What is the OET format?

Four sub-tests. Listening (about 45 minutes, 42 items) and Reading (60 minutes, 42 items) are the same for every profession. Writing (about 45 minutes) and Speaking (about 20 minutes) are specific to yours — these questions are written for NURSING. Reading Part A is separately timed: 15 minutes to find specific information across four short texts on one clinical topic. Parts B and C share the remaining 45 minutes. Listening runs in three parts: extracts from consultations, then short workplace extracts, then presentations and interviews. Writing is one letter built from case notes — usually a referral, discharge or transfer letter. You are marked on what you chose to leave OUT as much as what you put in. Speaking is two role-plays with an interlocutor, based on cards from your own profession. Each sub-test is scored 0–500 in 10-point steps and reported as a grade from A to E. 350 is Grade B, which is the bar nearly every regulator sets. The NMC (UK) alone accepts Grade C+ — 300 or above — in Writing, with Grade B (350) in Reading, Listening and Speaking. AHPRA, NMBI and the Nursing Council of New Zealand do not — they want 350 in all four. Scores must be under two years old when you apply for registration.

Are these OET practice questions free?

Yes. All 300 questions, with answers and explanations, are on one page with no sign-up, no login and no paywall. The page works with JavaScript switched off and once loaded it works offline.

Where do these questions come from?

They were written by language models and then cross-checked: every question was sent back to a different model with the answer removed, and only the ones where the second model independently chose the same answer are on this page. 224 of 300 have passed that check. Nobody who has sat the OET has reviewed them yet, so treat them as practice, not as an official answer key.

OET Practice Questions 2026 — Free, with Answers and Explanations

Q: What is the OET and who takes it?

Occupational English Test — Nursing, set by Cambridge Boxhill Language Assessment. Nurses registering to work in the UK (NMC), Australia (AHPRA/NMBA), Ireland (NMBI), New Zealand, Singapore and the Gulf. If you are applying to a university rather than a nursing register, you probably want IELTS instead.

Read this before you trust an answer. These questions were written by language models, not cut from past papers. Every one was then sent back to a different model with the answer hidden, and only the ones where the second model independently picked the same answer are on this page — 224 of 300 so far. That is a floor, not a guarantee: two models can agree and still be wrong, and nobody who has sat the OET has reviewed these yet. Use them to practise the shape of the test. For the official format and scoring, go to Cambridge Boxhill Language Assessment. Found a wrong answer? Tell us and we will pull it.

What the OET actually is

Four sub-tests. Listening (about 45 minutes, 42 items) and Reading (60 minutes, 42 items) are the same for every profession. Writing (about 45 minutes) and Speaking (about 20 minutes) are specific to yours — these questions are written for NURSING.
Reading Part A is separately timed: 15 minutes to find specific information across four short texts on one clinical topic. Parts B and C share the remaining 45 minutes.
Listening runs in three parts: extracts from consultations, then short workplace extracts, then presentations and interviews.
Writing is one letter built from case notes — usually a referral, discharge or transfer letter. You are marked on what you chose to leave OUT as much as what you put in.
Speaking is two role-plays with an interlocutor, based on cards from your own profession.
Each sub-test is scored 0–500 in 10-point steps and reported as a grade from A to E. 350 is Grade B, which is the bar nearly every regulator sets.
The NMC (UK) alone accepts Grade C+ — 300 or above — in Writing, with Grade B (350) in Reading, Listening and Speaking. AHPRA, NMBI and the Nursing Council of New Zealand do not — they want 350 in all four.
Scores must be under two years old when you apply for registration.

Nurses registering to work in the UK (NMC), Australia (AHPRA/NMBA), Ireland (NMBI), New Zealand, Singapore and the Gulf. If you are applying to a university rather than a nursing register, you probably want IELTS instead.

Tap an option to check it. Your score appears here.

Reading Part A — finding it fast 30 questions

Part A is a SEARCH task under time pressure, not a comprehension task: four short texts on one clinical topic (say, pressure ulcer staging, or paediatric fluid maintenance) and 15 minutes to locate specific facts.

Guideline for pressure ulcer prevention: 1. Reposition patient every 2 hours. 2. Use a pressure‑relieving mattress if ulcer stage I or greater. 3. Apply barrier cream twice daily. 4. Conduct skin inspection at least once per shift. 5. Document ulcer size weekly. 6. If ulcer progresses to stage III, refer to wound‑care specialist within 24 hours.
1. How often should a patient be repositioned to prevent pressure ulcers?
Answer: B. The guideline states 'Reposition patient every 2 hours.' The correct figure is 2 hours. Other options are plausible but not stated.
Hospital policy on venous thromboembolism (VTE) prophylaxis: Mechanical prophylaxis (compression stockings) is mandatory for all surgical patients immobilised >12 hours. Pharmacological prophylaxis (low‑molecular‑weight heparin) is given 12 hours post‑operatively, unless platelet count <100,000/µL, in which case it is delayed until count rises above that threshold. The prophylaxis course continues for a minimum of 5 days or until patient is fully ambulating, whichever is longer.
2. If a patient’s platelet count is 90,000/µL on day 2 post‑op, when should pharmacological prophylaxis be started?
Answer: C. Policy states prophylaxis is delayed until platelet count rises above 100,000/µL. Therefore the correct answer is C. Options A and B misread the threshold; D misinterprets delay as absolute contraindication.
Guideline for managing stage II pressure ulcers: - Initial assessment: wound size 2–4 cm, depth 0.5–1.0 cm, presence of erythema. - Debridement: enzymatic agents may be used if necrotic tissue is present. - Dressing: non‑adhesive foam dressing applied once daily. - Re‑assessment: wound dimensions measured every 48 hours. - Antibiotic therapy: indicated if purulent exudate or systemic signs of infection. - Off‑loading: patient repositioned every 2 hours. - Nutrition: protein intake increased to 1.5 g/kg body weight per day. - Follow‑up: wound healing expected within 4 weeks if risk factors controlled.
3. How often should the dressing be applied in stage II pressure ulcer management?
Answer: B. The passage states that a non‑adhesive foam dressing is applied once daily, which is equivalent to every 24 hours. The other options refer to re‑assessment intervals or are not mentioned.
Paediatric fluid maintenance guideline for children 2–12 years: - Baseline fluid requirement: 30 mL/kg/day. - Maintenance fluid rate: 100 mL/kg/day for 0–24 hours, then 75 mL/kg/day for 24–48 hours. - Electrolyte balance: serum sodium monitored every 12 hours. - Hypotension: treat with 20 mL/kg isotonic crystalloid bolus. - Diuretic therapy: not initiated until urine output >1 mL/kg/h for 6 hours. - Transition to oral intake: when the child tolerates 50% of maintenance fluids orally for 24 hours.
4. What is the recommended serum sodium monitoring interval in this paediatric fluid maintenance guideline?
Answer: A. The passage explicitly states that serum sodium is monitored every 12 hours. The other intervals are not mentioned in the guideline.
Drug monograph: Cefuroxime axetil 250 mg tablets. - Indications: uncomplicated urinary tract infection, skin and soft tissue infection. - Adult dose: 250 mg orally twice daily. - Paediatric dose: 25 mg/kg orally twice daily, maximum 500 mg per dose. - Contraindications: hypersensitivity to cephalosporins, severe renal impairment (eGFR <30 mL/min). - Adverse reactions: nausea, diarrhea, rash. - Drug interactions: increased risk of nephrotoxicity with aminoglycosides. - Monitoring: serum creatinine every 7 days for the first month.
5. What is the maximum single dose of cefuroxime axetil allowed for a child?
Answer: B. The monograph states the maximum paediatric dose is 500 mg per dose. The other figures are either the adult dose or not mentioned.
Policy note on antibiotic stewardship in the ICU: - Broad‑spectrum antibiotics should be initiated within 1 hour of sepsis diagnosis. - Empiric therapy: vancomycin 15 mg/kg IV every 12 hours plus piperacillin‑tazobactam 4.5 g IV every 8 hours. - De‑escalation: review culture results at 48 hours; if negative, discontinue vancomycin. - Duration of therapy: 7 days for uncomplicated infections, 10 days for complicated infections. - Monitoring: serum trough levels of vancomycin every 48 hours. - Documentation: antibiotic choice and duration recorded in the electronic health record.
6. At what time point should vancomycin be discontinued if cultures are negative?
Answer: B. The policy states that vancomycin should be discontinued after a 48‑hour review if cultures are negative. The other times are not specified for de‑escalation.
Guidelines for Management of Community-Acquired Pneumonia in Children (Under 5 Years)
7. According to the guidelines, what is the minimum age for a child to be considered for outpatient treatment of community-acquired pneumonia?
Answer: A. The text states: 'Children aged 12 months or older with mild to moderate CAP may be managed as outpatients.' This directly answers the question about the minimum age for outpatient treatment.
Guideline for Management of Type 2 Diabetes Mellitus
8. What is the target HbA1c level that patients with Type 2 Diabetes Mellitus should aim to achieve, according to this guideline?
Answer: A. The guideline states: 'The target HbA1c for most patients with Type 2 Diabetes Mellitus is below 7.0%.' This identifies the specific target value for HbA1c.
Community Nursing Guidelines for Venous Leg Ulcers. Compression Therapy Protocol: Full-support multi-layer compression bandaging is indicated for patients with an Ankle Brachial Pressure Index of 0.8 to 1.3. For patients with an ABPI between 0.6 and 0.79, reduced compression of 20 to 30 mmHg is permitted. Bandages must be changed weekly during the initial active treatment phase, though weeping wounds may require twice-weekly visits. Assessment of underlying arterial status must be repeated every twelve months for stable chronic patients, or immediately if new ischaemic symptoms develop. Referral to a vascular specialist is mandatory if ABPI falls below 0.6.
9. What is the minimum Ankle Brachial Pressure Index value required to safely apply full-support multi-layer compression bandaging?
Answer: B. Scan for full-support multi-layer compression bandaging. The text states it is indicated for patients with an ABPI of 0.8 to 1.3, making 0.8 the minimum value. Option A is the threshold for specialist referral, Option C is within the range, and Option D is the upper limit.
Hospital Policy on Postoperative Nausea and Vomiting Management. First-line rescue therapy for adult patients experiencing PONV within 6 hours of general anaesthesia is ondansetron 4 mg intravenously. If nausea persists after 30 minutes, a second-line agent such as droperidol 0.625 mg IV may be administered. Prophylactic intravenous dexamethasone 8 mg is given at the induction of anaesthesia for patients deemed high risk, provided fasting blood glucose is below 11 mmol/L. Continuous monitoring of cardiac rhythm via telemetry is required for 24 hours following any administration of droperidol due to QT interval prolongation risks.
10. How long must a patient be monitored via cardiac telemetry after receiving droperidol according to the policy?
Answer: C. Locate droperidol in the text. The policy states continuous monitoring via telemetry is required for 24 hours following any administration of droperidol. Option A is the timeframe for first-line rescue therapy, Option B is a distractor not in the text, and Option D overstates the duration.
Enteral Nutrition Administration Protocol via Nasogastric Tube. Gastric residual volumes must be checked every 4 hours during the first 48 hours of continuous feeding, and every 8 hours thereafter once feeding is established. If the measured GRV exceeds 500 mL on two consecutive checks, feeding must be temporarily suspended and the clinician notified. Flushes of 30 mL sterile water should be administered before and after intermittent bolus feeds, and at least once every 6 hours during continuous infusions to maintain patency. Head of bed elevation must be maintained at a minimum of 30 degrees at all times during formula delivery.
11. What is the maximum gastric residual volume threshold that, if exceeded twice consecutively, requires temporary suspension of feeding?
Answer: D. Scan for gastric residual volume thresholds and feeding suspension instructions. The text specifies that if GRV exceeds 500 mL on two consecutive checks, feeding must be suspended. Options A, B, and C are incorrect volumes that do not appear in relation to suspending feeds.
Management of Anaphylaxis in Adult Inpatients. Immediate intramuscular injection of adrenaline 0.5 mg into the mid-anterolateral thigh is the primary intervention for acute anaphylactic reactions. Vital signs, including blood pressure, pulse, and oxygen saturation, must be recorded every 5 minutes until the patient is completely stable. If no clinical improvement is observed after 5 minutes, a repeat dose of intramuscular adrenaline may be administered. Intravenous fluid resuscitation with normal saline 20 mL/kg should be initiated rapidly if hypotension persists despite two doses of adrenaline. Continuous pulse oximetry and supplemental oxygen at 15 litres per minute via a non-rebreather mask are mandatory throughout the acute phase.
12. What is the required time interval between intramuscular adrenaline doses if the initial clinical response is inadequate?
Answer: A. Scan the protocol for repeat adrenaline doses. The text explicitly states that if no clinical improvement is observed after 5 minutes, a repeat dose of intramuscular adrenaline may be administered. Option A matches this timeframe, while the other options represent incorrect intervals.
Patients undergoing elective surgery who are at high risk of venous thromboembolism (VTE) should receive pharmacological prophylaxis. For patients at moderate risk, prophylaxis should be considered. Mechanical prophylaxis, such as graduated compression stockings or intermittent pneumatic compression devices, is recommended for all patients undergoing major orthopaedic surgery, regardless of VTE risk. For patients undergoing general surgery, mechanical prophylaxis should be used in those at high risk of VTE. Prophylaxis should commence pre-operatively, ideally within 24 hours before surgery, and continue for at least 7 days post-operatively, or until the patient is fully mobile. For patients receiving mechanical prophylaxis with graduated compression stockings, they should be measured and fitted correctly to ensure optimal effectiveness. Patients should be advised to wear them continuously, removing them only for hygiene purposes once daily. The stockings should be replaced every 6 months or if they lose their elasticity.
13. For patients undergoing general surgery, when should mechanical prophylaxis ideally commence?
Answer: C. The passage states, 'Prophylaxis should commence pre-operatively, ideally within 24 hours before surgery'. Option A is incorrect as it refers to the duration post-operatively. Option B is incorrect as it describes when prophylaxis can stop. Option D refers to the removal of compression stockings for hygiene, not the commencement of prophylaxis.
The management of acute decompensated heart failure (ADHF) requires prompt assessment and treatment. Initial management focuses on improving oxygenation and haemodynamics. Intravenous diuretics are the cornerstone of therapy for patients with fluid overload. A typical starting dose for furosemide in patients not previously on diuretics is 40 mg. For patients already receiving oral diuretics, a dose equivalent to 1-2.5 times their home dose should be administered intravenously. If a patient does not achieve adequate diuresis with the initial dose, it can be repeated every 4-6 hours. In patients with severe renal impairment, higher doses may be required, and continuous infusion of furosemide may be considered. Monitoring of electrolytes, particularly potassium and magnesium, is crucial during treatment.
14. What is the recommended initial intravenous dose of furosemide for a patient not previously on diuretics?
Answer: B. The passage explicitly states, 'A typical starting dose for furosemide in patients not previously on diuretics is 40 mg.' Option A is incorrect as this dose is for patients already on oral diuretics. Option C is incorrect for the same reason as A. Option D is a consideration for patients with severe renal impairment, not a standard initial dose.
Post-operative pain management following major abdominal surgery aims to provide adequate analgesia while minimising side effects. Patient-controlled analgesia (PCA) with opioids is a common method. Morphine is frequently used, with a typical bolus dose of 1-2 mg every 5-15 minutes as needed. A background infusion may also be prescribed, usually at a rate of 0.5-1 mg/hour. The maximum hourly dose should not exceed 10 mg. For patients experiencing breakthrough pain despite PCA, additional boluses can be given. Regular assessment of pain scores and sedation levels is essential. If the patient is unable to use PCA due to sedation or confusion, alternative methods like intermittent intramuscular or intravenous injections should be considered.
15. What is the maximum hourly dose of morphine that should be administered via PCA?
Answer: C. The passage clearly states, 'The maximum hourly dose should not exceed 10 mg.' Option A describes the bolus dose parameters. Option B describes the background infusion rate. Option D is not a specified dose limit in the text.
The management of severe sepsis and septic shock requires adherence to established guidelines to improve patient outcomes. Following initial fluid resuscitation, vasopressor therapy should be initiated if the patient remains hypotensive despite adequate fluid volumes. Norepinephrine is typically the first-line vasopressor. The initial dose is usually 0.01-0.1 mcg/kg/min, titrated to maintain a mean arterial pressure (MAP) of at least 65 mmHg. If norepinephrine alone is insufficient to achieve the target MAP, vasopressin may be added at a dose of 0.03 units/min, or phenylephrine may be used in specific circumstances. Dopamine is generally reserved for patients with bradycardia or specific contraindications to norepinephrine. Regular reassessment of haemodynamic status is vital.
16. What is the minimum target Mean Arterial Pressure (MAP) that should be maintained in patients with septic shock?
Answer: B. The passage states that vasopressors should be titrated 'to maintain a mean arterial pressure (MAP) of at least 65 mmHg.' Option A refers to the initial dose range of norepinephrine. Option C refers to the dose of vasopressin. Option D is a condition for considering dopamine, not a target MAP.
Emergency Department Clinical Guideline: Management of Acute Anaphylaxis in Adults. Initial Assessment: Assess airway, breathing, circulation, and disability immediately. Administer adrenaline (epinephrine) 1 in 1000 (1 mg/mL) 0.5 mL intramuscularly into the anterolateral thigh every 5 minutes as required according to patient response. For refractory cases, commence an intravenous adrenaline infusion at 0.05 micrograms per kilogram per minute. Secondary Measures: Administer chlorphenamine 10 mg by slow intravenous or intramuscular injection over 1 minute. Administer hydrocortisone 200 mg slowly intravenously over 3 minutes. Observation: Patients must be observed in a clinical setting for a minimum of 6 hours following full resolution of the acute reaction before discharge is considered.
17. What is the required time interval between intramuscular adrenaline doses if the initial clinical response is inadequate?
Answer: B. Scan for intramuscular adrenaline and the interval instruction. The text states: administer adrenaline 1 in 1000 0.5 mL intramuscularly into the anterolateral thigh every 5 minutes as required. The other options are numbers appearing elsewhere in the text representing injection duration (1 minute, 3 minutes) or observation time (6 hours).
Inpatient Opioid Management Policy: Patient-Controlled Analgesia (PCA). Prescribing Parameters: Morphine is the standard first-line agent for PCA delivery. The recommended initial loading dose is 2 to 5 milligrams administered slowly by the nursing staff. The baseline or background infusion rate is typically set to zero milligrams per hour, though up to 1 milligram per hour may be permitted for opioid-tolerant patients by consultant approval. The demand dose should be programmed between 1 and 2 milligrams. The lockout interval must be set strictly to 5 minutes. The maximum cumulative dose limit must not exceed 20 milligrams of morphine per hour under any circumstances. Monitoring and Safety: Record sedation scores every 15 minutes for the first hour, then every hour.
18. What is the maximum hourly dose of morphine that should be administered via PCA according to the policy?
Answer: C. Scan for maximum hourly dose of morphine. The text states: The maximum cumulative dose limit must not exceed 20 milligrams of morphine per hour under any circumstances. Other figures like 1, 2, and 5 refer to background rates, demand doses, or loading doses, which trap candidates reading too quickly.
Clinical Protocol: Vasopressor Therapy in Septic Shock. Hemodynamic Goals: Fluid resuscitation must be completed or optimized before initiating vasopressors. Norepinephrine is the first-line vasopressor of choice and should be infused via a central venous catheter to restore and maintain vascular tone. The primary therapeutic target is to maintain a Mean Arterial Pressure (MAP) of at least 65 mmHg in all adult patients. If MAP remains below the target despite adequate fluid loading and initial norepinephrine titration, add vasopressin at a fixed rate of 0.03 units per minute. Secondary target parameters include a central venous pressure between 8 and 12 mmHg and a urine output greater than 0.5 mL per kilogram per hour. Titrate norepinephrine down as shock resolves.
19. What is the minimum target Mean Arterial Pressure that should be maintained in patients with septic shock?
Answer: D. Scan for Mean Arterial Pressure (MAP) target. The text explicitly states: The primary therapeutic target is to maintain a Mean Arterial Pressure (MAP) of at least 65 mmHg in all adult patients. Distractors are other numerical values present in the text (0.03, 0.5, 12) associated with different clinical parameters.
Surgical Ward Guidelines: Venous Thromboembolism (VTE) Prophylaxis. General Principles: All surgical inpatients must undergo formal VTE risk assessment on admission. Mechanical prophylaxis in the form of anti-embolism stockings or intermittent pneumatic compression devices should be applied to both lower limbs upon admission and maintained continuously until the patient is fully ambulatory. Pharmacological prophylaxis using low molecular weight heparin (e.g., enoxaparin 40 mg subcutaneously once daily) should generally commence 12 hours before surgery or within 12 hours postoperatively, depending on the bleeding risk profile determined by the surgical team. Early mobilization is encouraged for all patients starting on postoperative day 1.
20. For patients undergoing general surgery, when should mechanical prophylaxis ideally commence according to the guidelines?
Answer: C. Scan for mechanical prophylaxis and timing. The text states: mechanical prophylaxis... should be applied to both lower limbs upon admission and maintained continuously. The 12-hour and day 1 figures apply to pharmacological prophylaxis and mobilization, respectively, serving as distractors.
Guideline for paediatric fluid maintenance (per kg per hour): 0-10 kg = 100 ml/kg/day; 11-20 kg = 50 ml/kg/day; >20 kg = 30 ml/kg/day. Convert to hourly rates by dividing by 24. For a child weighing 8 kg, the maintenance fluid is 100 ml/kg/day × 8 kg = 800 ml/day, which equals 33 ml/hour. For a child weighing 15 kg, the rate is 50 ml/kg/day × 15 kg = 750 ml/day, or 31 ml/hour. For an adult weighing 70 kg, the standard maintenance is 30 ml/kg/day, giving 2100 ml/day or 88 ml/hour.
21. According to the guideline, what is the hourly maintenance fluid rate for a child weighing 8 kilograms?
Answer: B. The passage states 100 ml/kg/day for 0-10 kg. 100 × 8 = 800 ml/day. Divide by 24 = 33.3 ml/hour, rounded to 33 ml/hour. Option B matches; other numbers are plausible but correspond to different weight categories or rounding errors.
National pressure ulcer staging policy (2023) outlines the following criteria: Stage I – non‑blanchable erythema of intact skin; Stage II – partial‑thickness skin loss involving epidermis and/or dermis, presenting as a shallow open ulcer with a red‑pink wound bed; Stage III – full‑thickness skin loss extending into subcutaneous tissue, may have undermining or tunnelling; Stage IV – full‑thickness tissue loss with exposed bone, tendon or muscle. The policy also specifies that a pressure ulcer documented as Stage II must be reassessed at least every 48 hours to monitor progression.
22. What is the minimum reassessment interval for a pressure ulcer documented as Stage II?
Answer: C. The passage explicitly states a reassessment at least every 48 hours for Stage II ulcers. Option C is correct; the other intervals are common distractors but not mentioned for Stage II.
Medication safety alert – Intravenous potassium chloride (KCl) administration: Concentration must not exceed 20 mEq per 100 ml. For patients with serum potassium <3.0 mmol/L, the recommended replacement dose is 10 mEq over 30 minutes, repeatable after 2 hours if needed. For serum potassium 3.0‑4.0 mmol/L, give 5 mEq over 30 minutes, repeatable after 4 hours. Do not exceed a total of 40 mEq in any 24‑hour period. The infusion must be given through a central line if the concentration is greater than 10 mEq per 100 ml.
23. What is the maximum total amount of potassium chloride that may be administered in a 24‑hour period?
Answer: C. The alert states the total must not exceed 40 mEq in any 24‑hour period. Option C matches; other values are plausible limits but are not the stated maximum.
Infection control policy for catheter‑related bloodstream infections (CRBSI): A catheter should be removed if any of the following occur: (i) positive blood culture with the same organism from two separate draws; (ii) catheter tip culture yields >15 colony forming units per high power field; (iii) patient develops fever >38°C persisting for more than 48 hours despite antimicrobial therapy; (iv) signs of local infection such as erythema, pain or purulent discharge at the insertion site. The policy also mandates that, when a catheter is removed due to CRBSI, a new line may be inserted after a minimum interval of 24 hours if the patient remains haemodynamically stable.
24. According to the policy, after how many hours must a new catheter be delayed following removal due to CRBSI, provided the patient is stable?
Answer: C. The passage specifies a minimum interval of 24 hours before a new line can be placed. Option C is correct; other intervals are common misconceptions but are not stated in the policy.
The management of acute pancreatitis requires prompt assessment and intervention. Initial fluid resuscitation is crucial. For patients presenting with mild pancreatitis, intravenous crystalloids should be administered at a rate of 5-10 mL/kg/hour for the first 12-24 hours. For severe pancreatitis, a more aggressive approach is indicated, with an initial bolus of 20 mL/kg of crystalloid followed by a continuous infusion of 3 mL/kg/hour. Monitoring of urine output is essential, aiming for at least 0.5 mL/kg/hour. Electrolyte balance should be maintained, with serum sodium levels targeted between 135-145 mmol/L. Pain management should be initiated early with intravenous opioids, and nasogastric decompression may be considered if vomiting is persistent or abdominal distension is severe.
25. What is the recommended hourly fluid infusion rate for patients with severe acute pancreatitis after the initial bolus?
Answer: C. The passage states that for severe pancreatitis, after an initial bolus, a continuous infusion of 3 mL/kg/hour should be administered. Option A refers to the rate for mild pancreatitis, option B is the initial bolus volume, and option D is the target urine output rate.
Management of Hypoglycaemia in Neonates: Neonates with a blood glucose level below 2.6 mmol/L require immediate intervention. If the neonate is asymptomatic and able to feed, a feed of expressed breast milk or formula should be offered. If the blood glucose remains below 2.6 mmol/L after feeding, or if the neonate is symptomatic (lethargic, jittery, poor feeding, or seizures), intravenous dextrose therapy should be commenced. The initial concentration for intravenous dextrose is typically 10%. The infusion rate should be started at 4-6 mg/kg/minute, adjusted based on blood glucose response. Continuous monitoring of blood glucose is essential, with targets generally between 2.6-4.4 mmol/L. If levels do not respond to initial therapy, the dextrose concentration may be increased to 12.5% or 15%, and the infusion rate can be escalated up to 8 mg/kg/minute. Prolonged or recurrent hypoglycaemia may require further investigation and management.
26. What is the maximum recommended intravenous dextrose infusion rate for neonates with persistent hypoglycaemia?
Answer: D. The passage indicates that the initial infusion rate is 4-6 mg/kg/minute, and this can be escalated up to 8 mg/kg/minute if levels do not respond. Option A is a blood glucose level threshold, option B is the initial infusion rate, and option C is the initial dextrose concentration.
Post-operative Pain Management Protocol: For patients undergoing major abdominal surgery, the following pain management strategy is recommended. Patient-Controlled Analgesia (PCA) with morphine is the preferred method for moderate to severe pain. The bolus dose is set at 1 mg, with a lockout interval of 6 minutes. A continuous background infusion is not routinely recommended unless patient-controlled demands are very high and frequent. For breakthrough pain not adequately controlled by PCA, additional boluses of 1 mg can be administered every 10 minutes, with a maximum of 4 additional doses in any 1-hour period. Non-opioid analgesics, such as paracetamol 1g every 6 hours, should be administered concurrently. Regular reassessment of pain score and sedation level is mandatory every 2 hours.
27. What is the maximum number of additional morphine boluses allowed for breakthrough pain within a one-hour period?
Answer: C. The text clearly states that a maximum of 4 additional doses can be given in any 1-hour period for breakthrough pain. Option A is the bolus dose amount, option B is the lockout interval for PCA, and option D is the reassessment interval.
Guideline for Venous Thromboembolism (VTE) Prophylaxis in Medical Patients: All adult medical patients admitted to hospital should be assessed for VTE risk within 24 hours of admission. Patients identified as having a low risk of VTE require no specific prophylaxis. For patients with moderate risk, pharmacological prophylaxis with low molecular weight heparin (LMWH) or unfractionated heparin (UFH) should be initiated. For high-risk patients, combination prophylaxis (pharmacological plus mechanical, such as graduated compression stockings) is recommended. Pharmacological prophylaxis, if indicated, should commence as soon as possible, ideally within 24 hours of admission, and continue until the patient is fully mobile or discharged. Mechanical prophylaxis, such as intermittent pneumatic compression devices, should be applied when the patient is at rest and removed during mobilisation. For patients with contraindications to pharmacological prophylaxis, mechanical methods should be used exclusively.
28. Within what timeframe should pharmacological VTE prophylaxis ideally commence for high-risk medical patients?
Answer: A. The passage states that pharmacological prophylaxis, if indicated, should commence as soon as possible, ideally within 24 hours of admission. Option B describes when prophylaxis should cease, option C refers to the use of mechanical prophylaxis, and option D is a plausible but less precise answer than the 'ideally within 24 hours' stated in the text.
Post-Operative Venous Thromboembolism Prophylaxis Guideline. Section 4: Pharmacological Interventions. Low Molecular Weight Heparin (LMWH) should be initiated at 20 milligrams subcutaneously once daily for patients with severe renal impairment (creatinine clearance below 30 millilitres per minute). For standard-risk general surgical patients with normal renal function, the standard prophylactic dose of enoxaparin is 40 milligrams subcutaneously once daily, commencing 2 hours pre-operatively or 6 hours post-operatively. For high-risk orthopedic procedures such as total hip replacement, the dose is increased to 40 milligrams subcutaneously once daily, commencing 12 hours pre-operatively or 12 hours post-operatively. Treatment duration typically ranges from 7 to 10 days, though extended prophylaxis up to 28 days may be indicated for major cancer surgeries.
29. What is the recommended once daily subcutaneous dose of enoxaparin for standard-risk general surgical patients with normal renal function?
Answer: B. To find the correct answer, scan the text for the terms general surgical patients and normal renal function. The text states that for standard-risk general surgical patients with normal renal function, the standard prophylactic dose of enoxaparin is 40 milligrams subcutaneously once daily. Option A is the dose for severe renal impairment. Options C and D refer to treatment durations rather than the dose amount.
Guideline for intravenous fluid therapy in adult patients with moderate dehydration: initial bolus of 500 ml isotonic saline over 30 minutes, followed by a maintenance infusion of 125 ml per hour. For paediatric patients (weight 5‑12 kg), the initial bolus is 20 ml/kg over 15 minutes, then a maintenance rate of 4 ml/kg per hour. The maximum total daily fluid volume should not exceed 3 litres in adults and 150 ml/kg in children. Re‑assessment of fluid status is required every 4 hours during the first 24 hours.
30. What is the maintenance infusion rate for an adult patient according to the guideline?
Answer: A. The passage states that after the initial bolus, adults receive a maintenance infusion of 125 ml per hour. Option B describes the bolus, C is the paediatric maintenance rate, and D is the maximum daily volume, so only A correctly answers the maintenance rate.

