WRITING TEST

Time allowed:

Reading Time: 05 Minutes

Writing : 40 Minutes

Read the case notes and complete the writing task which follows.

Case Notes:

Samuel Zoel, a 63-year-old man, was admitted into the acupuncture hospital of which you are a head
nurse. The patient complained of chronic pain on both shoulders and around his neck.

Patient Details

Name: Samuel Zoel

Marital Status: Widower

Children: Jacob (Teacher at private school in London).

Kristina (married to Henry, runs a boutique shop, lives in Manchester).
Adla (works at IT Firm, married to Bill, lives in Sydney).

Admission Date: 29 June 2016

Discharge Date: 5 July 2016
Social Background

Lives in a care home (Max Care, London).

Likes gardening.
Actively involved in social services (teaches small children).

Patient History

Past Medical History

No history of any illnesses
Underwent successful acupuncture and cupping courses for shoulder pain and neck pain (first on 25
April 2016 and second on 27 May 2016) at a private acupuncture clinic. No side effects / no illness.

Underwent acupuncture and cupping course again in the month of June 2016.

Felt no discomfort during the procedure and went home after the treatment.

After three hours, the patient began to feel chest tightness, chest pain and heart palpitations.

The patient didn’t contact the doctor about these symptoms.

June 29 2016

His condition deteriorated with the emergence of extreme cold sweats and shortness of breath.

Shifted to hospital on the same day.

Physical examination:

Temperature - 36.2°C

Pulse rate - 140 times per minute

Respiratory rate - 40 times per minute

Blood pressure - 85/40 mmHg

Round visible ecchymosis on the skin on the neck and shoulder

Dull heart sounds

Percutaneous oxygen saturation - 76%

Cyanosis at skin and mucous membranes

Drum sound in percussion

Trachea in the middle

Reduced breathing exercises on both sides of the thorax

Moderate coma

Chest computed tomography showed a bilateral pneumothorax on both lungs (70% collapsed).

Treatment

Simple respirator assisted ventilation / endotracheal intubation were performed.

Operated a closed thoracostomy with standard chest drainage in the fifth intercostal space at the
midaxillary line, to treat the pneumothorax with bilateral thoracoscopy.

Result

The patient’s shortness of breath improved.

Percutaneous oxygen saturation returned to 96%.

30 June 2016

Transferred to ICU and given the treatments of mechanical ventilation, sedatives, analgesics and so on.
The patient finally recovered consciousness / showed obvious enhancement of breath sounds in both
lungs.

Bilateral chest drainage tube being pulled out.

1 July 2016

The patient was transferred into a general ward.

Discharge

The patient was in good condition at the time of discharge with no discomfort or feelings of pain.

Writing Task:

Using the information provided in the case notes, write a letter to head nurse, Sylvia Dian, at Max Care
Center, 1a Chase Side, London N14 5BP, UK who will be responsible for Mr Zoel’s continued care at the
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.

Answer

05 /August/ 2016

Ms Sylvia Dian

Head Nurse

Max Care Centre

La Chase Side

London N145BP

UK

Dear Ms Sylvia Dian,

Re: Mr Samuel Zeol, aged 63

Mr Samuel Zoel, who was treated for bilateral pneumothorax, is being discharged back to your
care, as he requires ongoing care to maintain his well being.

When Mr.Zoel was brought to the hospital on 29 June, 2016 he had severe cold sweats and
shortness of breath. He was found to be in moderate coma state with 76% of percutaneous
oxygen saturation. On physical examination, his vital signs were noted to be deranged. Cyanosis
over skin and mucous memberane and ecchymosis on the skin of neck and shoulder were noted.
In addition, dull heart sounds and reduced breathing on both sides of thorax were found on
auscultation . A computed tomography scan of chest revealed bilateral pnemothorax of the
lungs.

Mr Zoel’s condition was stabilised with simple respirator assisted ventilation. Inaddition a
closed thoracostomy was performed to treat pneumothorax and a chest drainage tube was
inserted. After the procedure it was noted that, his oxygen saturation retained to 96%. Also he
was treated with analgesics and sedatives. Later he gained consciousness and showed
enhancement of breath sounds in both lungs. Hence, he was shifted to a general ward after
removal of chest tubes. Currently, his symptoms and distress subsided.

In this regard, Mr. Zoel requires continued care from your provision to maintain optimal health
status.

