Mr Gerald Baker is a 79-year-old patient on the ward of a hospital in which you are Charge Nurse.

Patient Details:

Marital Status:  Widower (8 years)

Admission Date: 3 September 2010 (City Hospital)

Discharge Date: 7 September 2010

Diagnosis: Left Total Hip Replacement (THR) Ongoing high blood pressure

Social Background:

• Lives at Greywalls Nursing Home (GNH) (4 years) No children
• Employed as a radio engineer until retirement aged 65 Now aged-pensioner
• Hobbies: chess, ham radio operator
• Sister, Dawn Mason (66), visits regularly; v supportive – plays chess with Mr Baker on her visits
• No signs of dementia observed

Medications: 

• Aspirin 100mg mane (recommenced post-operatively)
• Ramipril 5mg mane
• Panadeine Forte (co-codamol) 2 qid prn

Medical Background:  2008 – Osteoarthritis requiring total hip replacement surgery

Nursing Management and Progress:

• 1989 – Hypertension (ongoing management)
• 1985 – Colles fracture, ORIF

• daily dressings surgery incision site
• Range of motion, stretching and strengthening exercises
• Occupational therapy
• Staples to be removed in two wks (21/9)
• Also, follow-up FBE and UEC tests at City Hospital Clinic
• Good mobility post-operation

Assessment:

• Weight-bearing with use of wheelie-walker; walks length of ward without difficulty
• Post-operative disoriention re time and place during recovery, possibly relating to anaesthetic – continued observation recommended
• Dropped Hb post-operatively (to 72) requiring transfusion of 3 units packed red  blood cells; Hb stable
• (112) on discharge – ongoing monitoring required for anaemia

Discharge Plan:

• Monitor medications (Panadeine Forte)
• Preserve skin integrity
• Continue exercise program
• Equipment required: wheelie-walker, wedge pillow, toilet raiser. Hospital to provide walker and pillow. Hospital social worker organised 2-wk hire of raiser from local medical supplier.

Writing task:

Using the information in the case notes, write a letter to Ms Samantha Bruin, Senior Nurse at Greywalls Nursing Home, 27 Station Road, Greywalls, who will be responsible for Mr Baker’s continued care at the Nursing Home.

In your answer:

expand the relevant notes into complete sentences

do not use note form

use letter format

The body of the letter should be approximately 180-200 words.

Sample answer by Lifestyle Training Centre

7/9/2010

Mr Baker requires continuity of care and management, following his discharge today. He is currently recovering from a Left Total Hip Replacement surgery that he underwent in our hospital.

At present, Mr Baker shows good mobility, and he can walk short distances with the help of a wheeliewalker. Hospital is providing him a wheelie-walker, wedge pillow as well as a toilet raiser; the latter has to be returned after 2 weeks.

Post operatively, Mr Baker had felt disorientated, probably due to anaesthetic. In addition, his haemoglobin level had dropped temporarily; therefore, he should be watched as well as monitored for anaemia. He was commenced on occupational therapy: a range of motion, stretching and strengthening exercises, which needs to be continued.

Based on the above information, please continue the care for Mr Baker. Kindly monitor his medication regimen: Aspirin, 100mg in the morning and Panadeine Forte/co-codamol, 4 times, as required. Please maintain his skin integrity. On 21/9/2010, he needs to go for FBE and UEC follow-up tests at City Hospital Clinic, and his staples need to be removed.

Should you have further queries, please do not hesitate to contact me.

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Read the case notes below and complete the writing task that follows.

Time allowed : 40 minutes

You are a Maternal and Child Health Nurse working at the Romaville Community Child Health Service.

Today’s date: 15 January 2012

Patient History

• Baby boy: Dylan Charles
• DOB: 04/12/11
• Born: Romaville Maternity Hospital
• First baby of Raymond and Sylvia Charles
• Address: 19 Mayfield St, Romaville
• Discharged 8/12/11

Family History

• Mother: Aged 24 First Child
• Father: Aged 25 Soldier Currently away from home on duty

Birth Histor

• Normal vaginal birth at term
• Birth weight: 3400gm
• Apgar score at 5 min: 9
• No antenatal or postnatal complications

15/01/12 Subjective

• Silvia and baby attended for routine 6 week check-up. Silvia says she is concerned about constipation: once every three days, hard stool. Mother is asking about stool softener or prune juice for baby.
• Breast fed for first three weeks after birth.
• Baby became unsettled during summer heatwave in December.
• Silvia got sick and had a fever for a few days. Mother-in-law (Mary Charles) came to visit and advised changing baby to formula feeds. Mary advised extra powder in formula feeds to improve weight gain.
• Silvia worried she does not have enough breast milk and now gives extra formula feeds as well as breast feeding. Dylan difficult to bottle feed.
• Silvia wishes to breast feed properly as she believes it would be the best thing for her son.
• Mary Charles plans to stay with the family for at least a further month to help with baby. Tensions developing between mother and mother-in-law over what is best feeding method for Dylan.