Reading Part B — workplace documents 35 questions

Six short workplace texts in the real test — a policy update, an equipment manual extract, an email to ward staff, a section of a care guideline — each with one three-option question about its MAIN POINT or its purpose.

Policy Update – Handovers (Effective 1 June 2024) All ward staff are reminded that the handover checklist will now include three mandatory sections: patient safety alerts, medication changes, and discharge planning status. The patient safety alerts section must be completed before any other items. Documentation of medication changes should be entered into the electronic drug chart within 30 minutes of the handover. Discharge planning status must be signed off by the responsible physiotherapist. Failure to comply will be recorded in annual performance reviews.
1. What is the main purpose of this policy update?
Answer: D. The document’s primary aim is to add a new mandatory patient safety alerts section to the handover checklist. The other statements are true details but not the reason the memo was written.
Equipment Manual – Portable Suction Device (Section 3.2) The device must be inspected weekly for battery integrity, filter condition, and tubing patency. Replace the battery if the charge indicator shows less than 20 per cent. Filters are to be changed after 50 uses or when resistance exceeds 150 mmHg. Tubing should be flushed with sterile water after each patient use and replaced after 30 days of continuous service. All maintenance records are to be logged in the equipment register within 24 hours of completion.
2. What is the main point of this equipment manual extract?
Answer: C. The extract’s central purpose is to state the specific criteria for replacing the battery, filter and tubing. The other options are accurate details but not the overarching reason for the passage.
Email to Ward Staff – Night Shift Staffing (12 May 2024) Dear Team, Please note that, with immediate effect, the night‑shift staffing levels will be increased from two nurses to three nurses per 12‑hour shift on the surgical ward. This change follows the recent audit which identified a 15 per cent increase in post‑operative complications during night hours. The additional nurse will be assigned to the high‑dependency area to ensure timely escalation of deteriorating patients. All shift managers are asked to update the roster by Friday and to inform agency providers of the new requirement. Thank you for your cooperation. Regards, Ward Manager
3. What is the primary purpose of this email?
Answer: B. The email’s main aim is to announce the new staffing levels and explain why the change is being made. The other options are true statements within the email but are secondary details.
Care Guideline – Pressure Ulcer Prevention (Version 4.0) All patients at risk of pressure injury must have a risk assessment completed within six hours of admission using the Waterlow tool. Repositioning schedules should be documented in the care plan and reviewed each shift. A pressure‑relieving mattress is required for any patient with a Waterlow score of 15 or higher. Staff must report any skin breakdown to the wound care team within two hours of detection. Training on the guideline is mandatory for all new hires and will be refreshed annually for existing staff.
4. What is the main point of this guideline excerpt?
Answer: A. The excerpt’s central purpose is to outline the procedures for assessing risk and repositioning patients to prevent pressure ulcers. The other options are specific requirements mentioned in the text but not the overall point.
Staff are reminded that the new handover protocol will be in effect from 1 October. The protocol introduces three changes: 1) all handover sheets must now include the patient’s current medication list; 2) the shift change nurse must sign a digital confirmation; and 3) any medication changes must be recorded in the electronic patient record within 30 minutes of the shift change.
5. Which statement best describes the main purpose of this memo?
Answer: B. The memo’s primary aim is to notify staff that a new handover protocol has been introduced. The other options describe specific details of the protocol, not its overall purpose.
The following is an excerpt from the ward’s infection control guideline: All staff must perform hand hygiene before and after patient contact. Hand hygiene should be performed using either an alcohol‑based hand rub or soap and water for at least 20 seconds. Failure to comply may result in disciplinary action.
6. What is the main point of this guideline excerpt?
Answer: C. The guideline’s core message is that hand hygiene is required before and after patient contact. The other statements are supporting details.
Dear Ward Team, Please note that the new patient transport policy will take effect next week. Under the policy, all patient transfers must be accompanied by a transport escort, and the escort must complete a brief safety briefing before each shift. Additionally, the policy requires that transport logs be updated in the central database by the end of each day. Thank you for your cooperation. Regards, Ward Manager
7. Which of the following best captures the main purpose of this email?
Answer: A. The email’s main purpose is to notify staff that a new policy has been introduced. The other options refer to specific elements of the policy.
Equipment Manual – Section 4.3: Ventilator Settings 1. The ventilator’s tidal volume should be set to 6 ml per kg of predicted body weight. 2. The respiratory rate must be adjusted to maintain an end‑tidal CO2 of 35–45 mmHg. 3. The inspiratory flow should be set to a square wave pattern. Failure to adhere to these settings may compromise patient safety and lead to ventilator‑associated lung injury.
8. What is the primary purpose of this equipment manual extract?
Answer: C. The extract’s main purpose is to provide the correct ventilator settings to ensure patient safety. The other statements are details or consequences rather than the core purpose.
MEMORANDUM To: All Nursing Staff From: Ward Manager, Ward 3B Date: 26 October 2023 Subject: Updated Patient Observation Schedule This memo serves to inform all nursing staff of an immediate update to the patient observation schedule, effective 0800 on 27 October 2023. Routine observations for all non-critical patients will now be conducted hourly between 0800 and 2000. Previously, these observations were conducted every two hours. Critical patients will continue to have observations as per their individual care plans. Please ensure all documentation reflects the new schedule. Any queries should be directed to the nurse in charge.
9. What is the primary purpose of this memorandum?
Answer: B. The memorandum explicitly states that routine observations for non-critical patients will now be conducted hourly instead of every two hours. Option A is incorrect because critical patients' observation schedules remain unchanged. Option C is a general reminder and not the primary purpose. Option D is incorrect as the change applies specifically to Ward 3B and not the entire hospital.
PATIENT CARE GUIDELINE: FALL PREVENTION Section 4.2: Mobility Assistance All patients identified as being at high risk of falls must be provided with appropriate mobility assistance when ambulating. This includes the use of walking frames, gait belts, and one-to-one supervision by nursing staff or a trained healthcare assistant. Staff must ensure that footwear is appropriate and non-slip. Patients should be encouraged to call for assistance if they need to mobilise, rather than attempting to do so independently. Regular review of mobility needs should be documented in the patient's care plan.
10. What is the main point of this guideline excerpt?
Answer: B. The excerpt focuses on the specific measures required for patients at high risk of falls when they are moving around, detailing the types of assistance and supervision needed. While options A, C, and D are true statements mentioned within the text, they are details supporting the main point, not the central message itself.
EQUIPMENT MANUAL EXTRACT: SYRINGE PUMP MODEL XP-500 Section 3: Priming the Pump Before connecting the infusion set to the patient, it is crucial to prime the pump correctly to eliminate air from the administration line. To do this, attach the infusion set to the pump and the medication bag. Open the pump's clamp and slowly advance the plunger using the manual control until the fluid reaches the end of the tubing. Ensure no air bubbles are visible. Once priming is complete, close the clamp and proceed with connecting the line to the patient's access device. Refer to Section 5 for troubleshooting air-in-line alarms.
11. What is the primary purpose of this extract?
Answer: C. The core instruction in this section is about 'priming the pump correctly to eliminate air from the administration line', detailing the specific steps to achieve this before patient connection. Option A is mentioned but is in a different section. Option B is the step that follows priming, not the purpose of this section. Option D is not discussed in this extract.
EMAIL COMMUNICATION To: All Theatre Staff From: Theatre Department Manager Date: 26/10/2023 Subject: Urgent: Sterilisation Process Update Dear Colleagues, This email is to inform you of an urgent, temporary alteration to our instrument sterilisation process, effective immediately. Due to an unforeseen issue with the main autoclave, all surgical instruments requiring high-level disinfection must now be processed using the secondary steam steriliser unit located in Room 12. This unit has a longer cycle time, so please factor this into your scheduling for upcoming procedures. Standard cleaning protocols prior to sterilisation remain unchanged. We are working to resolve the issue with the main autoclave as quickly as possible and will provide further updates. Please escalate any immediate concerns regarding instrument availability to the Senior ODP.
12. Which statement best describes the main purpose of this email?
Answer: B. The email's central message is the immediate, temporary change in sterilisation method due to a problem with the main autoclave, requiring the use of a secondary unit. Options A and D are mentioned as related points but are not the primary reason for the communication. Option C is a secondary point; the focus is on the operational change, not just the repair status.
Policy Update – Handovers (Effective 12 June 2024) All ward staff are reminded that the handover checklist must now include: 1) patient’s current mobility status, 2) any pending investigations, and 3) a clear escalation plan for deteriorating patients. The previous requirement to record the exact time of medication administration has been removed. Staff must complete the revised checklist before leaving the ward and sign the electronic handover log. Non‑compliance will be recorded in the annual appraisal.
13. What is the main purpose of this policy update?
Answer: B. The document’s purpose is to inform staff of the new handover checklist items. Options A, C and D are details mentioned in the text but are not the reason the policy was issued.
Email to Ward Staff – Revised Blood Test Request Procedure (28 May 2024) Dear Team, From 1 July 2024 all blood test requests must be entered directly into the electronic patient record (EPR) using the new ‘Blood Test Request’ template. Paper forms are no longer accepted. This change aims to reduce transcription errors and speed up laboratory processing. Please complete the short e‑learning module on the new template by 15 June and contact the IT desk if you encounter access issues. Kind regards, Clinical Governance Team
14. What is the primary purpose of this email?
Answer: A. The email’s main purpose is to inform staff of the policy change (no paper forms) and to point them to training. Options B, C and D are supporting details.
Guideline Excerpt – Pressure Ulcer Prevention (Section 4.1) All patients at risk of pressure injury must have a repositioning schedule documented in their care plan. The schedule should specify a minimum of two position changes per 24‑hour period, with the exact times recorded. If a patient refuses a reposition, the nurse in charge must be notified and an alternative strategy documented. Documentation of each reposition must be entered into the electronic care record within 15 minutes of the activity.
15. Which statement best captures the main point of this guideline excerpt?
Answer: B. The central message is that at‑risk patients require a documented schedule of at least two repositionings per day. Options A, C and D are specific procedural details, not the overarching purpose.
To all ward staff: Please note the following changes to the handover protocol, effective immediately: 1. All patient notes must now be signed by the admitting nurse. 2. The handover sheet will be completed in the electronic system rather than on paper. 3. The shift change time will be moved from 08:00 to 08:30. Staff are reminded that these changes aim to improve documentation accuracy and reduce handover errors.
16. What is the main point of this email?
Answer: D. The email lists three procedural changes, but its purpose is to inform staff that the changes are intended to improve accuracy and reduce errors. The other options describe specific details of the changes, not the overall aim.
Policy Update – Infection Control In response to the recent audit, the following updates have been made to the hand hygiene policy: - Alcohol gel dispensers will now be placed at the entrance of each patient room. - Staff must perform hand hygiene before and after each patient contact. - A new reminder sign will be posted in the staff lounge. These measures are designed to reduce the transmission of healthcare‑associated infections.
17. Which statement best describes the main purpose of this policy update?
Answer: C. The update lists specific actions, but its overall purpose is to reduce infection transmission. The other options are factual details of the policy changes.
Equipment Manual – Portable Oxygen Concentrator When using the portable oxygen concentrator, follow these safety steps: 1. Check the oxygen flow rate before attaching the mask. 2. Ensure the unit is on a stable surface. 3. Keep the device away from water and heat sources. Failure to comply may result in equipment malfunction or patient harm.
18. What is the main point of this equipment manual extract?
Answer: B. The passage lists safety steps, but the central message is that these steps are to prevent malfunction and harm. The other options are individual safety instructions.
Care Guideline – Management of Acute Pain Patients presenting with acute pain should receive a pain assessment within 30 minutes of admission. Pain scores should be recorded using the 0–10 numeric rating scale. If the score is 7 or above, administer paracetamol 1g orally, repeat every 6 hours as needed. For scores above 9, consider opioid therapy after consulting the senior physician. The guideline aims to standardise pain management and improve patient comfort.
19. What is the main point of this guideline excerpt?
Answer: C. The excerpt provides specific assessment and treatment steps, but its purpose is to standardise practice and enhance comfort. The other options describe individual recommendations rather than the overarching goal.
MEMORANDUM TO: All Nursing Staff FROM: Infection Control Department DATE: 26 October 2023 SUBJECT: Updated Hand Hygiene Policy This memorandum serves to inform all nursing staff of an update to the Hand Hygiene Policy, effective 1 November 2023. The key changes are as follows: 1. Introduction of a new alcohol-based hand rub formulation, which is more effective against a wider range of pathogens. 2. Mandatory use of gloves for all patient contact, regardless of whether blood or bodily fluids are anticipated. This is a significant shift from the previous policy which allowed exceptions in certain low-risk situations. 3. Enhanced training requirements, with all staff needing to complete a refresher module online by 31 December 2023. Failure to complete this training will be noted in your annual appraisal. We appreciate your cooperation in maintaining the highest standards of infection control. Please direct any queries to the Infection Control Nurse Specialist.
20. What is the primary purpose of this memorandum?
Answer: C. The memorandum details three specific changes to the hand hygiene policy, including a new hand rub, mandatory glove use, and updated training. Option C encompasses all these key changes, making it the main point. Options A and B are true statements but represent only one detail of the overall policy update, not the primary purpose. Option D is a general statement about infection control, not the specific reason for this memo.
EQUIPMENT MANUAL: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) MACHINE MODEL 3000 Section 4: Troubleshooting Issue: Patient reports dry mouth or nasal irritation. Possible Cause: Humidifier water level is low or off. Solution: Refill the humidifier chamber with distilled water to the marked fill line. Ensure the chamber is properly seated. Issue: Machine is making a loud or unusual noise. Possible Cause: Air filter is dirty or blocked; internal fan issue. Solution: Check and clean or replace the air filter as per Section 3. If the noise persists, contact biomedical engineering for service. Do not attempt to open the machine casing. Issue: Pressure reading is consistently lower than prescribed. Possible Cause: Mask leak; incorrect mask size; humidifier setting too high. Solution: Check mask fit and size. Adjust humidifier settings. If the problem continues, consult the prescribing physician to review the therapy settings.
21. Which of the following best describes the purpose of this section of the equipment manual?
Answer: B. This section is explicitly titled 'Troubleshooting' and provides a list of common issues, their possible causes, and solutions. Option B accurately reflects this purpose. Options A, C, and D describe other potential sections of a manual but are not the focus of this particular excerpt.
CLINICAL GUIDELINE: MANAGEMENT OF ACUTE DIARRHOEA IN ADULTS 1. Assessment: All patients presenting with acute diarrhoea should undergo a thorough history and physical examination. Key areas to assess include duration, frequency, volume, presence of blood or mucus, associated symptoms (fever, vomiting, abdominal pain), recent travel, antibiotic use, and dietary changes. Stool samples should be sent for culture and sensitivity if there is suspicion of bacterial infection (e.g., fever >38.5°C, bloody stools, severe abdominal pain) or if symptoms persist beyond 7 days. 2. Fluid Management: For mild to moderate dehydration, oral rehydration therapy (ORT) is the first-line treatment. Patients should be encouraged to drink oral rehydration solutions frequently. For severe dehydration or persistent vomiting, intravenous fluid replacement will be necessary. Monitor fluid balance closely. 3. Pharmacological Interventions: Antidiarrhoeal medications such as loperamide may be considered for symptomatic relief in patients with non-bloody diarrhoea and no signs of severe dehydration or systemic infection. These should be used with caution and are generally not recommended for infectious diarrhoea where the body is attempting to expel the pathogen. Antibiotics are generally not indicated for acute diarrhoea unless a specific bacterial pathogen has been identified and is deemed to be the cause of severe illness.
22. What is the main point of this guideline excerpt?
Answer: B. This guideline excerpt covers the entire initial management process for acute diarrhoea, from assessment and fluid management to pharmacological interventions. Option B provides the most comprehensive summary of the content. Options A, C, and D are all true statements found within the text but represent specific details or recommendations rather than the overall main point of the excerpt.
To all nursing staff. Please note that the annual mandatory fire safety training sessions are scheduled to take place throughout next month in the education centre. All ward nurses must complete one session before the end of the quarter to maintain compliance. Managers have been asked to release staff on their assigned dates. Sign up via the intranet booking portal as soon as possible, as slots fill quickly.
23. Which statement best describes the main purpose of this communication?
Answer: C. Option C is correct because the overarching message is the requirement for all ward nurses to complete the mandatory fire safety training. Options A, B, and D mention true details from the text regarding manager duties, booking instructions, and timing, but these are supporting points rather than the primary reason for the memo.
Clinical handovers at the change of shift must now be conducted using the updated SBAR format in the designated staff briefing room. Staff are reminded that mobile phones are strictly prohibited during this time to ensure uninterrupted communication regarding patient safety and care continuity. Any urgent clinical concerns must be escalated immediately to the nurse in charge rather than held for handover discussion.
24. What is the main point of this handover procedure update?
Answer: B. Option B is correct because the core instruction of the policy update is the mandatory adoption of the SBAR format for handovers. Options A, C, and D are accurate statements contained within the text, but they represent specific rules or subsidiary details rather than the main focus of the update.
Following recent audit findings regarding medication administration errors, all registered nurses are required to complete a competency assessment for intravenous infusion pumps by Friday. Ward managers will oversee the practical evaluations in the treatment room. Any nurse who fails to demonstrate correct setup will be restricted from administering intravenous medication until retraining is successfully completed.
25. Which statement best describes the primary purpose of this clinical memo?
Answer: C. Option C is the correct answer because the memo was issued to introduce the mandatory competency assessments for all registered nurses. Options A, B, and D provide background context and secondary details about consequences, managers, and audit findings, but these support the main directive rather than constitute the primary purpose.
Staff, please note the following changes to the handover protocol, effective 1 September: 1. All patients with a fall risk score above 3 must have a written fall risk assessment added to their handover sheet. 2. The handover sheet must now include a column for medication changes made during the shift. 3. Handover will be conducted via the secure messaging app instead of the traditional bedside briefing. The aim is to improve patient safety and streamline communication between shifts.
26. Which statement best captures the main point of this memo?
Answer: C. The memo lists three specific changes, but the overarching purpose is to change the method of handover to a secure messaging app. The other options describe individual details rather than the main point.
Equipment Manual – Portable Ultrasound Machine Model: SonoPro 3000 1. Power on: Press the green button for 3 seconds. 2. Probe selection: Use the side panel to choose the appropriate probe. 3. Image optimisation: Adjust depth and gain until the image is clear. 4. Maintenance: Clean the probe with 70% isopropyl alcohol after each use. 5. Troubleshooting: If the screen remains blank, check the power cable connection. This section provides step‑by‑step instructions for safe and effective use of the machine.
27. Which statement best describes the main point of this equipment manual extract?
Answer: D. The passage is a concise guide; its main point is to give step‑by‑step instructions. The other options are individual safety or troubleshooting details.
Clinical Guideline – Management of Acute Asthma Exacerbation 1. Assess the patient’s peak expiratory flow rate (PEFR) and classify severity. 2. Administer a short‑acting beta‑agonist via nebuliser at 5‑minute intervals. 3. If PEFR remains below 50% of predicted after three doses, add oral corticosteroids. 4. Monitor oxygen saturation continuously and adjust FiO2 to maintain SpO2 above 94%. 5. Reassess the patient every 30 minutes until PEFR improves to 80% of predicted. The guideline aims to standardise treatment and improve outcomes for patients with severe asthma attacks.
28. Which statement best captures the main point of this guideline excerpt?
Answer: A. The passage lists specific steps, but the overarching purpose is to standardise treatment and improve outcomes. The other options are individual treatment actions.
Ward staff are advised that all controlled drug cupboards must remain locked at all times when not actively in use, and keys are to be kept on the person of the designated nurse in charge. Due to recent audit discrepancies, signatures for schedule two drugs now require two registered nurses to witness and countersign every administration. Staff are reminded that borrowing keys between shifts is strictly prohibited under any circumstances. The purpose of this memo is to reinforce accountability following the internal audit.
29. What is the main point of this memorandum regarding controlled drugs?
Answer: C. Option C correctly identifies the overarching purpose stated explicitly in the final sentence of the text. Options A, B, and D are all true statements containing specific details or rules mentioned in the body of the text, but they represent individual points rather than the main point of the memo.
In response to ongoing supply chain delays, the hospital pharmacy has issued temporary guidance for the management of intravenous potassium chloride ampoules. All stock must be stored exclusively in the dedicated high-risk medication cabinet in treatment room two rather than individual drug trolleys. Ward managers must conduct weekly stock audits every Monday morning and submit figures via the intranet portal. This memo takes effect immediately and supersedes all previous local storage instructions until further notice.
30. Which statement best describes the primary purpose of this pharmacy notice?
Answer: A. Option A captures the overarching context and main objective of the notice, which is prompted by supply delays. Options B, C, and D are subordinate operational details contained within the text that support the main directive but do not constitute the primary purpose on their own.
Following a series of near misses involving enteral feeding tubes, all clinical staff are reminded of the mandatory pre administration check process. Nurses must verify tube placement using pH testing or capnography before instilling any feed or medication, and documentation must be completed within the electronic patient record immediately afterward. Any staff member unfamiliar with the updated verification device must complete the online training module before undertaking independent shifts on the ward.
31. What is the main point of this clinical safety alert?
Answer: B. Option B gives the primary reason the communication was issued, framing the entire text around safety after near misses. Options A, C, and D are specific procedural requirements mentioned in the text that act as supporting details rather than the main point.
To ensure consistency across surgical assessment units, the escalation protocol for deteriorating post operative patients has been revised. When a patient scores five or more on the early warning score chart, the bedside nurse must perform a focused ABCDE assessment and immediately inform the senior house officer. If no response is received within ten minutes, the nurse is authorized to contact the consultant on call directly. Staff must ensure all vital signs are fully documented before initiating this escalation pathway.
32. Which statement best captures the primary purpose of this protocol revision?
Answer: A. Option A correctly reflects the overarching aim of the text, which is to introduce the revised escalation protocol. Options B, C, and D are specific procedural steps within that protocol that serve as supporting information rather than the primary purpose of the document.
To: All Ward 12 staff From: Clinical Governance Team Date: 12 March 2024 Subject: Updated patient handover protocol – effective 1 April 2024 Effective from 1 April 2024 the handover process will incorporate three mandatory steps: 1. A brief clinical summary must be recorded on the electronic handover sheet within 15 minutes of patient transfer. 2. The receiving nurse must sign the handover sheet to confirm receipt of the information. 3. Any patient identified as high‑risk (e.g., falls risk, sepsis, or on anticoagulants) must have a verbal handover conducted in person before the shift change. All staff are reminded that failure to complete any of these steps will be logged as a breach of policy and may be subject to audit. Please ensure you familiarise yourself with the new electronic template attached.
33. What is the main point of this handover protocol update?
Answer: C. The purpose of the memo is to inform staff of the three new mandatory steps in the handover process. Options A, B and D are true details from the text but they describe individual requirements or consequences, not the overall reason for the document.
MEMORANDUM To: All Registered Nurses, Ward 6B From: Senior Charge Nurse, R. Mahmood Date: 14 March Subject: Waste segregation at point of disposal Colleagues will be aware that the Trust's waste audit in February identified a 22% misclassification rate on Ward 6B, predominantly orange-stream clinical waste being placed in black domestic bags. With immediate effect, please observe the following when disposing of items: - All items contaminated with bodily fluids other than urine, including PPE such as gloves and aprons, must be placed in the orange clinical waste stream. - Sharps, including insulin syringes and lancets, continue to go in the yellow-lidded sharps bin; under no circumstances should a sharp be disposed of in any other container, regardless of how small. - Empty urine bags, catheter leg bags and bedpan liners containing only urine may be disposed of in the black domestic stream once emptied into the sluice. The porters will no longer collect orange bags that contain obvious domestic items, for example used paper towels or food packaging from the staff room. Any queries should be escalated to the Nurse in Charge in the first instance. Thank you for your cooperation.
34. What is the main point of this memorandum?
Answer: A. The memo leads with the audit finding and a percentage figure, then announces 'With immediate effect' a new set of disposal rules. That structure (problem, then instruction) is the classic signal that the writer's point is the instruction, not the audit result or any single bullet point. Options B, C and D are all true statements drawn from the text — the porter line, the sharps rule, and the audit figure — but each is a detail that serves the main message rather than being it. The main purpose is to correct the misclassification problem by clarifying segregation.
EXTRACT: Trust Guideline for the Administration of Subcutaneous Insulin in Adult Inpatients (Section 4: Timing of Administration) 4.1 Rapid-acting insulin analogues (for example, insulin aspart and insulin lispro) should be administered within 15 minutes before the meal is served, or with the meal if the patient is able to eat immediately. 4.2 Isophane insulin should be administered at a consistent time each day, ordinarily 30 minutes before food. Where this is not practical on the ward round, administration up to 15 minutes after the meal may be acceptable provided the patient has eaten a reasonable portion. 4.3 Mixed insulin regimens (for example, Novomix 30) should be administered according to the patient's prescribed regimen and in accordance with the manufacturer's instructions. 4.4 Sliding-scale insulin must not be written up as a 'once daily' or 'prn' prescription. Prescribers are reminded that sliding scales must be reviewed at least once every 24 hours, with any adjustment documented in the medical notes by the prescriber making the change. For the avoidance of doubt, subcutaneous insulin must never be administered without a valid, legible, dated and signed prescription.
35. What is the primary purpose of this section of the clinical guideline?
Answer: A. The heading says 'Timing of Administration', and the body covers timing for rapid-acting analogues, isophane, mixed regimens, and the prescribing/review rules that govern sliding scales. That is exactly option A: it captures both halves of the section. Options B and C are true and tempting because they appear at the bottom of the section, where candidates often anchor, but each is one rule among several — a detail, not the purpose. Option D is wrong because the section does not exhaustively list preparations; it gives examples (insulin aspart, Novomix 30) within rules about timing. The signal is the section heading — the main point sits at the top of a document, and supporting rules hang off it.

