Every week someone searches for “RCSI aptitude test questions and answers PDF”. What they find is a 2019 slide deck on Scribd, YouTube videos reading out questions, and recruiter blogs. RCSI itself publishes ten sample MCQs without answers. So here is a proper set: 30 questions in the format of the theory paper, one from each of 30 topics on the reading list, with the answer, the reasoning and the source document under each one.
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14 pages, A4. Questions first, answers and explanations in Part 2. Free, no email needed.
How to use the set
- Set a timer for 36 minutes: that is 72 seconds a question, the pace of the real 150-question paper.
- No notes and no phone. Write your letters on paper, then open the answers.
- 15 out of 30 is the 50% pass line. Under 21 (70%), do not book yet.
- Note the topics you missed. Each one below links to its practice topic, where the wrong ones come back first.
The 30 questions
Tap “Show answer” under each question. The correct option is marked in green.
Question 1 · Cardiovascular
The 2024 ESC hypertension guideline (on the RCSI reading list) uses three blood pressure categories. Which set is correct?
- AOptimal below 100/60, normal 100 to 129/60 to 84, hypertension 130/85 or above
- BNon-elevated below 120/70, elevated 120 to 139/70 to 89, hypertension 140/90 or above
- CLow below 110/70, normal 110 to 159/70 to 99, hypertension 160/100 or above
- DNormal below 130/80, stage 1 130 to 139/80 to 89, stage 2 140/90 or above
Show answer
B. Non-elevated below 120/70, elevated 120 to 139/70 to 89, hypertension 140/90 or above
ESC 2024 (McEvoy et al., European Heart Journal 45(38)): office BP is classed as non-elevated (below 120/70 mmHg, no drug treatment), elevated (120 to 139/70 to 89 mmHg, drug treatment depending on cardiovascular risk and follow-up BP) and hypertension (140/90 mmHg or above, prompt confirmation and treatment in most). The 130/80 stage 1 definition is the 2017 American ACC/AHA scheme.
Question 2 · Respiratory
How often does the HSE Chronic Disease Management programme review a patient with COPD in general practice?
- AEvery five years
- BOnce a year
- CEvery three months
- DTwice a year
Show answer
D. Twice a year
HSE Chronic Disease Management programme: patients with COPD (and other eligible chronic conditions) with a medical card or GP visit card are reviewed twice a year in general practice by the GP and practice nurse.
Source: HSE: COPD symptoms
Question 3 · Gastrointestinal
Peptic ulcers are usually the result of which of the following?
- AA diet high in fat and spice
- BLong-term stress at work or at home
- CHelicobacter pylori infection
- DAn inherited defect of the stomach lining
Show answer
C. Helicobacter pylori infection
HSE: ulcers form when the protective layer of the stomach lining breaks down, usually because of H. pylori infection or long-term or high-dose NSAID use (ibuprofen, aspirin). Stress and certain foods do not usually cause them. This is one of the RCSI published sample MCQs, whose answer options are exactly these four.
Source: HSE: Stomach ulcer
Question 4 · Renal and urinary
What daily hygiene does the HSE recommend for a person with a long-term urinary catheter?
- AChange the catheter every day
- BApply an antibiotic cream to the entry site after washing
- CWash the entry site with soap and water twice daily
- DClean inside the urethra with an antiseptic solution daily
Show answer
C. Wash the entry site with soap and water twice daily
HSE: wash the area where the catheter enters the body with mild soap and water at least twice a day and after opening the bowels, and wash hands before and after touching the equipment. Antiseptics and creams are not recommended.
Question 5 · Neurological
What is the range of the total Glasgow Coma Scale score?
- A1 to 20
- B0 to 10
- C5 to 25
- D3 to 15
Show answer
D. 3 to 15
The GCS score combines the three components into a single index from 3 (no response) to 15 (fully alert). Eyes 4, Verbal 5, Motor 6 at maximum. NICE head injury guidance treats a drop of 2 or more points, or any fall in motor score, as a trigger for urgent review. GCS-P adds pupil reactivity.
Source: Glasgow Coma Scale: What is GCS
Question 6 · Diabetes
A relative gives glucagon to an unresponsive patient with type 1 diabetes. When does the HSE say to call 112 or 999?