Objective

• Reflexes normal
• Slightly lethargic
• No abdominal tenderness
• Heart Rate: 174
• Respirations: 56
• Temperature: 37.1
• Weight: 4200gms
• 3 wet nappies in last 24 hours
• Urine dark
• Mild constipation and dehydration

Plan

• Increase breast feeds
  • Refer to breast feeding support service
  • Check formula is correctly prepared
  • If continuing formula feeds, advise to supplement with water (boiled and cooled)
  • Advise on keeping baby cool in hot weather
  • Return for review in 48 hours.

Writing Task

Please write a referral letter to the Lactation Consultant at the Breast Feeding Support Centre, 68 Main Street, Romaville.

• In your letter expand the relevant case notes into complete sentences
  • Do not use note form
  • The body of your letter should be approximately 180~200 words
  • Use correct letter format.

Sample answer by Lifestyle Training Centre

15/01/2012

Dear Sir/Madam,

Re: Dylan Charles, 04/12/11

I am writing to refer baby Dylan, who suffers from mild constipation and dehydration; and also his mother, Sylvia, who requires education on breast feeding.

Dylan was breastfed the initial three weeks of birth and had no complications. Sylvia, then, switched to formula feed as per her mother-in-law’s advice as she got sick for a few days. She also mixes extra powder in formula feed, hoping to improve his weight, 4200gms.

Dylan is difficult to be bottle fed, and Sylvia prefers breast feeding over formula feed. However, she is concerned that she doesn’t have enough breast milk. Therefore, please teach Sylvia proper breast feeding technique and correct preparation of formula feed. If formula feed should be continued, boiled and cooled water needs to be added in the feed.

Dylan suffers from constipation, and his stool is hard every three days; the urine appears dark. He only had 3 wet nappies in the last 24 hours. Since he had become unsettled during summer wave, he needs to be kept hydrated and cool in hot weather. His reflexes and vitals are normal, but he is slightly lethargic.

In view of the above, we request you to assess the baby and help Sylvia to improve breast feeding. Please return them for review in 48 hours. Should you have further queries, please do not hesitate to contact me.

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Occupational English Test: WRITING SUB-TEST: NURSING

TIME ALLOWED:            READING TIME: 5 MINUTES

WRITING TIME:             40 MINUTES

You are a Surgical Nurse in a post-operative ward. Your patient is ready for discharge today after CABG surgery.

Date:29/05/2021

Patient Details

Name: Mr Darwish Woods

Age: 77 years

Diagnosis: Coronary artery bypass graft

Family History

Married, carer for his wife (registered blind)

Daughter, married with children and lives overseas

Hobbles: Reading, cooking daily

Past History

Hypertension since 2011 (perindopril 1tab/daily)

High cholesterol since 2009 (atorvastatin 1 tab/dally)

Arthritis since 2007 (paracetamol 1 gm daily 4times

CAD (ECG, stress test, angiogram

Surgery: off pump CABG

23/05/2021

Admitted to hospital and underwent surgery on 24/05/2021 (graft from left leg)

Admitted in ICU for 24 hours

Administered IV antibiotics , analgesics and antithrombolytic agents

Chest tube insitu, drainage 20ml

Temp-37. 7C, PR-78/mt, RR-22/mt, Spo2-100°/o, BP-130/80 mm of Hg

Dressing in graft site

Provided elastic stockings and elevated leg for 24 hours

25/05/2021

Transferred to ward

Chest tube removed, wounds WNL

Complaints of pain over the chest and shoulder (administered Brufen)

Daily physiotherapy (deep breathing exercises, walking 4-5 mts 4times per day)

Exercise data sheet provided

Temp-37C, PR- 84/mt, RR-18/mt, BP-120/76 mm of Hg

29/05/2021

Ready for discharge (planned transfer to rehabilitation unit for 3 weeks) Follow up appointment:07/06/2021

Discharge instructions:

•          Assess wound over the chest and graft site

•          Dressing over the wound 2/weekly until sutures removed

•          Sutures removal after 2 weeks

•          Continue deep breathing exercises, walking 4-5 mts increase gradually

•          Avoid heavy lifting

•          Arrange carer and meals before discharge to home

WRITING TASK:

Using the information in the case notes, write a transfer letter to Ms Smith Brown, head of nursing, rehabilitation centre. Address this letter to Ms Brown, Head of Nursing, Brisbane OLD, Australia 4001.

