NMC Test of Competence 2021: Computer-Based Test (CBT) Study Guide

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A hypothetical prescription requires 0.25 g, and each suitable tablet contains 125 mg. Convert 0.25 g to 250 mg, then divide 250 mg by 125 mg per tablet to obtain two tablets.

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An oral medicine calculation gives 0.6 mL. A medicine cup has 5 mL markings, while an appropriate oral syringe has 0.1 mL graduations. Select the oral syringe and verify the prescribed volume against its scale.

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For a hypothetical exercise, a prescribed dose is 450 mg and each suitable tablet contains 150 mg. Dividing 450 by 150 gives three tablets. Verify the tablet strength before treating that result as the quantity to prepare.

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A fictional oral preparation contains 120 mg in 5 mL, and the prescribed dose is 180 mg. Calculate 180 divided by 120, multiplied by 5, giving 7.5 mL for the specified preparation.

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A hypothetical prepared solution contains 100 mg in 2 mL. The prescribed dose is 75 mg. The concentration is 50 mg/mL, so 75 divided by 50 gives a required volume of 1.5 mL.

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An authorised hypothetical infusion contains 750 mL to run over six hours. Divide 750 by six to obtain 125 mL/hour. Multiplying 125 mL/hour by six hours returns 750 mL and checks the calculation.

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For an arithmetic exercise, 500 mL is prescribed over four hours using a set calibrated at 20 drops/mL. Calculate 500 multiplied by 20, divided by 240 minutes: 41.67, or 42 drops/minute when instructed to round.

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Over a defined shift, documented intake is 900 mL orally and 500 mL intravenously. Recorded output is 1,100 mL urine and 150 mL drainage. The recorded balance is 1,400 minus 1,250, or positive 150 mL.

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An adult agrees to a dressing change but believes it will permanently cure the underlying condition. Explain the actual purpose and limitations, invite questions and check understanding before asking whether they wish to proceed.

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A person declines washing because their usual carer is present. Speak privately, establish their preferences and offer another time or suitable staff member. Record the decision and maintain other agreed care without labelling them uncooperative.

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An adult with hearing loss initially cannot follow a treatment discussion. Restore their hearing aid and explain the options simply. They then describe the benefits, risks and consequences, weigh them against their priorities and refuse treatment. The refusal alone does not establish incapacity. By contrast, delirium that prevents weighing those consequences despite support may establish incapacity for that decision at that time.

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A caller identifies themselves as a patient's sibling and requests results. The patient has not authorised disclosure. Verify identity as appropriate, explain the confidentiality limit and ask the patient whom they want involved in receiving information.

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After urgent assistance delays documentation, record the event with its actual occurrence time and identify the later entry time. Include observed changes, whom you contacted, advice received, actions completed and the person's subsequent condition.

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A missed prescribed treatment has caused avoidable discomfort. Arrange appropriate review, explain the omission and known consequences, apologise and describe how it will be investigated. Record the discussion and ensure the person receives further information as it becomes available.

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You are asked to use an unfamiliar infusion device without training. Explain the limitation promptly, obtain a competent colleague and ensure the prescribed treatment is not simply abandoned while appropriate assistance is being arranged.

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A patient requests ongoing private messaging through your personal social media account after discharge. Thank them, explain the professional boundary and provide the appropriate service contact for questions about their continuing care and support.

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An adult says a carer has threatened them and asks you to tell nobody. Explain the limits of confidentiality, assess immediate safety, document their words accurately and contact the appropriate safeguarding lead through the service's procedure.

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A smoker says breathlessness makes playing with grandchildren difficult but doubts they can stop. Explore that goal, acknowledge previous efforts and offer contact with a stop-smoking service to discuss support matched to their needs.

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A person ready to stop usually smokes during work breaks. Help them plan a different break routine, identify someone supportive and arrange stop-smoking advice. Agree when they will review what worked and what remained difficult.

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A well 40-year-old walks briskly for 30 minutes on five days each week but does no strengthening activity. Recognise that the moderate aerobic target is met and discuss adding suitable strengthening activities on two days.

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A person with reduced vision receives a small-print smoking leaflet they cannot read. Ask about their preferred format, provide an accessible alternative and discuss one practical route to support that they can use independently.

