Core competency test To gain a certificate in the Stroke Core Competencies, complete the test. You should allow approximately 30 minutes to complete this test. To pass the test and gain your certificate you need to answer all the questions correctly. This certificate can be used as evidence of continual professional development (CPD). Please provide some personal information before proceeding with this Module Test. This information is required for creating your certificate and will also assist us in evaluating the website. Each of the Managed Clinical Networks (MCNs) in Scotland will be given the names of those who have been awarded Module Test Certificates within their areas. We do not collect or share information on the number of times a person attempts the Test, or where a certificate is not awarded.Name* First Last NB Your name is required for creating your certificate. Email* Do you live / work in Scotland?*YesNoAre you:*Employed by Scottish Ambulance ServiceEmployed by NHSEmployed by University or other Higher EducationEmployed by Local Authority/Private/Voluntary sectorA studentA carer or otherDo you work in a:*HospitalCommunityName of service (eg ESD, GP surgery):Enter your service nameWard no. / name:*You work in:*Nursing / residential homeHome care / communityPrivate hospitalCharitable organisationChoose your work environmentIs this ward a Stroke Unit?*YesNoHospital name*Name of institution:*Enter the name of your institutionTown / City:*Enter the town / city where you workNHS Board*Ayrshire and ArranBordersDumfries and GallowayFifeForth ValleyGrampianGreater Glasgow and ClydeHighlandLanarkshireLothianOrkneyShetlandTaysideWestern IslesEnglandWalesIrelandNorthern IrelandCanadaUSAAustraliaNew ZealandOtherSelect your NHS BoardYou arean AHP studenta Medical studenta Nursing studentCarer*CarerPerson who has had a strokeYour profession*Academic researcherAdministratorDoctorDietitianHealth Care AssistantOccupational TherapistOrthoptistPhysiotherapistRegistered NurseSocial WorkerSocial Care WorkerSpeech and Language TherapistTherapy AssistantOtherSelect your professionProfession (other)*AfC Band*Band 2Band 3Band 4Band 5Band 6Band 7Band 8AfC not applicableSelect your AfC bandUniversity / College*Aberdeen UniversityDundee UniversityEdinburgh UniversityEdinburgh Napier UniversityGlasgow UniversityGlasgow Caledonian UniversityQueen Margaret UniversityRobert Gordon UniversityStirling UniversityUniversity of the West of ScotlandOtherSelect your University / CollegeCountry*EnglandWalesNorthern IrelandIrelandCanadaUSAAustraliaNew ZealandOtherSelect your countryThis Master case scenario consists of 18 parts. Each part contains a multiple choice quiz, you should answer each question in the quiz yes or no. When you have answered all the quiz questions you will be able to proceed to the next part. If you answer any part incorrectly you will be asked to revise certain core competencies and points will be deducted. Please keep a note of these Core Competencies. To pass this scenario and receive your Stroke Core Competency Certificate you must answer all 18 parts correctly. You should allow approximately 30 minutes to complete this scenario. Core Competency Test Part 1: Mr Willis Mr Willis, aged 64 years old attends the well man clinic. He says he feels well but was told to attend by his wife. His mother is still alive and well aged 93 years however his father died suddenly aged 54 years of a presumed heart attack. He enjoys watching television and betting on the horses – he dislikes walking. He smokes 15 cigarettes each day and drinks three pints of beer most days. On examination he is very overweight and his blood pressure is high at 193/105. Part 1. Q. Which of the following actions are appropriate for Mr Willis?1.a. Reassure him that all is well and that he should just carry-on as normal*YesNo1.b. Warn him that his lifestyle is not very healthy*YesNo1.c. Advise him to cut down his smoking but his alcohol consumption seems OK*YesNo1.d. Suggest that he should get his blood pressure measured on another occasion soon*YesNo1.e. Advise him to get his cholesterol and blood sugar tested*YesNo1.f. Suggest switching to red wine since it will protect his heart.