Free NMC Test of Competence OSCE: Mental Health Nursing Exam Questions and Answers

Terry Thomas was referred by their GP to the primary care mental health team in the community clinic earlier today, increasing panic attacks and not leaving their home. A mental health nursing assessment has been carried out, and Terry has agreed to work with the primary care mental health team to explore interventions to manage the panic disorder. You are a mental health nurse, working in the primary care mental health team in the community clinic. Terry Thomas has been referred to you by the GP because of regular panic attacks. Please conduct a holistic mental health assessment using the recovery model of care areas including person's preferences goals and strengths. A patient health questionnaire (PHQ-9) has already been completed by Terry. You will need to calculate the score and refer to the scoring outcome table for the result. Identify and discuss the current risks for the patient, using the information from the GP telephone referral and the information gathered in your assessment. Please discuss the outcome of your assessment and the PHQ-9 with your patient. In the next station, you will be required to use the information gathered from your assessment to write a plan of care for two aspects of care. This document must be completed using a BLUE PEN. You have 20 minutes to complete this station, including all the required documentation. Assume that it is TODAY and that it is 09:00 hours.

Type your answer, then reveal.

Overview of recent history Patient history Name: Terry Thomas DOB: 01/01/1984 Address: 1 Sweet Street, Westshire, WW6 5PQ GP: Dr Andrew Gibson, The Plains Surgery, Westshire Presenting complaint: • Repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). History of presenting complaint: • Terry has feelings of impending doom and also feelings of being out of control. • Terry experiences shortness of breath, chest pain, and rapid, fluttering or pounding heart (heart palpitations). • These attacks are leading to worrying about them happening again and avoiding situations in which they've occurred. • Terry also fears what they might do when they are experiencing an episode. • Terry has visited A&E on two occasions because of the fast heartrate. Electrocardiograms showed no abnormalities. • Terry has recently completed a 6-week course of low-intensity cognitive behaviour therapy. • Terry has reported that this has not helped with the current episodes of panic attacks. Past medical history: • Iron deficiency anaemia. • Anxiety. • Acne. • Sick leave for 8 weeks. Social history: • Never married. • No children. • Lives alone, near mother and next of kin (Katy Thomas). • No pets or dependants. • Terry has been the headteacher of a secondary school for 5 years and used to enjoy this job, although has been on sick leave for 8 weeks. • Lives alone in a two-storey house with bedroom and bathroom upstairs. • Non-smoker. • Does not drink alcohol. Drug history: • Oxytetracycline 500mg two times a day. • Sertraline 100mg once a day. • Ferrous sulfate 200mg two times a day. Allergies: None known. The Patient Health Questionnaire (PHQ-9) Patient name: TERRY THOMAS NHS number: 0004321 Date: TODAY Over the past 2 weeks, how often have you been bothered by any of the following problems? (0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day) 1. Little interest or pleasure in doing things: 1 2. Feeling down, depressed or hopeless: 2 3. Trouble falling asleep, staying asleep, or sleeping too much: 1 4. Feeling tired or having little energy: 1 5. Poor appetite or overeating: 2 6. Feeling bad about yourself, or that you're a failure or have let yourself or your family down: 2 7. Trouble concentrating on things, such as reading the newspaper or watching television: 3 8. Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual: 2 9. Thoughts that you would be better off dead or hurting yourself in some way: 0 Column totals / Add totals together: (blank) PHQ-9 scoring outcome table PHQ-9 score | Provisional diagnosis | Treatment recommendation (Patient preferences should be considered) 5–9 | Minimal symptoms | Support, educate to call if worse, return in one month 10 – 14 | Minor depression | Support, watchful waiting 10 – 14 | Dysthymia | Antidepressant or psychotherapy 10 – 14 | Major depression, mild | Antidepressant or psychotherapy 15 – 19 | Major depression, moderately severe | Antidepressant or psychotherapy > 20 | Major depression, severe | Antidepressant and psychotherapy (especially if not improved on monotherapy) Scenario: Terry Thomas was referred by their GP to the primary care mental health team in the community clinic earlier today, for increasing panic attacks and not leaving their home. A mental health nursing assessment has been carried out, and Terry has agreed to work with the primary care mental health team to explore interventions to manage the panic disorder. Based on your nursing assessment of Terry, please produce an evidence-based person-centred nursing care plan for two relevant aspects of nursing care and self-care suitable for the initial phase of primary care treatment. Please ensure that your plans include the patient's mental health. This is a silent written station. Please write legibly and clearly. You have 14 minutes to complete this station, including all the required documentation. Complete all sections of the care plan (nursing problem/need, aim(s) of care, re-evaluation timeframe, nursing and self-care interventions). Assume that it is TODAY and that it is 10:00 hours.

