OSCE VIVA exam QUESTIONS FULLY SOLVED & UPDATED 2024

Identify and explain one test you could complete on a patient to assess their: - Immediate memory - Recent memory - Remote memory Immediate memory- Ask the person to repeat a series of 3 digits Recent memory- Ask the person to recall the recent events of the day, such as how they got to the clinic. Remote memory- Ask the person to describe a birthday or anniversary. The patients' care plan identifies ongoing Glascow Coma Scale assessment. How does the nurse complete the following in relation to completing a GCS? - CHECK, OBSERVE, STIMULATE, STIMULATE, RATE. Check- Check for things interfering with communication. Like the persons ability to respond. Observe - Observe for eye movement, content of speech and movements of right and left sides. Stimulate- Sound: spoken or shouted. Physical: Pressure on the finger tip. Rate- Assign according to highest response observed. Your patient's pupils are recorded as PERRLA in the patient notes. What does this mean? Explain each letter of the acronym Pupils - The pupils are in the center of the iris, which is the colored part of your eye. They control how much light enters the eye by shrinking and widening. Equal - Your pupils should be the same size. If one is larger than the other, your doctor will want to do some additional testing to figure out why. Round- Pupils should also be perfectly round, so your doctor will check them for any unusual shapes or uneven borders. Reactive to - Your pupils react to your surroundings to control how much light enters your eyes. This step reminds your doctor to check your pupils' reactions to the next two items in the acronym. Light - When your doctor shines a light in your eyes, your pupils should get smaller. If they don't, there could be a problem affecting your eyes. Accommodation - Accommodation refers to your eyes' ability to see things that are both close up and far away. Name two tests to assess a patients: Reflex's, Sensory function, Motor function. Reflex's- Babinski test patellar test. Sensory function- 1. Light touch 2. Proprioception. Motor function- 1. Finger to nose test 2. Coordination test. Your patient is needed a liquid medication. How do you measure a liquid medication in relation to the meniscus? You measure liquid medications using a meniscus by placing it on a flat surface, then slowly pour the liquid into the cup. As you pour it in you must make sure the cup is at eye level and you are not looking down at it. Your patient has been ordered the following medications: Paracetamol + Docusate and Senna. EXPLAIN 2 counselling notes and 2 practice points for these. PARACETAMOL- 2 counselling notes that you will share with your patient: - Avoid using more than one product containing paracetamol at the same time - Too much paracetamol can cause liver damage. 2 practice points that you need to be aware of as a nurse: - In osteoarthritis, regular paracetamol alone is the preferred treatment but is under-used - paracetamol may be used in all age groups and is used for mild-to-moderate pain as it has fewer adverse effects. DUCOSATE - Counselling notes: - Take tablets with plenty of fluid. practice points: - onset of action is 1-3 days SENNA- Practice points: - onset of action is 6-12 hours Your buddy nurse asks you to explain the difference between primary and secondary intention: Primary intention: Healing without loss of tissue. Surgical wounds. Secondary intention: Wound that involves extensive loss of tissue. Eg a laceration, pressure sore. Identify 4 questions you would ask your patient when completing a wound history. 1. How and when did the wound start? 2. How long have you had it for? 3. Do you have a history of wounds? 4. Do you have any pain? 8. List two intrinsic and two extrinsic factors that inhibit wound healing Intrinsic: nutritional status, increased age. Extrinsic: Smoking, skin moisture. Explain how you would describe the following attributes of a wound Depth of loss of tissue: • Superficial • Partial thickness • Full thickness Clinical appearance- • Necrotic • Sloughy • Granulating • Hypergranualting • Epithelialising • Infected Exudate- • Serous • Haemoserous • Sanguineous • Purulent Peri-wound- • Edges rolled or raised • Erythema • Contact dermatitis Wound measurement- length, width, depth. Your patient is complaining of urgency and frequency on voiding. Identify 4 areas of question you would explore for this patient no related to pain. 1. History of smoking? 2. On any medications? 3. Ask about fluid intake. 