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7 marks of the 100 in Part B, which runs for 150 minutes.
Annexe B is the procedural half of the standards, and it is where the CBT asks about technique. Taking and interpreting observations, managing a line, taking a specimen, keeping a field aseptic, relieving pressure and pain.
What this section asks about
Taking, recording and interpreting vital signs, manually and with devices
Venepuncture, cannulation and interpreting common blood results
Setting up and interpreting an ECG, and managing monitors and pumps
Managing and monitoring blood component transfusions
Collecting and observing specimens: sputum, urine, stool and vomit
Comfort, pain, rest, positioning and pressure area care
Infection prevention technique: hand hygiene, PPE, isolation, sharps, asepsis
Wound care and drainage using an aseptic technique
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
Knowing a procedure but not its escalation point. Most of these questions turn on what an abnormal finding means.
Getting the order wrong. Donning and doffing PPE and drawing up insulins are both sequences, and the sequence is the answer.
Reaching for alcohol gel by reflex. Spores need soap and water.
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 42-year-old man receiving ongoing treatment with haloperidol on a psychiatric intensive care unit insidiously develops severe lead-pipe rigidity, hyperthermia, altered consciousness, and elevated creatine kinase. Which adverse medication reaction should the nurse suspect?
Select one answer.
ARed man syndrome
BStevens-Johnson syndrome
CNeuroleptic malignant syndromeAnswer
DSerotonin syndrome
Why
The combination of haloperidol therapy, lead-pipe muscle rigidity, hyperthermia, and raised creatine kinase is diagnostic of neuroleptic malignant syndrome. Serotonin syndrome presents with hyperreflexia and clonus rather than lead-pipe rigidity, usually following serotonergic drug escalation.
NMC Standards of Proficiency Annexe B
Sample 2 of 2
A registered nurse on an oncology day unit is preparing to connect and administer an intravenous bolus infusion of a cytotoxic antineoplastic agent to an adult patient. Which hand protection is specifically indicated for this clinical procedure?
The safe handling and administration of cytotoxic antineoplastic medications requires chemical-tested, double-layered purple nitrile chemotherapy gloves to protect against permeation. Standard nitrile examination gloves are indicated only for non-hazardous tasks such as routine venepuncture.
NMC Standards of Proficiency Annexe B
The proficiency statements behind this section
Questions in this section are written against the NMC's Future Nurse standards. These are the 68 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.
B1.1Mental health and wellbeing status
B1.2Physical health and wellbeing
B2.1Take, record and interpret vital signs manually and via technological devices
B2.2Undertake venepuncture and cannulation and blood sampling, interpreting normal and common abnormal blood profiles and venous blood gases
B2.3Set up and manage routine electrocardiogram (ECG) investigations and interpret normal and commonly encountered abnormal traces
B2.4Manage and monitor blood component transfusions
B2.5Manage and interpret cardiac monitors, infusion pumps, blood glucose monitors and other monitoring devices
B2.6Accurately measure weight and height, calculate body mass index and recognise healthy ranges and clinically significant low/high readings
B2.7Undertake a whole body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status
B2.8Undertake chest auscultation and interpret findings
B2.9Collect and observe sputum, urine, stool and vomit specimens, undertaking routine analysis and interpret Note: In addressing the above the candidate must ensure they are ready to demonstrate procedures at an appropriate level for the adult field of nursing practice when undertaking procedures for assessing needs for person centred care
B2.11Recognise and respond to signs of all forms of abuse Note: In addressing the above the candidate must ensure they are ready to demonstrate procedures at an appropriate level for the adult field of nursing practice when undertaking procedures for assessing needs for person centred care
B3.1Observe and assess comfort and pain levels and rest and sleep patterns
B3.2Use appropriate bed-making techniques including those required for people who are unconscious or who have limited mobility
B3.3Use appropriate positioning and pressure-relieving techniques
B3.4Take appropriate action to ensure privacy and dignity at all times
B3.5Take appropriate action to reduce or minimise pain or discomfort
B3.6Take appropriate action to reduce fatigue, minimise insomnia and support improved rest and sleep hygiene
B4.6Use aseptic techniques when undertaking wound care including dressings, pressure bandaging, suture removal and vacuum closures