- AIf the person has not come round within 10 minutes of the injection
- BOnly if a second glucagon injection is also unsuccessful
- CBefore giving glucagon, and do not inject until the ambulance arrives
- DOnce the person is awake and able to eat
Show answer
A. If the person has not come round within 10 minutes of the injection
HSE: give glucagon, then call 112 or 999 if the person is not responding. If they do not come round within 10 minutes of the injection, whoever is with them should call an ambulance. Glucagon releases stored glucose from the liver and needs to be in date and stored in the fridge.
Question 7 · Sepsis
Blood cultures should be taken before antimicrobials unless doing so would delay the antimicrobials by more than how long?
- A2 hours
- B45 minutes
- C15 minutes
- D5 minutes
Show answer
B. 45 minutes
Cultures first, because antimicrobials given beforehand can make them falsely negative. But the antimicrobial must not wait more than 45 minutes for them. In practice, on a ward, you take the cultures while the antimicrobial is being prepared.
Source: HSE Sepsis Screening Tool for Adults (2025), Sepsis 6 step 1
Question 8 · Skin and pressure injury
A heel shows a persistent non-blanchable deep purple discolouration with intact skin. What is this?
- ASuspected deep tissue damage
- BA bruise needing no action
- CStage 1 pressure ulcer
- DIncontinence-associated dermatitis
Show answer
A. Suspected deep tissue damage
HSE Staging Tool 2024: a localised area of non-blanching erythema with purple or maroon discolouration of intact skin, or a blood-filled blister, due to pressure or shear is recorded as suspected deep tissue damage. It may be preceded by tissue that is painful, firm, flaccid, boggy, warmer or cooler than around it. Evolution may be rapid, exposing further layers even with optimal care: record what you see, and stage once the extent is revealed. In dark skin tones check colour, temperature, texture and sensation.
Question 9 · Stoma care
What is a stoma?
- AA hernia of bowel through a weakness in the abdominal wall
- BA surgical opening on the abdomen for bowel or urine output
- CA drain left in the abdomen after surgery to remove fluid
- DA feeding tube passed into the stomach through the abdomen
Show answer
B. A surgical opening on the abdomen for bowel or urine output
Irish Cancer Society: a stoma is an opening on the surface of the abdomen created by a surgeon so bowel motions (or urine) empty into a bag. A colostomy is formed from the large bowel, an ileostomy from the small bowel (ileum); a urostomy diverts urine.
Question 10 · Osteoporosis
Which of these is a good source of calcium for someone who cannot take dairy?
- AApples, pears and other fresh fruit
- BCoffee, tea and other hot drinks
- CKale, tinned sardines and fortified foods
- DWhite bread, pasta and breakfast cereals
Show answer
C. Kale, tinned sardines and fortified foods
Irish Osteoporosis Society: for people who cannot take dairy, kale, collards, okra, tinned salmon and sardines (with bones) and calcium-fortified foods and drinks are good sources of calcium.
Question 11 · Nutrition, malnutrition and obesity
A patient with obesity (BMI 34) is admitted acutely unwell and has taken almost nothing by mouth for 6 days. What is the MUST score?
- AMUST cannot be used when BMI is over 30
- B1, medium risk, because intake is reduced
- C0, low risk, because BMI is well above 20
- D2, high risk, from the acute disease effect
Show answer
D. 2, high risk, from the acute disease effect
MUST: acute disease effect scores 2 when there is no nutritional intake for more than 5 days, regardless of BMI, so the total is 2 = high risk. Obesity does not protect against malnutrition during acute illness.
Source: BAPEN: Malnutrition Universal Screening Tool (MUST), steps 1 to 4
Question 12 · Pain
Why does the HSE say to seek medical advice after a paracetamol overdose even if the person feels well?
- ARisk of severe allergic reaction
- BRisk of delayed, serious liver damage
- CRisk of immediate cardiac arrest
- DRisk of kidney failure within an hour
Show answer
B. Risk of delayed, serious liver damage
HSE: paracetamol overdose can cause serious liver damage that develops over 24 to 72 hours with few early symptoms, so medical advice is needed immediately even if the person feels well, because the antidote works best early.
Source: HSE: Paracetamol
Question 13 · Older person care
According to NMBI Standard 1, what is the organising framework through which the nurse delivers person-centred care?
