Nursing · Independent exam preparation
NMC Test of Competence Part 2 OSCE: Adult Nursing RN1 Preparation Guide Study Guide
Practise adult nursing assessment, safe procedures, escalation and evidence appraisal for the NMC OSCE, with focused explanations and original learning drills.
By CertMedbry · Updated 28 October 2026
Practise recognising deterioration, choosing measurable care goals, protecting patients during procedures and explaining evidence-informed decisions. This guide follows the adult nursing RN1 pathway at newly registered nurse level in UK practice. Its 60 selected concepts cover the four OSCE assessment areas; the official adult nursing blueprint, test specification and associated standards define the full examination scope. The accompanying questions and flashcards are independently authored learning materials.
Try 20 free practice questionsWhat is the exam format?
Check the question types, timing and outline before planning your revision.
Which examination and professional level does this guide cover?
This guide covers the adult nursing RN1 pathway of the NMC Test of Competence Part 2 OSCE in the United Kingdom. The nursing candidate booklet sets the assessment at the level expected of a newly registered nurse. Passing the OSCE is one part of the relevant registration or readmission process, rather than a separately awarded specialist certification.
Nursing (all fields): OSCE candidate information booklet, V2.4
How many stations or questions are there, and are any unscored?
The OSCE has ten stations: four linked assessment, planning, implementation and evaluation stations; four clinical skills stations arranged in two pairs; one professional values and behaviours station; and one evidence-based practice station. The supplied official material does not establish a separate scored/pretest question count. Candidates must achieve a pass score in every station.
NMC OSCE: Test of Competence · Nursing (all fields): OSCE candidate information booklet, V2.4
How long does the OSCE take?
The October 2026 nursing candidate booklet describes total testing time as about three hours. It states that a station or pair of linked stations lasts between eight and 21 minutes. These figures describe different units of assessment, so they should not be added as though every individual station has the same duration. Use the current nursing station timings linked by the NMC for detailed rehearsal.
Nursing (all fields): OSCE candidate information booklet, V2.4 · Test of Competence: Preparation materials
How is the examination delivered, and what response styles are used?
This is a centre-based practical examination involving clinical equipment, actors or manikins, observed clinical performance and nursing documentation. The professional values and evidence-based practice stations are written. The official material describes criterion-based station assessment rather than computer-adaptive item selection. The 20 four-option questions here are independent knowledge and reasoning drills; they do not reproduce OSCE delivery or predict a pass.
Nursing (all fields): OSCE candidate information booklet, V2.4
Which blueprint applies, and what do the domain proportions mean?
The applicable framework is Test of Competence 2021, introduced in August 2021, with Nursing Test Specification V1.1 and Adult Nursing Blueprint V1.0 in the supplied evidence. The four assessment areas occupy four, four, one and one stations respectively. This guide therefore uses 24, 24, six and six concepts, and eight, eight, two and two questions and cards. Those proportions reflect station counts, not published score weights. The specification's CBT percentage table must not be applied to the OSCE.
Test of Competence 2021: Nursing Test Specification for Candidates, V1.1 · Test of Competence 2021: Adult nursing blueprint, V1.0
What remains outside this selective guide?
The official adult nursing blueprint maps seven proficiency platforms: accountable professionalism; health promotion and prevention; assessing needs and planning care; providing and evaluating care; leadership, management and teamwork; safety and quality improvement; and coordinating care. Its annexes cover communication and relationship skills and nursing procedures. These standards, their OSCE mappings and the current preparation documents define the full scope; a 60-concept selection cannot replace them.
Which 2026 changes apply on the guide's reference date?
The guide's reference date is 28 October 2026. Adult additions available from 23 February 2026 include suspected-DVT APIE, anti-embolism stockings and pre-operative checks. The September announcement's additional nursing stations became available to first-time candidates from 26 October 2026 and therefore apply on this reference date. Its all-field additions include further written professional-values and evidence-based-practice topics. Use documents applicable to your pathway and sitting date.
How should version labels and marking criteria be interpreted?
The nursing candidate booklet is V2.4, updated October 2026. For adult RN1 preparation, use the NMC's [September 2026 Adult Nursing Marking Criteria](https://www.nmc.org.uk/globalassets/sitedocuments/registration/toc-materials-2026/rn1-adult-nursing-marking-criteria-sept-2026.pdf), whose cover states 'Last updated September 2026'. Its retained footer reads 'ToC 2021_v2.4 (Updated August 2024)'; that older footer does not override the cover date. The September announcement directs first-time candidates sitting from 26 October 2026 to the updated marking criteria for the announced changes. Marking criteria remain indicative and supplement education; use them alongside the blueprint, standards, candidate booklet and reading lists.
Nursing (all fields): OSCE candidate information booklet, V2.4 · rn1-adult-nursing-marking-criteria-sept-2026.pdf · Test of Competence: Preparation materials
How do the other nursing fields and midwifery differ?
Children's nursing RN8, mental health nursing RN3 and learning disabilities nursing RN5 have field-specific preparation materials. Midwifery has a separate blueprint and specification covering midwifery standards, including care of women and newborns. The April 2026 neonatal-assessment addition belongs to midwifery; it is not added to this adult RN1 guide. Candidates prepare for the pathway relevant to their registration application.
Test of Competence: Preparation materials · Test of Competence 2021: Midwifery blueprint, V1.0
What passing standard and test providers are confirmed?
A pass score is required in every station; the supplied evidence does not establish one universal numerical pass percentage. The current NMC page lists the University of Northampton, Ulster University and Leeds Teaching Hospitals NHS Trust as approved providers. It records the closure of Oxford Brookes University's centre on 31 July 2026 and Northumbria University's centre on 19 February 2026.
Nursing (all fields): OSCE candidate information booklet, V2.4 · NMC OSCE: Test of Competence
The NMC OSCE is Part 2 of the Test of Competence used within registration or readmission processes. This guide selects adult registered nursing RN1; it does not prepare candidates for nurse practitioner practice, nursing associate registration, another nursing field or midwifery. Practical performance, communication and written reasoning require rehearsal beyond multiple-choice study.
Outline used: Verified against the NMC's currently linked Test of Competence 2021 framework as accessed on 2026-10-11: Nursing Test Specification V1.1; Adult Nursing and Midwifery blueprints V1.0; nursing and midwifery OSCE candidate booklets V2.4, updated October 2026. The workbook label maps to the OSCE component of the NMC Test of Competence, with field-specific nursing and midwifery pathways, rather than a standalone certification. The assigned slug is preserved. Updates effective 23 February and 13 April 2026 are distinguished from the September announcement's changes effective 26 October 2026, which were not yet effective on the reference date.
60 key concepts: understand, apply and avoid the traps
Work through the questions by exam domain. Explain the answer in your own words, try the example, then check the common pitfall.
Assessment, planning, implementation and evaluation (APIE)40% of stations; score weight not stated
1.What makes an adult nursing assessment holistic?
A holistic assessment connects the presenting problem with physical function, emotional wellbeing, communication, social circumstances and the person's priorities. Establish the usual baseline before interpreting a new limitation: needing help today means something different for someone normally independent. Combine the patient's account, observations and relevant records, and resolve inconsistencies. The decision is which needs require action now and which need further assessment, rather than completing unrelated questions without interpreting their meaning.
Apply it
An adult admitted with breathlessness reports that washing is now exhausting and that nobody can help at home. Assess immediate physiological safety, then connect activity tolerance and available support to the person's care and discharge needs.
Common pitfall: A complete set of observations does not establish a complete assessment. Equally, a lengthy social history must not delay treatment of an immediate physiological threat.
Nursing (all fields): OSCE candidate information booklet, V2.4 · The Code: Read the Code online
2.How does ABCDE organise emergency assessment?
