NMC Test of Competence 2021 Part 2 OSCE: Adult Nursing Preparation Guide Study Guide

Apply it

An adult admitted with breathlessness also reports difficulty washing and fear of returning to an upstairs flat. Address breathing urgently, then include functional ability, anxiety and the home environment when identifying nursing needs and coordinating support.

Apply it

Before administering a medicine, a nurse finds that the date of birth stated by the patient differs from the chart. Pause administration, check the identification band and records, and establish which documentation belongs to the patient.

Apply it

A patient repeatedly agrees but gives inconsistent answers about symptoms. Check hearing aids and preferred language, reduce competing noise, and arrange suitable interpretation if necessary before treating agreement as evidence that the questions were understood.

Apply it

An adult describes discomfort as their usual indigestion but also reports sudden sweating and new breathlessness. Explore the changed features and seek urgent assessment rather than accepting the familiar label as an adequate explanation.

Apply it

During an assessment, a patient develops noisy obstructed breathing and becomes less responsive. Call for urgent assistance and address the airway immediately, then reassess breathing and circulation instead of completing the admission questions.

Apply it

A patient's respiratory rate rises across successive observations while they become more breathless, although their blood pressure remains similar. Reassess using ABCDE, communicate the trend and request timely review rather than focusing only on blood pressure.

Apply it

After analgesia, a patient reports pain falling from seven to four but still cannot take a comfortable deep breath. Record the improvement and remaining functional limitation, reassess associated findings and consider whether further review is needed.

Apply it

An adult is 1.60 m tall and now weighs 50 kg, compared with 56 kg three months ago. BMI = 50 ÷ 1.60² = 19.5 kg/m², scoring 1. Unintentional loss = 6 ÷ 56 × 100 = 10.7%, scoring 2. They continue eating and do not meet the acute-disease criterion, scoring 0. Total 3 means high risk. Arrange dietetic assessment, record intake, set nutritional goals and review the inpatient plan weekly. Investigate painful chewing and provide appropriate oral care and eating support.

Apply it

An adult who usually walks independently becomes bedbound after an acute illness. Reassess pressure risk and inspect vulnerable skin, then arrange assistance with repositioning and appropriate pressure relief rather than retaining the admission assessment unchanged.

Apply it

A patient's chart shows a positive balance, but several urine entries are missing and their breathing has worsened. Check the record's completeness, reassess clinically and escalate the findings rather than declaring hydration satisfactory from the total.

Apply it

An adult repeatedly asks to leave because they care for a dependent partner. Explore the immediate concern, assess their clinical needs and involve appropriate support so that treatment decisions can be discussed without dismissing their responsibilities.

Apply it

A breathless patient also wants help arranging transport home. Prioritise assessment and management of breathing, then include coordination needs once immediate safety is addressed. Describe the breathing-related nursing need rather than writing only the diagnosis.

Apply it

A patient wants to sit out for lunch despite movement-related pain. Agree a goal describing an acceptable pain level and ability to transfer with assistance, with review after the planned pain intervention and before lunch.

Apply it

A patient cannot reposition independently and has discomfort over a pressure area. Plan assisted position changes, suitable pressure relief and skin review, explaining how each action addresses the specific risk and how the patient's tolerance will be assessed.

Apply it

A plan schedules review of pain after an intervention, but the patient develops new severe discomfort before that time. Reassess immediately and seek appropriate help rather than waiting for the written evaluation point.

Apply it

An adult with hearing loss refuses a proposed injection. Provide working hearing aids, a quiet setting and an accessible explanation of benefits, material risks and alternatives. Ask them to explain their understanding and reasoning. If they can understand, retain, weigh and communicate the choice, respect their refusal even if clinicians disagree. By contrast, delirium that prevents weighing the consequences despite support may establish incapacity for that decision at that time. Document the evidence and support provided; any subsequent treatment decision must address best interests, the least restrictive option and any applicable advance refusal or legally authorised decision-maker.

Apply it

A prescription names a medicine and frequency but leaves the route unclear, while more than one formulation is available. Withhold that administration and obtain clarification through the appropriate prescriber rather than selecting a familiar route.

Apply it

The chart records no known allergies, but the patient describes swelling after the prescribed antibiotic on a previous admission. Pause administration, establish the reaction history and alert the prescriber so that the discrepancy can be assessed and documented.

Apply it

A valid prescription requires 300 mg of an oral medicine supplied as 150 mg in 5 mL. Calculate 300 ÷ 150 × 5 = 10 mL, then complete the remaining medicine and patient checks before administration.

