Platform 4: Providing and Evaluating Care in Adult Nursing

Scope and weight

This is the hands-on block. Fifteen questions at 1.5 minutes is about 22 minutes. The test specification groups it with evaluation, so expect questions that ask whether care worked and what to do next, not only how to deliver it. Platform 4 overlaps with Annexe B and with Part A numeracy, so revision here pays back in three places.

What is tested

• Medicines. The checks before giving a drug and administration by oral, topical, inhaled, subcutaneous and intramuscular routes.
• Intravenous therapy. Cannulation, flushes, phlebitis and extravasation.
• Controlled drugs. Storage, checking, administration and disposal.
• Oxygen. Targets, devices and hypercapnic risk.
• Tissue viability. Wound assessment, dressings and pressure ulcer management.
• Elimination. Urinary catheterisation and CAUTI prevention, bowel care, constipation, stomas and diarrhoea including C. difficile.
• Acute and long-term conditions. Hypoglycaemia and hyperglycaemia, insulin, acute coronary syndrome, heart failure, stroke care including swallow screening, COPD exacerbation, asthma attack, acute kidney injury and electrolyte disturbance.
• Nutrition and pain. Enteral feeding, NG tube checks, refeeding risk, the analgesic ladder, PCA and opioid safety.
• Blood and end of life. Transfusion checks, observations and reactions; symptom control, syringe pumps and verification of death.
• Emergencies and function. Anaphylaxis, choking, seizure, basic life support, post-operative care, moving and handling, mobilisation and evaluation against the care plan.

Local points to anchor your answers

• Medicines check. Right patient, medicine, dose, route, time and documentation, plus allergy status and expiry. Follow the Royal Pharmaceutical Society guidance. Confirm at source.
• Controlled drugs. Schedule 2 drugs such as morphine and oxycodone need a register entry, locked storage and, in most settings, a second-person check. Confirm at source.
• Oxygen. SpO2 target 94% to 98% for most acutely ill adults and 88% to 92% for those at risk of hypercapnic respiratory failure. Checked on Resuscitation Council UK and RCP documents.
• Hypoglycaemia. Glucose below 4.0 mmol/L; 15 to 20 g of fast-acting carbohydrate if conscious and able to swallow, recheck after 10 to 15 minutes; glucagon or intravenous glucose if unconscious. Confirm at source.
• Anaphylaxis. Intramuscular adrenaline 500 micrograms (0.5 mL of 1 mg/mL) for an adult, repeat after 5 minutes if no improvement, plus a fluid bolus of 500 to 1,000 mL of non-glucose crystalloid. Routine antihistamines and steroids are not part of initial treatment. Checked on Resuscitation Council UK.
• Basic life support. Compressions at 100 to 120 per minute, 5 to 6 cm depth, 30 to 2, call 999, use an AED as soon as available. Checked on the 2025 guideline.
• NG tube. Check position with pH of 5.5 or below, or by X-ray when pH is unavailable. Misplaced NG tube feeding is a Never Event. Confirm at source.
• Transfusion. Bedside identity check with the wristband and compatibility label, observations before, 15 minutes after the start and at least hourly, each unit completed within 4 hours of removal from controlled storage. Confirm at source.
• Stroke. Swallow screen before any oral intake. Confirm at source.

Three typical traps

1. High-flow oxygen for everyone. The target depends on risk of hypercapnia. A patient with COPD on a lower target needs a different response from one with an acute chest injury on the standard target.
2. Giving antihistamines or steroids first in anaphylaxis. They are not part of initial treatment in the Resuscitation Council UK guidance. Adrenaline comes first.
3. Treating the number, not the patient. A glucose reading below the threshold in a patient who is drowsy and cannot swallow calls for a different route from the same reading in a patient who is alert. Read the state of the person.

How the questions are framed

Platform 4 stems usually describe a patient in a defined clinical state and ask what the nurse should do first, what to monitor, or which action is inappropriate. Examples include a patient with chest pain after surgery, a diabetic patient who is sweating and confused, a patient with a cannula site that is red and swollen, and a person with a new swallowing difficulty after a stroke. A second family of items evaluates care: the intervention was given, the outcome is described, and you decide whether to continue, adjust or escalate.

What the exam asks about each group

• Medicines and controlled drugs. Identify the check that was missed, the step that comes next, or the action that breaches policy. Include allergy checks, the second-person check and secure storage.
• Intravenous therapy. Recognise phlebitis and extravasation early, stop the infusion, and follow policy for documentation and escalation.
• Respiratory and cardiac care. Choose oxygen delivery against the correct target, position the patient, monitor, and recognise when to escalate in asthma, COPD, heart failure or acute coronary syndrome.
• Diabetes. Treat hypoglycaemia by the route that suits the patient's level of consciousness and swallowing, and recheck. Recognise hyperglycaemia and know when to escalate.
• Stroke. Screen swallowing before oral intake, position safely and begin early rehabilitation.
• Renal and fluid care. Monitor fluid balance and urine output, and recognise a falling output as a warning sign.
• Nutrition. Check NG tube position before use and know the risk of refeeding.
• Pain, transfusion and end of life. Use the analgesic ladder, monitor opioid effects, follow transfusion checks and observations, and manage symptoms and syringe pumps for dying patients.

The common thread is sequence. Make the patient safe, assess, act, document and evaluate. An option that documents before treating a deteriorating patient is almost always wrong.

How to revise it

1. Write a first-action card for each emergency: anaphylaxis, hypoglycaemia, choking, seizure, cardiac arrest, deterioration.
2. Revise medicines safety as a procedure with the checks in order, then drill controlled drug and intravenous scenarios.
3. Link conditions to nursing actions. For each of heart failure, stroke, COPD and acute kidney injury, list what the nurse monitors, what the nurse does and when to escalate.
4. Do the numeracy overlap. Practise infusion and syringe pump calculations from Part A alongside.
5. Finish with evaluation questions. Ask what outcome you would expect and what you would do if it did not occur.

Pair this domain with Annexe B for technique and Platform 6 for medication errors.