B4.7Use aseptic techniques when managing wound and drainage processes Note: In addressing the above the candidate must ensure they are ready to CBT OSCE demonstrate procedures at an appropriate level for the adult field of nursing practice when undertaking procedures for assessing needs for person centred care
B4.8Assess, respond effectively manage pyrexia and hypothermia
B5.1Observe, assess and optimise nutrition and hydration status and determine the need for intervention and support
B5.2Use contemporary nutritional assessment tools
B5.3Assist with feeding and drinking and use appropriate feeding and drinking aids
B5.4Record fluid intake and output and identify, respond to and manage dehydration or fluid retention
B5.5Identify, respond to and manage nausea and vomiting
B5.6Insert, manage and remove oral/nasal/gastric tubes
B5.7Manage artificial nutrition and hydration using oral, enteral and parenteral routes
B5.8Manage the administration of IV fluids
B5.9Manage fluid and nutritional infusion pumps and devices
B6.1Observe and assess level of urinary and bowel continence to determine the need for support and intervention assisting with toileting, maintaining dignity and privacy and managing the use of appropriate aids
B6.2Select and use appropriate continence products; insert, manage and remove catheters for all genders; and assist with self-catheterisation when required
B6.3Manage bladder drainage
B6.4Assess bladder and bowel patterns to identify and respond to constipation, diarrhoea and urinary and faecal retention
B6.5Administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate
B6.6Undertake stoma care identifying and using appropriate products and approaches
B7.1Observe and use evidence-based risk assessment tools to determine need for support and intervention to optimise mobility and safety, and to identify and manage risk of falls using best practice risk assessment approaches
B7.2Use a range of contemporary moving and handling techniques and mobility aids
B7.3Use appropriate moving and handling equipment to support people with impaired mobility
B7.4Use appropriate safety techniques and devices
B8.1Observe and assess the need for intervention and respond to restlessness, agitation and breathlessness using appropriate interventions
B8.2Manage the administration of oxygen using a range of routes and best practice approaches
B8.3Take and interpret peak flow and oximetry measurements
B8.4Use appropriate nasal and oral suctioning techniques
B8.5Manage inhalation, humidifier and nebuliser devices
B8.6Manage airway and respiratory processes and equipment
B9.1Observe, assess and respond rapidly to potential infection risks using best practice guidelines
B9.2Use standard precautions protocols
B9.3Use effective aseptic, non-touch techniques
B9.4Use appropriate personal protection equipment
B9.5Implement isolation procedures
B9.6Use evidence-based hand hygiene techniques
B9.7Safely decontaminate equipment and environment
B9.8Safely use and dispose of waste, laundry and sharps
B9.9Safely assess and manage invasive medical devices and lines. Platform 3: Assessing needs and planning care
B10.1Observe, and assess the need for intervention for people, families and carers, identify, assess and respond appropriately to uncontrolled symptoms and signs of distress including pain, nausea, thirst, constipation, restlessness, agitation, anxiety and depression
B10.3Assess and review preferences and care priorities of the dying person and their family and carers
B11.1Carry out initial and continued assessments of people receiving care and their ability to self-administer their own medications
B11.2Recognise the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered; and the laws, policies, regulations and guidance that underpin them
B11.3Use the principles of safe remote prescribing and directions to administer medicines
B11.4Undertake accurate drug calculations for a range of medications
B11.5Undertake accurate checks, including transcription and titration, of any direction to supply or administer a medicinal product
B11.6Exercise professional accountability in ensuring the safe administration of medicines to those receiving care
B11.7Administer injections using intramuscular, subcutaneous, intradermal and intravenous routes and manage injection equipment
B11.8Administer medications using a range of routes
B11.9Administer and monitor medications using vascular access devices and enteral equipment
B11.10Recognise and respond to adverse or abnormal reactions to medications
B11.11Undertake safe storage, transportation and disposal of medicinal products
Questions people ask
Does the CBT test practical skills?
It tests what you know about them. Performing them is what the OSCE is for, but the CBT asks about technique, sequence and what a finding means.
How many Annexe B questions are on the paper?
The test specification draws them as one of the nine Part B categories, so a small and predictable share of the clinical paper.
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.