Free CBT mini mock.

The timed mini mock needs JavaScript. Here are the same 15 questions, each with its answer and the reasons.

Part A: numeracy

1. 1. A tablet label states 250 micrograms. What is this in mg?

   Answer and working

   Answer: 0.25 mg

   1. 1 mg = 1,000 micrograms.
   2. To change micrograms to mg, divide by 1,000.
   3. 250 / 1,000 = 0.25.
   4. Answer: 0.25 mg

   Watch for: Multiplying instead of dividing, or moving the point two places and writing 2.5 mg.

   Checked against: Part A questions: measuring the correct dose 2, metric units 2, oral medications 4, injections 3, intravenous infusions 3, fluid balance 1. [S5] Part A answers are numbers you type in yourself, and you may need to give the correct unit. [S5]

2. 2. Mr Clarke cannot swallow tablets and is prescribed 750 mg of paracetamol. The ward stocks paracetamol oral suspension 250 mg in 5 mL. What volume in mL should you measure?

   Answer and working

   Answer: 15 mL

   1. Dose wanted is 750 mg. Stock is 250 mg in 5 mL.
   2. Volume = dose wanted / strength x volume = 750 / 250 x 5.
   3. 750 / 250 = 3, and 3 x 5 = 15.
   4. Answer: 15 mL

   Watch for: Stopping at 3 and forgetting to multiply by the 5 mL that holds each 250 mg.

   Checked against: Paracetamol oral suspension for adults comes as 250 mg in 5 mL (one dose is 10 mL to 20 mL) or 500 mg in 5 mL (one dose is 5 mL to 10 mL), no more than 4 doses in 24 hours. [S60] Part A questions: measuring the correct dose 2, metric units 2, oral medications 4, injections 3, intravenous infusions 3, fluid balance 1. [S5]

3. 3. Mrs Obi is prescribed furosemide 25 mg by intravenous injection. The injection contains 10 mg in each 1 mL. What volume in mL should you draw up?

   Answer and working

   Answer: 2.5 mL

   1. Dose wanted is 25 mg. Stock is 10 mg in 1 mL.
   2. Volume = dose wanted / strength x 1 mL = 25 / 10 x 1.
   3. Answer: 2.5 mL

   Watch for: Multiplying the dose by the strength instead of dividing, which gives 250 mL.

   Checked against: Furosemide injection contains 10 mg in each 1 mL (20 mg in a 2 mL ampoule, 50 mg in 5 mL). Initial adult doses are 20 to 50 mg by intramuscular or intravenous injection, and intravenous furosemide must not be given faster than 4 mg per minute. [S70] Part A questions: measuring the correct dose 2, metric units 2, oral medications 4, injections 3, intravenous infusions 3, fluid balance 1. [S5]

4. 4. A patient is prescribed 500 mL of intravenous fluid over 6 hours through a gravity giving set that delivers 20 drops per mL. How many drops per minute, to the nearest whole number?

   Answer and working

   Answer: 28 drops/minute

   1. Total drops = 500 mL x 20 drops/mL = 10,000 drops.
   2. Minutes = 6 hours x 60 = 360 minutes.
   3. Drops per minute = 10,000 / 360 = 27.78.
   4. Round to the nearest whole number.
   5. Answer: 28 drops/minute

   Watch for: Dividing by the 6 hours instead of the 360 minutes, which gives about 1,667 drops/minute.

   Checked against: Part A questions: measuring the correct dose 2, metric units 2, oral medications 4, injections 3, intravenous infusions 3, fluid balance 1. [S5]

5. 5. Over 24 hours a patient has an intake of 2.6 litres and an output of 1,950 mL. By how many mL is the patient in positive balance (intake greater than output)?

   Answer and working

   Answer: 650 mL

   1. Use the same unit for both. 2.6 litres = 2,600 mL.
   2. Balance = intake - output = 2,600 - 1,950.
   3. Answer: 650 mL

   Watch for: Subtracting 1,950 from 2.6 without changing litres to mL.