Reading Part C — attitude and argument 30 questions

Part C is two long texts on healthcare topics of general professional interest — a clinician writing about burnout, an argument about antimicrobial stewardship, a reflection on a failed quality-improvement project — where the questions ask about the writer's ATTITUDE, the function of a phrase, or what a quoted expression means in its context.

During my decade in acute care, I have witnessed an alarming rise in staff burnout. The relentless pace, combined with high patient acuity and ever‑changing protocols, has left many nurses feeling exhausted, detached, and emotionally drained. I firmly believe that burnout is not a personal failing but a systemic issue that requires organisational change. The current emphasis on individual resilience—mindfulness apps, personal time‑off—fails to address the root causes. We need comprehensive support: adequate staffing ratios, realistic workload expectations, and a culture that values well‑being as much as clinical competence. Without these reforms, the quality of patient care will continue to suffer, and we risk losing the very professionals who are essential to our health system.
1. What is the writer’s attitude toward the current emphasis on individual resilience as a solution to burnout?
Answer: C. The writer states, "The current emphasis on individual resilience…fails to address the root causes." This shows a negative view of the approach, indicating it is insufficient.
Antimicrobial stewardship (AMS) programmes aim to optimise antibiotic use, but their success hinges on clinician engagement. In my experience, the most effective AMS interventions are those that integrate seamlessly into existing workflows and provide real‑time feedback. For instance, a simple dashboard that displays local resistance patterns next to the prescribing screen has dramatically reduced inappropriate prescriptions in my unit. However, many hospitals still rely on passive educational materials, which are rarely read. I argue that stewardship should be framed not as a punitive measure but as a collaborative effort to protect patient safety and preserve antibiotic efficacy. Only by shifting the narrative can we achieve lasting behavioural change.
2. In the passage, the phrase "shifting the narrative" most likely means:
Answer: B. "Shifting the narrative" refers to changing clinicians’ mindset about stewardship, not the content of policy or materials.
Last year, we launched a quality‑improvement project to reduce catheter‑associated urinary tract infections (CAUTIs) by implementing a daily catheter‑review checklist. Despite rigorous training and audit feedback, infection rates did not fall. The failure was not due to lack of compliance; rather, the checklist was too complex and time‑consuming, leading staff to skip it during busy shifts. Moreover, the project did not involve frontline nurses in its design, so it lacked practical relevance. I now advocate for a co‑design approach, where end‑users contribute to tool development, ensuring that interventions are both evidence‑based and user‑friendly. Only then can we expect sustainable improvements in patient outcomes.
3. What does the writer imply by describing the checklist as "too complex and time‑consuming"?
Answer: C. The writer says the checklist was "too complex and time‑consuming," meaning staff found it hard to use during busy shifts.
In the debate over antimicrobial stewardship, some argue that restricting antibiotic access will harm patients by limiting clinicians’ therapeutic options. I counter this view by pointing out that stewardship is not about limiting antibiotics but about ensuring they are used appropriately. The phrase "the right antibiotic, at the right time, for the right patient" encapsulates this principle. It reminds us that stewardship is a precision approach, not a blanket ban. By focusing on patient‑specific factors—culture results, comorbidities, and local resistance patterns—we can preserve antibiotic effectiveness while still safeguarding individual patient care.
4. The writer’s use of the phrase "the right antibiotic, at the right time, for the right patient" primarily serves to:
Answer: C. The phrase underscores the idea that stewardship tailors antibiotic choice to each patient, emphasising personalised medicine.
The relentless pursuit of 'wellness' in the workplace, often framed as individual resilience, has become a pervasive, yet ultimately unhelpful, response to the epidemic of burnout. While personal coping mechanisms have their place, this narrative conveniently sidesteps the systemic issues that fuel exhaustion: chronic understaffing, excessive workloads, and a culture that often prioritizes productivity over well-being. By placing the onus solely on the individual to 'bounce back', organisations deflect responsibility and perpetuate a cycle where staff are expected to adapt to unsustainable conditions rather than demanding change. This focus on individual resilience is not a solution; it is a sophisticated form of denial.
5. What is the writer's attitude towards the emphasis on individual resilience as a response to burnout?
Answer: B. The writer uses phrases like 'ultimately unhelpful', 'conveniently sidesteps the systemic issues', and 'sophisticated form of denial' to express a critical view of the focus on individual resilience. This indicates that the writer believes it is a superficial approach that ignores deeper organisational problems, making option B the correct answer.
The proliferation of antimicrobial resistance (AMR) is a global health crisis demanding immediate and concerted action. While stewardship programs are crucial, their effectiveness hinges on a multi-faceted approach that extends beyond mere guidelines. We must foster a culture of responsible prescribing, underpinned by robust diagnostic capabilities and accessible alternatives. The current landscape, however, often sees clinicians operating with limited resources, facing diagnostic uncertainty, and succumbing to patient pressure. Therefore, while the mantra of 'the right antibiotic, at the right time, for the right patient' is a sound principle, its practical implementation requires significant investment in infrastructure and education, not just adherence to protocols.
6. According to the writer, what is a significant barrier to the effective implementation of antimicrobial stewardship?
Answer: C. The passage states that clinicians often operate 'with limited resources, facing diagnostic uncertainty'. This directly supports option C as a significant barrier to implementing antimicrobial stewardship effectively. Options A, B, and D are not supported by the text; in fact, the text implies a need for better diagnostics, not an over-reliance on them, and does not mention patient willingness or regulatory enforcement as primary barriers.
Our recent attempt to implement a new electronic health record system was, by most measures, a failure. The initial enthusiasm waned as the reality of the steep learning curve and the system's inherent inflexibility became apparent. Clinicians, already stretched thin, found the added burden of data entry and navigation overwhelming. Despite extensive training sessions, the system's design seemed to actively work against intuitive use, leading to frustration and a significant increase in charting time. While the intention was to streamline patient care and improve data accessibility, the execution resulted in a net decrease in efficiency and a palpable sense of demoralisation among the staff.
7. What does the writer imply by describing the checklist as 'too complex and time-consuming'?
Answer: B. The passage describes the electronic health record system, not a checklist. However, assuming the question meant the system, the writer states that clinicians found the 'added burden of data entry and navigation overwhelming' and that it led to 'a significant increase in charting time'. This indicates that the complexity and time required hindered its intended purpose of streamlining care, making option B the most logical interpretation.
The discourse surrounding physician burnout often centres on individual coping strategies – mindfulness, better sleep hygiene, time management. While these are valuable tools for personal well-being, they risk becoming a convenient distraction from the root causes. We must confront the systemic factors: the crushing administrative burden, the erosion of professional autonomy, and the pervasive culture of 'always on'. To frame burnout solely as an individual failing is to absolve the healthcare system itself of its responsibility. True change requires a fundamental re-evaluation of how healthcare is structured and delivered, not just teaching doctors to meditate more effectively.
8. What is the writer's attitude toward the current emphasis on individual resilience as a solution to burnout?
Answer: B. The writer criticises the focus on individual coping strategies, stating they 'risk becoming a convenient distraction from the root causes' and that framing burnout 'solely as an individual failing is to absolve the healthcare system itself of its responsibility'. This clearly indicates an attitude that this approach is inadequate and overlooks systemic issues, making option B the correct answer.
The modern healthcare workplace often treats compassion fatigue as a personal failing rather than an occupational hazard. When institutions respond to chronic understaffing and overwhelming workloads by offering mindfulness apps and wellness workshops, they miss the mark entirely. This wellness agenda subtly shifts the burden of systemic reform away from employers and onto the bedside nurse. Resilience becomes a mandatory performance metric, and those who struggle are quietly viewed as deficient. Yet no amount of deep breathing can compensate for a broken shift pattern or a ratio of ten patients to one nurse. By framing structural deficits as emotional vulnerabilities, hospitals effectively silence legitimate grievances about working conditions. The individualisation of systemic distress creates a culture of endurance where nurses learn to suffer in silence rather than demand collective change. True reform requires leadership to acknowledge that psychological safety is impossible without adequate staffing levels and tangible institutional support, rather than cheap corporate wellness band-aids.
9. What is the writer's perspective on institutional wellness interventions?
Answer: B. The writer argues that wellness interventions shift the burden of systemic reform away from employers, pointing out that they are corporate band-aids used instead of fixing broken shift patterns and ratios. Option B correctly captures this critical view of deflection. Options A, C, and D attribute positive or neutral intent which contradicts the critical tone of the passage.
In many clinical settings, the introduction of standardized bedside handovers has been met with quiet resistance. Nurses frequently view the mandatory use of rigid digital templates as an administrative hurdle rather than a patient safety tool. While proponents argue that structured communication reduces clinical error, the reality on the ward is often quite different. Clinicians spend valuable minutes clicking through redundant dropdown menus while standing at a terminal, turning their attention away from the patient in front of them. The system assumes a linear workflow that rarely exists during an acute admission. When documentation becomes the primary focus of a shift, interpersonal communication suffers, and the qualitative nuances of patient care are lost in translation. Standardization, when pushed to an extreme, strips nursing practice of the contextual judgement that experienced clinicians rely on during complex handovers.
10. What does the writer suggest about the mandatory use of rigid digital handover templates?
Answer: C. The writer states that templates turn attention away from the patient and assume a linear workflow that rarely exists, meaning they distract from care and ignore ward realities as captured in option C. Options A, B, and D describe benefits that the writer directly challenges or does not support.
The historical divide between nursing theory and clinical practice has long frustrated nurse educators. Generations of students are taught holistic care frameworks in the classroom, only to enter hospital environments dominated by task-oriented efficiency and biomedical models. This jarring transition often leads to moral distress, as newly qualified nurses find themselves unable to deliver the idealized care they learned during their training. Hospitals operate under severe economic pressures that prioritize patient throughput over therapeutic engagement. Consequently, the core values of the profession are often compromised in the daily scramble to meet discharge targets. Bridging this gap requires more than curriculum reform in universities; it demands a cultural transformation within healthcare institutions so that compassionate care is valued as highly as operational speed. Until clinical environments align with educational ideals, young nurses will continue to experience disillusionment and early burnout.
11. According to the writer, what is a primary cause of moral distress among newly qualified nurses?
Answer: B. The writer notes that the transition from classroom holistic care to hospital task-oriented efficiency leads to moral distress because students cannot deliver idealized care, matching option B. Options A, C, and D mention challenges that are either contradicted or not the main focus of the text.
Family presence during resuscitation remains a contentious issue in acute care nursing, despite clinical guidelines supporting its practice. Many veteran nurses harbour deep reservations, arguing that the presence of distressed relatives compromises clinical focus and adds unnecessary emotional strain to an already chaotic cardiac arrest. Proponents, however, contend that witnessing resuscitation aids the grieving process and offers families a realistic understanding of the efforts made to save their loved one. The central tension lies in the dual responsibility of the nurse: providing immediate, high-tech life support while simultaneously offering compassionate psychological care to grieving onlookers. When staff are inadequately prepared or supported, the presence of families can indeed transform a controlled clinical response into a site of emotional conflict. Successful implementation requires dedicated support staff whose sole role is to guide and protect the family, allowing the clinical team to execute interventions without divided attention.
12. What does the writer imply about the role of nurses during resuscitation with family members present?
Answer: B. The writer highlights the central tension of the dual responsibility of providing life support while offering psychological care to onlookers, matching option B. Option A contradicts the need for psychological care, option C makes a claim about lack of qualification not in the text, and option D contradicts the deep reservations held by veteran nurses.
During the last audit of our ICU, I noted that 73% of patients received antibiotics within the first hour of admission, a figure that would normally be applauded. Yet, when I examined the timing of the prescriptions, I found that 58% were administered after the patient had already been on a broad‑spectrum agent for 12 hours. The data suggest that clinicians are more comfortable prescribing a ‘default’ antibiotic than tailoring therapy to culture results. This pattern reflects a deeper issue: the culture of ‘quick fixes’ that prioritises speed over precision. I am not arguing that rapid treatment is unimportant; on the contrary, early therapy saves lives. My point is that the current emphasis on speed has become a substitute for stewardship, and that is dangerous.
13. What is the writer’s attitude toward the emphasis on speed in antibiotic prescribing?
Answer: B. The writer states, ‘the current emphasis on speed has become a substitute for stewardship, and that is dangerous.’ This directly shows a negative attitude toward speed as a priority.
In our recent quality‑improvement project, we introduced a new handover protocol designed to reduce medication errors. The protocol required each nurse to complete a 12‑step checklist before leaving the ward. Within two weeks, the error rate fell by 4%, a modest improvement. However, staff reported that the checklist was too complex and time‑consuming, leading to rushed entries and occasional omissions. The data suggest that the protocol’s design, rather than its intent, undermined its effectiveness. The lesson is clear: well‑intentioned tools can become barriers if they are not user‑friendly.
14. What does the writer imply by describing the checklist as 'too complex and time‑consuming'?
Answer: A. The writer links the complexity to reduced effectiveness: ‘the protocol’s design, rather than its intent, undermined its effectiveness.’ This implies the checklist was a barrier.
When I first read the statement that ‘resilience is the key to preventing burnout,’ I felt a familiar pang of skepticism. Resilience, after all, is a personal trait that can be cultivated, but it is not a panacea. The real problem lies in the systemic pressures that push clinicians to work long hours, take on excessive administrative tasks, and neglect self‑care. If we continue to frame burnout as an individual failure, we risk blaming nurses for their own exhaustion and ignoring the organisational factors that create it. The solution, therefore, is not to ask nurses to be stronger, but to redesign the work environment so that it supports, rather than exploits, their well‑being.
15. What is the writer’s attitude toward the statement that ‘resilience is the key to preventing burnout’?
Answer: B. The writer says, ‘If we continue to frame burnout as an individual failure, we risk blaming nurses for their own exhaustion and ignoring the organisational factors that create it.’ This shows a negative attitude toward resilience as a sole solution.
The debate over mandatory digital handover templates has intensified. Proponents argue that standardised forms reduce errors and improve continuity. Critics, however, claim that these templates stifle clinical judgment and add administrative burden. In my experience, the real issue is not the template itself but the way it is implemented. When staff are forced to fill out a rigid form before they can even start the patient assessment, they are less likely to engage in thoughtful clinical reasoning. The template becomes a box‑checking exercise rather than a tool for communication. Therefore, I advocate for flexible, clinician‑driven templates that adapt to the context rather than dictate it.
16. What does the writer suggest about the mandatory use of rigid digital handover templates?
Answer: D. The writer states, ‘When staff are forced to fill out a rigid form before they can even start the patient assessment, they are less likely to engage in thoughtful clinical reasoning.’ This indicates that rigid templates can be a barrier.
The relentless pursuit of efficiency in healthcare, while seemingly beneficial, often comes at a significant cost to patient care and staff well-being. We are increasingly pressured to see more patients in less time, to complete documentation with haste, and to adopt technologies that promise streamlined workflows but often introduce new layers of complexity. This drive for speed, however, can lead to a superficial engagement with patients, a reduction in critical thinking, and an environment where errors are more likely to occur. The focus on metrics and throughput can overshadow the nuanced, humanistic aspects of nursing that are crucial for effective healing and compassionate care. It is a system that prioritises the appearance of productivity over the substance of quality care.
17. What is the writer's attitude towards the emphasis on efficiency in healthcare?
Answer: B. The writer uses phrases such as 'relentless pursuit of efficiency... often comes at a significant cost', 'pressured to see more patients in less time', 'superficial engagement with patients', and 'reduction in critical thinking' to convey a negative attitude towards the emphasis on efficiency. Option B accurately reflects this critical stance.
The introduction of electronic health records (EHRs) was heralded as a revolution in healthcare, promising improved data accuracy, enhanced communication, and more efficient patient management. However, the reality has often fallen short of these lofty expectations. While EHRs have undoubtedly brought some benefits, their implementation has frequently been marred by usability issues, significant costs, and an unintended increase in the administrative burden on clinicians. The time spent navigating complex interfaces and inputting data can detract from direct patient interaction, leading to frustration and burnout. The technology, intended to liberate us, has in many instances become another constraint.
18. What does the writer imply by stating that EHRs 'have in many instances become another constraint'?
Answer: B. The writer contrasts the 'lofty expectations' of EHRs with the 'reality' of 'usability issues, significant costs, and an unintended increase in the administrative burden'. The phrase 'intended to liberate us, has in many instances become another constraint' directly implies that the systems, rather than freeing up clinicians, have become a burden, supporting option B.
The concept of 'team-based care' is frequently promoted as the panacea for many of the challenges facing modern healthcare systems. The idea is that by bringing together professionals from various disciplines – doctors, nurses, therapists, pharmacists – each contributing their unique expertise, we can provide more holistic and effective patient care. While the theoretical underpinnings are sound, the practical application is often fraught with difficulties. Hierarchical structures, poor communication channels, and a lack of genuine interdisciplinary respect can undermine the collaborative spirit. Without a fundamental shift in organisational culture to truly empower all team members and foster open dialogue, team-based care risks becoming merely a buzzword, a superficial restructuring that fails to deliver on its transformative potential.
19. What is the writer's attitude towards the concept of 'team-based care'?
Answer: B. The writer acknowledges that 'the theoretical underpinnings are sound' and that it is 'frequently promoted as the panacea', indicating a recognition of its potential value. However, the writer also highlights 'practical application is often fraught with difficulties', 'risks becoming merely a buzzword', and 'superficial restructuring', which demonstrates skepticism about its actual effectiveness. This nuanced view aligns with option B.
The pressure to publish or perish is a well-documented phenomenon in academic medicine, driving research and innovation. However, this intense focus on publication metrics can inadvertently foster a culture where the quality and reproducibility of research are sometimes sacrificed for quantity. Researchers may feel compelled to present preliminary or even questionable findings to meet publication deadlines, or to focus on 'hot topics' that guarantee rapid acceptance rather than pursuing slower, more methodologically rigorous investigations into less glamorous but potentially more significant questions. This can lead to a proliferation of studies that are difficult to replicate, contributing to a 'reproducibility crisis' and potentially misleading clinical practice.
20. What does the writer imply by referring to the 'reproducibility crisis' in research?
Answer: B. The passage states that the 'intense focus on publication metrics can inadvertently foster a culture where the quality and reproducibility of research are sometimes sacrificed for quantity' and that this 'can lead to a proliferation of studies that are difficult to replicate'. This directly supports the idea that the crisis stems from research being unreliable and difficult to verify, as stated in option B.
The modern hospital ward runs on metrics. Every action must be timed, logged, and converted into a dashboard-ready integer. While administrators celebrate this quantification as the hallmark of rigorous governance, bedside nurses experience it as a systematic erosion of clinical judgment. When care is reduced to a series of checkbox items completed within arbitrary time limits, the invisible yet vital aspects of nursing—holding a frightened patient's hand, listening to nuanced concerns during a shift change, or noticing the subtle shift in a resident's demeanor that precedes a sepsis cascade—are marginalized. These human elements are deemed inefficient because they resist standardization. Yet, they are the very foundation of patient safety. We have built systems that measure everything except what matters most, creating an illusory sense of control while the actual fabric of compassionate care frays beneath the weight of bureaucratic demands.
21. What is the writer's attitude towards the current quantification and metric-driven management of hospital wards?
Answer: B. The correct answer is B because the writer states that metric-driven systems create an illusory sense of control while destroying the real foundation of compassionate care. Option A reflects the view of administrators, which the writer opposes. Option C and D are not supported by the text.
For decades, nursing culture has subtly endorsed the myth of the infallible practitioner. We are expected to absorb staggering workloads, witness profound human suffering, and transition between crises without psychological scarification. When nurses eventually display signs of burnout, exhaustion, or post-traumatic stress, the institutional reflex is almost invariably to offer mindfulness apps, resilience workshops, or stress-management seminars. This approach treats systemic operational failures as personal deficits. It suggests that if a nurse feels overwhelmed, the fault lies not in the unsafe staffing ratios or the relentless pace, but in the nurse's inadequate coping mechanisms. By framing structural exploitation as an individual wellness problem, healthcare organizations neatly evade their legal and ethical responsibilities to provide a safe working environment.
22. What does the writer imply about institutional resilience workshops and mindfulness apps?
Answer: C. The correct answer is C because the writer argues that offering these workshops treats systemic operational failures as personal deficits, thereby evading institutional responsibility. Option A directly contradicts the writer's critical view. Option B is contradicted by the claim that organizations evade responsibilities. Option D is never mentioned.
The introduction of multidisciplinary bedside rounds has been heralded as the ultimate solution to fragmented patient care. Proponents argue that bringing physicians, pharmacists, physical therapists, and nurses together at the patient's bedside eliminates communication barriers and accelerates discharge planning. However, in practice, these rounds frequently reproduce existing hospital hierarchies rather than dismantle them. The nurse, who spends the vast majority of time with the patient and possesses the most granular knowledge of their daily condition, is often reduced to a passive scribe tasked with updating charts while more vocal team members dominate the discussion. Instead of fostering genuine collaboration, these rigid structures often silence nursing expertise, transforming what was intended to be a democratic exchange of insights into another forum for top-down instruction.
23. What is the writer's perspective on multidisciplinary bedside rounds in current hospital practice?
Answer: B. The correct answer is B because the text states that rounds frequently reproduce existing hierarchies and often silence nursing expertise rather than fostering genuine collaboration. Option A contradicts the text. Option C is not stated. Option D goes further than the writer's critique of current practice.
Recent policy initiatives aimed at standardizing nursing documentation have promised to reduce administrative burdens through the adoption of streamlined electronic templates. Yet, the reality on the ground tells a very different story. Rather than liberating clinicians from the tyranny of the keyboard, these new systems have simply replaced old inefficiencies with new ones, requiring an endless series of redundant clicks and mandatory data fields that bear little relation to the dynamic nature of bedside nursing. When every clinical interaction must be shoehorned into a predefined software architecture, documentation ceases to be a meaningful record of patient progress and becomes an end in itself. Nurses find themselves spending more time satisfying the algorithmic appetites of the software than attending to the patients whose stories the software purports to capture.
24. What does the writer imply by stating that nurses spend time satisfying the algorithmic appetites of the software?
Answer: A. The correct answer is A because the writer describes the software as demanding redundant clicks and predefined fields that force nurses to prioritize system requirements over patient care. Option B is an exaggeration not supported by the text. Option C contradicts the writer's view that templates fail to capture dynamic nursing. Option D is false since the text highlights ongoing administrative burdens.
The recent surge in telehealth has been hailed as a triumph of modern medicine, yet I remain skeptical about its impact on the therapeutic relationship. While video calls certainly increase accessibility, they often strip away the subtle cues—body language, eye contact, the quiet reassurance of a shared physical space—that underpin trust. In my experience, patients frequently report feeling 'heard' less often when the screen mediates the encounter, suggesting that convenience may be coming at the cost of genuine connection. This is not to say telehealth should be abandoned; rather, we must recognise its limits and integrate it thoughtfully, preserving the human element wherever possible.
25. What attitude does the writer express toward the increasing use of telehealth?
Answer: C. The writer says telehealth "has been hailed as a triumph" but then states "I remain skeptical" and notes it "may be coming at the cost of genuine connection," showing a cautious, critical attitude rather than full endorsement.
Antimicrobial stewardship programmes (ASPs) are often portrayed as the panacea for rising resistance, but the reality is more nuanced. While judicious prescribing is essential, the current focus on strict target metrics can inadvertently pressure clinicians to withhold antibiotics even when clinical judgement suggests a benefit. This 'one‑size‑fits‑all' mentality may lead to under‑treatment, patient dissatisfaction, and ultimately, a loss of trust in the healthcare system. A balanced approach that respects both evidence‑based guidelines and individual patient contexts is therefore indispensable.
26. What does the writer imply about the current focus on strict target metrics in ASPs?
Answer: C. The writer warns that strict target metrics "can inadvertently pressure clinicians to withhold antibiotics even when clinical judgement suggests a benefit," indicating a negative implication.
Reflecting on the recent quality‑improvement initiative to reduce catheter‑associated urinary tract infections, I cannot help but feel that the project's failure was inevitable. The team was assembled hastily, data collection methods were poorly defined, and leadership offered only superficial support. Moreover, the underlying culture resisted change, viewing the initiative as an administrative burden rather than a patient safety priority. In hindsight, the lack of genuine engagement and realistic planning doomed the effort from the start.
27. What attitude does the writer display regarding the quality‑improvement project?
Answer: A. The writer describes the project as "inevitable" to fail, cites "hastily" assembled team, "poorly defined" data, and "superficial" leadership support, showing a critical attitude.
The push for metric‑driven performance dashboards in hospitals is often justified as a means to enhance accountability. However, the constant bombardment of numbers can obscure the nuanced realities of patient care. When clinicians are forced to prioritize measurable outcomes, they may neglect aspects of care that are harder to quantify, such as empathy, patient education, and interdisciplinary communication. This reductionist view risks turning healthcare into a series of check‑boxes rather than a holistic practice, ultimately compromising the very quality it seeks to improve.
28. What does the writer suggest about the effect of performance dashboards on patient care?
Answer: A. The writer states that dashboards "can obscure the nuanced realities" and cause clinicians to "neglect aspects of care that are harder to quantify," indicating the suggested negative effect.
During the last audit of our surgical ward, I noted that the team’s morale had dipped noticeably after the introduction of a new electronic prescribing system. While the system promised fewer medication errors, staff reported feeling more ‘checked’ than supported. I argued that the real problem was not the technology itself but the way it was implemented – a top‑down rollout that ignored frontline input. The narrative that ‘technology will solve human error’ feels like a convenient scapegoat, and I am convinced that without genuine collaboration, any digital tool will simply add another layer of bureaucracy.
29. What is the writer’s attitude toward the claim that ‘technology will solve human error’?
Answer: C. The writer states: ‘the narrative that ‘technology will solve human error’ feels like a convenient scapegoat,’ which shows scepticism and views it as an oversimplification.
In our recent antimicrobial stewardship meeting, the senior pharmacist suggested that we should strictly limit the use of broad‑spectrum antibiotics to a 48‑hour window. I countered that such a rigid time frame ignores the nuances of individual patient responses and could actually prolong hospital stays. I argued that stewardship should be guided by real‑time microbiology data and clinical judgment rather than a one‑size‑fits‑all rule. The phrase ‘one‑size‑fits‑all rule’ is used to underline the danger of applying a blanket policy without considering patient variability.
30. What does the writer imply by using the phrase ‘one‑size‑fits‑all rule’?
Answer: B. The writer uses ‘one‑size‑fits‑all rule’ to highlight that a blanket policy cannot accommodate individual patient differences, implying the need for tailored decisions.