Please do not hesitate to contact me for further clarifications.

Yours sincerely,

Head nurse
WRITING TEST

Time allowed : 40 minutes

Today’s Date

10/07/09

Notes

Betty Olsen is a resident at the Golden Pond Retirement Village. She needs urgent admission to hospital.
You are the night nurse looking after her.

Patient Details

Address : Golden Pond Retirement Village

83, Waterford Rd, Annerley, 4101

Phone : (07) 3441 3257

Date of Birth : 29/01/1926

Marital Status : Widowed

Country of birth : Australia

Social History

Moved to Retirement Village following the death of husband in December 2007.

Next of kin : Son, Nicholas Olsen

53, Palmer Street, Warwick 4370

Ph (07) 4693 6552

Normally alert and orientated. Enjoys bridge, bingo and reading.

Medical History

Hypothyrodism since 1997

Hypertension since 2003
Glaucoma since 2004
Allergic to penicilin

Prescription medications

Karvea 150mg 1 daily

Oroxine 0.1mg 1 daily
Timoptol Eye Drops 0.5% 1 drop each eye am & pm.
Normison 10mg as required

Non Prescription medications

Golden Glow Glucosamine Tablet – 1 with breakfast for arthritis

Vitamin C Complex Sustained Release – 1 with breakfast.

Mobility/ Aids

Independent with walking sticks. Arthritis in hands. Wears glasses.

Continence : Requires continence pad.

Recent Nursing Notes

16/05/09
Flu vaccination

29/06/09
Complaining of indigestion following evening meal. Settled with Mylanta.

07/07/09
Unable to sleep – aches in shoulder. Settled following 2 Panadol and 1 Normison.

09/07/09
Requested Mylanta for indigestion, Panadol for shoulder pain – slept poorly.

10/07/09 am
Tired and feeling generally weak. BP 180/95. Confined to bed. GP called and will visit 11/07/09 after
surgery.

10/07/09 pm
Didn’t eat evening meal. Says felt slightly nauseous. Trouble sleeping, complaining of shoulder and neck
pain. BP 175/95 Given 1 Normison 2 Panadol at 10pm
Rechecked 10.45pm – Distressed, pale and sweaty, comlaining of persistent chest pain, BP 190/100.
Ambulance called and patient transferred.

Writing Task
Write a letter for the admitting doctor of the Spirit Hospital Emergency Department. Give the recent
history of events and also the patient’s past medical history and condition.
Answer

10 /July/ 2009

The admitting Doctor

Emergency Department

Spirit Hospital

Dear Doctor,

Re: Ms Betty Olsen

DOB: 29 January, 1926

Ms Betty Olsen, a hypertensive client with persistent chest pain, is being transferred to your
care, as she requires immediate assessment and treatment at your provision.

Ms Olsen is a resident at Golden Pond Retirement village. She had tiredness and weakness today
morning and was confined to bed. At that time her blood pressure was 180/35mmhg. Later in
the evening, she refused meal as a result of nauseousness . She was also unable to sleep due to
shoulder and neck pain, which were treated with medications such as Nomison and Panadol.
Apart from the persistent chest pain , she was found to be pale and sweaty when she was
reassed at 10.45 pm. As her overall condition deteriorated, she is being referred to your facility
for an immediate admission.

In context of Ms Olsen past medical history, she has had hypothyroidism, hypertension and
glaucoma since 1997, 2003 and 2004 respectively. She is on regular medications for the same
.Importantly; she is allergic to pencillin and is on medications such as vitamin c and
glucosamine. She has athiritis in her hands. She also uses walking stick and wears glasses.

In this regard, you are requested to assess Ms Olsen condition and provide management as you
feel appropriate.

Thank you for accepting this referral. Should you require any clarifications, please do not
hesitate to contact me.

Yours sincerely,

Registered Nurse
WRITING TEST

Time: Reading – 5 minutes, Writing – 40 minutes

Read the case note below and complete the writing task which follows:

You are a nurse at Melbourne City Hospital.

Today’s Date : 3rd November, 2015

Personal Details : Jade Isow

D.O.B : 12th August, 2006

Date of admission : 2nd November, 2015

Date of Discharge : 3rd November, 2015

Social History : Lives with parents and younger brother in two bedroom house.

Medical History : No significant medical history

No known allergies to any drug or food item.

