NMCN Paper 1 & 2: 75 Mixed Clinical Judgement Questions with Answers

Two hours after thyroidectomy, a patient develops stridor and increasing neck swelling. What is the priority?

A woman has heavy bleeding after birth and a soft, enlarged uterus. While calling for help, which action addresses the likely cause?

During IV antibiotic administration, a patient develops wheeze, facial swelling and hypotension. Which medicine is first-line?

A child with diarrhoea is alert, thirsty and able to drink, without shock. What is the most appropriate initial fluid approach?

A patient with sudden facial weakness and slurred speech arrives on the ward. Which bedside test should accompany immediate stroke escalation?

A patient says, “The voices are telling me to kill myself.” What should the nurse do first?

Before giving digoxin, the nurse finds an adult apical pulse of 46/min with dizziness. What is the safest action?

A patient has suspected infectious pulmonary tuberculosis. Which precaution is required in addition to standard precautions?

A patient with DKA has potassium 2.8 mmol/L before insulin starts. Which issue requires immediate clarification?

During magnesium sulphate treatment, a woman has absent patellar reflexes and respiratory rate 8/min. What is the priority?

A child weighs 18 kg. The prescription is 15 mg/kg per dose. The suspension contains 120 mg/5 mL. What volume provides one dose?

A postoperative patient suddenly has pleuritic chest pain, dyspnoea and oxygen saturation 84%. What is the priority?

At an outreach clinic, an infant is due for vaccination and has only mild rhinorrhoea, no fever and normal feeding. What is usually appropriate?

A patient with suspected acute stroke asks for water before swallowing has been assessed. What should the nurse do?

A child with suspected epiglottitis is drooling, sitting forward and has stridor. Which action is safest?

Ten minutes after morphine, a patient is difficult to rouse with respiratory rate 6/min. What takes priority?

A woman at 32 weeks has painless bright-red vaginal bleeding. Which examination should be avoided until placenta praevia is excluded?

Fifteen minutes into a blood transfusion, a patient develops chills, back pain and hypotension. What should the nurse do first?

A patient taking lithium develops vomiting, coarse tremor and an unsteady gait after several days of diarrhoea. What is the safest action?

One litre of prescribed IV fluid must run over 8 hours using an infusion pump. What rate is required?

A patient in a leg cast reports severe pain despite analgesia and pain on passive toe extension. What is the priority?

A 3-week-old infant has temperature 38.4°C and reduced feeding. What is the appropriate disposition?

A conscious adult with diabetes is sweaty and trembling, glucose 2.9 mmol/L, and can swallow safely. What should be given first?

A nurse discovers that the wrong insulin dose was administered. What is the immediate priority?

An older postoperative patient becomes acutely confused and inattentive overnight. Which assessment is most appropriate?

Immediately after birth, a baby is apnoeic despite drying, warming and appropriate stimulation. What intervention is the priority?

A patient taking warfarin reports black tarry stools and dizziness. What is the safest response?

After caring for a patient during a C. difficile outbreak, the nurse has visibly soiled hands. Which method is appropriate?

A patient with acute kidney injury has potassium 6.8 mmol/L and new broad QRS complexes. What is the priority?

A patient taking an antipsychotic develops high fever, severe rigidity and autonomic instability. Which action is indicated?

A prescription is for 750 mg of an antibiotic. After reconstitution, the final concentration is 250 mg/mL. What volume is needed?

A child with a history of tetralogy of Fallot suddenly becomes deeply cyanosed while crying. Which position helps during urgent assessment?

A patient has a new ileostomy. Which observation requires prompt review?

A nurse sustains a needlestick from a used hollow-bore needle. What is the immediate appropriate response?

During oxytocin infusion, contractions become very frequent and the fetal heart rate remains low. What should the nurse do first?

A patient with a head injury has a declining level of consciousness and a newly unequal pupil. What is the priority?

A competent adult refuses a planned blood transfusion after the risks and alternatives are explained. What should the nurse do?

A patient is found unresponsive with absent normal breathing and only occasional gasps. What should the nurse do?

A child with nephrotic syndrome suddenly develops fever and abdominal pain. What should the nurse prioritise?

A patient with heart failure gains 2 kg in two days and develops worsening orthopnoea. What do these findings most strongly suggest?

An agitated patient is pacing and speaking loudly but has not attacked anyone. Which approach is best initially?

A prescribed infusion contains 25,000 units of heparin in 250 mL. The ordered dose is 1,200 units/hour. What pump rate is required?

A patient with a chest drain becomes acutely breathless. The drainage tubing is visibly kinked under the bed rail. What should the nurse do?

A pregnant woman with hypertension reports severe headache, visual disturbance and epigastric pain. What is the priority?

Several people develop vomiting and diarrhoea after the same community meal. What is the most useful initial public health action alongside patient care?

A patient with sickle cell disease develops chest pain, fever and new hypoxaemia. Which complication should be urgently suspected?

A patient develops lip and tongue swelling after starting enalapril. What is the priority?

A child with severe asthma becomes exhausted and has very little air entry despite less wheeze. What does this indicate?

A patient with haematemesis is pale, tachycardic and hypotensive. Which intervention has priority?

Which task is generally most appropriate to delegate to a trained assistant for a stable patient?

A prescribed 500 mL infusion must run over 4 hours using a giving set of 20 drops/mL. What is the rate, rounded to the nearest whole drop?

A breastfeeding mother has a painful red area on one breast and fever but no contraindication to breastfeeding. What advice is usually appropriate during assessment and treatment?

A patient after abdominal surgery suddenly has wound separation with visible bowel. What should the nurse do?

An older adult with dementia becomes restless during evening care. Which response should be tried first?

A nurse prepares to insert a urinary catheter. Which measure best reduces introduction of organisms during insertion?

An adult has arterial blood gas results: pH 7.29, PaCO2 58 mmHg and bicarbonate 26 mmol/L. What is the primary disorder?

During a generalised seizure, which nursing action is safest?

A patient receiving gentamicin reports tinnitus and reduced hearing. Which action is appropriate?

A woman reports partner violence but is not ready to leave. What is the best nursing response?

A patient on prolonged bed rest has intact heel skin with non-blanching redness. What is the most appropriate action?

A woman has persistent heavy bleeding after delivery despite a firm contracted uterus. What should the team assess next?

An adult is prescribed 0.5 mg of a medicine supplied as 250 microgram tablets. How many tablets are required?

A patient with cirrhosis becomes drowsy and has a flapping tremor. Which prescribed treatment is commonly used to reduce gut-derived ammonia?

A patient starting an SSRI asks when mood improvement is likely. What is the most accurate response?

A child with diarrhoea becomes lethargic, has cold extremities and a weak rapid pulse. What is the priority?

A ward compares infection rates before and after introducing a hand hygiene programme, with no randomisation or control ward. How is this design best described?

A patient has continuous bladder irrigation after prostate surgery. Drainage stops and suprapubic pain develops. What is the priority?

Which handover statement most clearly uses an urgent SBAR recommendation?

A screening test correctly identifies most people who have a disease but produces several false positives. Which property is high?

A patient with a new arteriovenous fistula has no palpable thrill. What should the nurse do?

At 30 weeks, a woman reports a clear reduction in her usual fetal movements. What advice is appropriate?

A patient with a tracheostomy develops sudden distress and noisy breathing; a suction catheter will not pass. What should the nurse suspect?

A patient in alcohol withdrawal develops a seizure followed by confusion and marked autonomic activity. What is required?

A nursing study finds a correlation between long working hours and burnout. What conclusion is justified?

At handover, which patient should the nurse assess first?