ABCDE orders assessment around airway, breathing, circulation, disability and exposure so that immediately life-threatening problems receive attention before less urgent findings. Assess and treat problems as they are found, call for appropriate help early and reassess the response. It is a repeating clinical process rather than a one-way examination. A newly identified airway problem therefore interrupts work on a lower-priority issue, even when the original reason for admission concerned another body system.
Apply it
During a routine assessment, an adult becomes drowsy and develops noisy breathing. Stop the routine history, call for help and assess airway and breathing immediately, treating identified threats within your competence while assistance arrives.
Common pitfall: Finishing every observation before acting defeats the purpose of ABCDE. Completing the sequence once also does not remove the need to reassess after intervention.
3.Which findings suggest an immediate airway problem?
Airway assessment asks whether air can pass freely to the lungs. The ability to speak normally supports airway patency at that moment, whereas abnormal airway sounds, reduced air movement or impaired consciousness require urgent attention. Look, listen and feel while considering visible obstruction and the person's ability to protect the airway. Obtain expert help early when patency is threatened; a reassuring oxygen saturation does not establish that the airway will remain safe.
Apply it
A patient who previously answered questions now makes gurgling sounds and cannot speak clearly. Treat this as a possible airway threat, summon urgent assistance and assess for an immediately reversible obstruction rather than continuing routine documentation.
Common pitfall: Assuming that a recorded saturation proves airway safety confuses oxygenation with patency. Deteriorating consciousness can also make a previously patent airway unsafe very quickly.
4.How should breathing assessment combine measurements and appearance?
Breathing assessment combines respiratory rate, depth, pattern, effort, chest movement and oxygen saturation with the clinical context. Record whether supplemental oxygen is being delivered, because a saturation achieved with oxygen has a different meaning from the same value on room air. Marked work of breathing or worsening exhaustion warrants escalation even before a complete observation set is available. A single numerical value should support, rather than replace, assessment of ventilation and respiratory distress.
Apply it
An adult has an apparently acceptable saturation while receiving oxygen but is using accessory muscles and speaking only a few words at a time. Report the oxygen delivery and visible distress, and seek urgent review.
Common pitfall: Reporting only saturation can conceal serious deterioration. Respiratory effort, oxygen requirement and the person's ability to speak provide information that the saturation number alone cannot supply.
5.Why can circulation be compromised before blood pressure falls?
Circulation assessment considers tissue perfusion using pulse, skin appearance and temperature, capillary refill, blood pressure and other relevant findings. Compensatory responses may preserve blood pressure despite evolving circulatory compromise, so a normal pressure must not override concerning changes elsewhere. Consider possible fluid loss, bleeding and reduced urine output in context. The decision depends on the combined pattern and its trajectory, with prompt help for suspected shock rather than waiting for one measurement to cross a threshold.
Apply it
Following surgery, a patient becomes pale and clammy with a rising pulse and reduced urine output, although blood pressure remains near baseline. Escalate the combined findings and assess for possible bleeding or other circulatory compromise.
Common pitfall: Waiting for hypotension can delay recognition of deterioration. Conversely, one isolated peripheral sign needs interpretation alongside the patient's condition and other perfusion findings before conclusions.
6.How should new reduced consciousness be assessed?
Reduced consciousness is a clinical change requiring assessment, not a diagnosis by itself. Address airway, breathing and circulation first, then assess responsiveness and check for reversible contributors such as abnormal blood glucose. Consider the medication history and compare with the person's baseline. Repeat assessments show whether the condition is improving or worsening. A familiar explanation such as tiredness becomes unsafe when it substitutes for evaluating a new change in responsiveness or protective reflexes.
Apply it
An adult who was alert becomes difficult to rouse after treatment. Reassess ABC, summon help, assess responsiveness and obtain a blood glucose measurement while reviewing the treatment history for information relevant to urgent clinical review.
Common pitfall: Attributing drowsiness to sleep or medication without assessment can miss an emergency. A plausible cause does not remove the need to assess physiological safety first.
7.How can exposure reveal problems while preserving dignity?
Exposure means examining sufficiently to identify clinically important findings such as bleeding, injury, skin changes or problems around devices. It follows attention to immediate ABCD threats and should be proportionate to the clinical question. Explain the examination, obtain consent where possible, maintain privacy and prevent unnecessary heat loss. Re-cover areas after inspection. The discriminating principle is purposeful access: inadequate examination can conceal a threat, while indiscriminate exposure adds discomfort without useful assessment.
Apply it
A deteriorating postoperative patient has no obvious bleeding on the visible sheet. Explain the need to inspect the operative area and relevant bedding, preserve privacy and warmth, and report any concealed blood loss immediately.
Common pitfall: Looking only at visible skin may miss the source of deterioration. Leaving the patient uncovered after inspection creates avoidable discomfort and loss of dignity unnecessarily.
Resuscitation Council UK: The ABCDE Approach · The Code: Read the Code online
8.Why do observation trends matter more than an isolated reassuring value?
Serial observations reveal direction and speed of change. Interpret the current measurement against previous values, the patient's baseline, symptoms and treatment, rather than simply describing it as within a reference range. A rising oxygen requirement or steadily increasing respiratory rate may be significant before an extreme value appears. Verify an unexpected reading without delaying help when the patient looks unwell. Trend information makes escalation more useful because it explains what has changed and how quickly.
Apply it
Over successive reviews, an adult's respiratory rate rises and oxygen support increases while saturation remains similar. Explain this worsening trend during escalation; the stable saturation has been maintained by increasing treatment rather than demonstrating stable breathing.
Common pitfall: Copying the latest value without its context can create false reassurance. Rechecking equipment should not become a reason to postpone help for a visibly deteriorating person.
Resuscitation Council UK: The ABCDE Approach · The Code: Read the Code online
9.When should clinical concern trigger early escalation?
Escalation is justified by a serious clinical concern or immediate threat, even while information is incomplete. State the concern, request the level of help required and continue assessment and treatment within competence. Share available findings and obtain additional observations as safety permits. The important distinction is between useful data gathering and avoidable delay: a complete history is valuable, but it is not a prerequisite for calling help when airway, breathing or circulation is threatened.
Apply it
A patient suddenly becomes severely breathless before you have completed the observation chart. Call for urgent assistance using the findings already available, remain with the patient and continue ABCDE assessment rather than waiting to finish the chart.
Common pitfall: Waiting for permission from an unavailable colleague can delay essential help. Escalating does not transfer away your responsibility to provide safe care while assistance is coming.
Resuscitation Council UK: The ABCDE Approach · The Code: Read the Code online
10.How does pain assessment guide evaluation?
Pain assessment establishes the person's account, location, character, timing, severity and effect on activities, using a communication method they can understand. Record a baseline that can be compared after an intervention. A lower numerical score is useful, but functional improvement and adverse effects also matter. New or changing pain may require reassessment of its cause rather than simply repeating the previous response. Agree what meaningful improvement would look like for that individual.
Apply it
An adult reports pain that prevents deep breathing and movement. Record the patient's description and an agreed pain measure, provide prescribed care safely, then reassess both pain and ability to perform the activities previously limited.
Common pitfall: A reduced pain score alone does not establish a good outcome if function remains poor or treatment causes concerning effects. Avoid substituting appearance for the patient's account.
Nursing (all fields): OSCE candidate information booklet, V2.4 · The Code: Read the Code online
11.How should communication be adapted to an adult's needs?
Accessible communication begins by identifying the individual's language, sensory, cognitive and communication needs. Ask what helps, use understandable language, allow time and check understanding without making assumptions from a diagnosis or disability. Arrange appropriate communication assistance when required. Speak directly to the patient and involve others according to the patient's wishes and lawful care needs. The key decision is which adaptation enables the person to participate meaningfully in assessment and choices about care.
Apply it
An adult with hearing difficulties repeatedly gives answers unrelated to your questions. Reduce background noise, check their preferred communication method and available hearing support, then confirm understanding before interpreting the responses as confusion or lack of cooperation.