   Checked against: Part A questions: measuring the correct dose 2, metric units 2, oral medications 4, injections 3, intravenous infusions 3, fluid balance 1. [S5] Part A answers are numbers you type in yourself, and you may need to give the correct unit. [S5]

Part B: clinical

1. 1. Mr Okafor, 68, has been assessed as able to understand, retain and weigh the information about his wound care. He declines a dressing change, and his wife says this is a foolish decision. What should the nurse do?

   1. Ask the doctor to treat him in his best interests because the decision he has made is unwise
   2. Respect his decision, explain the risks, offer alternatives and document the discussion
   3. Carry out the dressing change anyway, because leaving the wound alone may cause harm
   4. Ask his wife to consent on his behalf because she knows him best
   Answer and why

   • ABest interests decisions are only for people who lack capacity. Mr Okafor has capacity, and an unwise decision does not mean he lacks it.
   • BBest answer. He has capacity, so he decides. A person is not treated as unable to decide merely because the decision is unwise, and the Code asks nurses to respect, support and document a person's right to refuse care.
   • CGiving care he has refused is not consent, even when the nurse is worried about the wound. The Code requires properly informed consent and respect for a person's right to refuse care and treatment.
   • DA relative cannot consent for an adult who has capacity to decide. Mr Okafor makes this decision himself, whatever his wife thinks.

   Remember: A capable adult may make an unwise decision: respect it, explain the risks and document it.

   Checked against: A person is not to be treated as unable to make a decision merely because they make an unwise decision. [S40] Nurses respect, support and document a person's right to accept or refuse care and treatment, and balance this with acting in the person's best interests. [S7]

2. 2. A nurse gives Mr Hughes, 59, a dose of a medicine that was meant for the patient in the next bed. He is awake, and his observations are normal for now. What should the nurse do first?

   1. Stay with him, check his condition and get urgent medical advice to put the situation right
   2. Complete an incident form so that the error is on record before speaking to anyone else about it
   3. Wait to see whether he develops symptoms before telling the nurse in charge
   4. Apologise to Mr Hughes and ask him not to mention it while the matter is checked
   Answer and why

   • ABest answer. The first duty is to act immediately to put the situation right when a person may have been harmed. Checking him and getting urgent advice does this; the apology, documentation and escalation then follow.
   • BAn incident form is needed and the event must be documented formally, but doing this first delays the care he may need. Putting things right comes first.
   • CWaiting for symptoms delays treatment and goes against the duty to act immediately. The nurse in charge needs to know now so that help can be arranged.
   • DAn apology is part of candour, but asking him to keep quiet is the opposite of being open and honest. He must be told fully and promptly what happened.

   Remember: After an error, act immediately to put it right, then be open, apologise, document and escalate.

   Checked against: When someone has been harmed, or an incident could have caused harm, the nurse acts immediately to put it right, explains fully and promptly what happened and its likely effects, and apologises to the person and, where appropriate, their advocate, family or carers. [S7] The nurse documents these events formally and takes further action (escalates) if appropriate so they can be dealt with quickly. [S7]

3. 3. Mrs Hughes, 74, lives at home and attends the GP surgery for a blood pressure check. She tells the nurse she has had 2 falls in the last year. She got up without help each time and was not injured. What does NICE advise?

   1. Offer a comprehensive falls assessment and comprehensive falls management
   2. Assess her gait and balance only, because neither fall caused an injury
   3. Give general health, wellbeing and physical activity advice only
   4. Use a falls risk prediction tool to decide whether she needs any assessment
   Answer and why

   • ABest answer. Having had 2 or more falls in the last year meets the criteria for a comprehensive falls assessment and management in the community, even without injury.
   • BA gait and balance assessment is for people who have fallen in the last year but meet none of the criteria. She has had 2 falls, so she meets one of them.
   • CGeneral health, wellbeing and activity advice is for people who have not fallen, or who have had a single fall without a gait or balance impairment. Mrs Hughes does not fit that group.
   • DNICE says not to use falls risk prediction tools to predict a person's risk of falling.