*YesNo1.g. Advise him to take regular exercise and to try to lose weight*YesNo1.h. Suggest that he takes plenty of salt to prevent cramp*YesNo1.i. Offer him support to give up smoking*YesNo 1. Answer. Mr Willis did not receive adequate advice about preventing heart attacks and strokes and as a result suffered a heart attack the following year. You have answered one or more questions incorrectly. You should revise Core Competency 3: Reducing the Risk of Stroke.1. Answer. Well done, Mr Willis’ risk factors have been properly assessed and treated and as a result his risks of future heart attacks and strokes have been greatly reduced. He stopped smoking and reduced his alcohol intake. He buys a dog and now walks for at least an hour each day. As a consequence he has lost several kg in weight. His GP prescribed blood pressure tablets. He attends the nurse every few months for a check up. Core Competency Test Part 2: 5 years later Mr Willis has remained well for five years. He is now aged 69 years. He rings the clinic to report an episode earlier that morning when his right arm and leg had suddenly gone numb for 20 minutes and had completely recovered. He now feels fine. Part 2. Q. Which of the following actions are appropriate for Mr Willis?2.a. Explain that it was probably due to a trapped nerve but to report back if it happened again*YesNo2.b. Advise him that it may have been a “mini stroke” which might require some specific treatment*YesNo2.c. Tell him to mention it to the doctor when he next comes in for his blood pressure check*YesNo2.d. Reassure him that it sounds like one of his migraine attacks and to take some paracetamol and go to bed*YesNo2.e. Ask him to come into the clinic immediately to see the doctor*YesNo 2. Answer. Unfortunately, as Mr Willis did not see the doctor immediately, he suffered a major stroke. You have answered one or more questions incorrectly. You should revise the Core Competencies.2. Answer. Well done, Mr Willis is seen by his GP and as a result of prompt assessment and treatment he avoids having a major stroke in the next few weeks. The GP immediately gives Mr Willis some aspirin and he is told to continue taking this daily as prescribed. The GP also gives Mr Willis cholesterol lowering tablets in addition to the antihypertensive drugs and refers him to the local hospital for extra tests. Core Competency Test Part 3: The next day The next day Mrs Willis rings the surgery to report that Mr Willis has collapsed whilst having lunch and is on the floor, unable to move his right arm and leg and unable to get up.Indicate whether each of the following actions are appropriate or not. Part 3. Q. Which of the following actions are appropriate for Mr Willis?3.a. Reassure her that it sounds like a faint and to lift his legs above his heart*YesNo3.b. Make him comfortable and reassure them that the doctor will call later that day*YesNo3.c. Ask her if his face is drooping on one side, he can speak normally and lift both arms up and keep them there.*YesNo3.d. Sit him up and give him a brandy to stimulate his nerves*YesNo3.e. Tell her this could be a stroke and that she needs to seek medical help immediately*YesNo3.f. Lie him on his back and give him mouth-to-mouth resuscitation*YesNo3.g. Ring 999 and ask for an emergency ambulance*YesNo 3. Answer. Unfortunately, you have not recognised that Mr Willis has probably had a stroke and that he requires urgent medical assessment and treatment. You have answered one or more questions incorrectly. You should revise the Core Competencies.3. Answer. Well done, your advice and fast response in phoning 999 has ensured that Mr Willis will get to the hospital as soon as possible. Stroke is a medical emergency. Core Competency Test Part 4: At the hospital Mr Willis arrives at the hospital. You assess him using the FAST (Face, Arm and Speech Test) test to see if it is likely he has had a stroke and whether he may be suitable for clot busting treatment. Indicate whether each of the following actions are appropriate or not. Part 4. Q. Which of the following actions are appropriate on admission to hospital?4.a. Assess him immediately*YesNo4.b. Ask him to smile or show his teeth*YesNo4.c. Ask him to sprint across the room*YesNo4.d. Ask him to lift both arms up to the horizontal to see if one drops*YesNo4.e. Ask him to tell you his name and what has happened – listen to see if his speech is slurred or muddled*YesNo4.f. Ask him when he first noticed the symptoms*YesNo4.g. Check if his pulse is Fast – at least 100 per minute*YesNo 4. Answer. Unfortunately, you have not recognised that Mr Willis has had a stroke and his condition has deteriorated. You have answered one or more questions incorrectly. You should revise the Core Competencies.4. Answer. Well