Common pitfall: Speaking more loudly is not a universal solution. A communication difficulty does not itself demonstrate impaired decision-making ability or justify excluding the person from discussion.
The Code: Read the Code online · Nursing (all fields): OSCE candidate information booklet, V2.4
12.How does teach-back reveal misunderstanding?
Teach-back checks the clarity of an explanation by asking the patient to describe the plan in their own words or demonstrate the relevant action. It assesses understanding more effectively than asking whether everything is clear, because agreement can conceal uncertainty. Frame the request as checking your explanation, then clarify and recheck any gaps. Focus on decisions the person must make, such as when to seek help or how to carry out an agreed care activity.
Apply it
After explaining a discharge plan, ask the patient to describe what they will do if symptoms worsen. Their answer reveals that they intended to wait several days, so clarify the escalation advice and check understanding again.
Common pitfall: A fluent repetition of your exact wording may reflect memory rather than usable understanding. Avoid turning the exchange into a test that embarrasses the patient.
The Code: Read the Code online · Nursing (all fields): OSCE candidate information booklet, V2.4
13.Why should emotional and social concerns influence the care plan?
Emotional distress and practical circumstances can change what care a person can understand, accept or carry out. Explore concerns without judgement and distinguish the patient's stated barriers from assumptions about motivation. A treatment plan may be technically correct yet unworkable if the person cannot access support or is too anxious to absorb instructions. Use the findings to adjust communication, involve suitable colleagues and agree realistic actions while continuing to address immediate clinical needs.
Apply it
An adult repeatedly postpones teaching about a new care task because they fear coping alone. Explore that concern, identify available support and arrange a manageable teaching session rather than recording the person simply as unwilling to learn.
Common pitfall: Labelling someone unmotivated can conceal a solvable barrier. Emotional explanations should also not be used to dismiss new physical symptoms before adequate clinical assessment.
The Code: Read the Code online · Nursing (all fields): OSCE candidate information booklet, V2.4
14.Which assessed needs should receive priority in planning?
Prioritise needs by immediate threat, potential harm, time sensitivity and the person's priorities. Physiological instability requires action before routine education, but stable patients still need plans addressing function, comfort and prevention. Select problems that are supported by the assessment and distinguish an existing problem from a future risk. Explain why one need comes first. Priority is dynamic: a new acute change can supersede the order established earlier in the care episode.
Apply it
A patient needs discharge teaching but develops new respiratory distress while you are planning care. Prioritise assessment and urgent management of breathing, then return to education once the patient's condition allows safe and meaningful participation.
Common pitfall: Choosing the easiest problem to write about can produce an irrelevant plan. A previously agreed priority must change when a more urgent clinical threat emerges.
Resuscitation Council UK: The ABCDE Approach · Nursing (all fields): OSCE candidate information booklet, V2.4
15.What makes a care goal measurable and person-centred?
A useful goal describes an outcome for the patient, the evidence that will demonstrate progress and a suitable review time. It should respond to an assessed need and reflect what matters to the person. An action such as providing education is an intervention; explaining the plan accurately is an observable outcome. Select realistic measures that can change with care. Measurability permits evaluation, while shared agreement prevents the plan from becoming a purely professional exercise.
Apply it
An adult is uncertain about managing a prescribed device. Agree that, before discharge teaching is completed, they will demonstrate its use and explain when to obtain help, using a method suitable for their communication needs.
Common pitfall: Writing that the nurse will provide advice describes work, not success. A precise deadline is still inadequate if the outcome itself remains vague or irrelevant.
Nursing (all fields): OSCE candidate information booklet, V2.4 · The Code: Read the Code online
16.How should planned interventions connect to an identified problem?
Each intervention should address a stated need through an understandable mechanism, identify who will act and specify enough detail for consistent care. Link monitoring to an action if the finding is concerning; observation without interpretation is incomplete planning. Include patient participation and relevant multidisciplinary input. The discriminating question is whether the intervention could reasonably improve or detect deterioration in the selected outcome, rather than whether it is a familiar nursing activity that fits many unrelated plans.
Apply it
For a patient whose symptoms limit activity, plan assistance with necessary tasks, assessment of tolerance and escalation of deterioration. Explain how each action supports safe function, rather than listing generic observations without a response to abnormal findings.
Common pitfall: A long intervention list can look comprehensive while lacking purpose. Avoid including actions that are unrelated to the chosen problem or outside your competence and authority.
Nursing (all fields): OSCE candidate information booklet, V2.4 · The Code: Read the Code online
17.How should evaluation timing reflect clinical risk?
Choose an evaluation time that can detect whether the intervention is working before avoidable harm occurs. Acute physiological problems require prompt reassessment, while learning or rehabilitation goals may need a longer interval. State the planned review and the changes that require earlier review. A calendar date alone may be inadequate for a rapidly changing condition. Evaluation timing must follow the problem's urgency and expected response, rather than the convenience of the next routine documentation round.
Apply it
An adult receives an intervention for an acute breathing problem. Plan early reassessment of breathing and treatment response, with immediate review for deterioration, instead of assigning the same end-of-day evaluation used for routine discharge education.
Common pitfall: Using one standard review time for every problem ignores different risks. A planned later review never justifies waiting when the patient's condition has already worsened.
Resuscitation Council UK: The ABCDE Approach · Nursing (all fields): OSCE candidate information booklet, V2.4
18.How should an implementation plan respond to treatment refusal?
When a patient declines care, pause and establish the reason, understanding and any communication barriers. Explain relevant benefits, risks and alternatives without coercion, and respect a valid informed refusal. Assess and escalate concerns about decision-making ability or immediate safety through the appropriate process. Update the care plan, communicate the decision and document the discussion. The implementation task changes from completing the original action to maintaining safe, respectful care around the person's decision.
Apply it
An adult declines a planned procedure because they believe it is compulsory and painful. Clarify its purpose, discuss concerns and available options, check understanding and communicate their eventual decision before revising the immediate care plan.
Common pitfall: Recording refusal without exploring misunderstanding can abandon a remediable concern. Repeated pressure or proceeding because the procedure was prescribed does not establish valid consent.
19.When should a medicine discrepancy stop implementation?
A discrepancy affecting medicine identity, prescription clarity, allergy status or patient suitability must be resolved before administration. A prescription does not remove the nurse's responsibility to question a potential safety problem. Compare the available information, withhold the affected administration while clarification is obtained and communicate time-critical needs promptly. Record the reason and subsequent action accurately. The decision concerns the particular unsafe uncertainty; it does not justify silently omitting all treatment or guessing the prescriber's intention.
Apply it
Before administering a prescribed medicine, you find conflicting allergy information in the chart and the patient's account. Pause that administration, clarify the discrepancy with appropriate colleagues and ensure the patient receives a timely, safe treatment decision.
Common pitfall: An apparently familiar prescription can still contain an unsafe mismatch. Do not resolve conflicting allergy information by choosing whichever record makes administration easiest to complete.
The Code: Read the Code online · Test of Competence: Adult Nursing Marking Criteria, last update January 2026
20.How does new breathlessness change a suspected-DVT care plan?
A deep venous thrombus can break away and travel through the venous circulation to the lungs, blocking pulmonary blood vessels and causing a pulmonary embolism. Sudden breathlessness in someone with suspected DVT therefore raises concern for a potentially life-threatening complication. Pleuritic chest pain, meaning pain worse on breathing in, haemoptysis and collapse are additional concerning features. Summon emergency help and begin ABCDE assessment, treating identified threats within competence as they are found. Communicate the suspected-DVT history, symptom onset and current findings. These symptoms justify urgent action but do not establish a definitive diagnosis.
Apply it
An adult awaiting assessment for a painful, swollen calf suddenly becomes breathless and reports sharp chest pain on inspiration. Call for emergency assistance and assess airway, breathing and circulation immediately, continuing through ABCDE and reassessing after interventions. Explain during handover that pulmonary embolism is a concern because a venous clot can travel to the pulmonary circulation.
