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Station 1 of 24 · Free

Post-operative observations and a falling blood pressure.

  • Vital signs
  • Nursing assessment and care planning
  • Orthopaedic ward, 06:30
  • Simulated patient

Station timer

Station timer: two minutes of reading, then eight to perform [S1], with a bell when two minutes are left [S1].

Candidate instructions

Setting: Orthopaedic ward, 06:30. Patient: Simulated patient.

You are the registered nurse on the morning shift. Mr Daniel Kowalski, 67, is day 1 after a right total knee replacement. He has a wound drain and an IV infusion of sodium chloride 0.9% running at 80 mL per hour.

At 02:00 his observations were: blood pressure 132/78 mmHg, heart rate 84, respiratory rate 16, oxygen saturation 97% on room air, temperature 37.1 °C, alert. The night nurse wrote: drain 150 mL.

He tells you he felt light-headed when he sat up to use the urinal.

In eight minutes:

  1. Perform a full set of vital signs and record them on the observation chart.
  2. Assess anything else that is relevant to what you find.
  3. Tell the examiner your findings and what you are doing next.

In the room: Automatic blood pressure machine, manual sphygmomanometer and stethoscope, pulse oximeter, tympanic thermometer, watch with a second hand, adult observation chart with coloured response zones, alcohol-based hand rub.

END OF CANDIDATE INSTRUCTIONS

Findings: what the patient or examiner tells you

Open these as you assess, one at a time, the way an examiner or patient would give them.

  • Automatic blood pressure 96/58 mmHg. Manual recheck 94/56 mmHg.
  • Heart rate 118, regular, weak. Respiratory rate 22. Oxygen saturation 95% on room air. Temperature 36.8 °C.
  • Alert and oriented. Pale, hands cool, capillary refill 3 seconds. Knee pain 3 out of 10.
  • Drain 500 mL in total, so 350 mL since 02:00. Fresh blood ooze on the dressing. Urine 25 mL in the last hour.

The checklist

Tick what you really did. 10 points, 2 safety-critical, each mapped to the NMBA standards [S4]. Our own practice checklist, not the NMBA marking scheme.

Did you do these?
  • Why it matters

    Identification and consent come before any hands-on care, every time.

  • Why it matters

    People breathe differently when they know they are being watched, and a fast rate is an early warning sign.

  • Why it matters

    An unexpected reading must be confirmed before you act on it or dismiss it.

  • Why it matters

    A full set lets the chart's colour zones and the doctor see the whole picture.

  • Why it matters

    Numbers tell you something is wrong; the drain, dressing and urine tell you why.

  • Why it matters

    Early recognition of post-operative bleeding prevents shock. Comparing with the baseline is what turns numbers into a decision.

  • Why it matters

    A deteriorating patient needs the right person now. Leaving it until the round is how harm happens.

  • Why it matters

    A light-headed patient with a low blood pressure can faint and fall if he gets up.

  • Why it matters

    The plan has to say how you will know if he is getting better or worse.

  • Why it matters

    The record shows the trend and the response for the next nurse and the doctor.

Model walkthrough

Show it, minute by minute (try the station first)
  1. Reading

    Note the baseline: 132/78 and 84 at 02:00. Your job is to compare. Light-headed on sitting up plus a drain makes you think of bleeding. Plan: full set, manual recheck, drain and wound, escalate.

  2. 0:00

    Hand rub. Introduce yourself, check two identifiers against the ID band, ask consent.

    Say: Good morning, I'm (your name), one of the registered nurses. Can you tell me your full name and date of birth? I'd like to check your blood pressure, pulse, breathing and temperature. Is that all right?

  3. 0:45

    Radial pulse: rate, rhythm, strength. Keep your fingers on his wrist and count breathing for a full minute. Say the values out loud.

  4. 2:15

    Automated blood pressure reads 96/58. Do not accept it: manual recheck with the right cuff, arm at heart level.

    Say: That's lower than earlier, so I'm going to check it again by hand.

  5. 3:30

    Oxygen saturation, temperature, consciousness, pain score. Chart each value as you go.

  6. 4:15

    Look for the cause: dressing, drain level against the 02:00 note, hands and capillary refill, urine bag. Ask about dizziness, chest pain and breathlessness.

  7. 5:15

    Lie him flat, call bell in his hand, and call for help from the bedside.

    Say: Your blood pressure is lower than earlier, so I'm asking a doctor to see you now. Please stay lying down. I'll stay with you.

  8. 6:00

    Bell. ISBAR to the examiner as the doctor.

    Say: I'm (your name), RN on the orthopaedic ward, about Daniel Kowalski, bed 4, day 1 after a right knee replacement. I'm worried he's bleeding. BP 94/56, down from 132/78 at 02:00. Heart rate 118, up from 84. Light-headed, pale and cool. 350 mL more in the drain since 02:00 and the dressing is oozing. Please review him now. Meanwhile I'll keep him lying flat and repeat his observations at least every 15 minutes.

  9. 7:15

    Document observations, the call and the plan. Tell the examiner what you will watch next: blood pressure, heart rate, drain, urine, consciousness.

Common mistakes

  • Trusting one low automated reading, or dismissing it as a machine error.

    Recheck manually with the right cuff, then compare with the baseline.

  • Charting the numbers but never saying what they mean.

    Say the pattern out loud: pressure down, heart rate up, light-headed, drain up, so possible bleeding.

  • Leaving the room to phone while he sits on the edge of the bed.

    Lie him flat, call bell in his hand, call for help from the bedside.

  • A vague request: can you have a look when you get a chance?

    Ask for a review now, give the numbers and the trend, and say what you are doing meanwhile.

  • Counting breaths while he knows you are counting.

    Keep your fingers on the pulse and count breathing quietly for a full minute.

From the official handbook

  • Each station lasts 10 minutes: two minutes of reading time, then eight minutes to perform. [S1]
  • You are required to demonstrate the skills, not just talk about what you would do. [S1]
  • Communication is assessed at every station (spoken, non-verbal and written). Examiners look at things such as explaining care, seeking informed consent, dealing with anxious relatives and clear documentation. You should know the ISBAR approach for passing on clinical information. [S1]
  • The candidate instructions end with the line END OF CANDIDATE INSTRUCTIONS, and you must stay seated for the whole two minutes of reading time, even if you have finished reading. [S1]
  • When reading time ends, the candidate instructions are taken away: at one exam centre they disappear from the screen, at the other you return the instruction card before you enter the room. [S1]
  • It is a regulatory exam, not an educational one. Examiners do not coach, prompt or give feedback, and when station time is up you move on even if you have not finished. [S1]
  • Try to complete every task in the candidate instructions, including writing the documentation. You get a new piece of notepaper at each station, and you hand all your notes to the examiner when time is up. [S1]

Open my report · Study plan · All stations

Independent practice. Not affiliated with or endorsed by the NMBA, Ahpra, Prometric or any exam body. Every station is original practice material, not real exam content. Our checklists are our own, not the NMBA marking scheme. No guarantee of a pass. Written with AI from the official RN OSCE handbook and NMBA standards, with every fact linked to its source and checked word for word against it. Not advice for real patient care: follow your workplace policy and the NMBA standards.