Annexe A: communication and relationship management skills
Written and checked against the NMC’s published sources by The NMCMATE editorial team.Last checked .
7 marks of the 100 in Part B, which runs for 150 minutes.
Annexe A is a list of communication skills the NMC expects a registered nurse to have, and Part B draws questions from it in its own right. These questions usually give you something a patient has said and four things a nurse could say back.
What this section asks about
Active listening, and responding to what is not said as well as what is
Open and closed questioning, and when each is the right tool
Checking understanding, including teach-back rather than asking whether somebody understood
Accessible information: interpreters, written material, sensory impairment and communication aids
Clear records, reports and handover, including structured handover such as SBAR
Difficult conversations, breaking bad news, and supporting somebody who is distressed
Where the marks go
7 marks of the 100 in Part B, which runs for 150 minutes. The NMC splits this section across the levels of Bloom's taxonomy:
Remember and understand: 3
Apply and analyse: 2
Evaluate and create: 2
Where candidates lose marks
Choosing reassurance. "I am sure it will be fine" closes a conversation the patient opened.
Using a family member as an interpreter. Consent has to be informed, which means a professional interpreter.
Asking "do you understand?". People say yes. Ask them to tell you what they will do.
Sample questions
From our bank, with the explanation as a student sees it. These particular questions are kept out of the mock papers, so reading them here does not use anything up.
Sample 1 of 2
A 58-year-old man recovering from an acute stroke presents with expressive aphasia alongside preserved intellectual capacity. To involve him directly in care planning, the nurse uses written keywords, simple drawings, and gestures to verify comprehension. Which alternative communication technique is the nurse employing?
Select one answer.
ASupported Conversation for AphasiaAnswer
BPicture Exchange Communication System
CObjects of Reference approach
DSocial Stories intervention
Why
Supported Conversation for Aphasia utilises multimodal visual scaffolding such as keywords, sketches, and gesturing to unlock retained competence in adults with aphasia. The Picture Exchange Communication System would instead involve handing over discrete picture cards to make requests, typically in non-verbal autism.
NMC Standards of Proficiency Annexe A
Sample 2 of 2
A community nurse visits a 62-year-old woman with established, symptomatic peripheral arterial disease to provide structured foot care and supervised exercise therapy aimed at limiting functional mobility loss and preventing ischaemic ulcers. Which level of prevention does this nurse's intervention represent?
Select one answer.
AQuaternary prevention
BTertiary preventionAnswer
CPrimordial prevention
DPrimary prevention
Why
Providing interventions to an individual with an established, symptomatic disease to prevent deterioration, functional impairment, and secondary complications defines tertiary prevention. Primary prevention would instead involve intervening before the onset of disease in an individual with risk factors.
NMC Standards of Proficiency Annexe A
The proficiency statements behind this section
Questions in this section are written against the NMC's Future Nurse standards. These are the 21 statements it draws from. You are not expected to memorise them, and they are worth reading once so the language on the paper is familiar. The ones marked are patient safety proficiencies, which every paper has to reach a minimum of.
A1.1Actively listen, recognise and respond to verbal and non-verbal cues
A1.2Use prompts and positive verbal and non- verbal reinforcement
A1.3Use appropriate non-verbal communication including touch, eye contact and personal space
A1.4Make appropriate use of open and closed questioning
A1.5Use caring conversation techniques
A1.6Check understanding and use clarification techniques
A1.7Be aware of own unconscious bias in communication encounters
A1.8Write accurate, clear, legible records and documentation
A1.9Confidently and clearly present and share verbal and written reports with individuals CBT OSCE and groups
A1.10Analyse and clearly record and share digital information and data
A1.11Provide clear verbal, digital or written information and instructions when delegating or handing over responsibility for care
A1.12Recognise the need for, and facilitate access to, translator services and material
A2.1Share information and check understanding about the causes, implications CBT OSCE and treatment of a range of common health conditions including anxiety, depression, memory loss, diabetes, dementia, respiratory disease, cardiac disease, neurological disease, cancer, skin problems, immune deficiencies, psychosis, stroke and arthritis
A2.2Use clear language and appropriate, written materials, making reasonable adjustments where appropriate in order to optimise people’s understanding of what has caused their health condition and the implications of their care and treatment
A2.3Recognise and accommodate sensory impairments during all communications
A2.4Support and manage the use of personal communication aids
A2.5Identify the need for and manage a range of alternative communication techniques
A2.6Use repetition and positive reinforcement strategies
A2.7Assess motivation and capacity for behaviour change and clearly explain cause and effect relationships related to common health risk behaviours including CBT OSCE smoking, obesity, sexual practice, alcohol and substance use
A2.8Provide information and explanation to people, families and carers and respond to questions about their treatment and care and possible ways of preventing ill health to enhance understanding
A2.9Engage in difficult conversations, including breaking bad news and support people who are feeling emotionally or physically vulnerable or in distress, conveying compassion and sensitivity
Questions people ask
Is Annexe A really examined separately?
Yes. The published test specification draws Part B questions from Annexe A as its own category, alongside the seven platforms and Annexe B.
Can I use a bilingual colleague instead of an interpreter?
Not for consent or for clinical information. A professional interpreter is what the Code and the Accessible Information Standard require.
Practise this section
Practice is filtered by section, so you can work on this one on its own. Every account gets 10 new questions a day without a card.