Common pitfall: Continuing the limb assessment or waiting for diagnostic confirmation delays care for the new respiratory threat. Do not require chest pain, haemoptysis and collapse all to be present before escalating, or label pulmonary embolism as confirmed from symptoms alone.
Resuscitation Council UK: The ABCDE Approach · Test of Competence: Preparation materials · DVT (deep vein thrombosis) - NHS · Pulmonary embolism - NHS
21.How should evaluation distinguish completed care from effective care?
Evaluation compares current findings with the baseline and agreed goal, taking account of treatment, elapsed time and the patient's experience. State whether the outcome was achieved, partly achieved or unmet, and identify supporting evidence. Completing an intervention proves delivery, not benefit. If the outcome is unmet, reconsider the assessment, intervention and need for escalation. A defensible evaluation explains what should continue or change rather than merely repeating that the planned care was performed.
Apply it
A patient's education session has finished, but they cannot demonstrate the required care task safely. Record that the learning outcome remains unmet, explore the difficulty and arrange further supported practice rather than documenting successful preparation for discharge.
Common pitfall: Equating task completion with goal achievement can hide ongoing risk. Do not judge effectiveness without a baseline, an observable outcome and sufficient attention to adverse effects.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · The Code: Read the Code online
22.What makes an SBAR handover actionable?
SBAR organises communication into situation, background, assessment and recommendation. State the immediate concern first, provide only background relevant to that concern, summarise findings and treatment response, then request a clear action with appropriate urgency. Include unresolved risks and confirm the response when necessary. The structure supports clinical decisions rather than serving as four labels to recite. An actionable handover enables the receiver to understand why help is needed and what is being requested.
Apply it
You contact a clinician about worsening breathing. Identify the patient and urgent concern, explain the relevant admission history, report observation trends and oxygen delivery, then request immediate review and confirm the plan while continuing care.
Common pitfall: A detailed background without an explicit recommendation can leave responsibility unclear. Saying that a patient is unwell is weaker than describing the change and requested response.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · Resuscitation Council UK: The ABCDE Approach
23.How should delegation preserve safe evaluation?
Safe delegation matches the task to the other person's competence, gives clear instructions and ensures suitable supervision and confirmation of the outcome. Explain what findings need immediate reporting and retain accountability for the decision to delegate. Assessment and interpretation must remain with someone competent to perform them. The key distinction is between assigning a task and assuming the care need has been resolved; a delegated observation still requires appropriate review and action on its result.
Apply it
You ask a competent colleague to obtain routine observations on a stable adult. Explain which changes to report immediately, ensure they understand the task and review the results rather than assuming that completed measurements require no further nursing decision.
Common pitfall: Delegation does not make an unsuitable task safe or transfer all accountability. A task marked completed may still contain findings that require urgent interpretation and action.
24.How should discharge planning test whether care is workable?
Discharge planning connects current needs with the person's ability, support, understanding and access to continuing care. Confirm what the patient will actually do, who will provide agreed assistance and how concerns will be communicated. Provide understandable instructions and check that essential follow-up arrangements are clear. Readiness involves more than completion of hospital tasks: an unresolved care dependency or misunderstood escalation plan can make an otherwise clinically stable discharge unsafe or impractical for the individual.
Apply it
An adult is clinically stable but cannot perform a necessary care task and has no agreed support at home. Communicate the unresolved need, coordinate further assistance and check the person's understanding before treating discharge preparation as complete.
Common pitfall: Giving written information does not establish practical readiness. Avoid assuming that relatives can provide care without checking the patient's wishes, their availability and the agreed arrangements.
The Code: Read the Code online · Test of Competence 2021: Adult nursing blueprint, V1.0
Clinical skills40% of stations; score weight not stated
25.When is soap and water preferable to alcohol hand rub?
Hand hygiene reduces transfer of microorganisms between hands, patients and the care environment. Alcohol hand rub is suitable in many clinical situations when hands are clean, but wash with soap and water when hands are visibly dirty or soiled, potentially contaminated with blood, body fluids or excretions, or after caring for someone with vomiting or diarrhoeal illness. Washing is also required for suspected or confirmed gastrointestinal infection such as norovirus or Clostridioides difficile, even when hands look clean. Soap and water physically remove contamination; alcohol hand rub does not reliably address every organism, including C. difficile spores. Clean all hand surfaces and dry thoroughly.
Apply it
After removing gloves following care of an adult with suspected norovirus and diarrhoea, your hands look clean. Wash with soap and water and dry thoroughly before the next care activity because the illness and potential contamination require washing despite the absence of visible soil.
Common pitfall: Visibly clean hands are not sufficient grounds to choose alcohol hand rub after gastrointestinal-infection care or potential blood, body-fluid or excretion contamination. Gloves do not remove the requirement for hand hygiene after removal.
26.Why must gloves be changed between contaminated and clean tasks?
Gloves provide a barrier when the task involves relevant exposure risk, but their outer surfaces become contaminated during use. Moving from a contaminated task to a clean procedure with the same gloves transfers microorganisms despite the barrier protecting the wearer. Remove gloves at the appropriate point, perform hand hygiene and use new gloves if the next task requires them. Glove selection follows the procedure and exposure risk; unnecessary continuous glove use can undermine safe hand hygiene.
Apply it
After handling a patient's soiled materials, you prepare to assist with a clean procedure. Remove the used gloves, clean your hands and reassess whether new gloves are required before touching clean equipment or the patient again.
Common pitfall: The same patient does not mean the same contamination risk throughout care. Cleaning or keeping disposable gloves on between tasks is not a substitute for changing them.
27.How should protective equipment match the anticipated exposure?
Choose personal protective equipment by assessing likely contact with blood, body fluids and other contamination during the task. Gloves protect hands; an apron or gown protects clothing and skin as appropriate; eye or face protection is needed when splashing to the face is anticipated. The selection is task-specific rather than a ritual requirement for every encounter. Remove equipment safely and perform hand hygiene so that the protection itself does not become a route of contamination.
Apply it
Before a procedure likely to splash body fluid, assess the exposure and prepare appropriate hand, clothing and face protection. A task involving only clean, intact-skin contact would require a different equipment decision based on its actual risk.
Common pitfall: More equipment is not automatically safer if it is unnecessary or removed poorly. Wearing gloves alone leaves other exposed areas unprotected when splashing is anticipated.
28.Which parts must remain protected during aseptic non-touch technique?
Aseptic non-touch technique protects key parts and key sites from microorganisms. Key parts are equipment surfaces that contact a susceptible site or a sterile fluid pathway; key sites are vulnerable entry points or exposed tissue requiring protection. Identify them before starting and organise equipment to avoid touching or contaminating them. The technique is defined by maintaining asepsis throughout the procedure, rather than by wearing gloves alone or reproducing a fixed hand-movement sequence.
Apply it
While preparing a sterile connection, identify the surfaces that will enter the fluid pathway and keep them protected. Arrange the equipment so these parts can be connected without touching the ends or contacting an unclean surrounding surface.
Common pitfall: Sterile gloves do not excuse avoidable contact with key parts. An apparently tidy procedure can still be contaminated if a protected connection touches an unclean surface.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · NHS Scotland National Infection Prevention and Control Manual: Standard Infection Control Precautions
29.How should an aseptic breach change the procedure?
A recognised breach requires action before the contaminated item or field contacts a susceptible site. Stop at a safe point, identify what was compromised and replace or re-establish the affected equipment or field as necessary. Reassess hand hygiene and technique before continuing. The visible cleanliness of an item does not establish sterility. Correcting a breach demonstrates safe practice; continuing silently allows a known contamination risk to enter the procedure and potentially reach the patient.
Apply it
A sterile connector touches the bed linen during preparation. Keep it away from the patient, replace the contaminated component and restore the protected setup before proceeding, explaining any necessary pause in a calm and professional manner.