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An inactive adult wants more energy but cannot afford a gym. Agree a short walking routine that fits their day, identify a safe route and arrange a review of participation and confidence before increasing the target.

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An adult admitted with reduced mobility normally lives alone and manages medicines independently. Assess current transfers, cognition, confidence and home support as well as physical symptoms, because these findings affect both immediate assistance and later discharge planning.

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A previously conversational inpatient becomes intermittently inattentive and withdrawn after developing fever and poor intake. Establish the baseline, arrange 4AT assessment and assess oxygenation, hydration, infection, pain and recent medicine changes. The acute fluctuation supports possible delirium rather than assuming dementia progression.

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An older adult becomes quiet and confused, has low oxygen saturation, has drunk little and reports pain. Begin urgent ABCDE assessment, address hypoxia, assess fluid needs with attention to heart or kidney disease, and arrange pain and medicine review. Explain where they are, restore their hearing aid and reassess attention and observations after interventions.

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A patient wants to regain confidence washing at the sink. Assess baseline ability, agree the level of assistance and a review time, then document an observable participation goal alongside the support needed to work towards it.

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After repeated vomiting, an adult develops a rising pulse, cool hands and reduced urine output despite a blood pressure close to their earlier value. Seek urgent review, assess circulation and ongoing losses, check the fluid chart and prepare to deliver prescribed fluid treatment. Reassess pulse, perfusion, blood pressure, urine output and breathing after treatment.

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An adult receiving intravenous amoxicillin develops worsening renal results and reduced urine output. Request prompt prescriber or pharmacist review of the regimen before the next dose is due, communicate the trend and monitor neurological status and fluid balance. A seizure requires an immediate emergency response rather than waiting for routine dose review.

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A patient who previously walked independently now needs two people to stand safely. Reassess the change, seek appropriate clinical review and update mobility assistance and handover information before the next transfer is attempted.

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A responsive adult with no identified risk of hypercapnic respiratory failure and no different prescribed oxygen target speaks clearly, indicating a currently patent airway, but has a respiratory rate of 30 and oxygen saturation of 88%. Summon urgent help and administer oxygen under emergency guidance, titrating delivery to achieve 94–98%. Reassess saturation, respiratory rate, effort and consciousness promptly after starting oxygen and after each adjustment. Assess a rapid pulse, low blood pressure and cool skin for poor perfusion; check glucose, then inspect for bleeding, rash or infection. Recheck breathing and circulation immediately after treatment.

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An adult collapses, does not respond and makes occasional irregular gasps. Call for emergency help and an AED, begin CPR promptly and follow the defibrillator instructions when it arrives, rather than waiting for routine observations.

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A patient becomes less mobile after an acute illness and cannot turn independently. Reassess pressure risk, inspect relevant skin areas and arrange an individual prevention plan with repositioning assistance and suitable pressure-redistributing support.

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A high-risk adult cannot turn independently. Document assistance at least every four hours and any need for more frequent relief. A newly discoloured, warmer, firmer heel prompts immediate pressure relief, review of heel offloading and the support surface, and closer skin reassessment. A specialist mattress does not replace repositioning.

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An adult treated for pneumonia has saturation within their prescribed target on oxygen, but their respiratory rate rises from 20 to 30 and they become confused. Begin urgent ABCDE reassessment and seek review; do not record improvement solely from saturation or assume the antibiotic dose has already corrected the respiratory problem.

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After an agreed pain intervention, a patient still cannot move comfortably for essential care. Reassess pain and relevant observations, check for adverse effects and seek review of the plan rather than recording the treatment as successful.

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A patient repeatedly leaves meals untouched because they cannot open packaging or reach the tray. Provide appropriate assistance, record actual intake and reassess whether these changes improve eating, while investigating any additional symptoms or concerns.

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An adult receiving amoxicillin develops frequent diarrhoea with abdominal pain. Assess stool pattern, hydration and physiological observations, obtain prompt medical review for possible antibiotic-associated colitis and follow infection precautions. Do not simply give an anti-peristaltic medicine. In a separate adult case, sudden wheeze and collapse during administration indicate suspected anaphylaxis even without a rash. Stop the medicine, activate emergency help and immediately administer 500 micrograms of intramuscular adrenaline using the 1 mg/mL preparation. Provide ABCDE care, reassess the response and repeat adrenaline after five minutes if there is no improvement.

