RCSI NMBI Aptitude Test cheat sheet

The NMBI Code of Professional Conduct and Ethics requires nurses to act with integrity, compassion, and accountability and to protect the dignity, privacy, and confidentiality of people in their care.

Four ethical principles: autonomy respects informed choice; beneficence promotes benefit; non-maleficence avoids avoidable harm; justice requires fair treatment and fair use of resources.

Valid consent requires capacity, sufficient information, and voluntariness; it may be written, verbal, or implied by behaviour, and the discussion and decision must be documented.

Capacity is presumed unless there is evidence otherwise; assess understanding, retention, ability to communicate a choice, and ability to weigh information. If capacity is absent, act in the person's best interests under law and local policy.

Confidential information is shared only with consent, when required by law, or when necessary to prevent serious harm; disclosure is limited to those who need to know.

Accountability stays with the nurse even when a task is delegated; delegation requires the delegate to be competent, the task to be within scope, and appropriate supervision and feedback.

Scope of practice is set by law, regulation, and competence; a nurse who lacks competence for a required task must seek education, supervision, or escalation rather than proceed unsafely.

Documentation must be contemporaneous, factual, legible, dated, timed, signed, and person-centred; record assessments, decisions, consent, interventions, escalation, and outcomes.

Open disclosure is prompt, honest, and empathetic communication after a patient safety incident, covering what happened, known consequences, apology or regret, and learning actions.

Cardiac output (CO) = heart rate × stroke volume; normal adult CO is about 4–8 L/min. Mean arterial pressure (MAP) = diastolic BP + 1/3 (systolic BP − diastolic BP), with a usual minimum near 65–70 mmHg for organ perfusion.

Typical adult resting observations: respiratory rate 12–20/min, heart rate 60–100/min, temperature 36.0–37.5°C, oxygen saturation 94–98% on room air; trends and early warning scores matter more than single values.

Acid–base normal values: pH 7.35–7.45, PaCO2 35–45 mmHg, bicarbonate 22–26 mmol/L. Respiratory disorders change PaCO2 first; metabolic disorders change bicarbonate first; compensation moves the other value.

Total body water is about 60% of body weight in adults; about two-thirds is intracellular and one-third extracellular. Isotonic fluid stays in extracellular space; hypotonic fluid shifts into cells; hypertonic fluid pulls water out of cells.

Renal regulation: antidiuretic hormone increases water reabsorption; aldosterone increases sodium reabsorption and potassium excretion; renin–angiotensin–aldosterone activation raises blood pressure and conserves sodium and water.

Insulin lowers blood glucose; glucagon raises it. Hypoglycaemia is blood glucose below 4 mmol/L; for a conscious adult give 15–20 g fast-acting carbohydrate, recheck in 15 minutes, and repeat if still low.

Sepsis is suspected when infection is accompanied by new tachycardia, tachypnoea, fever or hypothermia, hypotension, or altered mental state; priority actions include cultures, antibiotics, fluid resuscitation, and lactate measurement.

Wound healing phases are haemostasis, inflammation, proliferation, and maturation or remodelling; infection, poor perfusion, malnutrition, diabetes, and pressure impair healing.

Oxygen delivery depends on cardiac output and arterial oxygen content, which is mainly determined by haemoglobin and saturation; anaemia or low cardiac output can impair delivery despite normal SpO2.

ABCDE primary assessment order is Airway, Breathing, Circulation, Disability, Exposure; life-threatening findings are treated immediately before a full history or diagnosis.

The nursing process is cyclic: Assessment, Nursing diagnosis, Planning, Implementation, Evaluation. Reassess whenever the patient's condition, goals, or interventions change.

Care goals should be SMART: specific, measurable, achievable, relevant, and time-bound; they are agreed with the patient and reviewed at stated intervals.

An early warning score aggregates vital signs; a rising score or a score above the local trigger threshold requires escalation using a structured handover such as ISBAR.

Clinical judgement involves recognising cues, analysing them, prioritising hypotheses, generating solutions, acting, and evaluating outcomes; reassessment is required after every significant intervention.

Common risk screens include falls risk, pressure injury risk, malnutrition, venous thromboembolism, delirium, and sepsis; positive screens trigger a documented prevention or treatment plan.

Pain assessment records location, quality, severity, timing, aggravating and relieving factors, and functional impact; self-report is the most reliable measure when the patient can communicate.

Delirium is acute and fluctuating with altered attention; dementia is chronic and progressive. Sudden confusion in an older adult should prompt a search for infection, pain, constipation, drugs, hypoxia, or metabolic causes.

Escalation rule: if a patient fails to improve or deteriorates after initial intervention, call for senior help, document the change, and continue monitoring rather than waiting for the next routine observation.

ISBAR structures handover: Identify, Situation, Background, Assessment, Recommendation; it is used for referrals, escalation, and transfer of care.

Active listening includes open questions, full attention, reflection, paraphrasing, and summarising; interruption and premature reassurance reduce disclosure.

Therapeutic communication uses empathy, respect, congruence, and unconditional positive regard while maintaining professional boundaries and avoiding excessive self-disclosure.

Teach-back confirms understanding by asking the patient to explain the information in their own words; it is more reliable than asking 'Do you understand?'

Plain-language communication avoids jargon, uses short sentences and chunks, and supports understanding with written material, diagrams, or a professional interpreter when needed.

SPIKES structures breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions with empathy, Strategy and Summary.

Conflict de-escalation separates people from the problem, listens to concerns, seeks common ground, documents agreed actions, and escalates unresolved risk through the appropriate chain.

Cultural safety requires nurses to avoid assumptions, respect beliefs and preferences, use trained interpreters rather than family members for sensitive information, and check the patient's preferred name and pronouns.

Dose formula: amount to give = (desired dose ÷ stock dose) × stock volume; desired and stock doses must be in the same units.

IV pump rate: mL/hour = total volume (mL) ÷ time (hours). Infusion time: hours = total volume (mL) ÷ rate (mL/hour).

Drop rate: drops/min = (volume in mL × drop factor in drops/mL) ÷ time in minutes. Round to a whole drop for manual gravity infusion.

Conversions: 1 g = 1000 mg; 1 mg = 1000 mcg; 1 L = 1000 mL; 1 kg = 1000 g; 1 tsp = 5 mL; 1 tablespoon = 15 mL.

Percentage w/v solutions: 1% = 1 g per 100 mL = 10 mg/mL. So 0.9% sodium chloride = 0.9 g/100 mL = 9 mg/mL.

Dilution formula: C1 × V1 = C2 × V2, where C is concentration and V is volume; units must match on both sides.

Weight-based dose: dose = prescribed mg/kg × weight in kg; compare the result with the prescribed dose and the maximum safe dose before administration.

Body surface area (Mosteller) = √[(height in cm × weight in kg) ÷ 3600] m²; use it for drugs prescribed per m² and check against the safe range.

Safe-dose check: calculate the lower and upper limits of the prescribed range, compare with the ordered dose, and query any dose outside the range or any result with unclear units before giving.