- AAssessment, need identification, planning, implementation, evaluation
- BScreening, referral, review, reporting and audit
- CAdmission, observation, treatment, transfer and follow-up in the community
- DDiagnosis, prescription, treatment, review and discharge planning with the team
Show answer
A. Assessment, need identification, planning, implementation, evaluation
NMBI Standard 1: the nurse delivers person-centred care through the nursing process of assessment, identification of needs, planning, implementation and evaluation, in partnership with the older person.
Question 14 · Delirium
What is the attention task on the 4AT?
- AMonths of the year backwards, starting at December
- BDrawing a clock face showing ten past eleven with all the numbers
- CCounting backwards from 20 to 1 without error within 30 seconds
- DNaming three objects and recalling them later
Show answer
A. Months of the year backwards, starting at December
Item 3: "Please tell me the months of the year in backwards order, starting at December." One prompt (what is the month before December?) is permitted. Seven or more months correct scores 0, starting but under 7 or refusing scores 1, untestable because unwell, drowsy or inattentive scores 2.
Question 15 · Dementia
What does mixed dementia mean?
- AA diagnosis that has not been confirmed
- BDementia diagnosed before the age of 65 in a working person
- CMore than one type of dementia at the same time
- DDementia alternating with periods of normal cognition
Show answer
C. More than one type of dementia at the same time
NHS: mixed dementia is a combination of more than one type of dementia; vascular dementia with Alzheimer’s disease is the most common combination, and it can be hard to know how much each cause contributes. The Alzheimer Society of Ireland notes that people under 65 with suspected dementia are referred to a neurologist or memory clinic.
Source: NHS: Causes of dementia, mixed dementia; ASI: What is dementia
Question 16 · Frailty and deconditioning
Which of these is one of the apparently minor events the BGS names as enough to decompensate a person with frailty?
- AA move to respite care or a trial of a new analgesic
- BA course of major surgery under general anaesthetic
- CA stroke or an acute myocardial infarction
- DPneumonia that needs hospital admission
Show answer
A. A move to respite care or a trial of a new analgesic
BGS: even apparently small events can decompensate a person with frailty, such as a move to short-term respite care, a trip to the emergency department after a fall, or a trial of a new analgesic. Major illnesses and surgery are stressors for anyone; the point of the BGS list is that in frailty a minor event is enough.
Source: British Geriatrics Society: Introduction to frailty (Fit for Frailty)
Question 17 · Falls
What should happen at hospital discharge for a patient identified as at risk of falls, according to NICE?
- AConsider referral to community services for ongoing risk factors
- BFalls prevention ends when the patient leaves hospital; the GP takes over
- CAdvise the patient to rest in bed at home until the follow-up appointment
- DPrescribe a sedative for the journey home
Show answer
A. Consider referral to community services for ongoing risk factors
NICE NG249 1.3.16: at discharge, consider referring the person to community services so that risk factors identified in hospital and still relevant at home can be addressed, for example through exercise programmes and home hazard assessment.
Source: NICE NG249 Falls: assessment and prevention (2025), 1.3.16
Question 18 · Death and dying
Anticipatory medicines have started to be given to a dying patient. How often does NICE say to monitor their effect?
- AAt least daily, with feedback to the lead professional
- BEvery 4 hours, recorded on the observation chart with the vital signs
- COnce a week, at the multidisciplinary meeting
- DOnly if the family or carers notice a change in the symptoms
Show answer
A. At least daily, with feedback to the lead professional
NICE NG31 1.6.6: once anticipatory medicines are administered, monitor for benefits and any side effects at least daily, give feedback to the lead healthcare professional, and adjust the individualised care plan and prescription as necessary. Before each is given, 1.6.5 asks for a review of the person’s current symptoms rather than automatic use.
Source: NICE NG31 Care of dying adults in the last days of life (2015), 1.6.5 to 1.6.6
Question 19 · Chronic disease management
Which conditions are covered by the HSE Chronic Disease Management (CDM) Treatment Programme in general practice?
- AOsteoarthritis, osteoporosis and chronic back pain
- BEpilepsy, Parkinson’s disease and multiple sclerosis
- CCancer, dementia and chronic kidney disease
- DType 2 diabetes, COPD, asthma and cardiovascular disease
Show answer
D. Type 2 diabetes, COPD, asthma and cardiovascular disease
HSE Chronic Disease Management Treatment Programme covers type 2 diabetes, COPD, asthma and cardiovascular disease (heart failure, atrial fibrillation, ischaemic heart disease and stroke or TIA) for eligible patients in general practice.