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Before allocating mobility assistance, check the patient's current transfer needs and whether the colleague is competent with the required equipment. State the assistance plan and the changes that must be reported before another transfer.

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A competent colleague assists with agreed personal care and reports new skin damage. Review the finding, assess its significance and update care. Do not assume that delegation means the colleague alone must manage every resulting decision.

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Two patients require simultaneous urgent review while essential care for others is delayed. Call for support, allocate competent staff to immediate needs and inform the responsible manager of specific remaining risks and the resources required.

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A colleague's handover omits outstanding actions. Speak privately using a specific example, explain the continuity risk and agree a structure that identifies each action, its owner and urgency. Review a later handover together.

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You see a colleague preparing to use equipment they say they have never operated. Pause the unsafe step, arrange competent help and inform the appropriate supervisor. Address learning needs after the immediate patient risk is controlled.

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An incorrect patient label is detected before a specimen leaves the ward. Correct the immediate problem through the approved process and report the near miss, including how it arose and which check identified it.

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Repeated requests have not secured help for a worsening staffing-related risk. Restate the specific unmet needs and current safeguards, escalate to the next responsible level and keep a factual record of contacts and responses.

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A fictional audit finds complete records in 18 of 20 cases, then 24 of 30 cases. Although six more records are complete, compliance falls from 90% to 80%, prompting examination of comparable sampling and remaining omissions.

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A team adds an outstanding-actions field to handover. Define what counts as a complete action entry, sample handovers before and after introduction and ask staff whether the field improves follow-through without obscuring urgent information.

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An adult taking warfarin starts amoxicillin. Check that the responsible prescriber or anticoagulation service has arranged INR monitoring, assess and report bleeding symptoms, and include the antibiotic start and expected stop dates in handover. Ensure someone owns follow-up after withdrawal as well as during treatment.

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An admission record omits a patient's non-prescription medicine and records only 'antibiotic allergy'. Establish the actual product and reaction, verify the medicine history and clinically important last doses, and resolve differences with a competent practitioner. A dose due soon may require clarification before the 24-hour limit.

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A medicine appears on the patient's home list but not on discharge documentation, and no reason is recorded. Contact the responsible team to establish whether stopping was intended before giving the patient conflicting continuation advice.

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A patient transfers with a pending review of worsening mobility. Explain the current assistance level, relevant changes and outstanding review, identify who will follow it up and confirm that the receiving nurse understands the immediate care requirements.

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A patient needs help with daily care after discharge. Confirm the agreed service arrangements and start date, explain the plan in an accessible way and resolve any gap between leaving hospital and the first support visit.

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A multidisciplinary discussion identifies a need for mobility equipment before discharge. Record which service will assess and arrange it, the required timing and who will check completion before the patient leaves the ward.

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After discussing a follow-up plan, ask the patient to describe what they will do when they get home and whom they will contact with concerns. Correct any misunderstanding, then invite them to explain the revised plan.

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A tired patient needs several discharge instructions. Explain one priority topic, check their understanding and answer questions before moving to the next. Provide an accessible written summary that follows the same sequence for later reference.

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A patient can exchange greetings in English but cannot explain the proposed care. Arrange appropriate interpreting support, address the patient directly and check their understanding before relying on agreement to an important treatment decision.

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A patient repeatedly asks to leave and appears upset. Ask what is worrying them, listen without interruption and reflect their main concern. Discovering that a dependent relative is alone may reveal a practical issue requiring coordinated support.

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After removing gloves used for a contaminated task, a nurse needs to handle clean equipment for the next procedure. Perform hand hygiene before moving to that clean activity and select new protective equipment if indicated.

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In an NHS ward in England, a nurse finishes a contaminated care activity and then prepares to assist the same patient with a clean task. Remove the used gloves, perform hand hygiene and reassess protection for the next activity.

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During intravenous preparation, keep the syringe tip protected and avoid touching the disinfected access connection. If the syringe tip touches an unclean surface, stop and replace it with a sterile component. Re-establish any affected field or site preparation before continuing.

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During a planned non-emergency procedure, a patient asks you to stop because of unexpected pain. Pause, assess their condition and wishes, explain the next steps and obtain appropriate review before considering whether the procedure should resume.