Listening Part A — consultation notes 30 questions

Part A is note completion while a patient talks.

Nurse: Good morning, Mr. Davies. I see you're here for your annual review. Can you tell me about any changes in your health since your last visit? Patient: Well, I've been feeling a bit breathless lately, especially when I walk up the stairs. It's like I can't get enough air in. And my ankles have been swelling up something awful, particularly at the end of the day. It started about three weeks ago, I think. No, wait, it must be closer to four weeks now. I've also been taking my furosemide, but I've been forgetting to take it most days, maybe only half a tablet when I remember.
1. What is the correct clinical term for the patient's description of feeling 'like I can't get enough air in'?
Answer: A. The patient describes feeling 'like I can't get enough air in'. While 'shortness of breath' (C) is a lay term for this, the clinical term is dyspnea. Orthopnea (B) is difficulty breathing when lying down, and 'air hunger' (D) is a less common term. This question tests the ability to convert lay terms to clinical terminology, a key skill in Listening Part A. The audio transcript provides the lay term, and the correct answer requires knowledge of the equivalent medical term.
Nurse: And when did these symptoms of breathlessness and ankle swelling begin? Patient: It started about three weeks ago, I think. No, wait, it must be closer to four weeks now. I've also been taking my furosemide, but I've been forgetting to take it most days, maybe only half a tablet when I remember. My prescription says one tablet daily.
2. How has the patient been taking their furosemide compared to the prescribed dose?
Answer: C. The patient states, 'I've been forgetting to take it most days, maybe only half a tablet when I remember,' and the nurse notes the prescription is 'one tablet daily.' Therefore, the patient is taking half a tablet only when they remember, not the full prescribed dose daily. Option A is incorrect because they are not consistently taking half a tablet. Option B is incorrect as that is the prescribed dose they are not adhering to. Option D is not mentioned.
Nurse: Okay, Mr. Davies. And you mentioned your ankles swelling. Have you noticed any other issues? Patient: Not really. Just the swelling. Oh, and I went to see my doctor in London last month, on the 15th. No, that was the month before. Last month was the 15th of May. So, this month it would be June the 15th. Yes, that's right. I have a follow-up appointment scheduled for July the 18th.
3. What was the date of the patient's appointment in London last month?
Answer: C. The patient initially states they saw their doctor in London 'last month, on the 15th.' They then correct themselves, saying, 'No, that was the month before. Last month was the 15th of May.' This indicates that the appointment last month was indeed May 15th. The subsequent correction to 'June the 15th' refers to the current month, and 'July the 18th' is a future appointment. This tests the ability to identify and select the corrected piece of information, ignoring the incorrect initial statement and subsequent irrelevant dates.
Nurse: Thank you, Mr. Davies. I just need to confirm a few details. Could you spell out the name of the medication you are taking for your blood pressure?
4. What is the correct spelling of the blood pressure medication?
Answer: A. The nurse asks the patient to spell the name of their blood pressure medication. In a real test scenario, the patient would spell this out in the audio. This question requires the candidate to recognize the correct spelling from the options provided. The correct spelling is Amlodipine. Options B, C, and D represent common misspellings or phonetic variations that a candidate might mistakenly choose if they misheard or were unsure of the spelling.
Nurse: Tell me about your skin, Mrs Higgins. Patient: It has been driving me crazy for days, it feels like tiny insects are crawling all over my arms and legs. Nurse: Right, that persistent sensation of things moving on the skin can be quite distressing. Let us note that down as formication in your chart.
5. What clinical term should the nurse enter into the notes for the patient's sensation of bugs crawling on the skin?
Answer: B. This is a medium difficulty item testing medical terminology conversion from lay descriptions. The patient describes a crawling sensation, which maps directly to formication. Option A is incorrect because pruritus means itching without the specific crawling hallucination or sensation, while C and D denote tingling or heightened sensitivity.
Nurse: How are you managing your morning blood pressure medication, Ramipril? Patient: Well, the doctor told me to take two tablets daily, but because I felt dizzy last week, I have only been taking one tablet each morning. Nurse: You must stick to the prescribed dose of two tablets.
6. According to the exchange, how has the patient been taking the Ramipril medication?
Answer: B. This hard item tests numeric adherence tracking during rapid dialogue. The patient acknowledges the prescription of two tablets but admits to taking one daily due to dizziness. The candidate must catch the divergence between prescribed and actual intake, rejecting the prescribed dosage listed in option A.
Nurse: Can you spell the name of the regional clinic where you had your heart scan? Patient: Yes, it is spelled C-O-R-N-W-A-L-L Heart Centre. Nurse: Got that, Cornwall Heart Centre. And how did it go? Patient: They checked my valves carefully.
7. What is the correct spelling of the clinic name that the nurse must record in the referral notes?
Answer: A. This easy spelling item requires exact transcription of a spelled-out word from the audio. The patient clearly spells C-O-R-N-W-A-L-L, making option A correct. The other options represent phonetic misspellings or common typos that careless candidates often jot down before checking.
Nurse: "How are you feeling today?" Patient: "I feel like my chest is tight, almost like a heavy weight is pressing down on it." Nurse: "You have been taking 10 mg of Metoprolol as prescribed, but you say you take 5 mg twice a day. The hospital you are admitted to is called City General Hospital."
8. Which clinical term should replace the patient's lay description of the chest sensation?
Answer: C. The correct clinical term for a sensation of pressure or tightness in the chest is 'chest tightness'. Candidates may record the patient's own wording or a less precise term, which would be incorrect.
Nurse: "Tell me about your medication routine." Patient: "I take 5 mg of amlodipine every morning, but I actually take it at night. I also take 20 mg of losartan, but I think I take 10 mg. The clinic is called Riverside Care Clinic."
9. What is the correct dose of amlodipine the patient is actually taking?
Answer: B. The patient states the prescribed dose (5 mg) and then says they take it at night, not a different dose. The incorrect option would be to record the prescription dose as the actual dose, which is a common error.
Nurse: "When did you start feeling the rash?" Patient: "I think it was on 5th June, but I saw my GP on 5th July. I was wrong, it was 5th June." Nurse: "You have been taking 2.5 mg of hydralazine daily, but you say you take 5 mg every morning. The hospital you are admitted to is called St. John's Hospital."
10. What should the nurse record for the date the rash started?
Answer: B. The patient first gives an incorrect date (5th July) and then corrects it to 5th June. The correct entry must reflect the corrected date. Candidates often copy the first date, which is a frequent mistake.
Nurse: Good morning, Mr. Davies. I see you're here for your annual review. How have you been feeling since your last visit? Patient: Oh, not too bad, thank you. Just the usual aches and pains, you know. My knee has been a bit stiff, especially in the mornings. It started about three weeks ago, I think. I've been taking my co-codamol, two tablets, twice a day, but it doesn't seem to be helping much anymore. I did have a bit of a cough last week, but it's gone now.
11. What is the correct clinical term for the patient's description of their knee feeling 'stiff'?
Answer: C. The patient describes their knee as 'stiff'. This is a direct clinical term, so no interpretation is needed. The other options are incorrect because they are not the word the patient used or are not accurate synonyms in this context. This question tests careful listening for the exact word used.
Nurse: I see here you had a fall on the 15th of May. Can you tell me more about that? Patient: Oh, that was last month. No, sorry, it was the month before. The 15th of April, I think. I tripped on the rug at home. Landed on my left side. My hip was quite sore afterwards, and I had a nasty bruise. I saw Dr. Smith at the clinic in P-E-R-T-H.
12. What is the correct spelling of the clinic location mentioned by the patient?
Answer: A. The patient spells out the name of the clinic: P-E-R-T-H. This directly spells the word 'Perth'. The other options are incorrect spellings of the name. This question tests the ability to transcribe a spelled-out word correctly.
Nurse: And how long have you had this rash on your arm? Patient: It started a couple of weeks ago. It was just a few red spots at first, but then it spread and got really itchy. It feels like tiny ants are crawling all over it. I've been putting on some cream, but it's not really helping. I think it might be from that new washing powder I bought.
13. What clinical term should the nurse use to document the patient's description of the rash sensation?
Answer: B. The patient describes the sensation as 'like tiny ants are crawling all over it'. This is a lay description of formication, which is the medical term for the sensation of insects crawling on or under the skin. 'Itching' is also present but formication is the specific sensation described. 'Tingling' and 'Crawling sensation' are less precise clinical terms for this specific feeling. This question requires knowledge of medical terminology to translate a patient's description.
Nurse: "When did you first notice the rash?" Patient: "It started around the 12th of May, actually—no, wait, I think it was the 15th." Nurse: "Okay, noted. And how would you describe the feeling on your skin?" Patient: "It feels like tiny ants crawling all over it." Nurse: "Got it. What medication are you taking for your blood pressure?" Patient: "I'm on lisinopril, 10 milligrams, but I only take one tablet every other day instead of daily." Nurse: "And the pharmacy you use?" Patient: "I pick it up at the Greenfield Pharmacy on Main Street."
14. What should the nurse record in the notes for the date the rash started?
Answer: C. The patient initially says 12 May, then corrects to 15 May. The correct date is the corrected figure. Candidates often pick the first number, but the audio shows the correction, so the note must reflect 15 May.
Nurse: "Can you tell me how you take your inhaler?" Patient: "Sure, I use the salbutamol inhaler, two puffs when I feel short of breath, but I actually take three puffs each time." Nurse: "And the dosage prescribed?" Patient: "The doctor wrote two puffs, but I’ve been doing three." Nurse: "Understood. Any other meds?" Patient: "Just the inhaler, that's it."
15. How has the patient been using the salbutamol inhaler compared with the prescription?
Answer: C. The patient states the prescription is two puffs but they actually take three puffs. The correct note records the actual usage: three puffs. An unwary candidate might write the prescribed two puffs.
Nurse: "When did you last see the dermatologist?" Patient: "I went on the 22nd of June, but I think I meant the 24th." Nurse: "And what was the main symptom you reported?" Patient: "My skin felt like it was burning, like a hot iron on it." Nurse: "Okay, and the medication you were prescribed?" Patient: "They gave me clobetasol cream, 0.05 percent, to apply twice daily." Nurse: "Thanks. Where did you get the cream?" Patient: "From the Riverside Pharmacy on Oak Road."
16. What clinical term should replace the patient's description of the skin sensation?
Answer: C. The patient describes a "burning, like a hot iron" sensation, which corresponds to a burning sensation. Candidates might select 'pruritus' (itch) or 'erythema' (redness), but the audio points to burning.
Nurse: "Can you tell me how you’re taking your medication?" Patient: "I’ve been taking my amlodipine 5 mg once a day, but I actually take 10 mg each morning. I also say the drug is called ‘Amlodipine’ spelled A-M-L-O-D-I-P-I-N-E." Nurse: "You mentioned the rash feels like a ‘burning’ sensation. The clinic is called St. Mary's General Hospital."
17. What dose of amlodipine is the patient actually taking?
Answer: C. The patient admits to taking 10 mg each morning, which is higher than the prescribed 5 mg. The lay word ‘burning’ should be recorded as ‘erythema’ or ‘burning sensation’ in clinical notes.
Nurse: And how have you been taking your Metformin, Mr. Davies? Patient: Well, the prescription says one tablet twice a day, but I’ve been taking it only once a day after breakfast. I forget sometimes, and it’s just easier to remember the morning dose.
18. How is the patient taking their Metformin compared to the prescribed dose?
Answer: C. The patient states the prescription is 'twice a day' but they have been taking it 'only once a day'. Therefore, they are taking it less frequently than prescribed. Option C accurately reflects this discrepancy. This tests the ability to identify a deviation from the prescribed regimen, a common scenario in clinical notes.
Nurse: And can you spell out the name of the pharmacy for me, please? Patient: Yes, it’s the one on Elm Street. That’s E-L-M Street. They always have my prescriptions ready.
19. What is the correct spelling of the street name where the pharmacy is located?
Answer: B. The patient explicitly spells out the street name as 'E-L-M'. The correct spelling is therefore 'Elm'. This question tests the ability to capture and correctly spell out specific information, such as place names, which is a direct requirement in OET Listening Part A. The other options are plausible mishearings or misspellings.
Nurse: "When did the swelling start?" Patient: "It started on the 12th of May, I think. Oh, I mean the 22nd, sorry, the 22nd of May." Nurse: "You mentioned you’ve been taking 5 mg of amlodipine daily, but you say you actually take it twice a day. Also, you said the swelling is in your left arm, which you think is the ‘bicep’ area. Lastly, you mentioned the pharmacy is on ‘Elm Street’ but you spelled it as ‘Elme Street’."
20. Which of the following should the nurse record in the notes?
Answer: B. The patient corrected the date to the 22nd of May. The nurse must record the corrected date. The patient actually takes 5 mg twice daily, so the dose must reflect that. The clinical term for the area is left arm, not the lay term ‘bicep’. The correct spelling of the street is Elm Street, not Elme Street. The wrong options either keep the original wrong date, use the lay term, or misspell the street.
Nurse: "How long have you had the headache?" Patient: "Since the 3rd of March, but I think I mean the 13th of March, sorry." Nurse: "You say you’ve been taking 10 mg of paracetamol every 6 hours, but you actually take it every 8 hours. You also described the pain as a ‘dull ache’ and mentioned the pharmacy is on ‘Baker Street’ spelled as ‘Baker St.\n"
21. What should the nurse record for the onset of the headache?
Answer: B. The patient corrected the date to the 13th of March. The nurse must record the corrected date. The other options keep the original incorrect date or change the format but not the corrected date.
Nurse: "When did the rash appear?" Patient: "It started on the 10th of July, but I think I mean the 20th of July, sorry. I’ve been using 0.5% hydrocortisone cream twice a day, but I actually apply it three times a day. I described the rash as a ‘burning’ sensation and said the pharmacy is on ‘Maple Street’ spelled as ‘Maple Streeet’."
22. What should the nurse record for the dose of hydrocortisone?
Answer: B. The patient corrected the dose to three times daily. The nurse must record the actual frequency. The other options either keep the incorrect twice daily or give unrelated frequencies.
Nurse: Good morning, Mr. Davies. I see from your notes that you've been experiencing some breathing difficulties. Can you tell me when this started? Patient: Oh, it's been a while. I think it was around the 15th of May, no, wait, it was the 15th of June. It's been getting worse over the last month or so. I've been using my blue inhaler, the salbutamol, much more often than usual, maybe four or five times a day. I also tried that new one, the brown one, but it didn't seem to help much. It feels like my chest is really tight, like a band is squeezing it.
23. What should the nurse record for the onset of the breathing difficulties?
Answer: B. The patient initially states the wrong date (15th of May) but then corrects it to the 15th of June. The correct answer is the corrected date. This tests the ability to identify and select the corrected information, a common strategy in Listening Part A. The other options are incorrect because 'Last month' is too vague, and 'Four or five times a day' refers to inhaler use, not the onset of symptoms.
Nurse: Good morning, Mrs Patel. What's brought you in today? Patient: My left knee has been playing up. It feels stiff when I get out of bed in the morning, really stiff, and it clicks. Nurse: How would you describe that stiffness in your own words? Patient: It's like the joint is stuck, won't bend properly, almost as if it's locked in place. Nurse: And any swelling? Patient: Yes, it's puffy around the kneecap, hot to touch. Nurse: Are you taking anything for it? Patient: Just paracetamol when it's bad. The doctor at the other clinic, over on Hadrian Road, H-A-D-R-I-A-N, prescribed some ibuprofen but I haven't started it. Nurse: Right, and when did you first notice it? Patient: About three weeks ago now, the fourth of last month. Nurse: Any locking of the knee? Patient: Yes, I told you, it locks.
24. What clinical term should the nurse use to document the patient's description of the knee stiffness?
Answer: B. The patient describes the joint as 'stuck,' 'won't bend properly' and 'locked in place.' The clinical term that maps to this mechanical restriction is 'rigidity.' Option A 'aching' would suit a dull pain description, option C 'tenderness' suits pain on palpation, and option D 'crepitus' is the term for clicking or grating. The trap here is that 'stiff' sounds informal for 'aching,' which is why candidates who do not listen carefully choose A. The patient's words 'stuck' and 'locked' point clearly to a mechanical rather than a pain symptom, so rigidity is the clinical match.
Nurse: Mr O'Donnell, how have you been getting on with the new inhaler? Patient: Not bad, but I'm using it four times a day instead of the twice the label says. Nurse: Right, and the prednisolone tablets? Patient: Five milligrams once a day, that's what it says on the box. Nurse: Good. Any side effects? Patient: My mouth has been really dry, like cotton, and I feel a bit dizzy in the mornings. Nurse: How about your blood sugar, has the GP checked that recently? Patient: I went to the surgery on Fowler Avenue, F-O-W-L-E-R, last Tuesday and they said it was fine, a bit high but fine. Nurse: And the rash on your hands, is that still there? Patient: Worse, if anything. It's bright red, angry looking, and it burns like sunburn.
25. How is the patient using the salbutamol inhaler compared with the prescription?
Answer: A. The prescription on the label is twice a day, and the patient says, 'I'm using it four times a day instead of the twice the label says.' That makes the actual dose double what is prescribed. The trap options are designed for candidates who skim: A rewards the candidate who writes what the label says rather than what the patient reports, C reverses the ratio to catch candidates who confuse the direction of the discrepancy, and D introduces 'as required' which is not in the audio. Listening Part A always asks what the patient is actually doing, not what they should be doing, so 'four times a day' is the figure that belongs in the notes.
Nurse: Can you tell me what's been happening with your breathing? Patient: It started about a week ago, the ninth of June, no, sorry, the eleventh. I came back from holiday and it just went downhill. Nurse: Were you anywhere exotic? Patient: Turkey, Antalya, we were at the resort near the old town. Nurse: I see. And the cough? Patient: Dry at first, then it got yellow, thick, disgusting. Nurse: Any fever? Patient: Felt hot, shivery, with aches all over. Nurse: Temperature was 38.4 when the triage nurse checked. Patient: Right. I've been using the Seretide inhaler, S-E-R-E-T-I-D-E, the purple one, two puffs morning and night, but it hasn't helped much. Nurse: Any allergies? Patient: Penicillin, gives me a terrible rash.
26. What is the correct spelling of the inhaler the patient mentions?
Answer: A. The patient spells the drug out letter by letter as S-E-R-E-T-I-D-E. In Listening Part A, when a name is spelled, the audio is giving you the answer in slow motion, and the candidate's only job is to write down every letter in order. The trap options each move one letter: A drops the first E, C swaps the final E for an O, and D scrambles the final syllable. The method here is to write the spelling as you hear it without trying to second-guess it into a real-looking word, because fluticasone/salmeterol combination inhalers really are spelled Seretide. Candidates who try to 'correct' what they hear lose marks on spelled-out drug names every time.
Nurse: When did your cough start? Patient: I think it began around the 12th of March, no… actually the 15th of March. Nurse: Got it. How would you describe the feeling in your chest? Patient: It feels like a tight band around it. Nurse: And what inhaler are you using? Patient: I’ve been using Ventolin, two puffs every four hours, not the four puffs twice a day that was prescribed.
27. What should the nurse record for the date the cough started?
Answer: B. The patient initially said 12 March but then corrected to 15 March. The correct note takes the corrected date. Candidates may mistakenly write the first figure. This training mimics Listening Part A where the audio contains a correction; writing the corrected information is required.
Nurse: Can you tell me about the pain in your leg? Patient: It’s a throbbing kind of ache, like a hammer hitting it. Nurse: And the medication you’re on? Patient: I’m supposed to take ibuprofen 400 mg three times daily, but I only take one tablet twice a day. Nurse: Where is the pharmacy you pick it up from? Patient: It’s on Oak Street, but I think you mean Oak Streeet.
28. What clinical term should replace the patient’s description of the leg pain?
Answer: B. The patient uses lay language ‘like a hammer hitting it’; the clinical term is ‘hammering pain’. Unwary candidates might copy the lay phrase. This exercise trains note‑completion by converting colloquial descriptions to clinical terminology.
Nurse: When did you first notice the shortness of breath? Patient: It started about the 3rd of June, actually the 5th of June. Nurse: How are you using your inhaled steroids? Patient: I was told to use Fluticasone 250 micrograms once daily, but I’m using two puffs twice daily. Nurse: And the pharmacy address? Patient: It’s on Willow Avenue, not Willow Avenuue.
29. What dose of Fluticasone is the patient actually taking?
Answer: C. The prescription is 250 µg once daily, but the patient takes two puffs twice daily, which equals 500 µg twice daily. Candidates often record the prescribed dose instead of the actual usage. This note‑completion task mirrors the audio trap of a dosage discrepancy.
Nurse: When did your cough start? Patient: I think it was the 12th of March, but actually it was the 21st. Nurse: Noted. Any other symptoms? Patient: I’ve been feeling a tight band around my chest when I walk. Nurse: Okay. What about your blood pressure medication? Patient: The doctor gave me 10 milligrams of lisinopril once a day, but I’ve been taking one tablet of 5 milligrams twice a day because I thought that would work better. Nurse: And where do you collect your prescriptions? Patient: I go to the pharmacy on Oak Stret every week. Nurse: Thanks, that’s all I need.
30. What should the nurse record for the dose of lisinopril the patient is actually taking?
Answer: C. The transcript shows the patient correcting the date (12th to 21st) and describing a symptom in lay terms (tight band around my chest) which should be recorded clinically as thoracic tightness, but the question focuses on the dose. The patient says they are taking one tablet of 5 mg twice a day, which is the actual dose to record. Unwary candidates often pick the prescribed dose (10 mg once daily) or mis‑read the frequency. This practice mimics Listening Part A where you must write exactly what the patient says, not what was prescribed. Training with a written transcript is a valid way to develop that skill.

