OSCE APIE Scenario: Asthma
The NMC OSCE asthma scenario walked through Assessment, Planning, Implementation and Evaluation, with severity markers and 5 practice questions.
Asthma is the most commonly reported APIE scenario, and it rewards candidates who can grade severity fast and say the grading out loud. The four stations follow one patient, so a strong Assessment station feeds everything after it.
Assessment. Structure it as A to E with numbers attached: can they complete a sentence in one breath; respiratory rate, heart rate, saturations, temperature into a NEWS2 score; peak flow against their known best; accessory muscle use; what triggered it and what they’ve already taken. The severity table is the marking spine:
- Moderate: worsening symptoms, PEFR above 50% of best, no severe features.
- Severe: any of incomplete sentences, RR 25 or more, HR 110 or more, PEFR 33 to 50%.
- Life-threatening: silent chest, cyanosis, exhaustion, altered consciousness, hypotension, PEFR below 33%.
The silent chest is the scenario’s planted trap: a chest going quiet while the patient worsens is airflow failing, not the attack settling.
Planning. Prioritise: gas exchange first, then the supporting problems (anxiety, fatigue, education). Goals get numbers and timescales: saturations in the 94 to 98% range, PEFR climbing towards best, RR settling, reviewed at set intervals.
Implementation. The nursing actions available before and alongside the prescriber: sit the patient upright, oxygen titrated to target, support their own prescribed reliever, continuous observation, calm coaching (panic stacks on bronchospasm), and an SBAR escalation with the severity grade in the first sentence. New drugs need prescriptions; knowing that boundary is itself a marked safety point.
Evaluation. Re-measure the same things assessment measured, and compare: sentences, RR, HR, saturations, repeat PEFR. State the verdict and the plan either way: improving on treatment, continue and monitor; not improving or any life-threatening feature, emergency escalation. Discharge-phase evaluation brings the education in: inhaler technique checked by teach-back, trigger awareness, and a written asthma action plan mentioned.
Five questions below, then the pneumonia scenario, where the same A-E discipline meets infection and sepsis screening.
Sources & further reading
Frequently asked questions
What makes an asthma attack severe rather than moderate?
What signals life-threatening asthma?
What can the nurse do before the prescriber arrives?
Check your understanding
Quick quiz: OSCE APIE Scenario: Asthma
5questions. Click an answer to see the explanation. Your score is saved on this device only.
- 1
Your asthma patient can only speak in short phrases, RR 26, HR 112, PEFR 45% of best. This attack is:
- 2
During your assessment the wheeze disappears but the patient looks worse: drowsy, poor effort. You interpret this as:
- 3
Your first nursing implementations while awaiting the prescriber are:
- 4
Twenty minutes after treatment you re-evaluate. Which finding best shows genuine improvement?
- 5
In the Planning station, the highest-priority problem for this patient is documented as:
Keep reading
OSCE APIE Scenario: Pneumonia
The NMC OSCE pneumonia scenario through Assessment, Planning, Implementation and Evaluation: NEWS2, sepsis screening, oxygen, and 5 questions.
Peak Flow (PEFR): OSCE Station Checklist
The NMC OSCE peak flow station: technique coaching, best of three, predicted values and personal best, and 5 practice questions with answers.
Inhaled Medication: OSCE Station Checklist
The NMC OSCE inhaled medication station: MDI technique, spacers, steroid mouth-rinse, patient teaching, and 5 practice questions with answers.