   Remember: In the community, offer a comprehensive falls assessment and management to people who fell in the last year and are frail, were injured, could not get up or have had 2 or more falls.

   Checked against: In community settings, a comprehensive falls assessment and management is offered to people who have fallen in the last year and are living with frailty, were injured and needed medical treatment, were unable to get up independently, or have had 2 or more falls in the last year (among other criteria). People who have fallen in the last year but meet none of those criteria have their gait and balance assessed, and people who have not fallen, or have had a single fall and no gait or balance impairment, are offered health and wellbeing information and activity advice. [S35] Falls risk prediction tools should not be used to predict a person's risk of falling. [S35]

4. 4. Mrs Davies, 72, has a urinary tract infection and says she feels very unwell. Her NEWS2 total is 6. What should the nurse do first?

   1. Give regular paracetamol for her temperature and repeat the observations at the next routine round
   2. Immediately inform the medical team, request urgent assessment and consider sepsis as the cause
   3. Record the score and escalate to the medical team only if it rises to 7 or more
   4. Ask the healthcare assistant to repeat the observations at the end of the shift
   Answer and why

   • ATreating the temperature and waiting for the next round delays the response. With a known infection and a total of 5 or more, sepsis must be considered and the medical team told, not managed alone on the ward.
   • BBest answer. A total of 5 or more is the urgent response threshold: the registered nurse immediately informs the medical team, requests urgent assessment and monitors at least hourly. With an infection and a total of 5 or more, think sepsis.
   • CA total of 7 or more is the emergency threshold, but 5 or more already needs an urgent response. Waiting for a higher score allows further deterioration.
   • DHanding a late set of observations to a healthcare assistant does not escalate care. At a score of 6 the registered nurse must act now, and monitoring must be at least hourly.

   Remember: A NEWS2 total of 5 or more needs an immediate call to the medical team; with infection, think sepsis.

   Checked against: A total NEWS of 5 or more is the urgent response threshold: monitor at least hourly (1 hourly), and the registered nurse immediately informs the medical team and requests urgent assessment by a clinician or team with core competencies in the care of acutely ill patients. Care is given in an environment with monitoring facilities. [S52] Sepsis should be considered in any patient with a known infection, signs or symptoms of infection, or a high risk of infection, who has a NEWS of 5 or more ('think sepsis'). These patients need urgent assessment and intervention by a clinical team competent in the management of sepsis. [S54]

5. 5. A 40-year-old woman collapses in a GP surgery within minutes of an antibiotic injection. She has stridor, a swollen face and a weak, rapid pulse. Help has been called. Which treatment should the nurse give first?

   1. 500 micrograms of adrenaline (0.5 mL of 1 mg/mL) subcutaneously into the back of the upper arm
   2. 500 micrograms of adrenaline (0.5 mL of 1 mg/mL) as an intravenous bolus through a newly placed cannula
   3. 5 mL of 1 mg/mL adrenaline by nebuliser, then reassess her breathing and circulation
   4. 500 micrograms of adrenaline (0.5 mL of 1 mg/mL) intramuscularly into the anterolateral thigh
   Answer and why

   • AThe subcutaneous route is not recommended because it is less effective. Intramuscular adrenaline is the route of choice.
   • BIntravenous adrenaline should only be given by experienced specialists in an appropriate setting, because dosing and dilution errors can cause serious harm.
   • CNebulised adrenaline may help upper airway swelling only after intramuscular or intravenous adrenaline, and not as an alternative to it.
   • DBest answer. She has airway and circulation problems after exposure to a likely trigger, so anaphylaxis is treated at once with intramuscular adrenaline. The adult dose is 500 micrograms (0.5 mL of 1 mg/mL), best given into the anterolateral thigh.

