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NMC CBT·ModuleCLINICAL-CARE

Module 4: Clinical Care and Nursing Interventions

Module 4 covers the core clinical nursing interventions assessed in the NMC Test of Competence CBT. Topics span wound assessment and pressure ulcer prevention, wound dressing selection, leg ulcer management, nutritional screening using the MUST tool, enteral feeding, IV fluid therapy, catheterisation, oxygen therapy, airway management, ECG recognition, venepuncture and cannulation, perioperative care including the WHO surgical safety checklist, postoperative monitoring, and end of life care principles including advance decisions and DNACPR orders.

Questions
876
Units
5
Topics
20

What’s in it.

5 units

Sample questions

3 of many

A few questions from this module, with the answer and a full explanation. The complete bank is available when you start practising.

  1. What is the main difference between a nasogastric (NG) tube and a nasojejunal (NJ) tube?

    • An NG tube is inserted through the abdominal wall; an NJ tube is passed through the nose into the stomach.
    • An NG tube is placed via the nose into the stomach; an NJ tube is placed via the nose into the jejunum. NJ tubes bypass the stomach and are used when gastric feeding is not tolerated.
      Correct answer
    • There is no clinical difference; NG and NJ tubes are different names for the same feeding tube.
    • An NG tube is a permanent feeding device; an NJ tube is a temporary tube removed after each use.
    Explanation

    A nasogastric (NG) tube is passed via the nose into the stomach and is used for short-term feeding (up to 4–6 weeks). A nasojejunal (NJ) tube is passed via the nose past the stomach and through the pylorus into the jejunum. NJ feeding bypasses the stomach entirely and is indicated when gastric feeding is not tolerated (e.g., gastroparesis, high aspiration risk, pancreatitis). NJ tubes require radiological or endoscopic confirmation of placement and are typically administered as continuous infusions.

  2. During a wound dressing change, a nurse uses Standard ANTT. They open the dressing pack correctly but then reach across the sterile field to pick up gauze from the far side, contaminating the field with their non-sterile sleeve. Which ANTT principle has been breached and what should happen next?

    • The Key-Part Protected Aseptic Field has been contaminated; the sterile field must be discarded, and a new dressing pack opened and prepared correctly before continuing
      Correct answer
    • The dressing should be completed quickly to minimise wound exposure time; contamination risk is outweighed by minimising the open wound period
    • The nurse should change their apron and gloves and continue; contamination of the packaging does not contaminate the contents of the field
    • The field is still safe as long as the sleeve did not touch the wound directly; continue with the dressing change and document the near-miss
    Explanation

    In Standard ANTT, a Key-Part Protected Aseptic Field must be maintained throughout the procedure. Any contamination of the sterile field — including by non-sterile clothing touching the field — requires the field to be abandoned, the pack discarded, and a fresh sterile field prepared.

    Wiping with alcohol or continuing are not safe alternatives. The nurse must also decontaminate their hands and apply new gloves before opening a fresh pack. This is a core ANTT principle that prevents surgical site and healthcare-associated infection.

  3. A nurse is sitting with a recently bereaved family member who is silent. The nurse feels uncomfortable with the silence and starts to fill it with explanations about the care their relative received. Which therapeutic communication principle does this violate?

    • The principle of informed consent — the family has a right to receive clinical information about their relative's care at this time
    • The principle of active listening — the nurse should be asking questions rather than remaining silent or talking
    • Therapeutic use of silence — silence is an important communication tool that conveys presence and empathy; filling it with information may shift focus from the family member's grief to clinical justification
      Correct answer
    • The SPIKES protocol Knowledge step — sharing clinical knowledge at this stage is required to complete the protocol
    Explanation

    Silence is a valuable therapeutic communication tool in bereavement support. It communicates presence, acceptance, and empathy without words. Filling silence with explanations or justifications of care shifts the focus from the bereaved person's emotional needs to the nurse's discomfort. Remaining present and allowing silence sends the message: 'I am here with you and you do not need to perform for me.' This is recognised in palliative care communication guidance as an important skill.

Frequently asked questions

3 questions
What wound care topics are in the NMC CBT?

The NMC CBT assesses wound assessment, pressure ulcer prevention and the staging system, wound dressing selection principles, and leg ulcer management including compression therapy.

Is end of life care in the NMC CBT?

Yes. Module 4 includes questions on principles of palliative care, recognising when a patient is dying, advance decisions and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, and supporting families through bereavement.

What is the WHO Surgical Safety Checklist?

The WHO Surgical Safety Checklist is a three-stage perioperative safety tool (sign in, time out, sign out) that all theatre team members use to reduce surgical complications. It is tested in the NMC CBT perioperative care section.