4. Ask if they are in any pain You need to complete an abdominal assessment on you patient. Explain what you would be looking for in relation to: INSPECTION, AUSCULTATION, PALPATION Inspection- inspect for a localized enlargement as this may indicate a hernia, tumor, cysts, bowel obstruction, or enlargement of abdominal organs. - Scars give indication of previous operations or injuries. Auscultation- bowel sounds. Decreased sounds, such as no sounds for 1 minute, are a sign of decreased gut activity. Palpation- palpating for any tenderness as well as the internal organs. Your buddy nurse asks you to explain in what circumstances would you expect to see the following results when completing a dipstick: Bilirubin- Positive in hepatitis and jaundice. Blood- trauma or surgery of the lower urinary tract. Glucose- diabetic patients have this in their urine. Ketones- patients w dehydration, starvation or excessive aspirin usage. Leucocytes- suggests a UTI. Protein- Normally not present. Seen in renal disease. What is the normal SG and pH of urine? SG- The normal range for urine specific gravity is 1.016- 1.022. PH - the average value for urine pH is 6.0, but it can range from 4.5 to 8.0. Urine under 5.0 is acidic, and urine higher than 8.0 is alkaline, or basic. You are caring for a patient with a urinary catheter insitu. Prior to administering care your buddy nurse asks you the following questions Identify 4 indications for the insertion of a urinary catheter? 1. relief or acute or chronic urinary retention, 2. Measurement of urinary output 3. Following surgery on the bladder 4. To relieve discomfort. What are 3 complications associated with catheterisation? 1. Bacteria can enter the bladder at the connection between the catheter and the drainage bag. 2. The pooling of urine in the drainage bag can cause microorganism growth. 3. Bacteria can travel up the catheter's lumen. List 6 signs/symptoms of UTI's Pain, tenderness, nausea, vomiting, fever and chills. List 4 risk factors for urinary incontinence Coughing, laughing, sneezing, alcohol or caffeine ingestion. How many bladder measurements should you do when performing a bladder scan? Minimum of three to ensure accuracy of your scan. You have a patient who is being discharged with a catheter. What discharge planning would you perform to ensure a safe discharge? • Ensure follow up appointment is made prior to discharge as appropriate • Ensure patient is discharged with appropriate equipment • Inform patient regarding management plan e.g. 'Trial of Void' if appropriate, catheter change Hypoglycemia Q's What 5 symptoms of hypoglycaemia? sweating, hunger, double vision, dizziness, shaking. What are two reasons for wiping the patients' hand with a warm cloth? Vasodilation and remove dirt to improve bleeding. Why do you rotate the sites when taking a BGL? To decrease pain What are two strategies they can use to encourage blood flow to the area prior to taking a BGL? - Gently massage fingers. - Place the arm downwards to assist bleeding. What part of the finger should they take the blood from? Why? The side of the finger, avoid finger pad as there are more nerve endings, its more painful. State 4 indications for intravenous infusion therapy. 1/2. Maintain and restore fluid and electrolyte balance 3. For nutritional purposes 4. To administer medications. What are 5 potential sources of infection for someone with an intravenous canula (IVC)? - Catheter tip contaminated on insertion - Skin flora - Contaminated entry port - Intraluminal spread - Extraluminal spread. Identify 3 risk management strategies a nurse implements to reduce the risk of infection for a patient with an IVC? - Change every 72 hrs - Change if any symptoms such as swelling or tenderness - Complete a PIVAS- (peripheral intravenous assessment score) Your buddy nurse asks you to explain how you will' look, listen and feel' when caring for a patient with an IVC. Look: observe the IVC site looking for erythema, swelling or exudate and looking if the dressing is clean, dry and intact. Listen: ask the patient if the IVC is causing any pain or tenderness on palpation or movement. Feel: palate the site and feel for temperature or vein hardening. Explain the three types of Phlebitis: Mechanical: traumatic movement of the IV against the vessel wall Chemical: response of the vein intimate to certain chemicals infused into the vascular system. Infectious: infection at cannula area. Your patient has charted passive range of movements. Explain the difference between active and passive range of movements. Active ROM is when the patients are able to move all their joints their ROM unassisted. Passive ROM is when patients are unable to move independently and need to be assisted through each ROM. Explain how the respiratory system is impacted in a patient with reduced mobility. Due to reduced mobility, there is a reduced ability to cough effectively, which results in increased mucus in the bronchi. Explain how the musculoskeletal system is impacted in a patient with reduced mobility. Reduced mobility on the musculoskeletal system can result in permanent impairment of mobilisation. Reduced motility can result in loss of endurance, strength and muscle mass. Bone tissue is less dense so impaired calcium metabolism occurs which can result in osteoporosis. When this occurs they are at risk for fractures Explain the 2 aspects that a nurse is assessing when completing a neurovascular assessment. Nerves (assesses motor and sensory responses) Vascular (assess pulses, colour, temperature and capillary refill) List 4 indications for taking a set of neurovascular observations (NVO's) on a patient. 1. Fractures or crush injuries 2. Tourniquets that have been applied for long periods 3. Application of a cast or skeletal traction 4. Signs of infection in the limb What are two conditions/local factors that may affect a patient's neurovascular status. 1. paralysis 2. Peripheral vascular disease