Listening Parts B and C — briefings and talks 30 questions

Part B is short workplace extracts (a handover, a team briefing, an instruction from a senior); Part C is longer presentations and interviews.

Nurse manager: Good morning, team. Just a quick reminder regarding the new electronic prescribing system going live on Monday. As we discussed last week, all medication charts must be fully digitized by Sunday midnight. Paper charts will be officially decommissioned at that point, so no late retrospective entries will be accepted on paper. I know some of you are concerned about the transition speed, but IT support will be stationed on the ward for the first forty-eight hours to assist with any login or interface issues. Please ensure your mandatory online training modules are completed before your next rostered shift.
1. What is the manager's main purpose in this briefing?
Answer: C. The speaker states that medication charts must be fully digitized by Sunday midnight and that paper charts will be decommissioned, making C correct. Option A is contradicted because the rollout is still happening on Monday. Option B is a supporting detail rather than the main purpose. Option D is incorrect because she is giving instructions, not asking for feedback.
Clinical educator: Today we are reviewing our wound care protocols. Historically, the standard clinical assumption has been that chronic venous leg ulcers require aggressive debridement to stimulate healing granulations. However, our recent twelve-month hospital audit challenged that exact assumption by tracking healing velocities across three hundred patients. What we found was that conservative cleansing combined with gentle compression actually outperformed aggressive debridement in terms of complete epithelialisation times. Consequently, our updated protocol shifts the focus entirely away from mechanical debridement for uncomplicated ulcers.
2. According to the clinical educator, what did the recent hospital audit reveal about wound care?
Answer: B. The speaker reports that the audit found conservative cleansing combined with gentle compression outperformed aggressive debridement, matching option B. Option A describes the historical assumption that the audit actually challenged, not the finding. Option C is not mentioned. Option D directly contradicts the final statement that the protocol shifts away from mechanical debridement.
Senior researcher: When we initiated the sepsis pathway redesign, the prevailing institutional consensus maintained that serum lactate levels alone were sufficient for risk stratification in the emergency department. Critics argued that adding point-of-care ultrasound would overburden triage nurses and delay antibiotic administration. Our pilot data, however, completely dismantled that theoretical objection. We demonstrated that integrating bedside ultrasound alongside lactate measurement actually shaved eighteen minutes off the time-to-antibiotic interval because it streamlined fluid responsiveness assessment right at the triage desk.
3. What does the researcher say about the initial criticism of the sepsis pathway redesign?
Answer: C. The researcher states that their pilot data completely dismantled the theoretical objection of the critics, showing that the criticism was unfounded, which matches option C. Option A is wrong because pilot data showed times actually decreased. Option B is incorrect because the objection was theoretical and disproven. Option D is not supported by the text.
"During the morning shift handover, the senior nurse said: 'Team, the new protocol for administering insulin has been in place for two weeks now. We have seen a 15% reduction in hypoglycaemic episodes. However, I want to remind everyone that the protocol still requires the patient’s weight to be recorded before each dose. Please double‑check the weight on the chart and document it in the notes. If you notice any discrepancy, alert the medical officer immediately.'
4. What is the main purpose of the senior nurse's statement?
Answer: D. The nurse’s primary aim is to remind staff that the protocol still requires weight recording and to ensure it is done. The other options describe aspects of the statement but are not the main purpose.
"Good afternoon, everyone. I want to give you a quick briefing on the upcoming audit of our falls prevention programme. The audit will cover all incidents over the past six months. We will be looking at the time of day, the location, and the interventions used. I will be collecting the data in the next two weeks, and I will share the preliminary findings with you by the end of the month. Please ensure that all falls are reported accurately in the incident log. If you have any questions, feel free to ask."
5. Which of the following best describes the speaker’s attitude towards the audit?
Answer: C. The speaker stresses accurate reporting and invites questions, showing concern for data quality. The other options do not match the tone.
Dr. Evans: ...and so, the key takeaway from this review is the need for a paradigm shift in how we approach chronic pain management. For years, the standard approach has been largely pharmacological, focusing on opioid-based pain relief. This has led to significant issues with addiction and dependence, as we all know. However, the guidance has always assumed that this pharmacological route is the most effective first-line treatment. That assumption is exactly what our audit challenged. We found that a multidisciplinary approach, incorporating physiotherapy, psychological support, and targeted exercise programs, yielded significantly better long-term outcomes and patient satisfaction, with far fewer side effects. Patients reported feeling more empowered and in control of their pain. So, while medication still has a role, it shouldn't be the automatic starting point.
6. According to Dr. Evans, what was the flawed assumption in previous chronic pain management strategies?
Answer: C. Dr. Evans states, 'the guidance has always assumed that this pharmacological route is the most effective first-line treatment. That assumption is exactly what our audit challenged.' This directly identifies the flawed assumption. Option A is incorrect as addiction is mentioned as a consequence, not the initial assumption. Option B is not mentioned. Option D is incorrect as he advocates for psychological support as part of the multidisciplinary approach.
Dr. Lee: ...and that brings us to the end of the presentation on the new anticoagulation protocols. I want to thank you all for your attention. Just a few final points before we break. Remember, the transition to the new direct oral anticoagulants, or DOACs, is mandatory from next month. The rationale behind this change is multifaceted: improved efficacy in certain patient groups, reduced monitoring requirements compared to warfarin, and a generally more favourable bleeding profile when used correctly. However, I've heard some concerns raised about the cost implications, particularly for patients with limited private insurance. While the upfront cost per pill might be higher, the long-term savings from reduced monitoring and fewer bleeding complications are substantial. We need to ensure clear communication with patients about these benefits and address any financial anxieties proactively. The formulary changes will be distributed via email this afternoon.
7. What is the primary purpose of Dr. Lee's concluding remarks?
Answer: B. Dr. Lee's remarks serve to summarise the key points and prepare the audience for the upcoming change. He explicitly states, 'the transition to the new direct oral anticoagulants, or DOACs, is mandatory from next month' and then proceeds to address potential concerns like cost. Option A is only one aspect discussed. Option C is a secondary action mentioned ('formulary changes will be distributed'). Option D is also a supporting detail, not the main purpose of the conclusion.
Nurse Manager: Right team, before we start the morning handover, I want to address the new agency shift sign-off procedure. A few of you have been sending them straight to payroll without my countersignature, which misses the audit trail entirely. I know the old way was faster, but from today onwards, every single time sheet needs my physical signature before it leaves this ward. No exceptions.
8. What is the nurse manager's main purpose in this briefing?
Answer: B. The manager states that every time sheet needs her physical signature before leaving the ward and that the old fast way is no longer allowed. Option B matches this instruction. Options A, C, and D introduce elements not mentioned in the text (reductions, software, and disciplinary warnings).
Clinical Educator: During our review of the recent falls data, we noticed an interesting trend. While the night shift recorded the highest number of overall incidents, our deeper analysis showed that patients who fell during the day shift sustained more severe injuries, primarily because they were more mobile and attempting unassisted transfers despite care plans advising otherwise.
9. According to the clinical educator, why did day shift falls result in more severe injuries?
Answer: A. The speaker directly states that day shift injuries were more severe because patients were more mobile and attempting unassisted transfers despite care plans advising otherwise. Option A captures this exact detail. The other options either misattribute findings or state things not claimed by the speaker.
Dr. Aris: The standard clinical guidelines have historically assumed that elderly patients with delirium should be kept in quiet, isolated side rooms to reduce sensory overload. However, our recent multi-site trial challenged that exact assumption by demonstrating that social contact in communal areas actually accelerates cognitive recovery.
10. What does Dr. Aris report about the traditional clinical guidelines for managing elderly patients with delirium?
Answer: D. The question asks what the speaker reports others think or what the historical guideline assumed. Dr. Aris states that guidelines have historically assumed that patients should be kept in isolated side rooms to reduce sensory overload. Option D reflects this reported view, whereas option C incorrectly attributes the trial finding to the old guidelines.
Lead Research Nurse: Critics of our new nurse-led discharge protocol argued that it would inevitably increase 30-day readmission rates because junior staff lack diagnostic intuition. But our twelve-month trial proved them wrong, showing a stable readmission rate alongside a significant drop in average length of stay.
11. Which statement correctly reflects what the lead research nurse reports others think about the new protocol?
Answer: A. The speaker reports that critics argued the protocol would increase readmission rates because junior staff lack diagnostic intuition. Option A accurately mirrors this reported criticism. The other options confuse the critics' warnings with the actual trial results or introduce unmentioned training requirements.
Senior Nurse: "Before we start the night shift, I want to remind everyone that the new medication reconciliation checklist was introduced last month. The pharmacy team told us it would cut errors by twenty percent, but our recent audit shows only a five percent reduction. So we need to keep a close eye on documentation and flag any discrepancies immediately."
12. What is the primary purpose of the senior nurse's statement?
Answer: D. The speaker points out the discrepancy between the promised twenty percent reduction and the actual five percent, then urges staff to monitor documentation. This shows the purpose is to highlight the gap and call for vigilance.
Clinical Educator: "The recent falls audit on the day shift has shown that most injuries occur when patients attempt to mobilise unaided. The senior physiotherapy team has always assumed that patients prefer to stay in bed to avoid falls, but our data contradict that. We now need to revise our risk assessments to reflect patients' actual behaviour."
13. Which statement correctly reflects what the speaker reports others think?
Answer: A. The educator says the senior physiotherapy team has always assumed patients prefer to stay in bed – that is what she reports others think. The other options misattribute opinions or facts.
Dr. Patel (presenting at a departmental meeting): "Historically, the infection control guidelines have assumed that hand hygiene compliance is solely a matter of individual choice. Our recent observational study, however, demonstrated that workflow design plays a much larger role. This challenges the long‑standing belief and suggests we need system‑level changes."
14. What does Dr. Patel report others think?
Answer: C. Dr. Patel states that others have assumed compliance is an individual choice. Option C captures that reported belief; the other options incorrectly attribute the belief to Dr. Patel or misstate the report.
Team Briefing: "I know many of you are concerned that the new electronic discharge summary will increase your workload. The IT department assures us the interface is user‑friendly, but the pilot data show an average increase of fifteen minutes per discharge. We must therefore allocate additional admin support during the rollout to maintain patient flow."
15. What attitude does the speaker display towards the IT department's claim?
Answer: A. The speaker acknowledges the IT department's assurance but points out pilot data that contradict it, showing a skeptical attitude.
"Good morning team. Today I want to highlight the new handover protocol that was introduced last month. The protocol states that each shift must record the patient’s vital signs, medication changes, and any incidents in the shared log. The senior nurses have been praising its clarity, but the audit last week showed that 12% of entries were still incomplete. Our goal is to reduce that figure to under 5% by the end of the quarter."
16. What is the main purpose of the speaker’s briefing?
Answer: D. The speaker’s main aim is to set a target for improving log completeness, as stated in the last sentence. The other options describe content that is mentioned but not the primary purpose.
"During the morning briefing, the charge nurse reminded the team that the new fall prevention checklist must be completed before each patient is transferred to the ward. She noted that the last incident report indicated a 15% increase in falls over the past two months. The senior nurse added that the checklist has been effective in other units, but the audit last month found that only 70% of staff were using it consistently. The charge nurse concluded that the team should aim for 90% compliance by the end of the month."
17. Which statement best reflects the speaker’s attitude toward the audit findings?
Answer: D. The speaker acknowledges the audit results and uses them to motivate higher compliance, indicating a need for improvement. The other options misrepresent her stance.
"In the recent audit of medication reconciliation, the senior pharmacist reported that the current practice assumes all nurses are fully trained in pharmacology. This assumption, however, was challenged by the audit, which found that 30% of nurses had not completed the required refresher course. The pharmacist noted that the guidance has always assumed this level of knowledge, and that assumption is exactly what our audit challenged."
18. Which statement incorrectly attributes the assumption to the speaker?
Answer: C. The speaker does not state that he/she believes the guidance is outdated; he/she only reports that the audit challenged the assumption. Options A, B and D correctly reflect reported information.
"During the afternoon presentation, the clinical educator explained that the new protocol for managing delirium in elderly patients assumes that all patients will respond to non-pharmacological interventions first. She then highlighted that the audit last year revealed that 40% of patients required pharmacological treatment within 48 hours. She emphasized that the protocol’s assumption was exactly what the audit challenged, and that the team should now consider a more flexible approach."
19. What does the speaker report others think about the new protocol?
Answer: B. The speaker reports that others believe the protocol assumes all patients respond to non-pharmacological interventions first. The other options are not stated by the speaker.
Good morning everyone. I'm Dr. Anya Sharma, and today I'll be presenting our findings from the recent audit of the hospital's antibiotic stewardship program. We've seen a concerning rise in C. difficile infections, and our investigation aimed to pinpoint the contributing factors. Our data suggests a significant correlation between the duration of broad-spectrum antibiotic use and the incidence of these infections. Specifically, patients receiving antibiotics for longer than seven days were found to have a substantially higher risk. This is despite current guidelines, which often recommend longer durations for certain conditions. We believe a review of these protocols is urgently needed to mitigate this risk.
20. What is the main finding of the audit presented by Dr. Sharma?
Answer: C. Dr. Sharma states, 'patients receiving antibiotics for longer than seven days were found to have a substantially higher risk' of C. difficile infections. This directly supports option C. Option A is contradicted by her statement that 'a review of these protocols is urgently needed'. Option B is contradicted by the 'concerning rise in C. difficile infections'. Option D is contradicted by the entire premise of the audit.
Alright team, let's talk about the new electronic health record system. I know there have been some initial hiccups, and I appreciate your patience as we navigate this transition. The vendor assures us that the stability issues we're experiencing are temporary and should be resolved with the upcoming patch. However, I've also heard from several of you that the user interface is not as intuitive as we were led to believe during the demonstrations. While we must continue to use the system as mandated, I want to gather specific feedback on the usability challenges. Please document any recurring problems or areas where you feel the design is hindering efficient workflow. We'll compile this and present it to the vendor to advocate for necessary improvements.
21. What is the speaker's primary purpose in this briefing?
Answer: C. The speaker acknowledges 'initial hiccups' and 'stability issues' but also states, 'I want to gather specific feedback on the usability challenges' and 'We'll compile this and present it to the vendor to advocate for necessary improvements.' This aligns with option C. Option A is incorrect as the speaker discusses ongoing use and improvements, not replacement. Option B is incorrect as the speaker validates concerns. Option D is incorrect as the speaker mentions issues and the need for vendor advocacy.
The current understanding within the medical community has largely been that the primary driver of post-operative delirium in elderly patients is the physiological stress of surgery itself. This perspective has informed much of the clinical guidance, leading to interventions focused on managing pain and fluid balance. However, our recent study suggests a more nuanced picture. We found that pre-existing cognitive impairment and the use of specific sedative medications were actually more significant predictors of delirium than the surgical stress response alone. The existing literature, while acknowledging these factors, has consistently placed greater emphasis on the surgical impact. Our findings challenge this established hierarchy of risk factors.
22. What does the speaker report about the traditional view of post-operative delirium in the elderly?
Answer: B. The speaker states, 'The current understanding within the medical community has largely been that the primary driver of post-operative delirium in elderly patients is the physiological stress of surgery itself.' They then contrast this with their findings: 'We found that pre-existing cognitive impairment and the use of specific sedative medications were actually more significant predictors of delirium than the surgical stress response alone.' This indicates that the traditional view, while acknowledging other factors, placed less emphasis on pre-existing cognitive impairment, making option B the correct answer. Option A is incorrect because the speaker's study challenges this view. Option C is incorrect for the same reason. Option D is incorrect as the speaker states the traditional view emphasized surgical stress, not sedative use.
This presentation focuses on the implementation of a new patient discharge protocol aimed at reducing readmission rates. Historically, our discharge process has been fragmented, with poor communication between ward nurses, GPs, and community care teams. Many in the previous administration believed that simply providing patients with a written summary was sufficient. However, evidence from other trusts suggests that a more proactive approach, involving direct handover and medication reconciliation *before* the patient leaves, is crucial. Our pilot study, which incorporated these elements, demonstrated a 15% reduction in 30-day readmissions. We are now proposing to make this enhanced protocol standard practice across all departments.
23. What does the speaker report others believed was sufficient for patient discharge in the past?
Answer: C. The speaker explicitly states, 'Many in the previous administration believed that simply providing patients with a written summary was sufficient.' This directly supports option C. Options A and B are elements of the *new* protocol that the speaker advocates for, not what was previously considered sufficient. Option D refers to the evidence supporting the new protocol, not a past belief about discharge sufficiency.
Nurse Manager: Morning team. Just a quick briefing regarding the new medication administration system rolling out across the ward next Monday. I know many of you are concerned about the double-signing delay slowing down the morning medication round, and that is a completely valid concern given our current staffing levels. However, the pharmacy department insists that the digital safety interlocks will ultimately reduce transcription errors by half. Our priority this week is ensuring everyone completes the mandatory thirty-minute online module before Friday afternoon so we avoid any access lockouts when the system goes live.
24. What does the nurse manager identify as the immediate priority for the nursing staff this week?
Answer: A. The speaker clearly states that the priority this week is ensuring everyone completes the mandatory thirty-minute online module before Friday afternoon. Option B is incorrect because testing the interlocks is not assigned to nurses. Option C is incorrect as challenging pharmacy is not the goal. Option D is incorrect because staff are told to complete training, not resolve delays themselves.
Clinical Educator: In today's session on chronic wound management, we need to address the widespread reliance on traditional saline gauze dressings. For years, the standard hospital protocol has assumed that keeping a wound bed saturated with wet-to-dry dressings provides the optimal moist environment for epithelial migration. But our recent tissue viability audit directly challenged that core assumption, revealing that modern hydrocolloid and foam dressings achieve significantly faster closure rates and far less patient discomfort.
25. What does the educator report about the traditional hospital protocol for chronic wound management?
Answer: B. The speaker states that the standard hospital protocol has assumed that keeping a wound bed saturated with wet-to-dry dressings provides the optimal moist environment. Option A and D attribute the benefits of modern dressings to the traditional protocol incorrectly. Option C is wrong because epithelial migration is achieved by the modern dressings revealed in the audit, not the traditional protocol.
Nurse Researcher: During our review of night-shift handover practices, we looked closely at the longstanding belief among senior administrators that a standardized five-minute verbal summary at the bedside completely eliminates clinical handover omissions. While the board has historically relied on that metric to satisfy accreditation standards, our observational data shows that interruptions and missing contextual details occur in over forty percent of those briefings, rendering the metric largely symbolic rather than clinically protective.
26. Which statement correctly separates the board's historical belief from the researcher's actual finding?
Answer: A. The speaker contrasts what the board has historically relied on (the belief that the summary eliminates omissions) with their own observational data showing frequent omissions and interruptions. Option B reverses the roles. Option C is contradicted by the text. Option D completely misstates the researcher's conclusion that the briefing is rarely protective.
Charge Nurse McAllister: Right, before we start the ward round, a quick word on the falls audit. I know some of you have been asking whether it was really necessary — and I hear you. But the picture the audit painted wasn't what any of us expected. We've always assumed that the falls on this ward happened mostly to patients who were already confused, or who tried to get out of bed when they shouldn't. That assumption is exactly what the audit challenged. When we looked at the actual incident forms, most of the falls were in patients who were fully oriented, mostly during the early evening, and mostly during the first three days of admission. So this isn't about confused patients wandering — it's about mobile, alert patients in an unfamiliar environment. We'll talk about the new assessment tool tomorrow, but for now, just be aware that the picture we've worked with for years doesn't really hold up.
27. Which statement correctly reflects what the speaker reports others have traditionally assumed about falls on the ward?
Answer: A. The question asks what others have TRADITIONALLY assumed — the speaker's own audit finding is the opposite. McAllister says, 'We've always assumed that the falls on this ward happened mostly to patients who were already confused, or who tried to get out of bed when they shouldn't.' That is the historical belief the audit challenged. Option B is the audit's actual finding, not the traditional view, which is the trap. Option C is unsupported. Option D contradicts the whole point of the audit.
Dr. Okoye, Consultant Geriatrician, speaking at a lunchtime education session: I want to talk today about post-operative delirium in elderly patients — specifically, what we used to believe and what the newer evidence is telling us. The textbook view for many years was that post-operative delirium in the elderly was essentially a transient phenomenon — it came, it stayed briefly, and it resolved without long-term consequences. Patients were reassured with that view, and so were their families. More recent work, though, has painted a rather different picture. The cohort study published last year followed patients for twelve months after surgery and found that delirium was associated with significantly higher rates of cognitive decline and institutional placement at one year. So we need to be cautious about giving families the comfortable message that delirium is just a short-lived inconvenience.
28. Which statement correctly reflects what the speaker reports others have traditionally believed about post-operative delirium in the elderly?
Answer: A. Dr Okoye distinguishes the OLD view from the new evidence. She says, 'The textbook view for many years was that post-operative delirium in the elderly was essentially a transient phenomenon — it came, it stayed briefly, and it resolved without long-term consequences.' That is exactly option A. Option B is the new finding from the cohort study, not the traditional belief — that is the trap. Options C and D are not mentioned at all.
Nurse Educator Singh, addressing new graduate nurses at orientation: Before we go into the new chronic wound management protocol, I want to give you some context, because you'll hear senior staff talk about the old way and it's worth knowing what they actually mean. Historically, the hospital protocol for chronic wound management assumed that daily dressing changes were the standard of care. That assumption was based on the idea that frequent inspection promoted healing. Senior staff were trained under that model, and many of them are genuinely attached to it. But the Cochrane review we now follow showed that longer wear times, where clinically appropriate, are associated with better healing rates and lower infection rates. So the daily-change mindset is the one we're moving away from — and some of your preceptors will need a bit of coaxing on that point.
29. Which statement correctly separates what the speaker reports the traditional protocol assumed from the educator's own view?
Answer: A. The educator clearly attributes daily changes to the historical protocol: 'the hospital protocol for chronic wound management assumed that daily dressing changes were the standard of care.' She then states her own position — longer wear times are better — citing the Cochrane review. Option A combines both correctly. Option B reverses the two. Options C and D misread the educator's own position.
Dr. Ferreira, presenting audit findings to the clinical governance committee: Thank you, Chair. I'll keep this brief. The trigger for this audit was a cluster of pressure injuries reported on Ward 6B over a six-month period. Before I present them, I want to be clear about what this audit is not. It is not an investigation of individual nursing practice, and it is not a blame exercise. What it is, is a systems review — we want to understand the conditions that allowed these injuries to develop, not to identify who is at fault. The board has historically taken the view that pressure injuries reflect poor nursing care, and the goal of this audit is to test that assumption against the evidence we gathered. I should say at the outset that the evidence does not support that assumption. Most of the injuries occurred in patients with multiple intrinsic risk factors, and the nursing documentation on the ward was of a high standard. The picture is more complicated than 'poor care equals pressure injury.'
30. Which statement correctly separates the board's historical belief about pressure injuries from the speaker's own finding?
Answer: A. Dr Ferreira is explicit: 'The board has historically taken the view that pressure injuries reflect poor nursing care, and the goal of this audit is to test that assumption against the evidence we gathered.' He then says, 'the evidence does not support that assumption.' Option A captures both halves of that contrast. Option B reverses the audit outcome. Option C reverses the board's view. Option D introduces documentation, which the speaker explicitly says was of a high standard.