Apply it

A patient refuses a tablet because it previously caused severe nausea. Listen to the concern, explain the intended treatment and contact the appropriate clinician about options. Record the refusal rather than signing that the dose was given.

Apply it

After prescribed analgesia, a patient reports less pain but becomes unusually difficult to rouse. Assess using ABCDE and obtain urgent help rather than recording pain relief as an uncomplicated treatment success without considering the altered responsiveness.

Apply it

A patient received repositioning assistance and pressure relief, but a painful skin change persists. Evaluate the skin finding and comfort against the goal, arrange further assessment and revise the plan rather than merely listing completed repositioning.

Apply it

When calling about worsening breathlessness, identify the patient, describe the deterioration and relevant history, give current observations and treatment, and explicitly request urgent bedside review. Confirm the response and what to do if the condition worsens.

Apply it

Before discharge, a patient cannot explain how to obtain follow-up or what to do if symptoms return. Clarify the plan, check understanding in their own words and coordinate unresolved support needs with the receiving team.

Apply it

After helping a patient use a commode, a nurse prepares to handle a vascular access connection. Remove used protective equipment and perform hand hygiene before the aseptic task rather than continuing because the patient has not changed.

Apply it

A nurse finishes care with visible material on their hands and reaches for hand rub. Use soap and water instead, then dry thoroughly before continuing with clean care or putting on new gloves for a further indicated task.

Apply it

After handling a used drainage container with gloves, a nurse intends to open a clean dressing pack. Remove the contaminated gloves, perform hand hygiene and select the protection required for the next procedure before touching clean supplies.

Apply it

While preparing a dressing procedure, identify the wound-contact surface and equipment tips as protected areas. Arrange supplies so they can be used without touching these parts, and maintain their protection throughout the procedure from preparation to disposal.

Apply it

A sterile connector tip brushes against a used bedside surface before attachment. Keep it away from the patient, replace the contaminated item and restore the aseptic setup rather than wiping it casually and completing the connection.

Apply it

A nurse starts a dressing change before gathering all supplies and repeatedly reaches into nearby drawers. Pause safely and organise the necessary equipment so that protected parts remain covered and the procedure can continue without avoidable interruptions.

Apply it

A urine culture is requested for a catheterised adult. Identify the sampling port, prepare it correctly and obtain the specimen aseptically into the appropriate container, maintaining the closed system rather than emptying urine from the drainage bag.

Apply it

Two catheter specimens are being collected on the same ward. Complete each collection and identification process with the correct patient before moving to the next, and state that the sample is catheter urine on the request.

Apply it

During one shift, intake is 750 mL orally and 500 mL intravenously. Recorded output is 900 mL urine and 150 mL vomit. Intake is 1,250 mL, output 1,050 mL and recorded balance positive 200 mL.

Apply it

A jug contained 1,000 mL, but 400 mL remains at the end of the recording period and no other use occurred. Record 600 mL consumed, rather than counting the full jug as intake because it was supplied.

Apply it

An adult collapses, does not respond and makes occasional noisy gasps without normal breathing. Activate the emergency response and begin CPR, while another person brings the defibrillator, instead of waiting for the gasps to become more regular.

Apply it

A rescuer is compressing rapidly but shallowly and keeps pressure on the chest between strokes. Coach a rate of 100–120 per minute, depth of 5–6 cm and full recoil, while arranging a timely compressor change.

Apply it

A defibrillator arrives while CPR is underway. Continue compressions while pads are prepared where possible, clear the patient for analysis and any advised shock, and restart compressions promptly rather than pausing for an extended equipment discussion.

Apply it

A newly inserted tube passes easily and the patient does not cough, but no acceptable position check has been obtained. Keep the tube unused and arrange the next required confirmation step before introducing water, medicine or feed.

Apply it

A new tube yields aspirate with pH 6.0. Explain that this does not meet the accepted pH confirmation range, withhold all tube use and arrange further confirmation through the nasogastric safety pathway before feeding.

Apply it

A patient has just eaten fruit and needs a fingertip glucose measurement. Ask them to wash and thoroughly dry their hands before sampling rather than wiping away a visible drop and assuming the skin is suitable.

Apply it

A patient appears acutely unwell, but the displayed result conflicts with their clinical presentation. Assess urgently, summon appropriate assistance and check the testing process while arranging confirmation rather than dismissing the symptoms because of one reading.

Apply it

A patient breathes out slowly for several seconds into the meter and obtains a low value. Explain and demonstrate a short, hard, fast blow after a full inspiration, then repeat using correct positioning and a sealed mouthpiece.