Common pitfall: Wiping a contaminated sterile component without an approved reprocessing method does not restore its original status. Avoid completing the procedure simply to preserve its apparent flow.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · NHS Scotland National Infection Prevention and Control Manual: Standard Infection Control Precautions
30.How does immediate sharps disposal prevent injury?
Used sharps create a percutaneous exposure risk while they remain in circulation. Prepare an appropriate sharps container close to the point of use, use safety features as intended and dispose of the sharp promptly without recapping or unnecessary handling. Do not leave a used needle on a tray for later disposal. A safe container must also be suitable and below its fill limit. Prevention depends on controlling the entire handling pathway, including preparation and disposal.
Apply it
Before giving an injection, check that a suitable sharps container is available nearby and not overfilled. After use, activate the device's safety feature as instructed and dispose of it immediately without replacing the needle cap.
Common pitfall: Recapping may appear to protect others but adds a preventable hand-to-needle movement. Carrying an exposed sharp elsewhere also extends the period in which injury can occur.
31.Where should a catheter urine specimen be collected?
A catheter specimen intended for microbiological assessment should be collected aseptically from the designated sampling port, using the correct equipment and port preparation. Urine in the drainage bag is unsuitable for this purpose because it has remained in the collection system and may not represent a fresh bladder specimen. Maintain the closed drainage system rather than disconnecting it for convenience. Label the sample correctly and provide relevant clinical information so the result can be interpreted appropriately.
Apply it
A clinician requests a catheter urine culture for a patient with new symptoms. Prepare the sampling port and collect the specimen aseptically using the appropriate device, maintaining the closed system instead of taking urine from the drainage bag.
Common pitfall: A fresh-looking drainage bag does not make bag urine an appropriate culture specimen. Disconnecting the catheter to obtain a sample introduces an avoidable route for contamination.
Gloucestershire Hospitals NHS Foundation Trust: Catheter urine · Test of Competence: Adult Nursing Marking Criteria, last update January 2026
32.Why does bacteriuria not automatically establish catheter-associated infection?
An indwelling catheter can become colonised, so bacteria in a urine specimen do not independently establish symptomatic infection. Interpret microbiology with the patient's symptoms, clinical condition and reason for sampling. Cloudiness or odour alone is not a reliable substitute for a clinical assessment. Report new concerns and obtain an appropriate specimen when indicated. The decisive distinction is between detecting organisms in a catheterised urinary system and demonstrating an illness that requires a clinical treatment decision.
Apply it
A catheterised adult is comfortable and clinically unchanged, but urine appears cloudy. Assess the person and review the indication for testing rather than declaring infection from appearance alone or assuming that any positive culture will require treatment.
Common pitfall: Treating a laboratory finding as a diagnosis overlooks colonisation. Equally, a previously positive culture must not distract from assessing new systemic or urinary symptoms.
Gloucestershire Hospitals NHS Foundation Trust: Catheter urine
33.How does midstream urine collection reduce contamination?
A midstream specimen aims to collect urine after the initial flow, reducing contamination from organisms around the urethral opening. Explain the collection clearly, provide a suitable sterile container and prevent contact with its inner surfaces. Confirm identity and label the specimen accurately, including relevant collection details. The specimen's usefulness depends on both collection quality and correct patient identification; even a technically clean sample is unsafe if its label links it to the wrong person.
Apply it
An adult can pass urine independently but has never collected a sample. Explain how to collect the midstream portion without touching the container's inside, check understanding and ensure accurate patient identification and labelling after the specimen is obtained.
Common pitfall: Collecting the first urine passed can increase contamination. Transferring urine from an unrelated receptacle or touching the container interior undermines the purpose of the technique.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026
34.When must a newly inserted nasogastric tube remain unused?
A newly inserted nasogastric tube must remain unused until its position has been confirmed by an accepted initial-placement check and the result has been documented appropriately. Do not administer feed, medicines or a flush through an unconfirmed tube. External appearance, absence of distress and the ability to speak do not establish gastric placement. The safety decision is binary at this stage: unresolved placement means no use, with further assessment through the approved confirmation pathway.
Apply it
A newly inserted tube appears comfortable, but no acceptable placement confirmation has been obtained. Keep feed, medicines and water out of the tube, document the unresolved check and arrange the next appropriate step to establish safe initial placement.
Common pitfall: Flushing to see whether the tube works can itself harm a patient if placement is wrong. Apparent tolerance of insertion does not establish gastric location.
NHS Improvement: Initial placement checks for nasogastric and orogastric tubes
35.How is aspirate pH used for initial nasogastric placement checking?
Initial placement can be confirmed using gastric aspirate within the accepted pH range of 1 to 5.5, tested with appropriate pH indicator strips intended for this purpose. A result above 5.5, an unreadable result or failure to obtain aspirate does not confirm safe placement and requires the next approved assessment step. Do not use an air-insufflation listening test. Record the actual result and confirmation decision rather than merely writing that the tube was checked.
Apply it
A newly inserted tube yields aspirate with pH 6.0. Treat placement as unconfirmed, keep the tube unused and follow the approved pathway for further confirmation instead of rounding the result down to the accepted range.
Common pitfall: Aspirate colour and an audible abdominal sound are not substitutes for an accepted placement check. A borderline or uncertain reading must not be treated as confirmation.
NHS Improvement: Initial placement checks for nasogastric and orogastric tubes
36.What must an X-ray confirmation decision establish before tube use?
When X-ray confirmation of nasogastric tube placement is required, an appropriately trained and competent practitioner must verify the correct patient and current image, then document four anatomical checks. The tube must follow an oesophageal course that avoids the bronchial contours; bisect the carina or bronchi as it descends; cross the diaphragm centrally; and have a clearly visible tip below the left hemidiaphragm. Assess the course and tip together: seeing a tip below the diaphragm alone is insufficient. Record the interpretation and an explicit decision about whether the tube is safe to use before administering feed, fluid or medication.
Apply it
A report states that the tube tip lies below the left hemidiaphragm but does not address its course. Keep the tube unused while a competent practitioner reviews the correct current image against all four checks and documents the safe-to-use decision. If the necessary anatomy or tip cannot be seen clearly, placement has not been adequately established.
Common pitfall: An X-ray being available, a report describing normal lungs or an isolated comment about the tip does not complete confirmation. An older image cannot establish the position of a subsequently inserted or repositioned tube.
NHS Improvement: Initial placement checks for nasogastric and orogastric tubes
37.Which records make a fluid balance chart clinically useful?
A useful fluid chart records measured intake and output with consistent units, correct times and relevant routes. Include prescribed intravenous fluids actually delivered and measurable losses, avoiding double counting. Identify estimates as estimates and distinguish missing information from a true zero. Accurate totals support assessment, but the chart must be interpreted alongside clinical findings. The critical distinction is between what was prescribed or offered and what actually entered or left the patient's body during the recorded interval.
Apply it
A patient is offered a full drink but consumes only part of it, while an intravenous bag remains partly infused at the review time. Record actual consumption and delivered infusion volume rather than the amounts originally provided.
Common pitfall: Blank output entries do not prove absent output. Recording prescribed infusion volume as delivered can create a misleading positive balance and conceal incomplete treatment delivery.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026
38.How should net fluid balance be calculated and interpreted?
Net recorded fluid balance equals total recorded intake minus total recorded output over the same interval. A positive result means recorded intake exceeded recorded output; it does not by itself diagnose fluid overload. Check arithmetic, units, omitted entries and whether all values cover the same period. Then relate the result to symptoms, examination and treatment. The calculation describes a record of measured flows rather than a complete measurement of total body water or every unmeasured loss.
Apply it
During one interval, oral intake is 700 mL and intravenous intake 900 mL; urine is 1,100 mL and drain output 150 mL. Calculate a positive recorded balance of 350 mL, then interpret it alongside the assessment.