Writing — the referral letter 40 questions

The hardest sub-test to pass and the one that decides most resits, so it gets the most items.

Mrs. Helen Davies 15 Willow Street Anytown Date: 26 October 2023 Dear Dr. Evans, Re: Mrs. Helen Davies, DOB: 12/05/1948, 82 years old I am writing to refer Mrs. Davies, a patient of mine with a history of Type 2 Diabetes and Hypertension, for ongoing management of a non-healing ulcer on her left foot. Mrs. Davies presented to the clinic two weeks ago with a small, superficial ulcer on the lateral aspect of her left foot. She reports no trauma. She has been managing her diabetes with Metformin 500mg twice daily and her hypertension with Ramipril 5mg daily. Her blood glucose levels have been generally well-controlled, with an HbA1c of 7.2% three months ago. She denies any pain associated with the ulcer, but notes it has not shown signs of improvement despite regular saline dressings at home. On examination, the ulcer is approximately 2cm in diameter, with mild surrounding erythema and no purulent discharge. There is reduced sensation in both feet, consistent with peripheral neuropathy. Peripheral pulses are palpable but diminished. Given the lack of healing and the presence of neuropathy, I would appreciate your assessment and management plan for this ulcer. I have advised Mrs. Davies to continue with her current dressings and to keep the area clean and dry. Please let me know if you require any further information. Yours sincerely, [Your Name] Registered Nurse
1. Which of the following details is ESSENTIAL for the specialist to include in the referral letter for Mrs. Davies?
Answer: B. Content: The case notes state Mrs. Davies's blood glucose levels have been generally well-controlled, with an HbA1c of 7.2% three months ago. This detail is essential for the specialist to understand the patient's overall diabetic status, which directly impacts ulcer healing. Options A, C, and D are biographical details not clinically relevant to the management of the foot ulcer.
Mr. John Smith 10 Maple Avenue Anytown Date: 26 October 2023 Dear Sir/Madam, Re: Mr. John Smith, DOB: 05/08/1965, 58 years old I am writing to refer Mr. Smith for an urgent surgical review. Mr. Smith presented to our clinic today with acute, severe abdominal pain. Mr. Smith describes the onset of pain as sudden, approximately 4 hours ago, located in the right iliac fossa, radiating to the groin. He reports associated nausea and vomiting. He has a temperature of 38.5°C and his pulse is 110 bpm. His abdomen is distended and tender, particularly in the right iliac fossa, with guarding and rebound tenderness. His past medical history is significant for diverticulosis, for which he has not required hospital admission previously. He is not on any regular medication. He is a non-smoker and drinks alcohol socially. Given the clinical presentation suggestive of acute appendicitis or a related surgical emergency, I would be grateful if you could review Mr. Smith as a matter of urgency. Please admit him for further investigation and management. Yours sincerely, [Your Name] General Practitioner
2. How should the GP's request for review be phrased, considering the urgency?
Answer: B. Genre and Style: The case notes indicate a high level of urgency ('acute, severe abdominal pain', 'sudden, approximately 4 hours ago', 'temperature of 38.5°C', 'guarding and rebound tenderness', 'surgical emergency'). Therefore, the request must be direct and clear. Option B uses direct language ('Please review... urgently') appropriate for an emergency. Options A, C, and D use hedging language ('earliest convenience', 'when you have a moment', 'at some point next week') which is inappropriate for an urgent clinical situation.
Patient Transfer Summary Patient Name: Mr. David Chen DOB: 15/02/1970 (53 years old) Transferring From: Anytown General Hospital, Ward 5 Transferring To: Community Care Facility, 'The Willows' Date: 26 October 2023 Reason for Transfer: Ongoing rehabilitation and long-term care following a stroke. Clinical Summary: Mr. Chen was admitted on 10 October 2023 following a left-sided ischemic stroke. He has made good progress with physiotherapy and occupational therapy during his admission. He is now medically stable and ready for transfer to a community care facility for continued rehabilitation and support. Neurological Status: Residual right-sided hemiparesis. Able to mobilise short distances with a four-wheeled walker and requires standby assistance for transfers. Speech is slightly dysarthric but generally understood. Swallowing is safe with a soft diet. Medications: Aspirin 75mg daily Atorvastatin 20mg daily Paracetamol 500mg PRN for pain Social History: Lives alone in a ground-floor flat. Wife deceased. Son lives overseas but visits regularly. He has a history of moderate alcohol consumption (approx. 10 units/week) which has been ceased during admission. Previously worked as an accountant. Care Plan Requirements: Physiotherapy: Continue with strengthening exercises for right arm and leg. Focus on gait training and balance. Goal: Independent ambulation within the facility. Occupational Therapy: Continue with ADL retraining, particularly dressing and meal preparation. Focus on adaptive strategies. Nursing Care: Wound care (no current issues), medication administration, monitoring of vital signs. Assistance required with personal care. Dietary Needs: Soft diet. Mobility Aids: Four-wheeled walker. Requires standby assistance for transfers.
3. Which of the following pieces of information is MOST essential for the receiving community care facility to know?
Answer: C. Content: The case notes clearly state that Mr. Chen 'requires standby assistance for transfers' and is able to 'mobilise short distances with a four-wheeled walker'. This information is critical for the community care facility to ensure appropriate staffing and safety measures are in place for his daily care and mobility. Options A, B, and D are biographical details that are less critical for the immediate care planning at the facility compared to his physical assistance needs.
Ms. Sarah Jenkins 12 Oak Street Anytown Date: 26 October 2023 Dear Dr. Lee, Re: Ms. Sarah Jenkins, DOB: 20/11/1995, 27 years old I am writing to refer Ms. Jenkins for a review of her persistent knee pain. Ms. Jenkins reports a 3-month history of right knee pain, which she describes as a dull ache, worse with prolonged standing and walking. She denies any specific injury. She has tried over-the-counter analgesia with minimal relief. She has no significant past medical history apart from childhood asthma, which is well-controlled and requires no regular medication. She is a student and lives with her parents. On examination, there is mild tenderness over the medial joint line of the right knee, with no effusion or instability. Range of motion is full, but she reports pain at the extremes of flexion and extension. X-rays of the knee were unremarkable. I would be grateful if you could assess Ms. Jenkins and advise on further management. I have advised her to continue with simple analgesia and to try to modify activities that exacerbate her pain. Please contact me if you require further details. Yours sincerely, [Your Name] Physiotherapist
4. Which of the following belongs in the OPENING line of the referral letter, rather than the body?
Answer: B. Genre and Style: The opening line of a referral letter should clearly state the purpose of the letter and identify the patient. Option B directly states the reason for referral ('review of her persistent knee pain') and identifies the patient ('Ms. Jenkins'), serving as an effective opening statement. Options A, C, and D are details that belong in the body of the letter to provide clinical context and examination findings.
Case Notes: Patient name: Arthur Pendelton, DOB: 14 September 1941. Referral to: Community Physiotherapist. Reason: Post-stroke rehabilitation. Social history: Lives alone in a second-floor apartment, lift is currently out of order, 34 steps to reach ground level. Current mobility: Uses a frame indoors, unable to manage stairs independently. Past medical history: Hypertension, controlled on amlodipine. Hobbies: Enjoys oil painting and local history.
5. Which of the following details from the case notes is ESSENTIAL to include in the referral letter to the community physiotherapist?
Answer: A. Criterion: Content. Quote: Lives alone in a second-floor apartment, lift is currently out of order, 34 steps to reach ground level. A community physiotherapist needs to know environmental barriers like stairs before planning a home visit or mobility assessment. The other details are either unrelated biographical padding or already recorded administrative data.
Case Notes: Patient name: David Vance, DOB: 22 May 1968. Referral to: Emergency Department via On-Call Medical Registrar. Clinical status: Acute chest pain radiating to left jaw, diaphoresis, sudden onset 20 minutes ago while resting, ECG shows ST-elevation in leads V1-V4.
6. Which of the following sentences represents the most appropriate way to phrase the referral request given the clinical urgency?
Answer: A. Criterion: Language. Quote: ECG shows ST-elevation in leads V1-V4. Urgency outranks politeness; hedging phrases like consider reviewing understate a critical medical emergency. A direct and urgent imperative is required.
Case Notes: Patient name: Eleanor Vance, DOB: 12 December 1950. Referral to: Community Mental Health Team. Presenting complaint: Severe depressive symptoms following spousal bereavement three months ago, expressing active suicidal ideation with a specific plan today. Medical history: Type 2 diabetes, hypothyroidism.
7. Which of the following options represents the most effective statement of the reason for referral for the opening line of the letter?
Answer: B. Criterion: Purpose. The opening line must immediately state the core clinical reason for the referral. Active suicidal ideation requires urgent mental health intervention, making option B the only clinically accurate and prioritised opening.
Patient: Mr Ahmed, 68, male. Diagnosis: Chronic obstructive pulmonary disease (COPD) GOLD stage III. Recent admission for exacerbation, now stable. Current meds: salbutamol inhaler PRN, tiotropium daily, prednisolone 30mg daily for past 5 days. Oxygen saturation 92% on 2L nasal cannula. Home situation: lives alone in a two‑storey house with stairs, no lift. No carer visits. Referral to community physiotherapist for pulmonary rehabilitation.
8. Which detail is essential to include for the physiotherapist?
Answer: A. Criterion: Content – the physiotherapist must know the home environment and stair access to plan safe exercises. Quote: "lives alone in a two‑storey house with stairs, no lift" is the essential detail.
Patient: Mrs Patel, 45, female. Diagnosis: Type 2 diabetes mellitus, poorly controlled (HbA1c 9.2%). Recent foot ulcer on left heel, 2 cm, no signs of infection. Current meds: metformin 1000mg BID, insulin glargine 20 units nightly. Referral to vascular surgeon for assessment of arterial insufficiency. Urgency: ulcer has been present for 3 weeks, risk of progression.
9. How should the request be phrased to the vascular surgeon?
Answer: D. Criterion: Request‑versus‑urgency – the notes state the ulcer has been present for 3 weeks with risk of progression, so an urgent request is required. The phrase "Please urgently assess" matches the urgency.
Patient: Mrs O'Connor, 82, female. Diagnosis: Hip fracture (right) post‑fall, scheduled for surgical repair. Current meds: aspirin 81mg daily, calcium supplement, vitamin D. Vital signs stable. She uses a wheelchair and requires a hoist for transfers. Referral to orthopaedic ward for pre‑operative optimisation. The notes include: "Patient lives on the second floor, no elevator, family visits daily."
10. Which sentence belongs in the opening line of the referral letter rather than the body?
Answer: B. Criterion: Opening‑line‑versus‑body – the opening line should state the purpose of the referral, i.e., the reason for writing. Quote: "Mrs O'Connor sustained a right hip fracture after a fall" provides that purpose and belongs in the opening.
Case notes: Patient Arthur Pendelton, 82. Admitted to acute ward following fall. History of controlled hypertension. Lives alone in second-floor flat without lift. Uses quad cane indoors, wheelchair outdoors. Daughter visits weekly to do shopping. Referred to occupational therapist for home assessment prior to discharge.
11. Which of the following details is ESSENTIAL to include in the referral letter to the occupational therapist?
Answer: B. Criterion: Content. Quote: Lives alone in second-floor flat without lift. An occupational therapist conducting a home assessment requires environmental details such as stairs and lift access to evaluate safety and mobility aids. The hypertension is inert biography, the daughter's visits do not affect home layout, and the ward admission is contextual rather than essential for the OT's assessment.
Case notes: Patient Charles Ng, 68. Admitted with acute chest infection and severe COPD exacerbation. Respiration rate 32, oxygen saturation 85 percent on room air. Needs immediate transfer to the intensive care unit for close monitoring and potential intubation.
12. How should the request for transfer to the intensive care unit be phrased in the letter?
Answer: A. Criterion: Language and Tone. Quote: Needs immediate transfer to the intensive care unit for close monitoring and potential intubation. Urgency outranks politeness; hedging phrases such as consider or might be beneficial understate a critical clinical need. A direct imperative is required.
Case notes: Patient Doris Higgins, 76. History of severe osteoarthritis, bilateral knee replacements in 2012, mild cognitive impairment. Presented with right wrist fracture following a trip over a rug at home. Referred to the outpatient physiotherapy department for rehabilitation exercises.
13. Which of the following sentences represents the most appropriate way to state the reason for referral in the opening line?
Answer: B. Criterion: Purpose. Quote: Presented with right wrist fracture following a trip over a rug at home. The opening line must state the current acute reason for the referral rather than chronic history or past surgical milestones that are irrelevant to the current presenting complaint.
Patient: 45‑year‑old female, Ms. Patel, admitted to the acute medical ward with acute exacerbation of COPD. She has a history of chronic bronchitis, is a current smoker (20 pack‑years), and is on inhaled corticosteroids and long‑acting bronchodilators. She is currently on oxygen 2 L/min via nasal cannula, has a temperature of 38.2°C, heart rate 110 bpm, and is in respiratory distress. The attending physician has requested a transfer to the respiratory high‑dependency unit for close monitoring and advanced respiratory support. Referral: to the respiratory high‑dependency unit.
14. How should the request be phrased to the respiratory high‑dependency unit?
Answer: D. The situation is urgent; the physician explicitly requests transfer for advanced support. The correct phrasing uses a direct, urgent request: 'Please admit… urgently'. This aligns with the Urgency vs Politeness criterion, avoiding hedging.
Case Notes: Patient: Arthur Pendelton, 74 years old Living situation: Lives alone in a first-floor flat with 22 external stone steps and no lift. Son visits on Sundays. Medical history: Osteoarthritis of bilateral knees, mild hypertension controlled with ramipril. Current situation: Discharged today following right total knee replacement. Range of motion 0 to 90 degrees. Uses a zimmer frame for indoor mobility and requires physical assistance of one person to manage stairs.
15. Which of the following pieces of background information is ESSENTIAL to include in the referral letter to the district nurse for home follow-up visits?
Answer: A. Criterion: Content. Quote: Lives alone in a first-floor flat with 22 external stone steps and no lift. For a community or district nurse conducting home visits, architectural barriers and domestic layout are clinically load-bearing facts required for safe planning. Distractors B and C are routine medical facts already known or documented elsewhere, while D is social padding that does not affect home-nursing logistics.
Case Notes: Recipient: Dr Marcus Vance, Consultant Cardiologist, St Jude Hospital Patient: Eleanor Rigby, 68 years old Clinical situation: Admitted to emergency department with acute chest pain, ST-elevation myocardial infarction diagnosed. Urgent primary percutaneous coronary intervention performed successfully 2 hours ago. Currently stable in coronary care unit, requires ongoing monitoring and specialist outpatient follow-up.
16. How should the opening salutation of the referral letter to the consultant cardiologist be written?
Answer: B. Criterion: Genre and Style. Quote: Recipient: Dr Marcus Vance, Consultant Cardiologist, St Jude Hospital. When the case notes explicitly provide the name and title of the addressee, a named salutation using the surname is strictly required. Option A uses a role instead of a name, Option C uses an unnecessary title prefix instead of the standard format, and Option D is incorrect because the recipient is fully identified.
Case Notes: Patient: David Miller, 51 years old Clinical situation: Presenting in general practice with severe, crushing central chest pain radiating to the jaw, accompanied by diaphoresis and acute shortness of breath. Onset 35 minutes ago. Suspected acute myocardial infarction. Nearest emergency department is 15 minutes away by ambulance.
17. Which of the following sentences represents the most appropriate way to phrase the transfer request to the emergency department?
Answer: B. Criterion: Language. Quote: Presenting in general practice with severe, crushing central chest pain... Suspected acute myocardial infarction. Urgency outranks politeness, and hedging undermines critical safety. Option B uses direct imperative language appropriate for an acute life-threatening emergency. Options A, C, and D use hedged or softened phrasing that inappropriately understates an urgent clinical emergency.
Case Notes: Patient: Sarah Jenkins, 34 years old Admission date: 14 October Social history: Works as a primary school teacher, lives with her husband in a two-storey house. Clinical summary: Admitted with severe community-acquired pneumonia requiring intravenous antibiotics and supplemental oxygen. Over the past 48 hours, pyrexia has resolved, inflammatory markers have normalized, and she has maintained oxygen saturation above 95 percent on room air for a full day.
18. Which of the following sentences correctly translates the clinical progress into the level of detail required for the opening summary line of the discharge letter?
Answer: A. Criterion: Conciseness and Clarity. Quote: Admitted with severe community-acquired pneumonia... pyrexia has resolved, inflammatory markers have normalized... ready for discharge. The opening line of a discharge letter must synthesize identity, reason for admission, and current disposition without unnecessary raw data. Option A captures this synthesis, whereas B and D provide excessive clinical minutiae, and C focuses on irrelevant social details.
Case notes: Patient Margaret Higgins, 45. Admitted with acute severe asthma exacerbation. Responding well to nebulised salbutamol and IV hydrocortisone. Peak flow now 85 percent of predicted. Requesting transfer back to the general medical ward under Dr Thomas. Case notes note ward bed availability is confirmed and patient is keen to move.
19. How should the request for transfer back to the general medical ward be phrased in the letter?
Answer: B. Criterion Language. Urgency outranks politeness, and hedging is not courtesy. The patient is clinically stable and a bed is confirmed, so a direct, clear imperative is required. The case notes state ward bed availability is confirmed, making Please transfer the patient back to the general medical ward appropriate, while hedged requests understate the administrative certainty.
Case notes: Patient David Vance, 64. Referred to a consultant cardiologist for evaluation of new-onset exertional chest pain. Referral letter written by Dr James Vance, General Practitioner. The specific consultant name is unknown and not mentioned anywhere in the clinical record.
20. How should the opening salutation of the referral letter to the consultant cardiologist be written?
Answer: A. Criterion Genre and Style. If the notes give only a role rather than a named addressee, the correct opening is Dear Sir or Madam. Inventing a name or using an informal placeholder like Dear Doctor is a genre error. The notes provide no individual name, making Dear Sir or Madam the correct choice.
Case notes: Patient Robert Chen, 56. Attended clinic with persistent dry cough and weight loss over three months. Chest X-ray reveals a 3 centimetre speculated mass in the right upper lobe. Patient is a retired accountant who enjoys oil painting and has a forty pack-year smoking history.
21. Which of the following sentences represents the most appropriate way to state the clinical findings in the referral letter to the respiratory specialist?
Answer: D. Criterion Clarity and Conciseness. The sentence translates the clinical findings into the professional level of detail required for a specialist referral without colloquialisms or vagueness. Chest radiography demonstrates a 3 centimetre spiculated mass in the right upper lobe uses precise terminology, whereas the other options are either too informal or imprecise for specialist correspondence.
Case Notes: Patient name Arthur Higgins age 78. Admitted via ED 03 May with acute confusion and suspected delirium on a background of mild dementia. Found wandering near railway line by police. Lives alone in a two-storey terraced house with external stone steps and no indoor bathroom. Daughter visits on Sundays. Referral to the district nursing service for assessment of home safety, medication management support, and wound check for skin tear on right forearm sustained during fall. Addressed to The District Nursing Team, Central Health Clinic.
22. Which of the following pieces of information from the case notes is ESSENTIAL to include in the referral letter to the district nursing service?
Answer: C. Criterion Content. A district nurse visiting a patient at home must know the physical layout and access requirements, making the housing details essential. Distractors A, B, and D are background or biographical details not critical for a home-visiting nurse's immediate safety and assessment logistics. The case note reads: Lives alone in a two-storey terraced house with external stone steps and no indoor bathroom.
Case Notes: Patient name Clara Vance age 52. Admitted to surgical ward following elective laparoscopic cholecystectomy. Post-operative recovery is uncomplicated. Wound is clean and intact, vital signs stable, pain well-managed on oral analgesia. Discharging today to her own home where she lives with her husband. Referral letter to be written to Dr James Sterling, General Practitioner, Oakwood Medical Centre.
23. How should the opening salutation of the discharge referral letter to Dr James Sterling be written?
Answer: D. Criterion Genre and Style. When the case notes name a specific clinician and provide their full details, the standard professional convention is to use the title and surname only. Distractor A spells out Doctor, B includes the first name redundantly, and D uses an unpersonalised role title despite a named doctor being provided.
Case Notes: Patient name Samuel Roberts age 45. Admitted to the Emergency Department following severe asthma exacerbation unresponsive to nebulised salbutamol at home. Peak expiratory flow rate is 40 percent of predicted. Patient is in acute respiratory distress, speaking in short fragments, with intercostal recession. Immediate transfer to the intensive care unit is required for continuous monitoring and possible intubation. Addressed to the ICU Consultant on duty.
24. How should the request for transfer to the intensive care unit be phrased in the letter?
Answer: D. Criterion Purpose and Tone. Urgency outranks politeness in critical clinical situations; hedging phrases like consider or if beds permit understate acute life-threatening need. The notes state that immediate transfer is required, making a direct imperative request appropriate. The case notes record: Immediate transfer to the intensive care unit is required.
Case Notes: Patient name: Arthur Pendelton, 82. Admitted to acute medical ward 03/04 with severe delirium secondary to a urinary tract infection. Now medically stable, antibiotic course completed today. Pre-admission baseline: mobilises with a frame, lives alone in a second-floor flat with a manual wheelchair lift, daughter visits daily. Social work assessment completed: package of care required 4 times daily for personal care and meals. Referral to the discharge lounge team for transport and handover on 10/04.
25. Which of the following pieces of background information is ESSENTIAL to include in the referral letter to the discharge lounge team?
Answer: C. Under the criterion of Content, the discharge lounge team requires administrative and social details necessary for safe transit and immediate placement upon arrival, making the social work assessment for the care package essential. Quote from notes: Social work assessment completed: package of care required 4 times daily for personal care and meals.
Case Notes: Patient name: Charles Montgomery, 45. Admitted following a workplace chemical splash to both eyes. Initial emergency irrigation performed. Patient is currently in severe pain, reporting a burning sensation of 9 out of 10, with persistent corneal epithelial defect and significantly reduced visual acuity in the left eye. Urgent review by the ophthalmology registrar on call is required immediately to prevent permanent vision loss.
26. How should the request for urgent review be phrased in the referral letter to the ophthalmology registrar?
Answer: A. Under the criterion of Language and Tone, urgency outranks politeness and hedging is inappropriate for acute clinical risks. The direct request is necessary. Quote from notes: Urgent review by the ophthalmology registrar on call is required immediately to prevent permanent vision loss.
Case Notes: Patient name: Diana Prince, 29. Admitted at 38 weeks gestation with pre-eclampsia. Spontaneous vaginal delivery of a live female infant at 0400 today. Third-degree perineal tear sustained, repaired in theatre under spinal anaesthesia at 0700. Post-operative observations stable: blood pressure 120 over 80, pulse 76, temperature 36.8. Wound dressing intact, minimal serosanguinous ooze. Transferring to the postnatal ward for ongoing midwifery care and analgesia management.
27. Which of the following sentences represents the most appropriate way to state the clinical findings in the transfer letter to the postnatal ward midwife?
Answer: A. Under the criterion of Conciseness and Clarity, the letter must state the exact clinical fact at the right level of detail without unnecessary dramatisation or vagueness. Quote from notes: Third-degree perineal tear sustained, repaired in theatre under spinal anaesthesia at 0700.
Case Notes: Patient name: David Vance (42). Condition: Acute severe asthma attack, unresponsive to initial nebulised salbutamol in the emergency department, oxygen saturation 88 percent on room air, respiratory rate 32 breaths per minute, intercostal recession visible. Referred to: Intensive Care Unit registrar on duty.
28. How should the request for transfer to the intensive care unit be phrased in the letter?
Answer: B. Criterion: Language and Purpose. Rule 3 states that urgency outranks politeness and hedging understates real clinical needs. Given the acute distress, low oxygen saturation, and tachypnoea, a direct imperative is required. Distractors A, C, and D use hedged language inappropriate for an emergency escalation.
Case Notes: Patient name: Eleanor Rigby (55). Admitted with severe community-acquired pneumonia. Progress notes day 4: Patient afebrile for 48 hours, inflammatory markers trending down, chest auscultation reveals clear breath sounds in right lower zone, completed IV antibiotics, transitioned to oral amoxicillin today. Ready for discharge home tomorrow.
29. Which of the following sentences represents the most appropriate way to state the clinical progress in the discharge letter?
Answer: B. Criterion: Clarity and Conciseness. Option B translates the clinical notes into professional, objective medical prose without colloquialisms or unsupported exaggeration. Distractors A, C, and D use subjective or imprecise language unsuited to professional nursing handover.
Patient: Eleanor Vance, 68 years old. Referred to the community physiotherapy department for post-stroke gait re-education and fall prevention. Case notes state: stroke affecting right side six weeks ago, discharged from stroke unit yesterday. Uses a four-point walking frame indoors, requires physical assistance of one person for stairs. Lives with husband in single-level ground-floor apartment.
30. Which of the following pieces of information from the case notes is ESSENTIAL to include in the referral letter to the physiotherapist?
Answer: C. Criterion: Content. The correct option is B because a physiotherapist providing home-based gait re-education must know the exact physical assistance required for stairs to plan safe interventions. The discharge date is secondary administrative context, the single-level apartment makes stair help seem contradictory unless clarified, and the husband's presence is primarily the domain of a community nursing referral rather than targeted physical therapy.
Patient: Sarah Jenkins, 29 years old. Admitted with acute asthma exacerbation. Current peak flow is 40 percent of personal best, speaking in fragments, drowsy, failing to respond to initial nebulised salbutamol and ipratropium bromide. Medical officer writing an urgent referral to the senior intensive care registrar for immediate intubation and mechanical ventilation.
31. How should the urgent request for transfer and intervention be phrased in the letter?
Answer: C. Criterion: Language and Tone. The correct option is C because urgency outranks politeness, and clinical safety demands a direct, unambiguous imperative when a patient is failing medical therapy and deteriorating rapidly. Options A, B, and D use hedging verbs and understated phrasing that inappropriately diminish an emergency situation.
Case notes: Patient Arthur Pendelton, 74 years old. Admitted to acute ward with acute kidney injury secondary to dehydration. Discharged today, baseline renal function restored. Lives alone in a two-story house, has a history of mild osteoarthritis managed with paracetamol, and was treated for appendectomy in 1982. GP is Dr Sarah Jenkins. Referral required to the community nursing service for wound check and medication reconciliation.
32. Which of the following pieces of background information from the case notes is ESSENTIAL to include in the referral letter to the community nursing service?
Answer: C. Criterion: Content. Quote: Lives alone in a two-story house. District and community nurses visiting patients at home must know about stairs and living arrangements to plan their visit safely, whereas childhood surgeries or unrelated resolved conditions are inert biography that should be omitted for conciseness.
Patient: Mr John Patel, 55, admitted with acute myocardial infarction. Urgent coronary angiography required. Referral to interventional cardiologist. Note: "Chest pain ongoing, ST elevation, troponin 12 ng/mL, pain not relieved by nitrates."
33. How should the request be phrased in the referral letter?
Answer: D. Criterion: Request‑versus‑urgency. The notes indicate an urgent need; the correct style is a direct request: "Please arrange urgent coronary angiography as soon as possible."
Patient: Ms Emily Ross, 32, pregnant 28 weeks, presenting with severe itching. Referral to dermatology consultant. Note: "No rash, normal labs, history of eczema in childhood, currently on prenatal vitamins."
34. Which opening salutation is appropriate?
Answer: A. Criterion: Genre and Style. The case notes name the recipient as "Dermatology consultant Dr Singh," so a named salutation is required.
Patient: Mr Luis Ortega, 68, chronic obstructive pulmonary disease, admitted for exacerbation. Transfer to respiratory ward needed. Note: "SpO2 88% on 2L O2, wheeze audible, no fever, smoking history 40 pack‑years, uses inhaler PRN."
35. Which sentence best reflects the appropriate level of detail for the clinical findings in the referral?
Answer: A. Criterion: Language. The correct sentence includes the specific details required for the receiving ward, quoted from the note: "SpO2 88% on 2L O2, wheeze audible, smoking history 40 pack‑years."
36. Dr Patel, gastroenterology consultant, will receive a referral letter about Mrs Joan Whitfield, a 64-year-old who developed sudden severe epigastric pain radiating to her back while an inpatient on the medical ward. She is haemodynamically stable but the surgical and gastroenterology teams disagree about the likely cause. Which of the following pieces of information from the case notes is ESSENTIAL to include in the referral letter?
Answer: D. Decision: which detail is essential to include. Criterion: Purpose and Content. For a gastroenterology consultant asked to differentiate between biliary and non-biliary acute pancreatitis and decide on urgent MRCP, the haemodynamic picture and the amylase are the case-defining numbers — without them the consultant cannot triage or plan imaging. Quote from the notes: 'admission blood pressure of 92/58 mmHg, tachycardia of 118 beats/min, and serum amylase of 1,240 U/L.' A, B and C are inert biography: a retired occupation, a hobby and a resolved orthopaedic surgery from over a decade ago. None of them changes the on-call decision and including them wastes the word count a real letter cannot afford. The trap is that biography always looks harmless; in Writing, every line you spend on it is a line you did not spend on the reason the reader is being asked to see the patient.
37. Mr Hugh Llewelyn, a 79-year-old retired engineer, is being transferred from the acute stroke unit to the rehabilitation ward under Dr Christine Adeyemi, consultant in rehabilitation medicine. He had a left middle cerebral artery infarct nine days ago and now has dense right-sided weakness, dysphagia to thin fluids only, expressive aphasia and moderate urinary incontinence. He lives alone in a bungalow and his daughter visits daily. Which of the following sentences represents the most appropriate way to state the clinical progress in the transfer letter?
Answer: B. Decision: right level of detail for a named recipient of the same specialty. Criterion: Genre and Style, with Content doing the work. Dr Adeyemi is a rehabilitation consultant taking over the patient's care in the same hospital group — she needs the diagnosis, the specific deficits, the timeline and a one-line statement that the acute phase is over. Quote from the notes that decides it: 'left middle cerebral artery infarct nine days ago… dense right-sided weakness, dysphagia to thin fluids only, expressive aphasia and moderate urinary incontinence… medically stable.' B delivers that in the register of a clinical handover. A is a lay-summary register that omits the diagnosis and pads every deficit with a softener; D inflates one sentence into a paragraph and lists symptoms the receiving team already knows how to manage; C is a confident distractor that invents clinical detail the notes do not support ('able to mobilise a few steps', 'soft solids and pureed fluids safely', 'continent during the day'). Inventing improvement is the dangerous variant of level-of-detail and would mislead the rehabilitation team about what the patient can do on arrival.
Case notes: Referral to the community health visitor for newborn follow‑up. Infant: Emma Jones, 2 weeks old, born at 38 weeks, weight 3.2 kg, Apgar 9 at 5 minutes. Mother: Sarah Jones, 28, no complications, breastfeeding well. No concerns noted. The health visitor’s role is to assess feeding and parental confidence. The notes do not name the health visitor.
38. What is the correct opening salutation for this referral letter?
Answer: B. Criterion: Genre and Style. When the recipient is not named, the appropriate generic salutation is "Dear Sir/Madam". Using a specific name would be a genre error.
Patient: Ms Laura Patel, 55, diagnosed with acute exacerbation of COPD. SpO2 88% on room air, respiratory rate 28, wheeze audible. She has been on oral steroids for 3 days with no improvement. Referral to respiratory specialist urgently for possible non‑invasive ventilation. The notes state: "Patient is deteriorating rapidly and requires immediate specialist input."
39. How should the request for urgent specialist input be phrased?
Answer: C. Criterion: Urgency (Purpose). The notes indicate rapid deterioration, so a direct request "Please assess the patient urgently..." is required. Hedging or polite deferment would understate the urgency.
Case notes: Patient: Mr Alan Doherty, 58 years old Diagnosis: Lower back pain, ?cauda equina syndrome History: Acute onset 48 hours ago after lifting a heavy box. Pain radiates down right leg. Reports numbness in groin area and difficulty passing urine this morning. On examination: reduced sensation S2-S4, reduced anal tone, weak plantar flexion bilaterally. Past history: hypertension (on amlodipine 5 mg daily), appendicectomy aged 16. Previously worked as a lorry driver, currently unemployed. Lives with wife, no children at home. Walks unaided, no mobility issues prior to onset. Smoking history: 20 pack-years, stopped 8 years ago. Allergies: NKDA. Vital signs today: BP 142/88, HR 96, T 36.9, RR 18, SpO2 97% on air. Bloods pending. MRI requested but not yet performed. Plan: Urgent referral to orthopaedic spinal surgeon on-call for assessment and possible surgical decompression. Re: Mr Alan Doherty, DOB 14/03/1967 Dear [Recipient], [Opening line] [Body of letter] I would be grateful if you could review this gentleman at your earliest convenience. Yours sincerely, Nurse J. Williams, RN
40. Which sentence is most appropriate as the OPENING LINE of the referral letter to the orthopaedic spinal surgeon on-call?
Answer: D. Decision: opening-line-versus-body. The opening line of an OET referral letter must state PURPOSE and URGENCY in the first sentence so the receiving clinician can triage immediately. C does this — it names the patient, gives the timeframe, names the suspected diagnosis ('red-flag symptoms suggestive of cauda equina syndrome'), and states the urgency ('urgent assessment and possible surgical decompression'). A names the patient and the urgency but buries the diagnostic suspicion under biographical detail and omits cauda equina, the diagnosis the spinal surgeon must read first. B introduces biographical background (retired lorry driver, hypertension) before the clinical reason; this material belongs in the body, not the opening line, and the opening is therefore weak on purpose. D is hedged ('would like your opinion', 'whether further investigation is warranted') — for a possible cauda equina syndrome, where delay risks permanent neurological damage, the opening must signal the urgency rather than frame the referral as discretionary. Criterion: Content and Conciseness — the opening line carries the reason for the letter.