Type your answer, then reveal.

Implementation Station. Scenario: Terry Thomas was referred by their GP to the primary care mental health team in the community clinic earlier today for increasing panic attacks and not leaving their home. A mental health nursing assessment has been carried out and Terry has agreed to work with the primary care mental health team to explore interventions to manage increasing panic attacks and not leaving their home. Terry has been prescribed additional medication to help with their panic attacks, the GP asks you to administer the first dose while in the community clinic and adds this to the community prescription chart. Please administer and document Terry's 10:00 hours medications in a safe and professional manner. • Talk to the person. • Please verbalise what you are doing and why to the examiner. • Read out the chart and explain what you are checking/giving/not giving and why. • Complete all the required drug administration checks. • Provide an explanation to the person of what each drug being administered is for, and highlight any specific information regarding instructions for administration, including any possible contraindications and relevant medical information. • Complete the documentation and use the correct codes. • The correct codes for non-administration are on the chart. • Check and complete the last page of the chart. You have 15 minutes to complete this station, including all the required documentation. Complete all sections of the document. Assume that it is TODAY and that it is 10:00 hours.

Type your answer, then reveal.

Terry Thomas was referred by their GP to the primary care mental health team in the community clinic earlier today, for increasing panic attacks and not leaving their home. A mental health nursing assessment has been carried out, and Terry has agreed to work with the primary care mental health team to explore interventions to manage their increased anxiety and low mood. Terry has been prescribed additional medication to help with the increased anxiety. This is a verbally assessed station. Using the situation, background, assessment and recommendation (SBAR) tool, please hand information regarding your patient over verbally to the nurse on the next shift (the examiner). You may make notes on the SBAR form, but they will not be assessed by the examiner. You have 8 minutes in total to make notes on the SBAR form (this is not assessed), and to complete the verbal handover to the examiner. Assume that it is TODAY and that it is 11:30 hours.

Type your answer, then reveal.

You are working on the surgical admissions unit. You are caring for Catherine Higgins, who has been diagnosed with obstruction of the bowel, and the doctor has requested the insertion of a urinary catheter for fluid monitoring. All identification checks have been completed and the patient has no known allergies. The trolley has been cleaned. The patient is lying in bed, with their lower clothing removed, is covered with a towel and has an absorbent pad underneath them. All the equipment you need is provided. You are not required to document anything during this skills station. Please insert the urinary catheter according to current evidence-based practice. You have 8 minutes to complete this station.

Type your answer, then reveal.

You are working on a post-operative surgical ward. You are caring for Kendi Abara, who has undergone a right hemicolectomy and colostomy formation. They are 3 days post surgery, the one-piece stoma bag needs to be replaced, and Kendi is currently not well enough to do this themselves. All identification checks have been completed, and the patient has no known allergies. The trolley has already been cleaned prior to the procedure. All the equipment you need is provided. You are not required to document anything during this skill station, but if necessary, verbalise to the examiner what would be documented or reported. Please change the patient's stoma bag and speak to your patient throughout the procedure. You have 8 minutes to complete this station. Assume that it is TODAY and that it is 12:00 hours.

Type your answer, then reveal.

You are working on a post-operative surgical ward. You are caring for Kendi Abara, who has undergone a right hemicolectomy and colostomy formation. They are 3 days post surgery, the one-piece stoma bag needs to be replaced, and Kendi is currently not well enough to do this themselves. All identification checks have been completed, and the patient has no known allergies. The trolley has already been cleaned prior to the procedure. Please change the patient's stoma bag according to current evidence-based practice. Please change the patient's stoma bag and speak to your patient throughout the procedure. All the equipment you need is provided. You are not required to document anything during this skill station, but if necessary, verbalise to the examiner what would be documented or reported. You have 8 minutes to complete this station. Assume that it is TODAY and that it is 12:00 hours.