Reason of presenting : Fall onto an outstretched arm, pain, tenderness, bruising and swelling, wrist
hangs in an odd or bent way.

Diagnosis : Distal radius fracture

Treatment : X-rays of the wrist

Plaster cast applied
Analgesics and anti-inflammatory drugs : Ibuprofen and Acetaminophen to relieve pain and
inflammation.
Advice : Child may be sore for several days.
If child is in pain, please give painkillers as directed.
Please be sure not to overdose him nor he becomes addicted to the medicines.
May give painkillers regularly for the first 2-3 days as needed.

Child can go back to school as soon as he feels well enough.

X-ray after 3 weeks
Start Physiotherapy to help him improve the motion and function of the injured wrist.

Cast must be kept dry. A plastic bag over the arm while showering. If the cast does become
wet, it will not dry very easily.
A hair dryer on the cool setting may be helpful.

Child can resume light activities, such as swimming or exercising the lower body in the gym
 within 1 to 2 months after the cast is removed.
Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after
the injury.

Cast to be removed after about 6 weeks if no complication.

If you donot understand the advice provided, please speak to a member of the nursing staff or
doctors. If child suffers a lot of pain at home that does not get better with the painkillers,
please contact the doctor.

Writing Task

Write a letter of advice to Mr & Mrs Isow, 4/445 Hawlock St., Rokewood, Melbourne 3008 VIC
following discharge of their son, Samy, from the hospital.

In your answer

 Expand the relevant notes into complete sentences.

 Do not use note form.
 Use letter format.
Answer

03 November, 2015

Mrs and Mr Isow

4/445 Hawlock st

Rockwood

Melbourne 3008 VIC

Dear Mrs and Mr Isow,

Sub: Advice on your son’s care at home

As your son Jade Isow is being discharged home, I am briefing his current health status and the
care requires for your perusal.

During hospitalization, plaster cast was applied to him, as he had fracture to his forearm, which
was revealed on an x-ray. He was treated with medications such as ibuprofen and
acetaminophen to relieve pain and swelling. Jade recovers now and can go back to school as
soon as he feels well enough. Please note he may have pain for several days, for that painkillers
can be given as directed. However he should not be overdosed.

Though the child is able to do light activities within one to two months, vigorous activities such
as skiing or football can be resumed between three to six months. The applied cast must be kept
dry and you are requested to cover the site with plastic bag while showering. A hair dryer on the
cool setting may be helpful if it does become wet.

In view of above an x-ray is suggested after three weeks and his cast can be removed after six
weeks if there is no complications. It is important to initiate physiotherapy to improve the
motion and function of her injured wrist.

You are free to contact the nursing staff or doctors, if you need any clarification or assistance.

Yours sincerely,

Charge Nurse

Melbourne City Hospital

WRITING TEST

Time : Reading – 5 minutes , Writing – 40 minutes

Read the case notes below and complete the writing task which follows :

Information Letter

Notes :

You are a Community Nurse working in the Department of public Health and Awareness Camp , in
Melbourne ,Australia .

Background: Ebola is an infectious fatal disease marked by fever and severe internal bleeding spread
through contact with infected body fluids by a file virus (Ebola virus),whose normal host species is
unknown.

The spread of Ebola and its fatality has threatened Australian cities and the government has started
awareness campaigns for the forever safety of local people .

Ebola-case contacts:

Any person having been exposed to suspect ,probable or confirmed case of Ebola in at least one of the
following ways :

 Has slept in the same household with a case

 Has had direct physical contact with the case (alive or dead ) during the illness
 Has had direct physical contact with the (dead) case at the funeral
 Has touched his/her body or body fluids during the illness
 Has touched his/her cloths or lines
 Has been breastfed by the patient (baby)

Provided that this espouse has taken place less than 21 days before the identification as a contact by
surveillance teams .

Contact of dead or sick animals :

Person exposed to a sick or dead animal in at least one of the following ways :

Direct physical contact with the animal, expose to infected animal , contact with the animal’s blood or
body fluids ,eating raw fresh meat of stick animals.
Laboratory contacts :

Any person having been exposed to biological material in a laboratory in at least one of the following
ways :

 Has had direct contact with specimens collected from suspected Ebola patients .
 Has had direct contact with specimens collected from suspected Ebola animal cases

Provided that exposure has taken place less than 21 days before the identification as contact
surveillance teams.