Speaking — the two role-plays 35 questions

Two profession-specific role-plays where the nurse must handle a patient who is anxious, reluctant, angry, or has not understood.

1. You are a nurse in a community health clinic. A 45‑year‑old patient has just been told he needs a colonoscopy. He looks anxious and says, "I don't know if I can do this. It sounds scary." Which of the following responses would earn you the highest grade?
Answer: B. Option B demonstrates relationship‑building by acknowledging the patient’s fear, shows understanding of his perspective, provides a clear structure by offering an explanation and planning, and gives information pitched to the patient. The other options either give information without addressing the fear (A), are vague and unhelpful (C), or dismiss the concern (D).
2. You are a nurse in an acute ward. A 30‑year‑old woman is angry because she was told her blood test results would take two days, but she needs the results urgently. She says, "I don't understand why this is taking so long!" Which response would earn you the highest grade?
Answer: B. Option B shows relationship‑building by acknowledging frustration, demonstrates understanding of her perspective, provides structure by explaining the process and next steps, and gives information tailored to her urgency. Options A and D are too brief and do not plan further action, while C is unhelpful and dismissive.
3. You are a nurse in a maternity ward. A 22‑year‑old patient has just delivered her baby and is very tired. She says, "I don't know how to care for my newborn, and I'm scared." Which response would earn you the highest grade?
Answer: B. Option B meets all four criteria: it acknowledges the patient’s fear, shows empathy, outlines a clear structure (walking through basics and practicing), and provides information pitched to her level of experience. The other options are either too brief, dismissive, or lack structure.
4. You are a nurse in a psychiatric unit. A 35‑year‑old patient is angry and says, "I don't want to take my medication; it makes me feel worse." Which response would earn you the highest grade?
Answer: B. Option B shows relationship‑building by acknowledging anger, demonstrates understanding of the patient’s perspective, provides a clear structure by offering to discuss concerns and adjust treatment, and gives information pitched to the patient’s experience. Options A, C, and D either give information without addressing the emotional state or are too vague.
5. You are a nurse on a surgical ward. Mr. Patel, a 60‑year‑old man, has just been told he will need a postoperative physiotherapy programme and looks worried that it will delay his discharge. Which response would earn the higher grade?
Answer: C. This response demonstrates relationship‑building by acknowledging the patient’s concern before providing information. (criterion: relationship‑building)
6. You are a nurse in an oncology day unit. Ms. Ahmed, a 55‑year‑old woman, is angry because she feels the nurse has not explained the side‑effects of her new chemotherapy regimen, and she says, “I don’t want to go through this again without knowing what will happen.” Which response would earn the higher grade?
Answer: B. The nurse gathers information by asking what the patient already knows, showing understanding of her perspective before providing tailored information. (criterion: information‑gathering)
7. You are a nurse in a cardiac rehabilitation centre. Mr. Gomez, a 68‑year‑old man recovering from a heart attack, says he is reluctant to join the exercise program because he fears it will cause another attack. Which response would earn the higher grade?
Answer: A. The response acknowledges the patient’s fear first, demonstrating relationship‑building before providing information. (criterion: relationship‑building)
You are a nurse in a community pharmacy. A 28‑year‑old woman has just been prescribed a new inhaler for asthma. She looks visibly upset and says she is scared that the inhaler will make her feel worse.
8. Which of the following statements would earn the highest grade?
Answer: A. Option A demonstrates relationship‑building by acknowledging the patient’s fear and then provides structured information, satisfying the information‑gathering criterion.
You are a nurse in a geriatric ward. Mr. Thompson, 82, is refusing to take his prescribed pain medication because he believes it will make him drowsy and unable to move. He is visibly frustrated and says he does not want to be a burden to the staff.
9. Which response would earn the highest grade?
Answer: A. Option A shows understanding of the patient’s perspective, acknowledges his frustration, and offers a plan, meeting the relationship‑building and information‑gathering criteria.
You are a nurse in a surgical recovery unit. A 35‑year‑old man is angry because he was told his incision might take longer to heal than expected. He is shouting that the hospital is wasting his time and that he will leave if he is not satisfied.
10. Which statement would earn the highest grade?
Answer: A. Option A acknowledges the patient’s anger, provides a clear structure of what will happen next, and gathers information about signs, satisfying all four criteria.
You are a nurse in an intensive care unit. A 50‑year‑old woman is anxious because she has been told her brain scan shows a small bleed that may need surgery. She is crying and says she does not understand why the doctors are not doing anything now.
11. Which response would earn the highest grade?
Answer: A. Option A acknowledges the patient’s anxiety, shows empathy, and offers a structured explanation, meeting the relationship‑building, understanding, and information‑gathering criteria.
12. You are a nurse in a respiratory clinic. Mr. Lee, a 58‑year‑old man with COPD, says he is terrified of using the new home oxygen machine because he thinks it will make him look sick. Which response would earn the highest grade?
Answer: D. This answer demonstrates relationship‑building by acknowledging the fear, shows understanding of the patient’s perspective, and provides structure by offering step‑by‑step support. It meets the relationship‑building criterion.
13. You are a nurse on a surgical ward. Mrs. Patel, a 45‑year‑old woman recovering from a hysterectomy, says she is upset because she feels the pain medication is not working and she cannot sleep. Which statement would earn the highest grade?
Answer: A. This response acknowledges the concern (relationship‑building) and then gathers information by checking the chart, showing the information‑gathering criterion.
14. You are a nurse in a pediatric outpatient clinic. Mrs. Gomez, mother of a 3‑year‑old with asthma, says she is anxious because her child keeps wheezing after using the inhaler. Which response would earn the highest grade?
Answer: A. The answer acknowledges the mother’s anxiety, demonstrates understanding of her perspective, and provides structured next steps by reviewing technique – meeting the relationship‑building and understanding criteria.
15. You are a nurse in an oncology day unit. Mr. Singh, a 62‑year‑old man receiving chemotherapy, says he is angry because he feels the staff are rushing his treatment and not listening to his concerns about side effects. Which response would earn the highest grade?
Answer: B. This response shows relationship‑building by apologising, understands the patient’s perspective, and provides structure by allocating time to discuss side effects – fulfilling the relationship‑building criterion.
You are a nurse in a community mental health clinic. Mr. O'Connor, a 48‑year‑old man, has just been told he needs to start a new antipsychotic medication. He is visibly upset and says, "I don't trust these drugs. I don't want to take them."
16. Which response would earn the highest grade?
Answer: D. Option D demonstrates relationship‑building by acknowledging the patient’s worry, understanding his perspective, providing a structured plan (explaining benefits and risks) and engaging in shared decision‑making. Option A is clinically correct but lacks the structure and shared decision component. Option B is directive and dismissive. Option C is vague and gives no information.
You are a nurse in a geriatric ward. Mrs. Patel, a 79‑year‑old woman, has been admitted for a hip fracture. She is anxious about the upcoming surgery and says, "I don't know if I can handle this."
17. Which response would earn the highest grade?
Answer: A. Option A shows relationship‑building by acknowledging fear, understanding the patient’s perspective, providing structure by explaining the process, and giving information pitched to her level. Option D is similar but the wording is less specific about structure. Option B is reassuring but lacks depth. Option C offers a solution that is not feasible.
You are a nurse in a cardiac rehabilitation centre. Mr. Lee, a 65‑year‑old man, has just finished a treadmill session and is frustrated because he feels he is not improving fast enough. He says, "I’m not getting better, why do I have to keep doing this?"
18. Which response would earn the highest grade?
Answer: A. Option A shows relationship‑building by acknowledging frustration, understanding the patient’s perspective, providing a structured explanation of the program and expected progress, and giving information pitched to his level. Option D is similar but the wording is less explicit about progress. Option B is directive. Option C is supportive but lacks structure.
19. You are a nurse in a dialysis unit. Mr. Khan, a 70‑year‑old man, says he feels dizzy and is worried the treatment will make his blood pressure drop. Which response would earn the highest grade?
Answer: B. The best response uses relationship‑building by acknowledging the concern, then provides structure and information‑gathering – the key criterion is relationship‑building.
20. You are a nurse in a mental health community team. Mrs. O'Leary, a 34‑year‑old woman, says she is anxious about starting the new antipsychotic because she heard it can make her feel ‘zombie‑like’. Which response would earn the highest grade?
Answer: A. This answer demonstrates understanding the patient’s perspective and then provides structured information – the criterion tested is understanding the patient’s perspective.
21. You are a nurse on a post‑operative orthopaedic ward. Mr. Patel, a 58‑year‑old man, says he is angry that his physiotherapy sessions start later than expected and he feels his recovery will be delayed. Which response would earn the highest grade?
Answer: B. The response acknowledges the concern (relationship‑building) and then gathers information and offers a concrete plan – the tested criterion is providing structure.
22. You are a nurse in a paediatric asthma clinic. Mrs. Liu, mother of a 5‑year‑old boy, says she is terrified that using the inhaler will hurt her child because she heard the medication is strong. Which response would earn the highest grade?
Answer: B. This answer shows understanding the parent’s perspective and then provides clear sign‑posting of steps – the criterion is providing structure (signposting).
You are a nurse in a community wound‑care clinic. Mrs. Ahmed, a 68‑year‑old woman with a chronic leg ulcer, says she is scared that the dressing change will hurt and she will bleed more.
23. Which of the following statements would most likely earn the highest grade?
Answer: C. The best response uses relationship‑building by acknowledging the fear first, then provides structure by outlining the plan – this meets the relationship‑building criterion.
You are a nurse on a surgical ward. Mr. Brown, a 55‑year‑old man recovering from a bowel resection, says he is angry because he feels the pain medication is not working and he thinks the staff are ignoring his needs.
24. Which response would earn the highest grade?
Answer: B. This answer acknowledges the patient’s perspective (understanding), then provides structure by stating the steps to be taken – it satisfies the understanding criterion.
You are a nurse in a dialysis unit. Mr. Liu, a 72‑year‑old man, says he feels dizzy during treatment and is worried the dialysis machine is causing his blood pressure to drop, so he wants to stop the session.
25. Which of the following replies would earn the highest grade?
Answer: B. This answer acknowledges the patient’s concern (relationship‑building), gathers information by checking vitals, and provides a structured plan – fulfilling the relationship‑building and information‑gathering criteria.
You are a nurse in a maternity ward. Mrs. Patel, a 28‑year‑old first‑time mother, is anxious about the pain management plan for her upcoming caesarean section.
26. Which response would earn the highest grade?
Answer: A. Option A demonstrates relationship‑building by acknowledging the patient’s anxiety before providing information, and it also shows understanding of the patient’s perspective. It offers a structured plan and invites collaboration, which meets the OET speaking criteria.
You are a nurse in an acute stroke unit. Ms. Garcia, a 68‑year‑old woman, is reluctant to start physiotherapy because she fears falling.
27. Which response would earn the highest grade?
Answer: A. Option A acknowledges the patient’s reluctance, demonstrates empathy, and offers a structured, safe plan, meeting all four clinical communication criteria.
You are a nurse in a pediatric oncology ward. Mr. Lee, a 12‑year‑old boy, is angry that his chemotherapy schedule has been delayed.
28. Which response would earn the highest grade?
Answer: A. Option A shows relationship‑building by acknowledging the child’s anger, provides a clear explanation, and offers a plan for the next steps, covering all OET speaking criteria.
29. You are a nurse on a surgical ward. Mrs. Ahmed, a 45‑year‑old patient, says she is terrified that the post‑operative pain pump will make her feel drowsy and unable to care for her baby. Which response would most likely earn the highest grade?
Answer: A. This response demonstrates relationship‑building by acknowledging the fear first, then provides clear information about the pump – meeting the criteria of acknowledging concern and giving pitched information.
30. You are a nurse in a community diabetes clinic. Mr. Lewis, a 62‑year‑old man, says he is angry because he feels the diet plan you gave him is too restrictive and will make his life miserable. Which reply would most likely earn the highest grade?
Answer: D. The nurse acknowledges the patient’s perspective (understanding), then provides structure by signposting three options, fulfilling the relationship‑building and structure criteria.
31. You are a nurse in a paediatric asthma clinic. Mrs. Patel, mother of a 7‑year‑old boy, says she has not understood how to use the spacer correctly and is worried it won’t help during an attack. Which statement would most likely earn the highest grade?
Answer: A. This response acknowledges the mother’s concern (relationship‑building), offers a clear structure (step‑by‑step demonstration), and provides information tailored to her need, meeting multiple criteria.
32. You are a nurse on an oncology ward. Ms. Green, a 58‑year‑old patient, says she feels anxious because the chemotherapy schedule seems confusing and she fears missing a dose. Which response would most likely earn the highest grade?
Answer: D. The nurse acknowledges the patient’s anxiety (understanding), then provides structured information by reviewing and writing down dates, satisfying the relationship‑building and information‑giving criteria.
33. You are a nurse in a wound‑care clinic. Mr. Alvarez, a 62‑year‑old man, says he is scared that the dressing change will hurt and he might bleed more. Which of the following statements would most likely earn the highest grade?
Answer: A. The best response demonstrates relationship‑building by acknowledging the patient’s fear, shows understanding of his perspective, and provides a clear structure (checking the wound, explaining steps). This meets the relationship‑building and structuring criteria.
34. You are a nurse on a cardiac rehabilitation unit. Mrs. Chen, a 55‑year‑old patient recovering from a bypass, says she is angry because she feels the exercise program is too intense and she fears it will damage her sternum. Which response would earn the highest grade?
Answer: D. This answer acknowledges the patient’s anger (relationship‑building), shows understanding of her concern about the sternum, and offers to modify the plan, covering both understanding and information‑giving. It meets the relationship‑building and understanding criteria.
35. You are a nurse in a hospice care setting. Mr. Osei, a 78‑year‑old man with advanced lung cancer, says he does not understand why the nurse is increasing his morphine dose and is afraid it will hasten his death. Which of the following statements would most likely earn the highest grade?
Answer: A. The response acknowledges the patient’s fear (relationship‑building), clarifies the purpose of the dose increase (information‑giving), and invites shared decision‑making, demonstrating understanding of his perspective. It satisfies relationship‑building and understanding criteria.