Apply it

Three technically satisfactory blows produce 310, 350 and 330 L/min. Record 350 L/min as the result, and document relevant circumstances such as treatment timing when these are needed for comparison with earlier measurements.

Apply it

After a fingertip sample, a nurse considers leaving the lancet on the trolley until documentation is finished. Activate any safety feature and dispose of it immediately in the suitable sharps container before moving to other tasks.

Apply it

A nurse notices that a prepared injection is intended for subcutaneous administration while the prescription specifies intramuscular treatment. Stop and resolve the mismatch, including formulation and equipment, instead of treating the difference as a minor technique adjustment.

Apply it

For MDI use with a compatible spacer, the RN1 criteria assess shaking, fitting the inhaler, exhaling, sealing around the spacer mouthpiece and releasing a single puff while inhaling slowly and deeply. The single-breath technique uses a slow 2–3-second inhalation followed by an approximately 10-second breath hold. If the patient cannot hold for more than five seconds, the criteria allow five steady tidal breaths. Observe a demonstration: a patient taking a gentle, shallow sip through a loaded Turbohaler needs correction to a deep, forceful inhalation. Rehearse with a training device and reassess performance.

Apply it

An immobile adult has a pressure-relieving mattress but still reports localised discomfort. Inspect the area, assist a suitable position change and review the prevention plan rather than assuming the mattress alone has removed the risk.

Apply it

An oxygen saturation reading fluctuates while the patient moves, but they also look increasingly breathless. Improve signal quality and reassess breathing while seeking appropriate review, rather than attributing the entire concern to the device or accepting one isolated number.

Apply it

A support worker is asked to measure observations on a patient whose condition has changed. Clarify what must be reported immediately, ensure the task is appropriate and review the findings yourself rather than assuming delegation completes the assessment.

Apply it

A patient receives an unintended medicine dose. Assess and obtain clinical help, inform the appropriate senior staff, explain the known facts honestly to the patient and apologise, while arranging monitoring, incident reporting and updates about unresolved information.

Apply it

A patient's neighbour telephones asking for the diagnosis and says the family already knows. Verify neither identity nor entitlement by assertion alone; protect the information and follow the patient's preferences and the appropriate information-sharing process.

Apply it

A nurse realises that an earlier assessment was not documented. Add a clearly identified late entry stating the assessment time and current entry time, recording only information that can be accurately supported rather than backdating the note.

Apply it

Several dependent patients need urgent care that the available team cannot safely provide. Inform the responsible senior clinician or manager of the specific unmet needs, request assistance and document the response while prioritising immediate patient safety.

Apply it

A colleague suggests skipping an explanation because a patient has a learning disability. Use accessible language and appropriate communication support, check the person's understanding and challenge the assumption rather than excluding them from decisions about their care.

Apply it

A report recommends a ward intervention because satisfaction scores improved. Check how patients were selected, what comparison was used and whether outcomes such as sleep or adverse effects were actually measured before recommending the intervention for those purposes.

Apply it

In a hypothetical six-month study, complications occur in 20 of 100 control patients and 12 of 100 intervention patients. The absolute risk reduction is eight percentage points, equivalent to eight fewer complications per 100 patients during six months.

Apply it

Two hypothetical populations experience the same 50% relative reduction. Risk changes from 20% to 10% in one and from 2% to 1% in the other, producing absolute reductions of 10 and one percentage points respectively.

Apply it

A ward programme appears to shorten admission, but participants were more mobile and less ill before enrolment. Identify baseline health as a plausible confounder and avoid attributing the entire difference in length of stay to the programme.

Apply it

A carefully conducted study evaluates an intervention in independent younger adults, but the ward mainly cares for frail adults needing assistance. Recognise the potential applicability gap without claiming that the study must therefore have been badly conducted.

Apply it

Consider two hypothetical trials measuring pain on a 0–10 scale, with lower scores better and the difference defined as intervention minus control. Suppose a one-point difference is the agreed threshold for clinical importance. Trial one estimates −0.3 points, with a 95% confidence interval of −0.5 to −0.1: width 0.4 points. It excludes zero but indicates only a small benefit, below the illustrative clinical threshold. Trial two also estimates −0.3, but its interval is −1.8 to +1.2: width 3.0 points. It includes zero, clinically important benefit and clinically important harm, so the result is inconclusive. Similarly, a risk ratio of 0.8 with an interval of 0.5–1.3 for an adverse event spans a 50% relative reduction through no effect to a 30% relative increase.