Writing Task :

Using the information given above , write a letter to Mr .Martin John, Social Worker , Peace Way
Suburbs Health Clinic to conduct an awareness class for a group of Melbourne residents , many of whom
work in airline industry .

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

Answer

05/ July /2019

Mr Martin John

Social Worker

Peace Way Suburbs Health Clinic

Dear Mr Martin John,

Subject: To conduct an awareness class

Thank you for accepting the invitation to conduct an awareness class on the outbreak of Ebola
to a group of Melbourne residents.

As you are aware, the spread of Ebola has threatened Australian cities and the government has
started awareness campaigns. As Ebola is highly contagious and fatal disease, it is important for
Melbourne residents to know about its mode of transmissions and preventive measures. Ebola is
an infectious disease with the symptoms of fever and internal bleeding. It spreads through
contact with Ebola cases such as, contact with body fluids, direct physical contact or through
breast feeding by an infected mother

In addition, kindly educate on the other modes of transmission of Ebola such as contact with a
sick or dead animal or its body fluids, or consuming raw meat of sick animal. A person, who has
been exposed to biological materials such as, specimens collected from suspected patients or
animals, is also at risk of contracting the infection. Importantly, Ebola exposure takes place
within 21days of contact through suspected or confirmed cases.

If you have any queries, please contact me. Appreciating your effort to educate the residents.

Yours faithfully,

Community nurse

Public health and awareness camp

WRITING TEST

Time : Reading – 5 minutes , Writing – 40 minutes

Read the case notes below and complete the writing task which follows :

CASE NOTES

Name Mrs. Taylor Chapman

Age :38 years old

Family and social history

Marketing Manager ,married ,one child (four –year –old boy)

Medical history

Unremarkable ,no medications

11/07/05

Complaints of tiredness ,difficulty sleeping for 2 months due to work stress plans another child for 12
months ,currently on oral contraception pill (OCP)

P\E : Appears pale, tired and slightly restless.

Bp140\80 mmttg

Assessment:stress –related anxiety

Plan : advised relaxation techniques , reduce working hours ,prescribe sleeping tablets tds

15/08/06

Stopped OCP 4 months earlier .still menstruating

Worried

Sleep still difficult , stress unchanged ,not possible to reduce hours.

P/E:Tired –looking ,slightly restless

Assessment : work stress, growing anxiety failure to conceive

Plan : discussed nature of conception – takes time patience

Discussed frequency sexual intercourse

Discussed methods – temperature /cycle

18/01/07

Expressed anxiety re failure to conceive , says she’s too “old”

Sleep still problem

P/E:crying ,pale,fidgety

Vital signs / general exam NAD

Pelvic exam, Pap smear

Assessment : as per previous consultation

Improper prescription

Suggested she re- present next week accompanied by husband

25/01/07

Mr.Chapman very supportive of having another child

No erectile dysfunction, libido normal

Mr.Chapman normal

Plan : Check Mr. Chapman’s sperm count

02/02/07

Sperm count normal, Plan : Refer for specialist advice

WRITING TASK

Using the information in the case notes, write a letter of referral to Dr Lucy Clooney, a Gynecologist , at
123 Church St, Richmond 3121

In your answer :

 Expand the relevant notes into complete sentences

 Do not use note form
 User letter format

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

Answer

02 February, 2007

Dr Lucy Clooney

Gynecologist

123 Church st

Richmond 3121

Dear Dr Lucy Clooney,

Re: Mrs Taylor Chapman

Age: 38 years

Mrs Chapman, who is anxious about repeated failure to conceive a second child is being referred
to your care, as she requires further advice from you.

Mrs Chapman has a four- year old son and is planning to have another child. Mr Chapman’s
sperm count is normal as per the reports. It was noted that he has no erectile dysfunction and
has normal libido. However she failed to have a second pregnancy. She was pale, anxious and
complained about persisting sleeping problem, when she visited on 18 January 2007. Inaddition
pelvic examination and Pap smear was done at that time.

She was on oral pills, when she presented initially 2 years back on 11 July 2005, as they wish to
have their next baby after twelve months. She complained of tiredness and difficulty to sleep
due to work stress. On her second visit after one year, she was worried as she was still
menstruating, though she stopped the ocp four months earlier. Apart from the methods,
nature and frequency of conception also were discussed with her.

Your attention towards this case is greatly appreciated. Please feel to contact in case of any
queries.

Yours sincerely,

Charge Nurse