Common pitfall: A positive balance is not automatically a harmful balance. Combining intake from one interval with output from another produces a precise-looking result that is clinically invalid.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026
39.How does BMI contribute to adult malnutrition screening?
Body mass index is weight in kilograms divided by height in metres squared. In MUST, BMI contributes one component of risk: above 20 scores zero, 18.5 to 20 scores one, and below 18.5 scores two. BMI alone cannot exclude malnutrition risk because recent unplanned weight loss and the acute disease effect are assessed separately. Use reliable measurements where possible and recognise when fluid changes or measurement difficulties make the result less representative of nutritional status.
Apply it
An adult weighs 57 kg and is 1.70 m tall, giving a BMI of approximately 19.7. This contributes one MUST point; complete the weight-loss and acute-disease components before assigning the overall nutritional risk category.
Common pitfall: A BMI above the low-weight range does not cancel significant unplanned weight loss. Screening is also not a standalone diagnosis of the cause of nutritional problems.
40.How is percentage unplanned weight loss calculated for MUST?
Percentage weight loss equals previous weight minus current weight, divided by previous weight, multiplied by 100. MUST assesses unplanned loss over the preceding three to six months: below 5% scores zero, 5% to 10% scores one, and above 10% scores two. Establish whether loss was unplanned and whether the weights are credible. The denominator is the earlier weight because the calculation asks what proportion of the starting body weight has been lost.
Apply it
An adult's weight has fallen unintentionally from 80 kg to 72 kg over four months. The loss is 8 divided by 80 multiplied by 100, or 10%, contributing one point to the MUST weight-loss component.
Common pitfall: Dividing by current weight overestimates the percentage lost. At the exact 10% boundary, distinguish the 5% to 10% category from the category above 10%.
41.When does the MUST acute disease effect add risk?
The MUST acute disease effect adds two points when a person is acutely ill and there has been, or is likely to be, no nutritional intake for more than five days. Acute illness alone is insufficient, and reduced appetite is not identical to no intake. Add this component to BMI and unplanned weight-loss scores. The total identifies low risk at zero, medium risk at one and high risk at two or more, guiding further nutritional management.
Apply it
An acutely ill adult has had no nutritional intake for three days and is expected to have none for another three. The anticipated total exceeds five days, so add two acute-disease points and complete the overall MUST assessment.
Common pitfall: Adding two points for every hospital admission inflates risk incorrectly. Conversely, waiting until five days have already elapsed ignores the tool's explicit consideration of likely future intake.
42.How should anti-embolism stockings be selected and fitted?
Assess and document suitability before fitting. Major contraindications include suspected or established peripheral arterial disease, peripheral neuropathy or other sensory impairment, vulnerable or damaged skin, allergy to the stocking material, severe swelling and limb shape or size that prevents a safe fit, as described in [North Tees and Hartlepool NHS guidance](https://www.nth.nhs.uk/resources/antiembolism-stockings/). Compression can further compromise arterial blood supply, while sensory impairment can conceal pressure injury. Diabetes itself is not an automatic contraindication; associated vascular or neurological complications may make stockings unsuitable. If suitable, measure each leg using the product instructions, document measurements and select the corresponding size. Apply smoothly without folds or rolled tops, reassess fit when the limb changes and remove daily for hygiene and skin inspection.
Apply it
An adult prescribed stockings reports diabetes, poor circulation and reduced sensation in both feet. Do not proceed directly to sizing: assess and document the arterial and sensory concerns and obtain an appropriate suitability decision before fitting. If stockings are suitable, measure both legs individually and demonstrate daily removal, washing, skin inspection and correct reapplication.
Common pitfall: Neither a prescription nor correct sizing overrides a contraindication. Diabetes alone does not justify automatic rejection, but its vascular or neurological complications must be assessed. Pain or cold, discoloured toes require removal and prompt assessment; absent pain does not establish safety when sensation is impaired.
Cambridge University Hospitals: Anti-embolic stockings, version 7
43.Which symptoms require action during anti-embolism stocking use?
Pain, numbness, cold toes or discolouration during stocking use may indicate harmful pressure or impaired circulation. Remove the stockings and seek prompt clinical advice rather than simply encouraging continued wear. Inspect the skin and assess the limb, communicating the findings and timing. Ongoing checks matter because an initially acceptable fit can become problematic. The decisive cue is a new adverse symptom or circulation change, not the fact that stockings were appropriately prescribed earlier in care.
Apply it
After stockings are applied, a patient reports increasing foot pain and you observe cold, discoloured toes. Remove the stockings, assess and report the findings promptly, and obtain advice before considering whether and how they should be reapplied.
Common pitfall: Pain is not evidence that the stockings are working. Adjusting the top band alone is inadequate when symptoms suggest a circulation problem requiring assessment.
Cambridge University Hospitals: Anti-embolic stockings, version 7
44.How should a pre-operative discrepancy be handled?
Pre-operative checking is a safety process that compares the patient's identity and account with the documented procedure, consent and relevant preparation information. A mismatch must be clarified before progressing through the affected step. Do not alter documentation to make records appear consistent or assume another team has already resolved the issue. Communicate the exact discrepancy to the responsible team. A completed checklist is useful only when its entries represent verified findings and unresolved concerns remain visible.
Apply it
During preparation, a patient describes a procedure that differs from the procedure recorded on the paperwork. Pause progression, clarify the discrepancy with the responsible team and document the concern rather than reassuring the patient that the paperwork must be correct.
Common pitfall: Signing a check before verifying it converts uncertainty into false assurance. The patient's uncertainty deserves clarification even when several documents repeat the same information.
The Code: Read the Code online · Test of Competence: Preparation materials
45.How do patient and prescription checks prevent medicine errors?
Safe administration links the intended patient to a clear, valid prescription and the correct medicine, formulation, dose, route and time. Check relevant allergy information, expiry and suitability before administration, and document what was actually given. Use active identification and the approved identifiers rather than location or recognition alone. Every check addresses a different failure point: the correct medicine can still be wrong for this patient, and a correct dose can still be unsafe by the wrong route.
Apply it
Two adults on the ward share a surname. Before administration, use the required patient identifiers and match them to the prescription and medicine, then complete allergy, dose, route and timing checks rather than relying on bed location.
Common pitfall: Knowing a patient's face does not replace identification. A familiar medicine package can also conceal a different strength or formulation, so recognition is not verification.
The Code: Read the Code online · Test of Competence: Adult Nursing Marking Criteria, last update January 2026
46.How can units expose a liquid-medicine calculation error?
For a prescribed liquid dose, divide the required medicine amount by the available concentration expressed as amount per millilitre. Convert units before calculating and check that the units cancel to millilitres. Then assess whether the volume is measurable and plausible for the supplied formulation. Arithmetic does not establish that a prescription is appropriate or that administration is authorised. An unexpected result requires checking the original information and obtaining clarification rather than changing the prescription to fit the calculation.
Apply it
In a calculation exercise, a valid prescription specifies 300 mg and the supplied liquid contains 150 mg in 5 mL. The concentration is 30 mg/mL, so the required volume is 10 mL, subject to all administration checks.
Common pitfall: Dividing by the amount printed without its associated volume produces a unit error. A mathematically correct answer never substitutes for checking the patient and prescription.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · The Code: Read the Code online
47.Why must inhaler teaching match the device?
A conventional pressurised metered-dose inhaler requires a slow, smooth inhalation coordinated with pressing the canister to release the aerosol. A dry-powder inhaler requires a strong, deep inhalation after loading the dose according to its instructions. These breathing patterns are not interchangeable. A compatible spacer holds aerosol from a metered-dose inhaler in a chamber, reducing the coordination required between actuation and inhalation. It helps medicine reach the lungs and reduces deposition at the back of the throat. Follow the particular inhaler and spacer instructions, including preparation, breathing technique and any breath hold.