Source: HSE: GP chronic disease programme makes a difference for 400,000 people (2025)
Question 20 · Nursing process in the acute situation
A nurse is concerned about a patient whose INEWS is 2 but who "does not look right". What does INEWS V2 permit?
- AIncreasing observations to hourly without informing anyone
- BDocumenting the concern and rechecking at the next round
- CCalling an urgent response on the basis of clinician concern
- DNothing formal until the total score reaches 3 or more
Show answer
C. Calling an urgent response on the basis of clinician concern
INEWS V2 Recommendations 1, 13 and 19 emphasise clinical judgement: an urgent response can be called for low scores when there is concern. The chart is an adjunct to, not a replacement for, the nurse’s assessment.
Source: NCG No. 1 INEWS V2 summary (2020), Recommendations 1, 13 and 19
Question 21 · Pre- and post-operative care
What must be verified before a patient is marked and sent for surgery, under the HSE Safe Surgery policy?
- AThe anaesthesiologist visit completed and the premedication given on the ward
- BA full antiseptic shower, hair removed from the site and a gown put on
- CBlood taken for group and save and cross-match, with the result filed in the chart and checked by two nurses
- DIdentity, the exact procedure and side or site, consent, then the site marked in indelible ink
Show answer
D. Identity, the exact procedure and side or site, consent, then the site marked in indelible ink
HSE National Policy and Procedure for Safe Surgery 2022, sections 12 to 14: the patient’s identity (first and last name, date of birth, healthcare record number) is verified against the documentation, the planned procedure with exact side, site, level or digit is written in full (Left/Right never abbreviated), informed consent is obtained under the National Consent Policy, and the identity, procedure and side are verified again with the patient before site marking, which the consultant or nominated deputy who will be present for Time Out performs in indelible ink before transfer to theatre. Fasting, blood group and screening follow local policy.
Question 22 · Fundamentals of nursing care
Which five components make up the nursing process, remembered by the mnemonic ADPIE?
- AAssessment, Diagnosis, Planning, Implementation, Evaluation
- BAirway, Drugs, Pulse, Infusion, Escalation
- CAssess, Delegate, Prioritise, Inform, Escalate
- DAdmission, Documentation, Prescription, Investigation, Education
Show answer
A. Assessment, Diagnosis, Planning, Implementation, Evaluation
OpenStax Clinical Nursing Skills 1.3: the nursing process is a critical thinking model based on a systematic approach to patient-centred care and on the ANA Standards of Professional Nursing Practice; ADPIE stands for its five components, Assessment, Diagnosis, Planning, Implementation and Evaluation. Open RN teaches the same cycle as six components (ADOPIE), listing Outcome identification as a step of its own.
Question 23 · Infection prevention and control
What does the HPSC say about Klebsiella pneumoniae?
- AAn airborne bacterium caught by breathing in droplets from an infected person
- BA bacterium that causes disease in young children whose immunity is immature
- CA skin bacterium that is reliably cleared by a short course of oral amoxicillin
- DA bowel bacterium; multi-drug resistant strains resist several common antibiotics
Show answer
D. A bowel bacterium; multi-drug resistant strains resist several common antibiotics
HPSC: Klebsiella pneumoniae is one of many bacteria that can live in the bowel, grouped with E. coli as Enterobacteriaceae, bacteria of the enteric tract. Multi-drug resistant K. pneumoniae (MDR-KP) has become resistant to several commonly used antibiotics, so those antibiotics may not help in treating infection. The HPSC counts invasive infection as isolation from blood or cerebrospinal fluid.
Question 24 · Medication and drug calculations
How many "rights" of medication administration does the NMBI 2020 guidance list?
- ASix
- BFive
- CEight
- DTen
Show answer
D. Ten
The 10 rights: right patient, reason, medication, route, time, dose, form, action, documentation and response. Many overseas curricula teach five or six; the RCSI test follows the NMBI list.
Source: NMBI Guidance on Medication Administration (2020), guiding principle 4
Question 25 · Peripheral venous catheter and IV therapy
Which level of aseptic technique does the Irish guidance require for inserting a midline catheter or a central venous access device?
