary paralysis of bowel motility. Giving oral food or fluids will worsen distension and cause vomiting. The bowel must be rested (NBM), decompressed (NG tube on free drainage to remove gastric secretions/air), and the patient kept hydrated via IV fluids.

✅ Correct Answer: Washing the meatus and surrounding area daily with warm tap water and non-perfumed soap

💡 Rationale: NICE guidelines state that routine daily personal hygiene (washing with warm water and non-perfumed soap) is sufficient. Antiseptic solutions or creams can irritate the sensitive mucosa, alter normal flora, and promote resistant bacteria.

✅ Correct Answer: 450 hours

💡 Rationale: The NMC strictly requires registered nurses and midwives to undertake a minimum of 450 practice hours over the three years prior to the renewal of their registration.

✅ Correct Answer: An 'opt-out' (deemed consent) system, where all adults are considered donors unless they have explicitly recorded a decision not to be, or are in an excluded group

💡 Rationale: The UK (England, Wales, and Scotland) has moved to an 'opt-out' or deemed consent system. It is presumed adults agree to organ donation unless they have registered a decision to 'opt out' or are part of specific excluded groups.

✅ Correct Answer: Increasing pain, spreading erythema (redness), localized heat, and purulent (pus) exudate

💡 Rationale: The classic signs of a localized surgical site infection (SSI) include increasing pain/tenderness, spreading redness, localized heat/swelling, and the production of malodorous or purulent (pus-like) discharge.

✅ Correct Answer: International Normalised Ratio (INR)

💡 Rationale: Warfarin therapy is monitored exclusively using the INR (International Normalised Ratio). The dose is adjusted based on this result to keep the blood clotting time within a specific target range to prevent thrombosis or bleeding. APTT is used for heparin.

✅ Correct Answer: No, only the patient is permitted to press the PCA button to prevent accidental overdose

💡 Rationale: A critical safety mechanism of PCA is that the patient must be awake enough to press the button themselves. If a relative or nurse presses it (PCA by proxy), it bypasses this safety feature and can lead to severe respiratory depression and fatal overdose.

✅ Correct Answer: Complete a local incident report (e.g., Datix) as a 'near miss' to help identify system risks

💡 Rationale: A 'near miss' is an incident that had the potential to cause harm but was prevented. The NMC and NHS strictly encourage reporting near misses via incident reporting systems (like Datix) to investigate root causes (e.g., look-alike drug packaging) and improve system safety.

✅ Correct Answer: Early and frequent mobilization/ambulation

💡 Rationale: Venous stasis is a major risk factor for DVT. Early and frequent ambulation promotes muscle pump activity in the legs, drastically improving venous return and reducing the risk of clot formation.

✅ Correct Answer: A framework to assess whether a child under 16 has enough maturity and understanding to consent to their own medical treatment

💡 Rationale: Gillick competence is a legal principle used to determine whether a child under the age of 16 has the maturity, intelligence, and understanding to validly consent to medical treatment (such as contraception) without parental permission or knowledge.

✅ Correct Answer: Respect their religious practice, and discuss with the prescriber and pharmacist whether a once or twice-daily antibiotic alternative can be safely prescribed to fit around their fasting hours

💡 Rationale: The NMC Code dictates that nurses must respect people's cultural and religious beliefs. The safest and most ethical approach is to facilitate their beliefs safely by consulting the multidisciplinary team to adjust medication regimens (e.g., using long-acting alternatives).

✅ Correct Answer: Extravasation

💡 Rationale: While 'infiltration' is the leakage of a non-irritating fluid, 'extravasation' is the specific and highly dangerous leakage of a vesicant fluid (like chemotherapy or concentrated potassium) into surrounding tissue, causing severe tissue necrosis and blistering.

✅ Correct Answer: Bradycardia, weight gain, fatigue, and cold intolerance

💡 Rationale: Hypothyroidism (underactive thyroid) slows down the body's metabolism. Classic symptoms include a slow heart rate (bradycardia), unexplained weight gain, extreme tiredness, feeling cold, and dry skin. Tachycardia and weight loss are signs of hyperthyroidism.

✅ Correct Answer: Pulmonary Embolism (PE)

💡 Rationale: The sudden onset of pleuritic chest pain, dyspnoea, and hemoptysis (coughing up blood) in a post-operative or immobile patient are the classic red flag signs of a Pulmonary Embolism (a blood clot in the lungs).

✅ Correct Answer: Compartment Syndrome

💡 Rationale: Severe pain out of proportion to the injury (especially pain on passive stretch), pallor, paresthesia (tingling), and unresponsiveness to strong opioids are hallmark signs of Compartment Syndrome, a surgical emergency requiring immediate cast removal or fasciotomy to save the limb.

✅ Correct Answer: Dry mucous membranes, tachycardia, confusion, and dark, concentrated urine

💡 Rationale: In the elderly, skin turgor is a highly unreliable sign of dehydration due to the natural loss of subcutaneous tissue and skin elasticity with age. Reliable indicators include dry mucous membranes, tachycardia, new-onset confusion, low urine output, and dark urine.