Apply it
During a demonstration with a training metered-dose inhaler, a patient presses the canister before starting to breathe and then takes a rapid sniff. Demonstrate breathing out, sealing the lips around the mouthpiece and coordinating actuation with a slow inhalation. Consider a compatible spacer to assist coordination, then ask the patient to demonstrate again. For a dry-powder device, teach the required strong, deep inhalation instead.
Common pitfall: Giving every inhaler user the same breathing instructions can impair delivery. A spacer does not remove the need to check technique and product instructions. Observe the person's demonstration before attributing poor benefit to failure of the prescribed medicine.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · Good inhaler technique | Kent Community Health NHS Foundation Trust
48.How should peak expiratory flow measurement distinguish effort from deterioration?
Position the person upright and reset the peak-flow meter before each attempt. Ask them to breathe in fully, close their lips tightly around the mouthpiece and blow out as hard and fast as possible in a short maximal expiratory effort. Allow rest between attempts and record the highest of three technically acceptable readings, rather than their average. Explain and demonstrate the technique before measurement. Interpret the result alongside symptoms and relevant previous or personal-best values: a low reading can reflect airflow obstruction, poor technique or inadequate effort.
Apply it
An adult produces widely differing readings, with air escaping around the mouthpiece. Correct the seal, check that each attempt begins with full inspiration and reset the meter before repeating. If the person remains clinically able, obtain three acceptable readings with rest between attempts and record the highest. Document and assess persistent low results alongside the person's clinical condition.
Common pitfall: A prolonged, gentle exhalation does not measure peak flow reliably. Neither an average of inconsistent attempts nor a high reading produced by faulty technique should guide interpretation. Severe breathlessness, exhaustion or other deterioration requires urgent ABCDE assessment and care; repeated attempts must not delay treatment.
Test of Competence: Adult Nursing Marking Criteria, last update January 2026 · Resuscitation Council UK: The ABCDE Approach · rn1-adult-nursing-marking-criteria-sept-2026.pdf
Professional values and behaviours10% of stations; score weight not stated
49.What distinguishes informed consent from simple agreement?
Informed consent requires understandable information about the proposed care and a voluntary decision by someone able to make that decision. Check understanding, address communication needs and respect the right to refuse or withdraw consent. A signature or passive cooperation alone does not establish that these conditions are met. Decision-making ability concerns the particular decision and circumstances; disability, age or disagreement with professional advice does not automatically remove the person's authority over their own care.
Apply it
An adult agrees to a procedure but cannot explain its purpose and says they feared losing care if they refused. Pause, clarify the information and voluntariness, provide communication support if needed and reassess consent before proceeding.
Common pitfall: A signed form cannot repair coercion or misunderstanding. An unwise choice is also not sufficient evidence that a person lacks decision-making ability for that choice.
50.When is sharing confidential information appropriate?
Confidentiality requires protecting personal information while sharing relevant information lawfully when needed for care or protection. Verify who is requesting it, their role, the purpose and the patient's wishes, and disclose only what is necessary. Family relationship alone does not create unrestricted access. Where sharing without consent is justified or required, use the appropriate process and record the reasoning. The key distinction is between a legitimate need to know and curiosity or convenience.
Apply it
A caller claiming to be a patient's relative requests detailed results. Verify identity and authority, check the patient's preferences and the purpose of disclosure, and provide only information that can appropriately be shared through the agreed route.
Common pitfall: Being a relative does not automatically authorise disclosure. Conversely, treating confidentiality as absolute secrecy can obstruct necessary safeguarding or appropriate communication within the care team.
51.How should professional candour follow a harmful care error?
Professional candour requires openness when care goes wrong and causes, or could cause, harm or distress. Address immediate safety, tell the patient what is known, apologise, explain likely consequences and next steps, and offer appropriate support. Report through the organisation's process and keep the person informed as facts develop. Distinguish known facts from uncertainty without speculation or blame. An apology acknowledges the person's experience and the failure; it should not depend on completing the investigation first.
Apply it
You discover an administration error that may harm a patient. Arrange immediate clinical assessment, report the incident and ensure an appropriate conversation explains the known facts, includes an apology and describes monitoring, support and how further information will be provided.
Common pitfall: An incident report does not replace speaking openly with the patient. Waiting for complete certainty before acknowledging a known error can compound distress and undermine trust.
Openness and honesty when things go wrong: The professional duty of candour
52.How should a safeguarding disclosure be handled?
Respond to a safeguarding disclosure by listening, taking the concern seriously and assessing immediate safety. Explain that relevant information may need to be shared to protect the person or others; do not promise absolute secrecy. Record the person's words accurately and raise the concern through the appropriate safeguarding route. Avoid conducting an independent investigation or confronting an alleged perpetrator. The nursing decision concerns protection, appropriate referral and factual communication rather than proving the allegation personally.
Apply it
An adult says a carer has threatened them and asks you to tell nobody. Listen privately, explain the limits of confidentiality, assess immediate danger and seek appropriate safeguarding support while recording the account accurately and respectfully.
Common pitfall: Promising secrecy can obstruct protective action. Leading questions, personal investigation or confronting the alleged abuser may increase risk and compromise the quality of the account.
The Code: Read the Code online · Nursing (all fields): OSCE candidate information booklet, V2.4
53.How should unsafe staffing or discriminatory practice be challenged?
Act on concerns that place people at risk or undermine fair, respectful care. Describe the specific behaviour or unmet safety need, take proportionate immediate protective action and raise the concern through appropriate channels. Escalate further if the response does not address continuing risk, and keep an accurate record. Professional accountability requires action rather than silent acceptance. Distinguish factual concerns about care from personal criticism, and ensure that a person's background or protected characteristics do not determine access to care.
Apply it
Staffing leaves essential observations repeatedly undone, and a colleague dismisses one patient's needs using discriminatory language. Address immediate safety, challenge the inappropriate conduct and raise specific documented concerns with the responsible senior person, escalating continuing risk if necessary.
Common pitfall: Normalising a recurring problem does not make it safe. Reporting only that the shift was difficult is less useful than identifying the unmet care and resulting risk.
The Code: Read the Code online · Test of Competence: Preparation materials
54.What makes a clinical record accountable and trustworthy?
A trustworthy record is clear, accurate, attributable and completed at the time of care or as soon as possible afterwards. Record relevant findings, decisions, risks, actions and communication without speculation or falsification. Identify a delayed entry honestly and preserve the original record when correcting an error using the approved method. Documentation supports continuity and accountability because another professional can distinguish what happened, what was observed and what remains unresolved, rather than infer events from an incomplete narrative.
Apply it
You realise that an assessment completed earlier was not recorded. Make a clearly identified late entry with the actual assessment time and current entry time, documenting relevant findings and actions without pretending the entry was made contemporaneously.
Common pitfall: Backdating creates a false chronology. Recording that care was completed when it was only planned can mislead subsequent staff and conceal an unresolved patient need.
Evidence-based practice10% of stations; score weight not stated
55.How does a focused clinical question establish evidence applicability?
A focused question identifies the population, intervention, comparator and outcomes relevant to the decision. Compare those features with the study before applying its findings. Differences in illness severity, setting, usual care or outcome definition may reduce direct relevance even when the topic sounds similar. Applicability is therefore a reasoned comparison, not a judgement based solely on the study title. State which differences matter and how they change confidence in a recommendation for the patient under discussion.
Apply it
A study tests an intervention in independent community adults, while your patient is a frail inpatient needing assistance. Compare the populations, care setting and outcome priorities before deciding how directly the reported benefit informs this person's care.
Common pitfall: Sharing a diagnosis does not guarantee comparable patients or circumstances. Rejecting every imperfect match is also unhelpful; explain the specific difference and its likely importance.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
56.Why does study conduct matter alongside the reported result?
A study's estimate can be distorted by differences in group selection, treatment delivery, missing outcomes or outcome measurement. Appraisal asks how the methods could move the result away from the true effect, rather than accepting a conclusion because it is published. Randomisation can reduce confounding, but its benefits can be undermined by poor conduct or incomplete follow-up. Distinguish a precise estimate from a trustworthy estimate: many participants do not automatically remove systematic bias.