done, this confirms that his face does not move properly on one side, he has weakness in one arm and cannot speak clearly. He is likely to have had a stroke but as he has had the symptoms for about 7 hours emergency treatment with clot busting drugs is unlikely to be appropriate. Core Competency Test Part 5: Confirmation of stroke The doctor confirms that Mr Willis has had a stroke but then rushes off to another emergency. Mr Willis is unable to communicate – his daughter asks you to tell her what is wrong.You tell her that the doctor thinks that Mr Willis has had a stroke and that: Part 5. Q. Which information would you give Mr Willis's daughter?5.a. Stroke is due to a blocked blood vessel in the heart*YesNo5.b. Stroke is usually due to a burst blood vessel in the brain*YesNo5.c. Stroke is due to an interruption to the blood vessels going to the brain*YesNo5.d. Strokes usually come on slowly and recover quickly*YesNo5.e. Strokes are often caused by stress and overwork*YesNo5.f. Some brain cells are deprived of oxygen and therefore don’t work properly*YesNo5.g. Strokes usually come in threes*YesNo5.h. Strokes usually come on quickly but take a very variable time to improve*YesNo 5. Answer. Unfortunately, you have not given Mr Willis’ daughter accurate information which leads to confusion. You have answered one or more questions incorrectly. You should revise the Core Competencies.5. Answer. Well done, Mr Willis' daughter thanks you for your clear explanation. Core Competency Test Part 6: Admission Mr Willis requires further tests and treatment in the hospital and the doctor asks you to arrange a bed for him. Indicate whether each of the following actions are appropriate or not. Part 6. Q. Which of the following actions are appropriate or not?6.a. Ringing around the surgical wards to ask if they would accept him*YesNo6.b. Asking the bed manager to find a bed on the medical unit*YesNo6.c. Ringing the acute stroke unit to see if they can admit him*YesNo6.d. Send him up to the coronary care unit*YesNo6.e. Arrange for him to stay on a trolley until the next day*YesNo 6. Answer. Unfortunately, as Mr Willis is not admitted to a stroke unit promptly he develops several medical complications which slows his recovery and he is now unlikely to return home. You have answered one or more questions incorrectly. You should revise the Core Competencies.6. Answer. Well done, the stroke unit has a bed and accepts Mr Willis. They ask whether the brain scan will be done on the way up to the unit. You ask the doctor to arrange this. Core Competency Test Part 7 As you pass Mr Willis on the stroke unit he asks you for a glass of water. Indicate whether each of the following actions are appropriate or not. Part 7. Q. Which of the following actions are appropriate or not?7.a. Go to the kitchen to get a glass of water for him*YesNo7.b. Tell him that you are in a hurry and to get it for himself*YesNo7.c. Ask him if he has any problems swallowing – if he says not then give him the water*YesNo7.d. Look around the bed to see if there is any indication of his current ability to swallow safely*YesNo7.e. Find a qualified member of staff who knows him to ask whether he can have a drink*YesNo 7. Answer. Mr Willis is unable to swallow water safely. As a result of this incident he develops pneumonia and is very unwell. You have answered one or more questions incorrectly. You should revise the Core Competencies.7. Answer. Well done, the sign above the bed indicates that Mr Willis does not currently have a safe swallow. The nurse in charge confirms that the he is only able to take thickened fluids with supervision. Your appropriate actions prevent him having a frightening coughing fit and a life threatening pneumonia. Core Competency Test Part 8 Mr Willis is lying in bed and asks you to take him to the toilet urgently. Indicate whether each of the following actions are appropriate or not: Part 8. Q. Which of the following actions are appropriate or not?8.a. Tell him that you are too busy and to wait till a nurse comes*YesNo8.b. Tell him that it is good to try to do things for himself and not to rely on other people*YesNo8.c. Find the nurse responsible for his care and ask for their help*YesNo8.d. Ask Mr Willis if he can walk. If he says he can then get him out of bed*YesNo8.e. Look around the bed area for any indication of his abilities to transfer and walk*YesNo 8. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.8. Answer. Well done, the sign above the bed indicates that Mr Willis cannot currently transfer or walk safely. You find a nurse who, with a colleague, transfers him onto a commode with a hoist. He manages to maintain his continence and dignity whilst not being put at risk of injury. Core Competency Test Part 9 As you walk past a side room on the stroke unit you see Mr Willis lying on the floor next to his bed. He is still and his eyes are closed. Indicate whether each of the following actions are appropriate or not. Part 9. Q. Which of the following actions are appropriate or not?9.a. Call for help*YesNo9.b. Walk quickly on since you have not had your first aid training*YesNo9.c. Roll him onto his back and thump his chest to restart his heart*YesNo9.d. Shout his name to see if he responds*YesNo9.e. Immediately start mouth-to-mouth resuscitation*YesNo9.f. If he doesn’t respond to his name, give him a gentle shake*YesNo9.g. Check that he is breathing*YesNo 9. Answer. You have put Mr Willis at risk by not responding appropriately to this situation. Before starting cardiopulmonary resuscitation (CPR) it is vital that you carry out an assessment using the Basic Life Support Sequence. You have answered one or more questions incorrectly. You should revise Core Competency 6.9. Answer. Mr Willis had collapsed having choked on his dinner. The resuscitation team were called. They found a sausage blocking his airway. Once this was removed he quickly regained consciousness. Because of your prompt action he survived and went on to make a good recovery. Core Competency Test Part 10 Mr Willis, who has had communication problems since his stroke, is crying and upset. You discover that he has wet the bed.Indicate whether each of the following actions are appropriate or not. Part 10. Q. Which of the following actions are appropriate or not?10.a. Talk to him and explain that incontinence sometimes happens after stroke but that it often gets better*YesNo10.b. Ignore him so as not to cause embarrassment*YesNo10.c. Explain to him that sometimes it is more difficult to control one's emotions after a stroke – sudden crying often occurs but improves with time.*YesNo10.d. Change the bed linen and tell him not to do it again*YesNo10.e. Suggest that a urinary catheter should be put in*YesNo10.f. Talk with Mr Willis and staff to try to identify the factors which may be contributing to his incontinence*YesNo 10. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.10. Answer. Good, even if Mr Willis has problems talking it does not mean he does not understand your explanation. It is important that people understand that incontinence and uncontrolled crying are common affects of strokes and, that like most other effects, they usually improve with time. Also that there are often several factors which contribute to the problems – if these are dealt with then the problem often lessens. The team identify that Mr Willis is constipated which makes control of urine more difficult. Also, the buzzer was not within reach so he could not alert the nurse that he needed the toilet. Having dealt with these issues he remained continent. Core Competency Test Part 11 Mr Willis is unable to transfer without help. He has been sitting out in a wheelchair for a couple of hours but now complains that his bottom is sore. Indicate whether each of the following actions are appropriate or not. Part 11. Q. Which of the following actions are appropriate or not?11.a. Arrange for him to be helped back into bed by staff with the appropriate skills*YesNo11.b. Tell him that sitting out is good for him and to stay as he is for as long as possible – give him some paracetamol for the pain*YesNo11.c. Once back in bed ensure that his bottom is examined to look for signs of pressure damage*YesNo11.d. Review the cushion on his wheelchair to check if it is giving adequate pressure relief*YesNo 11. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.11. Answer. Well done, Mr Willis thanks you for making him more comfortable. His bottom is red so that the cushion on his wheelchair is changed to one which relieves more pressure. The factors which might contribute to pressure sores are reviewed by the team. Core Competency Test Part 12 Mr Willis is lethargic, incontinent, not eating or drinking much and unwilling to participate in therapy. Indicate whether each of the following actions are appropriate or not. Part 12. Q. Which of the following actions are appropriate or not?12.a. Check if he is dehydrated*YesNo12.b. Tell him that lethargy is inevitable after stroke*YesNo12.c. Ask him why he is not eating and drinking*YesNo12.d. Assess his mood*YesNo12.e. Check that he does not have an infection*YesNo 12. Answer. Mr Willis deteriorates slowly over the next few days, develops a pneumonia and dies. If the patient becomes less well it is very important that common and simple causes of the deterioration are sought and treated effectively. You have answered one or more questions incorrectly. You should revise the Core Competencies.12. Answer. Well done, Mr Willis is dehydrated. His swallowing is reassessed and found to be OK. He has no signs of an infection. He explains that he is embarrassed about being incontinent and therefore has been trying not to eat or drink. He feels much better having been given some fluids. His mood improves and he starts to participate in therapy again. Core Competency Test Part 13 Mr Willis waves you over. You cannot understand what he is trying to say to you as his words seem to be coming out in the wrong order. Indicate whether each of the following actions are appropriate or not. Part 13. Q. Which of the following actions are appropriate or not?13.a. Ignore him since he is obviously confused or demented*YesNo13.b. Explain politely that you have not understood and ask him to repeat what he said*YesNo13.c. Give him a pen and paper to see if he can write*YesNo13.d. Pretend you understood him, nod, smile and walk away*YesNo13.e. Hand him the picture board which is sitting on his bedside table*YesNo13.f. Ask the speech and language therapist for advice about how best to communicate with him*YesNo 13. Answer. Mr Willis has aphasia and he simply wanted to communicate that he needed to go to the toilet. You failed to facilitate communication with him and as a result he was incontinent and he feels low and depressed. You have answered one or more questions incorrectly. You should revise the Core Competencies.13. Answer. Well done, Mr Willis manages to indicate using his picture board that he needs to go to the toilet. You alert the nursing staff who take him to the toilet. Mr Willis maintains his continence and dignity and his mood improves. Core Competency Test Part 14 Mr Willis is sitting in his chair eating lunch. He calls you over and asks whether you could get him a glass of water. However the nurse has put a full glass next to his fork on his left side. Indicate whether each of the following actions are appropriate or not. Part 14. Q. Which of the following actions are appropriate or not?14.a. Tell him not to waste your time*YesNo14.b. Tell him that the glass is near his left hand*YesNo14.c. Ignore him since he is clearly confused*YesNo14.d. Move the glass to his right side*YesNo14.e. Ask a member of the multidisciplinary team to check his visual fields and assess for visual neglect/inattention*YesNo 14. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.14. Answer. Well done, Mr Willis has a left hemianopia so he cannot see the glass. In addition, he neglects his left side so is not very good at scanning across to look into his left visual field. Encouraging him to look to the left is a good thing but equally, it is important that he finds his drink so he does not become dehydrated. Core Competency Test Part 15 Mr Willis is sitting in their wheelchair with his right arm hanging down next to the radiator under the window. There is a pillow on the floor however, he seems unconcerned. Indicate whether each of the following actions are appropriate or not. Part 15. Q. Which of the following actions are appropriate or not?15.a. Pick the pillow up and put it back on his bed but don’t disturb him*YesNo15.b. Ask if he can lift his right arm onto the arm of the chair*YesNo15.c. Carefully pick up his arm and place it on the pillow to support his shoulder*YesNo15.d. Check his right arm for injury*YesNo15.e. Move the wheelchair away from the radiator*YesNo 15. Answer. Mr Willis has a floppy arm in which he has no feeling. He cannot feel temperature or pain. Because his arm was unsupported his shoulder was at risk of dislocation and permanent damage. You have answered one or more questions incorrectly. You should revise the Core Competencies.15. Answer. Well done, Mr Willis has a floppy arm in which he has no feeling. He cannot feel temperature or pain. Because his arm was unsupported his shoulder was at risk of dislocation and permanent damage. Also his arm was at risk of being badly burnt on the hot