   Remember: In anaphylaxis give adrenaline early by the intramuscular route: 500 micrograms (0.5 mL of 1 mg/mL) for an adult, into the anterolateral thigh.

   Checked against: The intramuscular adrenaline dose for an adult or a child over 12 years is 500 micrograms, which is 0.5 mL of 1 mg/mL (1:1000) adrenaline. The best site is the anterolateral aspect of the middle third of the thigh. [S51] Intramuscular adrenaline is first line in all healthcare settings and is safer than the intravenous route. Subcutaneous and inhaled routes are not recommended because they are less effective, and IV adrenaline is for experienced specialists only. [S51] Nebulised adrenaline may help with upper airway obstruction from laryngeal oedema, but only after intramuscular or intravenous adrenaline and not as an alternative to it. [S51]

6. 6. A registered nurse is allocating work on an older people's ward. Dev, a care assistant, has been trained and assessed as competent to help people wash and dress. Which task is most appropriate to delegate to Dev?

   1. Helping Mrs Green to wash and dress, with clear instructions and a check afterwards
   2. Deciding whether Mr Owen's new confusion since last night needs a review by the medical team
   3. Giving Mr Owen his insulin, because the nurse is busy with the medicines round
   4. Deciding whether a patient's wound needs referral to the tissue viability team
   Answer and why

   • ABest answer. Washing and dressing is within Dev's assessed competence. The nurse gives clear instructions, makes sure Dev is supervised and supported, and checks that the outcome meets the standard.
   • BJudging whether new confusion is a sign of worsening health needs a nurse's assessment and timely referral. Dev has not been assessed as competent to make that judgement.
   • CGiving insulin is not within the competence Dev has been assessed for. Being busy is not a reason to delegate beyond a person's competence.
   • DDeciding whether a wound needs referral is a nurse's clinical judgement. It goes beyond Dev's assessed competence.

   Remember: Delegate only tasks within the person's competence, with clear instructions and a check on the outcome.

   Checked against: A nurse delegates only tasks within the other person's scope of competence and makes sure they fully understand the instructions. [S7] Nurses give clear verbal, digital or written information and instructions when delegating or handing over responsibility for care. [S9]

7. 7. A nurse working a night shift on a medical ward finds that staffing is unsafe: two patients need one-to-one care and there is no extra support. She has told the nurse in charge, who says nothing can be done. What should she do next?

   1. Escalate the concern through the available channels, such as the manager on call, and document it
   2. Do the best she can for the rest of the shift and mention the concern at her next appraisal
   3. Ask a student nurse to take over the care of the two highest-need patients so that she can help others
   4. Leave the concern with the nurse in charge, since the decision about staffing is theirs
   Answer and why

   • ABest answer. Raise and, if necessary, escalate concerns about patient safety or the level of care using the channels available and local working practices. The first line did not resolve it, so she escalates further and documents what she did.
   • BAn appraisal is too late for a risk that exists tonight. Act without delay if there is a risk to patient safety.
   • CGiving the highest-need care to a student would be beyond their competence and would add risk. Tasks must only be delegated within the other person's scope of competence.
   • DLeaving it there is not enough when the risk to patients continues. A concern that is not addressed must be escalated.

   Remember: If a safety concern is not resolved locally, escalate through the available channels and document it.

   Checked against: The Code says to act without delay if you believe there is a risk to patient safety: raise and, if necessary, escalate concerns about patient or public safety or the level of care people are receiving, using the channels available and local working practices, and raise concerns immediately if you are asked to practise beyond your role, experience and training. [S7]

8. 8. A nurse prepares the medicines information for Mr Davies, 68, who is moving from hospital to a care home. He has a weekly injectable medicine. Which information is most important to include so that the care home can give his medicines safely?