Apply it
A report claims better recovery with an intervention, but many more participants are missing from one group's follow-up. Consider whether their unobserved outcomes could change the conclusion before accepting the reported difference as a reliable treatment effect.
Common pitfall: A large sample does not repair systematic bias. Equally, naming a possible limitation without explaining its direction or consequences contributes little to a clinical recommendation.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
57.How is absolute risk reduction calculated?
For an undesirable outcome, absolute risk reduction is the comparator risk minus the intervention risk over the same follow-up period. Express the result in percentage points or events per a stated number of people. For example, reducing risk from 12% to 8% gives a four-percentage-point reduction, equivalent to four fewer events per 100 people. Keep outcome definition and time horizon consistent. This measure communicates the size of the expected difference at the observed baseline risk.
Apply it
In an invented study, 30 of 300 comparator participants and 18 of 300 intervention participants experience the same adverse outcome. Risks are 10% and 6%, so the absolute reduction is four percentage points over the stated follow-up.
Common pitfall: Subtracting event counts is misleading when group sizes differ. A four-percentage-point reduction must not be described as a 4% relative reduction without calculating relative effects.
Cochrane Handbook, Chapter 6: Choosing effect measures and computing estimates of effect
58.How do relative and absolute effects describe different benefits?
Risk ratio divides intervention risk by comparator risk. For an undesirable outcome, relative risk reduction is one minus that ratio. A fall from 10% to 5% has a risk ratio of 0.5 and a 50% relative reduction, but an absolute reduction of five percentage points. The same relative reduction produces a smaller absolute benefit when baseline risk is lower. Presenting both measures helps patients distinguish proportional change from the actual difference in event probability.
Apply it
Compare two invented settings: risk falls from 20% to 10% in one and from 2% to 1% in the other. Both show a 50% relative reduction, but their absolute reductions are ten and one percentage points respectively.
Common pitfall: A striking relative percentage can exaggerate the apparent practical benefit when baseline risk is low. Always retain the comparator risk and follow-up period when explaining effects.
Cochrane Handbook, Chapter 6: Choosing effect measures and computing estimates of effect
59.How should a confidence interval influence an evidence conclusion?
A confidence interval describes uncertainty around an estimated effect under the study's statistical assumptions. Consider whether the range includes clinically important benefit, little difference or harm, rather than relying only on a significance label. For a risk ratio, one represents no difference between groups; for a risk difference, zero does. An interval crossing the no-effect value does not prove equivalence. Imprecision should change the strength and wording of the recommendation, especially when serious harms remain plausible.
Apply it
An invented study reports a risk ratio of 0.85 with a 95% confidence interval from 0.60 to 1.20. Explain that the estimate favours intervention but remains compatible with meaningful benefit or increased risk, so certainty is limited.
Common pitfall: Statistical non-significance does not establish that treatments are identical. A narrow interval also cannot remove bias or make an outcome clinically important merely by being precise.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
60.How should evidence become a proportionate care recommendation?
An evidence-informed recommendation combines the size and certainty of benefit with harms, applicability, practical demands and the person's preferences. Distinguish measured patient-important outcomes from surrogate measures that may not demonstrate the benefit patients value. Explain what the evidence supports, where uncertainty remains and what monitoring or review is needed. A positive study does not automatically justify universal adoption. The strength of the recommendation should match the evidence and the consequences of making the wrong decision.
Apply it
A small study improves a laboratory marker but does not measure symptoms, admissions or adverse effects. Recommend cautious consideration and further assessment of patient-important outcomes rather than claiming the intervention has already demonstrated better overall health.
Common pitfall: A favourable surrogate result is not proof of meaningful clinical benefit. Avoid recommendations that ignore harms, patient priorities or uncertainty simply because the conclusion sounds promising.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions · The Code: Read the Code online
What to focus on during revision
The following are CertMedbry study suggestions. Use the official outline to check the full scope of your examination.
- Use ABCDE to identify and treat immediate threats, then reassess and communicate the response.
- Connect assessment findings to prioritised nursing problems, patient outcomes, purposeful interventions and suitable review times.
- Practise adult RN1 procedures with particular attention to contamination, identification, placement confirmation and reasons to stop.
- Calculate fluid balance, MUST components and medicine volumes with explicit units and correct boundaries.
- Write concise professional-values responses that identify the concern, protect the patient and explain disclosure, reporting or escalation.
- Appraise effect size, uncertainty, bias and applicability before recommending a change in care.
- Use the full adult nursing blueprint and current RN1 documents to identify skills beyond this selective guide.
A practical preparation plan
1. Map your adult RN1 preparation
Read the adult blueprint's OSCE mappings and the current nursing specification. Build a personal coverage list across the seven proficiency platforms and communication and procedure annexes.
2. Rehearse one linked APIE case
Assess a new adult scenario, select supported needs, write measurable goals and review times, explain safe implementation and evaluate using new findings. Finish with an actionable SBAR handover.
3. Practise procedures with stop points
For each RN1 skill, identify the checks that permit progression and the findings that require a pause. Rehearse contamination recovery, unresolved NG placement, medicine discrepancies and stocking-related circulation concerns.
4. Explain calculations aloud
Work through fluid totals, BMI, weight loss and liquid volumes. State units, time intervals and category boundaries, then explain what the numerical result does and does not establish.
5. Write and critique short responses
Practise professional-values and evidence-appraisal answers. Include the decisive concern, immediate action, reasoning and follow-up; remove unsupported assumptions and conclusions stronger than the evidence.
6. Combine knowledge with observed practice
Use the questions and cards to expose reasoning gaps, then repeat the associated practical skill with feedback. Review the current RN1 materials and station timings for your sitting, including changes available from 26 October 2026.
Use your sample score as a starting point
The free set contains 20 original practice questions. It is a small learning sample, not an official examination or a validated pass prediction. Review each explanation and its source before moving to another topic.
Start the free sampleOfficial sources and updates
- NMC OSCE: Test of Competence
- Test of Competence: Preparation materials
- Nursing (all fields): OSCE candidate information booklet, V2.4
- Midwifery: OSCE candidate information booklet, V2.4
- Test of Competence 2021: Nursing Test Specification for Candidates, V1.1
- Test of Competence 2021: Adult nursing blueprint, V1.0
- Test of Competence 2021: Midwifery blueprint, V1.0
- Test of Competence: Adult Nursing Marking Criteria, last update January 2026
- Learning Disabilities Nursing Marking Criteria, V1.8, updated March 2025
- Mental Health Nursing Marking Criteria, V2.2, updated May 2025
- Children's Nursing Marking Criteria, updated February 2026
- Midwifery Marking Criteria, updated February 2026
- The Code: Read the Code online
- Openness and honesty when things go wrong: The professional duty of candour
- Resuscitation Council UK: The ABCDE Approach
- NHS Scotland National Infection Prevention and Control Manual: Standard Infection Control Precautions
- Gloucestershire Hospitals NHS Foundation Trust: Catheter urine
- NHS Improvement: Initial placement checks for nasogastric and orogastric tubes
- Cambridge University Hospitals: Anti-embolic stockings, version 7
- BAPEN: Malnutrition Universal Screening Tool
- Cochrane Handbook, Chapter 6: Choosing effect measures and computing estimates of effect
- Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
- rn1-adult-nursing-marking-criteria-sept-2026.pdf
- DVT (deep vein thrombosis) - NHS
- Pulmonary embolism - NHS
- Good inhaler technique | Kent Community Health NHS Foundation Trust
- Consent to treatment - Assessing capacity - NHS
- Managing the risk of needlestick or sharps injuries - HSE
- hsis7.pdf
- Chapter 3: Defining the criteria for including studies and how they will be grouped for the synthesis | Cochrane
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