Nursing Practice and Clinical Care
Domain overview
The Nursing Practice and Clinical Care domain tests safe, evidence-based decisions across assessment, medication, infection prevention, maternal and child care, chronic care and documentation. Questions usually ask what the nurse should do first or next, so link assessment findings to escalation.
Core clinical rules
- Use the nursing process: assess, diagnose (nursing), plan, implement, evaluate. Reassess after every intervention.
- Apply ABCDE for deterioration: airway, breathing, circulation, disability, exposure. Abnormal vital signs require interpretation, not just recording.
- Medication safety includes the right patient, drug, dose, route, time, documentation and reason; check allergies, interactions and calculations. Never administer an unclear order.
- Infection prevention follows hand hygiene at the WHO five moments, asepsis for invasive procedures, safe sharps disposal and correct use of personal protective equipment.
- Document contemporaneously: objective findings, actions, time, response and escalation.
Maternal and emergency care
Postpartum haemorrhage is an obstetric emergency. Uterine atony is common: massage the uterus, give uterotonics per protocol, ensure IV access, monitor shock signs and escalate. For any shocked patient, lie flat, keep warm, give oxygen and IV fluids as ordered, and prepare for referral.
Worked example. Day 1 after laparotomy, a patient has BP 92/60 mmHg, pulse 118/min, respiratory rate 24/min, cool peripheries and urine output 15 mL/hour. Reasoning: these are signs of hypovolaemia or another cause of shock, not merely pain. The nurse reassesses ABCDE, checks the wound and drains for bleeding, confirms urine output, obtains a repeat BP, gives oxygen, ensures IV access, and urgently notifies the surgeon while preparing fluids and monitoring. Oral fluids are unsafe in this unstable patient.
Traps that cost marks
- Attributing tachycardia and low urine output to pain only.
- Recording abnormal observations without escalation.
- Giving a medicine before checking allergy or dose calculation.
- Breaking asepsis because the ward is busy.
- Writing retrospective or vague notes such as “condition same”.
- Ignoring the patient’s own report of breathlessness or bleeding.