- ASurgical aseptic technique with maximum sterile barrier precautions
- BClean technique with hand hygiene, as for a peripheral cannula
- CNo specific level; each ward decides according to local policy
- DStandard aseptic technique with non-sterile gloves, as for a PVC
Show answer
A. Surgical aseptic technique with maximum sterile barrier precautions
HSE AMRIC 2026: standard aseptic technique (typically non-sterile gloves) is used for PVC insertion, accessing devices and dressing changes. Surgical aseptic technique, with a critical aseptic field, sterile gloves and maximum sterile barrier precautions (mask, cap, sterile gown, full body drape), is required for midline and CVAD insertion.
Question 26 · Safeguarding, consent and open disclosure
An unconscious patient arrives after a road collision and needs immediate surgery. How does the HSE consent policy handle consent?
- ATwo doctors sign on the patient’s behalf
- BProceed without consent to save life
- CThe hospital manager gives consent
- DWait until a relative signs the form
Show answer
B. Proceed without consent to save life
HSE consent policy: in a serious emergency where the person cannot consent, the necessary intervention may proceed without consent to save life or prevent serious harm, unless a valid and applicable advance healthcare directive refuses it. Relatives cannot consent on an adult’s behalf.
Source: HSE National Consent Policy 2022 (v1.2, effective January 2024), Part One, section 2.5
Question 27 · NMBI Code and professional matters
A patient’s daughter phones the ward asking for her mother’s test results. The patient is alert and competent. What does the Code require?
- ARefuse under all circumstances
- BGive the results after confirming date of birth
- CObtain the patient’s consent first and document it
- DGive the results because she is next of kin
Show answer
C. Obtain the patient’s consent first and document it
NMBI Code Principle 4 (Trust), standard 8: information about a competent patient is shared with family only with the patient’s consent, which should be documented. Next of kin status confers no automatic right to information.
Source: NMBI Code of Professional Conduct and Ethics (2025), Principle 4, standard 8
Question 28 · Social prescribing and community care
What are meals services (meals-on-wheels) and how are they accessed?
- AHospital catering delivered after discharge
- BMeals for people who cannot prepare them, usually by referral
- CA supermarket delivery scheme funded by the HSE for people over 70
- DFree restaurant vouchers for people on low incomes, issued by the HSE
Show answer
B. Meals for people who cannot prepare them, usually by referral
Citizens Information: meals services (meals-on-wheels) are provided by voluntary and statutory bodies for people who cannot prepare meals, generally by referral, sometimes with a contribution towards cost.
Question 29 · Irish health system and law
Since 2024 the HSE delivers hospital and community services through how many health regions?
- ASix
- BFour
- CNine
- DTwenty-six
Show answer
A. Six
Six HSE Health Regions began on 1 March 2024 and replaced the Hospital Groups and Community Healthcare Organisations from October 2024: Dublin and North East, Dublin and Midlands, Dublin and South East, Mid West, South West, West and North West. Each has a Regional Executive Officer reporting to the HSE CEO, and is split into Integrated Healthcare Areas (20 nationally).
Source: HSE, HSE health regions
Question 30 · Teaching the junior student nurse
A preceptor tells a student, ‘You are careless.’ Which feature of good feedback, as described by NMBI, is missing?
- AImmediate: given at the earliest opportunity
- BDocumented: recorded in the student’s portfolio
- CSpecific: focused on behaviours, not personalities, with suggestions
- DBalanced: includes positive feedback as well as areas to improve
Show answer
C. Specific: focused on behaviours, not personalities, with suggestions
NMBI QCLE: good feedback is specific, focused on behaviours not personalities or subjective data, and includes suggestions for development. Calling a student careless labels the person. Better: ‘You did not check the wristband before giving the tablets; check name and date of birth every time.’
Source: NMBI: Quality Clinical Learning Environment, good feedback
What to notice
Thirty questions from thirty topics, and maybe a third are “clinical” in the way nursing school meant it. The rest are Irish policy and guideline numbers: how often the HSE reviews a COPD patient, how many rights of medication administration NMBI lists, when NICE says to prescribe anticipatory medicines. That mix is the paper. A nurse with ten years on a ward abroad can fail it on the Irish documents alone, which is why the reading list matters more than any textbook.
The full bank has 1,173 questions across 41 topics, one of them fully free (Observations and INEWS), and 3 free questions with explanations and sources in every other topic. The short mock is free once.