Free Recognising Deterioration, NEWS2 and SBAR MCQs with Answers
50 Recognising Deterioration, NEWS2 and SBAR MCQs from International Nursing Practice, each with the correct answer and a written explanation of why it is correct. Free and unlimited, with no account needed.
Recognising deterioration involves trends in respiratory rate, oxygen saturation, blood pressure, pulse, temperature, consciousness and urine output, together with clinical concern. NEWS2 scoring, its oxygen scale and escalation thresholds support structured response, while SBAR communicates the situation, background, assessment and recommendation; NEWS2 supports judgement but does not replace bedside assessment or urgent action.
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- A. Continue routine observations on the usual ward schedule
- B. Inform the nurse in charge and request an emergency response
- C. Repeat the observations in four hours without further action
- D. Document the score and wait for the next medical ward round
Explanation: The NEWS2 score is 8: respiratory rate 25 scores 3, oxygen saturation 94% scores 1, systolic pressure 105 scores 1, pulse 115 scores 2 and…
Correct answer: Inform the nurse in charge and request an emergency response- A. Arrange an urgent ward-based clinical review
- B. Wait until the total score reaches five
- C. Repeat observations at the routine frequency
- D. Discharge the patient from physiological monitoring
Explanation: A single NEWS2 parameter scoring 3 requires an urgent ward-based response, even when the total score is only 3.
Correct answer: Arrange an urgent ward-based clinical review- A. Use SpO2 Scale 1 for every patient
- B. Use SpO2 Scale 2 for the prescribed target range
- C. Record oxygen saturation but exclude it from NEWS2
- D. Use the normal target range unless the patient becomes cyanosed
Explanation: NEWS2 SpO2 Scale 2 is used for patients with a documented clinician-determined target range of 88% to 92%, such as some patients with…
Correct answer: Use SpO2 Scale 2 for the prescribed target range- A. Record new confusion as a score of 3
- B. Record the patient as alert because the observations are normal
- C. Exclude mental status because it is not a vital sign
- D. Record confusion only if the temperature is also raised
Explanation: New confusion or a reduced level of consciousness scores 3 on NEWS2. This finding requires prompt clinical assessment and must not be…
Correct answer: Record new confusion as a score of 3- A. Situation, Background, Assessment, Recommendation
- B. Situation, Assessment, Background, Recommendation
- C. Background, Situation, Recommendation, Assessment
- D. Assessment, Recommendation, Situation, Background
Explanation: SBAR means Situation, Background, Assessment and Recommendation. This structure gives the receiving clinician the immediate problem…
Correct answer: Situation, Background, Assessment, Recommendation- A. Complete a full written SBAR before seeking help
- B. Assess airway and breathing while calling for urgent help
- C. Calculate the NEWS2 score before touching the patient
- D. Wait for the next scheduled set of observations
Explanation: Severe breathlessness and cyanosis indicate a possible life-threatening airway or breathing problem.
Correct answer: Assess airway and breathing while calling for urgent help- A. Request an urgent clinical review and increase observation frequency
- B. Continue routine observations because the score is below seven
- C. Ask the patient's relative to monitor breathing overnight
- D. Record the score and wait for a routine outpatient appointment
Explanation: A NEWS2 score of 5 or 6 requires an urgent response, including prompt clinical assessment and increased monitoring.
Correct answer: Request an urgent clinical review and increase observation frequency- A. Escalate the concern and request clinical assessment
- B. Reassure the patient because the NEWS2 score is low
- C. Wait until the score reaches five before escalating
- D. Record the concern but take no further clinical action
Explanation: NEWS2 supports, but does not replace, clinical judgement. A nurse must escalate a concerning change in condition even when the numerical…
Correct answer: Escalate the concern and request clinical assessment- A. The patient was admitted with pneumonia yesterday
- B. The patient is febrile and breathing at 30/min
- C. I need an immediate clinical review at the bedside
- D. The patient's observations were normal earlier today
Explanation: The Recommendation states what action is needed, such as an immediate bedside review.
Correct answer: I need an immediate clinical review at the bedside- A. Compare the trend, reassess the patient and escalate concern if needed
- B. Ignore the changes because the current total is below the threshold
- C. Remove the patient from observations to reduce unnecessary interventions
- D. Wait for the next shift to decide whether the trend is important
Explanation: A rising trend may indicate early deterioration even when the current NEWS2 total is below an escalation threshold.
Correct answer: Compare the trend, reassess the patient and escalate concern if needed- A. Continue routine observations only
- B. Arrange an urgent clinical assessment
- C. Repeat the blood pressure at the next round
- D. Record the result without further action
Explanation: A single NEWS2 parameter scoring 3 requires an urgent clinical response, even when the total score is low.
Correct answer: Arrange an urgent clinical assessment- A. 0 points
- B. 1 point
- C. 2 points
- D. 3 points
Explanation: On NEWS2 Scale 1, a saturation of 95% scores 0, but receiving supplemental oxygen adds 2 points.
Correct answer: 2 points- A. The patient was admitted three days ago with pneumonia
- B. I am worried because the patient is newly breathless
- C. The patient has crackles and a respiratory rate of 30
- D. Please review the patient and prescribe further treatment
Explanation: The Situation section states the immediate problem and why the nurse is calling.
Correct answer: I am worried because the patient is newly breathless- A. Every 30 minutes
- B. Every 2 hours
- C. Every 4 to 6 hours
- D. At least every 12 hours
Explanation: A NEWS2 score of 0 generally requires observations at least every 12 hours under the standard framework.
Correct answer: At least every 12 hours- A. Wait until the next scheduled observation round
- B. Assess the patient using an ABCDE approach
- C. Enter the previous oxygen saturation in the record
- D. Calculate NEWS2 using the available blood pressure
Explanation: An unreliable measurement and sudden deterioration require immediate clinical assessment using Airway, Breathing, Circulation, Disability…
Correct answer: Assess the patient using an ABCDE approach- A. The patient was admitted with a urinary infection
- B. I am calling from the surgical ward
- C. The patient is more tachypnoeic and NEWS2 has risen
- D. I recommend immediate review by the medical team
Explanation: Assessment summarises the nurse's interpretation of current findings, including changes and the NEWS2 trend.
Correct answer: The patient is more tachypnoeic and NEWS2 has risen- A. The patient's preferred sleeping position
- B. The oxygen device and prescribed flow rate
- C. The number of visitors during the shift
- D. The time of the patient's last meal
Explanation: NEWS2 scoring depends on whether the patient is receiving supplemental oxygen, so the device and flow rate should be recorded with the…
Correct answer: The oxygen device and prescribed flow rate- A. End the call once the clinician stops speaking
- B. Repeat the key instructions and clarify any uncertainty
- C. Ask another nurse to remember the instructions
- D. Document only the clinician's name and grade
Explanation: Closed-loop communication requires the receiver to repeat back the important instructions and clarify anything unclear.
Correct answer: Repeat the key instructions and clarify any uncertainty- A. Assume the intervention worked once it is given
- B. Continue assessment and record the patient's response
- C. Stop recording observations until the review is complete
- D. Remove the patient from further NEWS2 monitoring
Explanation: Recognition and escalation must be followed by ongoing reassessment to determine whether the patient is improving or deteriorating.
Correct answer: Continue assessment and record the patient's response- A. 3
- B. 5
- C. 7
- D. 9
Explanation: The score is 2 for respiratory rate, 2 for oxygen saturation, 1 for systolic blood pressure, 1 for pulse and 1 for temperature.
Correct answer: 7Recognising Deterioration, NEWS2 and SBAR MCQs: common questions
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