radiator. Thanks to your appropriate actions he sustains no serious injury. Core Competency Test Part 16 Mr Willis has an obvious right sided weakness and is lying in bed having slipped down on his pillows. Having checked with the nurse in charge you ask him whether he would like a cup of tea. He looks at you blankly but does not answer. Indicate whether each of the following actions are appropriate or not. Part 16. Q. Which of the following actions are appropriate or not?16.a. Position yourself in front of him so he can see your face and ask him again, speaking clearly and slowly*YesNo16.b. Assume that he is not thirsty and move on to the next patient*YesNo16.c. Check with the nurse if he has a hearing problem or wears a hearing aid. Look to see if he is wearing a hearing aid*YesNo16.d. Show him the cup and ask him again*YesNo16.e. Pull him up by both arms so that he is sitting upright to make it easier to drink his tea*YesNo16.f. Ask the nurse to help sit him up to drink his tea*YesNo 16. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.16. Answer. Well done, Mr Willis is deaf so he did not answer first time. However he can lip read when you sit in front of him. Also gesturing with the cup made it clearer. He needed to sit up more to drink his tea but because his right arm is floppy / weak it is at risk of injury if not handled and positioned properly. Your appropriate actions have helped prevent him becoming dehydrated or sustaining a shoulder injury. Core Competency Test Part 17 Three months after the stroke Mr Willis complains to you that his hand is still very clumsy so that he has difficulties with dressing and washing. Indicate whether each of the following actions are appropriate or not. Part 17. Q. Which of the following actions are appropriate or not?17.a. Offer to wash and dress him*YesNo17.b. Explain that most of the recovery occurs early on and that he should give up on the affected hand and learn to use the other one*YesNo17.c. Explain that often improvement after a stroke is very slow but can carry on for many months or even years*YesNo17.d. Suggest he asks the doctor, physiotherapist or occupational therapist about the chances of gaining more function*YesNo17.e. Suggest that, despite the difficulties, it is good to keep trying to use his affected hand*YesNo 17. Answer. It is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Although in the majority of people most recovery occurs in the early months, in some it continues for many months or years. You have answered one or more questions incorrectly. You should revise the Core Competencies.17. Answer. Well done, it is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Mr Willis continues to practice using his hand and within a few months has regained almost normal function. He can now wash and dress himself without any help. Core Competency Test Part 18 Following his discharge from hospital Mr and Mrs Willis return to the out patient clinic. Mrs Willis takes you aside and complains that Mr Willis has changed since the stroke, he is not the same as before. He seems distant, cold, and often cries. Sometimes he gets very angry and swears a lot. “Its not like him.” Indicate whether each of the following actions are appropriate or not. Part 18. Q. Which of the following actions are appropriate or not?18.a. Sympathise with her but explain that it is simply that he is very unhappy*YesNo18.b. Explain that stroke can affect people’s emotions and personality, however, often with time these effects lessen*YesNo18.c. Seek his permission to refer him to a psychologist*YesNo18.d. Ask whether she would like you to arrange the liaison nurse to call*YesNo18.e. Suggest that if he can’t control his anger she ought to consider moving out*YesNo18.f. Explain that swearing is often a problem where people’s ability to communicate has been affected by a stroke*YesNo 18. Answer. Mrs Willis gets increasingly stressed and when Mr Willis is admitted to hospital a few months later with a urinary infection she refuses to have him home. Mr Willis is admitted to a nursing home for long-term care. You have answered one or more questions incorrectly. You should revise the Core Competencies.18. Answer. Well done, the liaison nurse and psychologist are able to explain the reasons for his problems. An antidepressant has reduced the frequency of crying and Mr Willis is now more willing to go out. Mrs Willis feels better able to cope, less isolated and is optimistic about their future.