In your answer:

•          Expand the relevant notes into complete sentences

•          Do not use note form

•          Use letter format

The body of the letter should be approximately 180-200 words.

Sample answer by Lifestyle Training Centre

Dear Ms Brown,

Re: Darwish Woods, aged 77 years.

I am writing to transfer Mr Woods who requires rehabilitative care and management for the subsequent 3 weeks. He is currently recovering from a coronary artery bypass graft that he underwent in our hospital on 25/04/2001.

During hospitalisation, Mr Woods was treated with IV antibiotics, analgesics, and antithrombotic agents. His graft site, left leg, was dressed.  Daily physiotherapy, deep breathing, and walking for 4-5 mts, 4 times a day, were started. He was administered Brufen for chest pain. His recovery was good.

Mr woods has been hypertensive since 2011. He also suffers from Arthritis and high cholesterol since 2007 and 2009, respectively. He follows his medication regime for the same.

Mr woods is the only care taker for his wife, who is a registered blind. His daughter, with her family, lives abroad.

Based on the above, kindly receive him and provide on-going care. His wound over the chest and graft site requires daily monitoring and dressing twice every week. His sutures need to be removed at the end of 2 weeks. He needs to continue his deep breathing exercises and should gradually increase his daily walk. He must avoid heavy lifting. Prior to his discharge, please arrange a carer and provision for meals at his residence. His follow-up appointment will be on 07/06/2021.

If you have any further queries, please do not hesitate to contact me.

Yours sincerely,

Surgical nurse. 

(words count: 219)

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Sample answer by Lifestyle Training Centre

I had the privilege of visiting the iconic Colosseum in Rome, a structure steeped in historical significance. This ancient amphitheater is located in the heart of Rome, Italy, and is a testament to both architectural marvel and a darker part of human history.

My visit to the Colosseum was a surreal experience. Standing amidst the ancient ruins, I couldn’t help but be awestruck by the grandeur and scale of this remarkable edifice. The Colosseum, with its towering walls and the sheer magnitude of its structure, is a vivid reminder of the incredible engineering prowess of the Romans.

However, it’s not just the architecture that makes the Colosseum significant. This colossal arena is also associated with a darker chapter in history. It was here that numerous gladiatorial contests took place, where enslaved individuals, prisoners, and even exotic animals were pitted against one another, often resulting in bloodshed and death. It’s a somber part of history that’s difficult to overlook while touring the Colosseum.

As I walked through the ancient corridors and seating areas, I couldn’t help but feel a mixture of emotions. There was admiration for the architectural achievement and a deep respect for the history that unfolded within these walls. At the same time, there was a sense of sorrow, thinking about the lives lost and the immense human suffering that occurred here.

My visit to the Colosseum was a valuable lesson in history. It reinforced the importance of remembering the past, both its achievements and its atrocities. This ancient structure serves as a poignant reminder of the need for progress, empathy, and a commitment to a more humane and just society.

In conclusion, my visit to the Colosseum was a profound experience, allowing me to appreciate both the architectural brilliance of the Romans and the historical significance of this arena. It’s a reminder that history is not only about grand monuments but also about the lessons we learn from the past.

I became aware of the role of a lifeguard during a summer job at a local community pool. This experience allowed me to understand the job more intimately and appreciate its importance. Learning about the vigilant watchfulness, CPR training, and teamwork required to keep swimmers safe was eye-opening.

The most intriguing aspect of being a lifeguard is the sense of responsibility that comes with it. Knowing that you hold the lives of others in your hands while they enjoy the water is both challenging and gratifying. The need for constant alertness and quick decision-making adds an element of excitement to the job.

Moreover, the opportunity to work in a beautiful outdoor environment, particularly at beaches or pools with stunning vistas, is a significant perk. It combines a sense of duty with a connection to nature, which is truly unique.

Would I consider pursuing such a job? Absolutely. The role of a lifeguard offers an opportunity to make a difference by ensuring the safety of those enjoying aquatic activities. It’s a chance to develop valuable skills, including strong communication, adaptability, and the ability to remain calm under pressure. The job can also be a stepping stone to careers in related fields like emergency response or healthcare.