Type your answer, then reveal.

Professional values and behaviours: Drug misuse You are just about to commence the lunchtime drug round. You enter the clinical room and one of your nursing colleagues is in the room already. You witness the nurse take a 30 milligram codeine phosphate tablet from the drug cupboard. She puts it in her mouth and swallows it in front of you. You ask if she is okay, and she tells you that she needs the tablet for a headache. As far as you are aware, this is an isolated incident. Using your knowledge of NMC (2018) 'The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates', consider the professional, ethical and legal implications of this situation. Please summarise the actions you would take in a number of bullet points. This is a silent written station. Please write clearly and legibly. You have 10 minutes to complete this station.

Type your answer, then reveal.

Evidence-based practice: Sleep in intensive care Scenario You have been working on an Intensive Care Unit (ICU) for the past 6 months. Most of your patients are given medication to induce a coma while they receive care and treatment. As patients improve and are weaned off the sedation, you notice that it is common for patients to report that they have not slept for the whole time they have been on the unit. The patient you are looking after today, Mrs Green, reports this same lack of sleep. She asks if is this common and, if so, why it might be. Article summary A systematic review in a well-regarded peer-reviewed journal investigated the sleep disturbances in patients in intensive care units. The review found that: • Study A, a large-scale study, showed that 60% of patients discharged from ICU reported sleep disorders and deprivations. • Study B, a smaller study, found similar results, with 51% of patients experiencing dreams and nightmares, and 14% reporting nightmares negatively impacting their quality of life 6 months after discharge from ICU. The study recommended that patients return for a follow-up support appointment 2 to 3 months after leaving ICU. • Study C, a quantitative study, concluded that the inability to obtain physiological sleep depends on the patient's illness, previous sleep experience and the varying severity of their illness. • Patients in Study C reported a number of sleep-disturbing factors impacting their sleep, including: noise, light, pain, anxiety, nursing interventions, diagnostic tests, medications and non-invasive ventilation. The review concluded that sleep disorders in ICU were common and that there were multiple influencing factors causing sleep deprivation. Please identify the main points from the summary and apply the findings to the scenario below. This is a silent written station. Please write clearly and legibly. You have 10 minutes to complete this task. What is the relevance of the findings of this research for Mrs Green, and what advice would you give her? Give your responses here as bullet points.

Type your answer, then reveal.

Evidence-based practice: Sleep in intensive care Scenario You have been working on an Intensive Care Unit (ICU) for the past 6 months. Most of your patients are given medication to induce a coma while they receive care and treatment. As patients improve and are weaned off the sedation, you notice that it is common for patients to report that they have not slept for the whole time they have been on the unit. The patient you are looking after today, Mrs Green, reports this same lack of sleep. She asks if is this common and, if so, why it might be. Article summary A systematic review in a well-regarded peer-reviewed journal investigated the sleep disturbances in patients in intensive care units. The review found that: • Study A, a large-scale study, showed that 60% of patients discharged from ICU reported sleep disorders and deprivations. • Study B, a smaller study, found similar results, with 51% of patients experiencing dreams and nightmares, and 14% reporting nightmares negatively impacting their quality of life 6 months after discharge from ICU. The study recommended that patients return for a follow-up support appointment 2 to 3 months after leaving ICU. • Study C, a quantitative study, concluded that the inability to obtain physiological sleep depends on the patient's illness, previous sleep experience and the varying severity of their illness. • Patients in Study C reported a number of sleep-disturbing factors impacting their sleep, including: noise, light, pain, anxiety, nursing interventions, diagnostic tests, medications and non-invasive ventilation. The review concluded that sleep disorders in ICU were common and that there were multiple influencing factors causing sleep deprivation. Scenario: You have been working on an Intensive Care Unit (ICU) for the past 6 months. Most of your patients are given medication to induce a coma while they receive care and treatment. As patients improve and are weaned off the sedation, you notice that it is common for patients to report that they have not slept for the whole time they have been on the unit. The patient you are looking after today, Mrs Green, reports this same lack of sleep. She asks if is this common and, if so, why it might be. What is the relevance of the findings of this research for Mrs Green, and what advice would you give her? Give your responses here as bullet points.

Type your answer, then reveal.