   1. The ward where he stayed and the name of his consultant
   2. The date and time of his last weekly injection, and any medicine changes made with the reasons
   3. The brand name of each medicine and the pharmacy that supplied it in hospital
   4. A statement that his medicines are unchanged from admission, to avoid any confusion for the staff at the care home
   Answer and why

   • AContact details matter, but the ward and consultant do not tell the care home what he takes or when the next dose is due. Medicines details and the time of the last dose matter more for safety.
   • BBest answer. A transfer should include current medicines, changes with reasons, known allergies, and the date and time of the last dose of weekly or monthly medicines, including injections.
   • CBrand names and the supplying pharmacy are not what the care home needs to give the right dose at the right time. The last dose and any changes matter more.
   • DMedicines are often changed during a stay. Changes, including medicines started or stopped or doses altered, and the reasons must be passed on, so a blanket statement could cause errors.

   Remember: Pass on current medicines, changes and reasons, known allergies, and the date and time of the last dose of weekly or monthly medicines, including injections.

   Checked against: Information shared at a transfer of care should include the contact details of the person and their GP, known drug allergies and reactions, the medicines currently taken, changes to medicines and the reasons, and the date and time of the last dose of weekly or monthly medicines, including injections. [S37]

9. 9. Mrs Nowak, 70, speaks very little English. The nurse needs to explain a treatment option and obtain her consent. What is the most appropriate action?

   1. Speak slowly and loudly, using the correct medical terms so that nothing is lost in the explanation
   2. Recognise her language need and arrange access to an interpreter or translated material
   3. Give her the English consent form and ask her to sign it if she agrees to the treatment
   4. Rely on her nodding and smiling as a sign that she agrees
   Answer and why

   • ASpeaking louder does not help someone who does not understand the language, and medical terms make it harder.
   • BBest answer. Nurses recognise the need for, and facilitate access to, translator services and material, taking reasonable steps to meet her language and communication needs.
   • CAn English form she cannot read does not give her the information she needs, so her consent would not be properly informed.
   • DNodding and smiling may only show politeness. Understanding has to be checked, which needs communication in a language she can follow.

   Remember: When language is a barrier, recognise the need for and arrange an interpreter or translated material before explaining treatment or taking consent.

   Checked against: Registered nurses recognise the need for, and facilitate access to, translator services and material. The Code asks nurses to take reasonable steps to meet people's language and communication needs and to provide assistance, wherever possible, to those who need help to communicate. [S9] [S7]

10. 10. A nurse has finished helping Mr Ward, who has diarrhoea caused by Clostridium difficile, to use the commode. She has taken off her gloves. How should she decontaminate her hands?

    1. With liquid soap and water, as alcohol-resistant organisms may be present
    2. With alcohol handrub, rubbing until dry, because it is quicker and works on all organisms
    3. With alcohol handrub, then with soap and water only if the hands look soiled
    4. With an antiseptic wipe, then an emollient hand cream to protect the skin
    Answer and why

    • ABest answer. Liquid soap and water must be used where alcohol-resistant organisms, such as Clostridium difficile or other causes of diarrhoeal illness, may spread. Alcohol handrub is not suitable here.
    • BAlcohol handrub is preferred in most situations, but not here. It is not reliable against alcohol-resistant organisms such as Clostridium difficile.
    • CThe rule does not depend on whether the hands look soiled. In diarrhoeal illness from alcohol-resistant organisms, soap and water must be used from the start.
    • DAn antiseptic wipe is not a method of hand decontamination here, and emollient cream protects skin but does not decontaminate hands.

    Remember: Use liquid soap and water, not handrub, when hands are visibly soiled or contaminated with body fluids, or where C. difficile or diarrhoeal illness is a risk.

    Checked against: Hands are preferably decontaminated with an alcohol handrub, except that liquid soap and water must be used when hands are visibly soiled or potentially contaminated with body fluids, or where alcohol-resistant organisms such as Clostridium difficile or other causes of diarrhoeal illness may spread. [S25]