In conclusion, being a lifeguard is a captivating job with elements of responsibility, excitement, and the opportunity to save lives. The profound impact lifeguards have on ensuring the safety of water enthusiasts and their connection to the great outdoors make it a highly interesting and honorable profession.

One place that I’m eagerly looking forward to visiting in the future is the enchanting Dzukou Valley, nestled in the picturesque state of Nagaland, India. Dzukou Valley is a natural marvel, known for its breathtaking landscapes and unique biodiversity.

Located on the border of Nagaland and Manipur, Dzukou Valley is a haven for nature enthusiasts. The valley is often described as the “Valley of Flowers of the Northeast” due to its lush, colorful meadows that burst into bloom during the monsoon season. These meadows are adorned with a vibrant tapestry of wildflowers, making it a visual delight.

What captivates me about Dzukou Valley is its untouched natural beauty. The valley offers pristine, unspoiled landscapes that are still relatively unexplored by tourists. The serenity of the place is alluring, with its clear streams and lush greenery creating a sense of tranquility that’s hard to find in our fast-paced world.

My desire to visit Dzukou Valley is driven by the yearning to immerse myself in nature’s splendor. I long to traverse its well-maintained trekking trails, breathing in the fresh mountain air and reveling in the grandeur of the surrounding hills. The valley’s unique biodiversity, including rare and endemic species, adds to its appeal for a nature enthusiast like me.

In planning my trip to Dzukou Valley, I would ensure that I choose the right season, typically between June and September, to witness the valley in full bloom. I’d prepare for a moderate trek to reach the valley, packing essentials like comfortable hiking gear, camping equipment, and a good camera to capture the scenic beauty.

In summary, Dzukou Valley’s unspoiled natural beauty, lush meadows, and unique biodiversity make it a destination I’m eager to explore in the future. I believe this journey would not only offer me a respite from the hustle and bustle of everyday life but also allow me to connect with the wonders of the natural world.

Sample answer 2

Given the fact that international travel can be quite an expensive endeavour, I’ve settled down to explore territories with in India. I’ve been visiting one place after another.

So far, I’ve covered Delhi and Tamil Nadu, checking off the top of my bucket list without a second thought, the next destination on my list is none other than Nagaland. I’ve heard incredible things about it, especially from the BBC.

I’ve learned that the people there were once headhunters and warriors, engaged in conflicts. Additionally, I’ve heard about the Second World War, with something significant happening at the Kohima War Cemetery. I’m eager to go there. There’s also Dzukou Valley, known for its abundance of flowers and stunning nature. Moreover, its people embody beauty with their unique culture and traditions. With at least 16 tribes, each speaking a different language, I’ve been contemplating this destination for quite some time.

Perhaps, by next December, I’ll be able to go, considering they have a festival every December 12th. I’m planning to take a flight, even though there are other options like trains. The challenge with trains is the considerable time it takes, at least three days, whereas flights, despite being indirect, would still be more time-efficient, taking approximately 16 to 20 hours.

I have many friends from Nagaland who have shared positive feedback, and I’m eagerly looking forward to experiencing it myself.

Sample answer by Lifestyle Training Centre

The person who has inspired me the most is my high school English teacher, Mrs. Johnson. I first came to know her when I was in the 10th grade, and she became my teacher for two consecutive years.

Mrs. Johnson possessed several remarkable qualities that made her an exceptional inspiration. Firstly, her dedication to teaching and genuine passion for literature were palpable. She had an incredible ability to make even the most complex literary works come alive in our classroom. Her enthusiasm for the subject was contagious, and it ignited a love for literature in all of her students.

What truly set Mrs. Johnson apart, however, was her unwavering belief in her students’ potential. She saw something special in each of us and encouraged us to reach for the stars. She was patient, supportive, and always available to provide guidance and mentorship.

Under Mrs. Johnson’s influence, I developed a deep appreciation for literature and writing. Her encouragement led me to explore creative writing, and I eventually started contributing articles to our school newspaper. This newfound passion for writing played a pivotal role in shaping my academic and career choices.

While I have not had the opportunity to meet Mrs. Johnson in recent years, her impact on my life is immeasurable. Her lessons in literature extended far beyond the classroom, teaching me about perseverance, the importance of mentorship, and the transformative power of education.

In conclusion, Mrs. Johnson, my high school English teacher, is the person who has inspired me the most. Her dedication, passion, and belief in her students left an indelible mark on my life, influencing my academic and career journey and instilling in me a lifelong love for literature and learning.