Clinical and lay register 40 questions

The specific bilingual skill OET actually tests: saying the same clinical thing two ways and knowing which room you are in.

1. A 68‑year‑old patient reports that his heart was "going like a hammer". Which clinical term should be recorded in the notes?
Answer: B. The patient’s description of a rapid, irregular heartbeat corresponds to palpitations, a common clinical term for an abnormal heart rhythm. Tachycardia refers only to a fast heart rate, not the sensation of irregular beats. Hypotension and dyspnoea are unrelated.
2. The nurse must explain to a frightened patient that the doctor has decided to keep him "nil by mouth" for the next 24 hours. Which lay phrase is most appropriate?
Answer: A. "Nil by mouth" means the patient should not ingest any food or drink. Option A conveys this clearly without medical jargon. Option B uses "fluids" which can be confusing, and C and D describe diets that are not nil.
3. When a patient is admitted with sudden swelling of the legs, the nurse should note that the patient ________ oedema.
Answer: B. The correct collocation is "presents with" to describe the symptom the patient shows. "Has been given a cannula" and "is prescribed a diuretic" are actions that may follow, but do not describe the initial presentation. "Complains of" is a verb phrase, not a noun phrase.
4. The doctor orders a medication to be given to the patient. The nurse writes in the notes: "The patient ________ a drug." Which phrase is most appropriate?
Answer: B. In clinical notes the passive form "receives" is used to describe a medication given to a patient. "Administers" would imply the patient is giving it, "takes" is informal, and "gives" is ambiguous.
5. A 45‑year‑old woman says her chest feels tight and she feels a rapid, irregular beat. In the clinical notes the nurse should record:
Answer: B. The patient describes an irregular, pounding sensation, which is best expressed clinically as palpitations. Tachycardia refers to a fast heart rate, not the sensation. Hypotension and dyspnoea are unrelated.
6. The nurse is writing a discharge summary for a patient who has been on a ventilator. She notes that the patient was "given a 500ml bag of saline". Which phrase best reflects the correct clinical terminology for the fluid given?
Answer: D. In clinical notes the verb should be ‘administered’ to indicate the nurse delivered the fluid. ‘Gave’ is informal, ‘received’ would be used for the patient, and ‘took’ is incorrect for a fluid.
7. A patient is admitted with sudden swelling of the legs. The nurse should record that the patient ________ oedema.
Answer: A. The phrase ‘presents with’ is the standard clinical collocation for describing symptoms at admission. The other options are either too vague or not the usual phrasing.
8. During a handover the nurse says: "We’re going to keep the patient nil by mouth until the morning." Which clinical term best replaces the lay phrase?
Answer: B. NPO (nil per os) is the concise clinical abbreviation used in notes. ‘Nil by mouth’ is the full phrase, but the question asks for the term that replaces the lay phrase. ‘Fasting’ and ‘no oral intake’ are less specific in a medical context.
A 55‑year‑old man is admitted with sudden swelling of both legs and reports feeling a rapid, irregular beat in his chest.
9. Which clinical term should be recorded in the notes for the irregular heartbeat?
Answer: B. The patient describes a rapid, irregular beat, which is best described clinically as arrhythmia. Tachycardia refers to a fast but regular rhythm, bradycardia is a slow rhythm, and hypotension is low blood pressure.
A patient is being discharged after a 5‑day stay on a ventilator. The nurse must note the ventilator status in the discharge summary.
10. Which phrase best records the ventilator status?
Answer: D. Option D accurately records both that the patient was on a ventilator and that the ventilator was weaned before discharge. Option C omits the fact that the patient was on a ventilator. Options A and B are less precise and do not mention weaning.
During a handover, the nurse says: "We’re going to keep the patient nil by mouth until the morning."
11. Which clinical phrase best matches this statement?
Answer: A. The statement only specifies that the patient will not eat or drink (nil by mouth). Option A captures that exactly. Options B, C and D add additional information about fluids that is not stated in the original sentence.
12. A 62‑year‑old man says his breathing feels like a tight band around his chest. Which clinical term should be recorded in the notes?
Answer: C. The patient describes a sensation of difficulty breathing; the correct clinical term is dyspnoea. Tachypnoea refers to rapid breathing, hypoxaemia to low blood oxygen, and hyperventilation to excessive breathing, none of which match the description.
13. A 52‑year‑old man says his breathing feels like a tight band around his chest. Which clinical term should be recorded in the notes?
Answer: B. The patient describes a sensation of tightness and difficulty breathing, which is the clinical definition of dyspnoea. Tachypnoea refers to rapid breathing, hypoxaemia to low blood oxygen, and hyperventilation to excessive breathing. The correct term is dyspnoea.
14. A 70‑year‑old woman reports that her heart was "going like a hammer". Which clinical term should be recorded in the notes?
Answer: A. The patient’s description of a hammer‑like heart rhythm corresponds to palpitations, the clinical term for an irregular or forceful heartbeat. Tachycardia is a fast heart rate, arrhythmia is a broader term for any abnormal rhythm, and myocardial infarction is a heart attack.
15. The nurse explains to a patient that they will not eat or drink for the next 24 hours. Which lay phrase best matches this clinical instruction?
Answer: D. Option D uses plain language without medical jargon and clearly states the restriction. Option A uses the clinical phrase 'nil by mouth', which is not lay language. Options B and C are longer and less concise.
16. A patient reports that their heart was "going like a hammer". In the clinical notes, the nurse should record the symptom as:
Answer: D. The patient’s description indicates irregular, rapid heartbeats, which is best described clinically as palpitations. Tachycardia and bradycardia refer to heart rate extremes, while arrhythmia is a broader term.
17. A 68‑year‑old man says his breathing feels like a tight band around his chest. Which clinical term should be recorded in the notes?
Answer: A. Dyspnoea is the clinical term for the sensation of difficult breathing. The other options are lay descriptions or less specific clinical terms.
18. A patient says, "I feel my chest tight like a band around it." Which clinical term should be recorded?
Answer: C. The patient describes a sensation of difficulty breathing, which is clinically termed dyspnoea. Chest pain and palpitations refer to different symptoms, and tachycardia is a heart rate finding.
19. A patient reports feeling very weak and dizzy, as if they might faint. Which clinical term should be recorded?
Answer: D. The description matches pre-syncope, the stage before fainting. Syncope indicates a fainting episode, vertigo is spinning dizziness, and hypotension is low blood pressure.
20. During a handover, the nurse says: 'The patient presents with sudden swelling of the legs and is prescribed a 40 mg dose of furosemide orally once daily.' Which collocation is missing from this sentence?
Answer: D. The sentence describes giving a medication; the correct collocation is 'administer a drug'. 'Take observations' refers to monitoring, 'escalate a concern' to raising issues, and 'is for discharge' to patient status.
21. A 60‑year‑old man says his heart was 'going like a hammer' during the night. In the clinical notes, the nurse should record the symptom as:
Answer: B. The description indicates irregular heartbeats, which is recorded as 'palpitations'. Chest pain, shortness of breath, and headache are unrelated to the symptom described.
22. A 58‑year‑old man says his breathing feels like a tight band around his chest. Which clinical term should be recorded in the notes?
Answer: B. The patient describes a sensation of breathlessness, which is clinically termed dyspnoea. Tachypnoea refers to rapid breathing rate, hyperventilation to excessive ventilation, and hypoxia to low blood oxygen.
23. A 72‑year‑old woman reports that her heart was "going like a hammer" during the night. In the clinical notes, the nurse should record the symptom as:
Answer: C. The description indicates irregular, pounding heartbeats, which is clinically termed palpitations. Tachycardia is simply a fast heart rate, arrhythmia is a broader term for any abnormal rhythm, and myocardial infarction is a heart attack.
24. During a handover, the nurse says: "The patient presents with sudden swelling of the legs and is prescribed a 40‑mg dose of furosemide orally once daily." Which collocation correctly describes the medication administration?
Answer: A. Furosemide is an oral medication, so the appropriate collocation is "administer a drug." "Give an injection" would be for parenteral drugs, "take observations" refers to monitoring vital signs, and "escalate a concern" is about raising an issue.
25. A patient says, "I feel my breathing is like a tight band around my chest." Which clinical term should be recorded in the notes?
Answer: D. The patient describes a sensation of difficulty breathing, which is clinically called dyspnoea. Tachypnoea is rapid breathing, hypoxia is low oxygen, and hyperventilation is over‑breathing – none match the description.
26. The nurse must explain to a patient that the doctor will give a medication through a vein. Which lay phrase is most appropriate?
Answer: C. Giving a medication through a vein is an injection or 'shot'. The other options refer to oral or non‑injection routes and would be misleading.
27. During a handover, the nurse says: "The patient presents with sudden swelling of the legs and is prescribed a 20 ml infusion of 0.9% saline." Which phrase best describes the fluid being given?
Answer: C. 0.9% saline is a normal saline solution given intravenously as a drip. Hypertonic solutions are higher concentration, a bolus is a single large dose, and subcutaneous injection is under the skin.
28. A 62‑year‑old man reports that his heart was "going like a hammer" during the night. In the clinical notes, the nurse should record:
Answer: B. The patient’s description indicates irregular, rapid heartbeats – clinically termed palpitations. Tachycardia is simply a fast heart rate, myocardial infarction is a heart attack, and arrhythmia is a broader term for any rhythm disorder.
29. A 55‑year‑old woman reports that her heart was "going like a hammer" during the night. In the clinical notes, the nurse should record which term?
Answer: C. The description matches palpitations, a subjective feeling of a rapid or irregular heartbeat. Myocardial infarction is a heart attack, arrhythmia is a broad term for any rhythm disorder, and tachycardia is a fast heart rate.
30. A 68‑year‑old man says his breathing feels like a tight band around his chest. Which clinical term should be recorded?
Answer: D. The patient describes a sensation of difficulty breathing that is best described clinically as dyspnoea. Tachypnoea refers to rapid breathing, hypoxaemia to low blood oxygen, and hyperventilation to excessive breathing. The lay description matches dyspnoea.
31. During a handover, the nurse says: "The patient presents with sudden swelling of the legs and is prescribed a 40 mg subcutaneous dose of enoxaparin." Which phrase best describes the route of administration in clinical notes?
Answer: C. Enoxaparin is given under the skin, so the correct clinical phrase is subcutaneously. Intravenously would be for IV drugs, orally for tablets, and topically for creams.
32. A 54‑year‑old woman says her heart was "going like a hammer" during the night. In the clinical notes, the nurse should record the symptom as:
Answer: C. The patient’s description of a pounding heartbeat is best recorded as palpitations. Tachycardia is a fast heart rate, arrhythmia is an irregular rhythm, and myocardial infarction is a heart attack.
33. A patient says, "I feel short of breath, like I'm trying to breathe through a straw." Which clinical term should be used in the nursing notes?
Answer: A. The phrase describes difficulty breathing, which is dyspnoea. Candidates may choose tachypnoea (rapid breathing) but the patient is describing effort, not rate.
34. The patient tells the nurse, 'My ankles have blown up like balloons since I started the new tablets.' Which clinical phrase should the nurse write in the notes?
Answer: A. 'Bilateral lower limb swelling' is the standard clinical translation of the patient's everyday phrase; 'pitting oedema' (B, D) is more specific than what the patient described and would require the nurse to have tested for pitting. 'Ankle distension' (C) is a hybrid that sounds neither clinical nor natural. A also keeps the correct verb collocation 'complains of', which is the fluent form for a symptom the patient has volunteered.
35. A patient says, "I feel short of breath, like I'm trying to breathe through a straw." Which clinical term should be recorded?
Answer: B. The phrase describes difficulty breathing, which in clinical language is dyspnoea. Candidates may choose tachypnoea (fast breathing) or hypervent (over‑breathing), but the key symptom is breathlessness itself.
36. A 68‑year‑old man says his heart was "going like a hammer" during the night. In the clinical notes, which term should be used?
Answer: C. "Going like a hammer" describes the sensation of palpitations. Arrhythmia and ventricular fibrillation are specific rhythm disorders, and tachycardia is a fast rate, not the subjective feeling.
37. A patient says, 'I’ve got this lump in my throat that won’t go away, even when I swallow.' Which clinical term should the nurse record in the notes?
Answer: B. The correct term is 'globus sensation,' a clinical collocation for the feeling of a lump in the throat. Option A is wordy and incorrect as it misrepresents the symptom. Option C incorrectly labels the symptom as a cough, and Option D misidentifies the condition as laryngitis without evidence. The nurse must use precise clinical language to avoid confusion.
38. During a handover, the nurse says: 'The patient is prescribed a diuretic for her fluid overload, but she’s still complaining of shortness of breath. We need to escalate this concern.' Which phrase correctly reflects the nurse’s clinical reasoning?
Answer: B. The correct phrase reflects the nurse’s clinical reasoning by acknowledging the lack of improvement and the need for reassessment without jumping to conclusions about dosage changes or psychological causes. Option A incorrectly assumes immediate oxygen level checks without context, Option C incorrectly suggests dosage changes without evidence, and Option D incorrectly attributes symptoms to anxiety.
39. The nurse must explain to a patient that the doctor will insert a catheter to drain excess fluid from her abdomen. Which lay phrase is most appropriate?
Answer: A. The correct lay phrase is simple and avoids unnecessary medical jargon. Option A uses 'tube' and 'take out,' which are easily understandable. Option B incorrectly uses 'needle,' which is not accurate for a catheter. Option C uses 'incision,' which is too technical, and Option D is overly wordy and less clear for a layperson.
40. A 78-year-old patient says, 'I feel like my heart is racing all the time, and I can’t sleep because of it.' In the clinical notes, which term should the nurse use to describe this symptom?
Answer: B. The correct term is 'palpitations,' which accurately describes the patient’s sensation of a racing heart. Option A incorrectly uses 'tachycardia,' which is a clinical term for a consistently rapid heart rate, not the patient’s subjective experience. Option C is vague and does not use precise clinical language. Option D incorrectly identifies bradycardia, which is a slow heart rate, not applicable here.

Grammar that costs a Grade B 30 questions

The written-accuracy errors that pull a nurse from 350 to 300 in Writing, each in a sentence a real nurse would write in a letter or say on a ward.

1. Which sentence uses the correct article before the body part?
Answer: A. When referring to a specific body part, use 'the' before the noun: 'the left knee'. Option B misplaces the article, C adds an unnecessary 'a', and D omits the article entirely, a common error for nurses.
2. Choose the sentence that correctly uses the passive voice for a wound dressing note.
Answer: B. Clinical writing prefers the passive to focus on the patient: 'The wound was dressed...'. Option A is active, C is ungrammatical, D uses present perfect active which is less appropriate for a procedural note.
3. Select the sentence that correctly reports what the patient said about their medication allergy.
Answer: B. When reporting speech after a past reporting verb, shift the verb to past: 'she was allergic'. Option A keeps present tense, C mixes present reporting with past content, D lacks correct verb form.
4. Identify the sentence with the correct use of a conditional for giving advice about fall risk.
Answer: D. For realistic advice about a possible future event, use the first conditional: present simple in the if‑clause and 'will' in the main clause. Option A uses 'should' which changes the nuance, B uses past unreal conditional, and C mixes unreal conditional with future simple, making it awkward.
5. The wound on her left heel ____ by the nursing staff at 08:00 and reviewed by the podiatrist later that morning.
Answer: A. Healthcare notes favour the passive when the action matters more than who did it: 'the wound was dressed'. Option B is incomplete — no auxiliary. Option C uses 'had dressed' as if it were active past ('the nurse had dressed the wound' would be correct). Option D shifts into present perfect, which clashes with the specific past time 'at 08:00'.
6. Since her discharge in February, she ____ three further admissions for the same presenting complaint.
Answer: B. A continuing situation that reaches up to the present — here, still relevant after discharge — takes present perfect: 'has had'. Past simple 'had' would lock the admissions at a finished point in time, which contradicts 'since her discharge in February' (an action still connecting to now). 'Is having' is present continuous and implies an admissions process currently unfolding; 'was having' is past continuous and is incompatible with the count 'three'.
7. The tissue viability nurse recommended that the patient ____ repositioned two-hourly to reduce the risk of pressure damage.
Answer: B. After recommend, suggest, advise, ask and insist, the verb in the that-clause drops to the base form and, for any other verb, takes 'be' in the subjunctive. So 'that the patient be repositioned'. Option A reads as a normal indicative and breaks the grammar of recommendation. Option C is past indicative, which softens the recommendation into a report of fact. Option D, present perfect passive, is the tense you would use to describe an established state, not a recommendation about future care.
8. The patient was discharged home yesterday and is to continue her regular dose of metformin.
Answer: B. After 'discharged' the correct preposition for medication the patient is taking home is 'with'. 'Discharged on' refers to the day or the route of ongoing care (e.g. discharged on day three post-op), not to a drug. 'Discharged home' is wrong because 'discharged' already implies destination; in OET nursing writing the natural phrasing is simply 'The patient was discharged yesterday and is to continue metformin 500 mg twice daily.' Recognise the signal verb 'discharged', then check the preposition that follows it for an object.
9. The on-call registrar asked the nursing staff to ____ the patient's vital signs hourly and to report any deterioration immediately.
Answer: B. After a reporting verb of request such as 'asked', healthcare English follows the pattern: subject + asked + object + to + bare infinitive. So 'asked the nursing staff to monitor'. 'To have monitored' is the perfect infinitive, used only when the requested action is earlier than another past action; it does not fit this clinical instruction. 'Be monitored' would make the staff the ones being monitored, which reverses the meaning. 'Monitoring' drops the required 'to' and breaks the infinitive pattern. The signal is the verb 'asked' followed by an object — expect 'to + verb' next.
10. Which sentence correctly employs the passive construction required for a wound‑care note?
Answer: A. In clinical documentation the passive voice is preferred: 'The dressing was changed' (past simple passive). Option A follows this pattern; the others are active or incorrect forms.
11. Identify the sentence that accurately reports the patient’s statement about their medication allergy, using correct reported speech and tense.
Answer: B. When reporting speech, the verb 'said' shifts the present simple to past simple: 'she was allergic'. Option B correctly uses past simple after 'said' and retains the modal 'must' for present obligation.
12. On review, the team noted that the patient ____ penicillin and was therefore commenced on erythromycin.
Answer: A. Look at the verb that introduces the report. 'On review... the team noted that the patient...' is past simple, so the reported information needs to back-shift too. 'Is allergic' stays in present simple and is wrong for a written clinical note describing a past finding. 'Has been allergic' keeps a present-perfect frame that does not match the past reporting verb. 'Had allergic to' is ungrammatical — 'allergic' is an adjective, not a past participle, and the preposition 'to' is fixed. 'Was allergic to' gives the correct past simple after a past reporting verb, and 'allergic to' is the fixed clinical collocation.
13. If her pain score had been documented more frequently, the nurses ____ able to escalate her analgesia earlier.
Answer: C. Read the two halves. 'If her pain score HAD BEEN documented' is past perfect, so the result clause must also sit back in the past — a third conditional. The structure is 'if + past perfect, would have + past participle'. 'Will be' and 'would be' are second conditional and only fit a present unreal condition. 'Had been' has no 'would' and is ungrammatical on its own as a result clause. 'Would have been able' is the only completion that matches the past-perfect condition and the finished past result the sentence describes.
14. The patient, who has a documented allergy to latex and is awaiting a cataract procedure on her right eye, was referred ____ the ophthalmology team for pre-operative assessment.
Answer: D. The clinical-verb-and-preposition frame is 'referred TO'. 'Referred for' would need a service or a purpose, not a team — 'referred for cataract surgery' works, but 'referred for the ophthalmology team' does not. 'Referred with' is wrong because 'referred with' describes the condition being passed on, not the receiving team. 'Referred by' would make the ophthalmology team the referrer, which reverses the meaning. Only 'referred to' correctly takes the receiving team as its object.
15. An 82-year-old man with a history of falls ____ to have a comprehensive geriatric assessment before any further changes are made to his medications.
Answer: A. The long subject is 'an 82-year-old man with a history of falls' — singular, so the verb must be singular too. 'Require' is plural and would only be correct if the subject were 'men' or 'patients'. 'Is requiring' and 'has been requiring' use the progressive for a routine clinical recommendation, which is inappropriate; the present simple states the requirement as a standing order.
16. The ward round documented that Ms Khan was commenced on amoxicillin, she ____ a mild rash on her trunk later that day.
Answer: D. The two clauses 'Ms Khan was commenced on amoxicillin' and 'she had developed a mild rash' are both completed past events, so they cannot be joined with just a comma and 'and'. The sentence as printed is a comma splice. Option D rewrites the second clause in the past perfect, which matches the earlier time frame and lets the two events be linked cleanly. 'Develops' is present tense and breaks the past narrative; 'and develop' would need a plural subject.
17. The IV cannula site showed no signs of phlebitis, the patient ____ that the dressing had been changed that morning.
Answer: A. Two independent past-tense clauses can be joined, but they need a conjunction that signals the contrast between the clean site and the patient’s account. 'But' supplies that contrast. 'And reported' simply lists two facts with a comma splice; 'yet reported' is stylistically awkward in clinical notes; and 'and reports' drops into present tense partway through a past-tense sentence, which is the classic ward-note shift a marker penalises.
18. The nurse noted that the patient ___ a fever of 38.5°C on admission and was started on paracetamol.
Answer: A. The correct past simple 'had' is needed for a specific event in the past. 'Has had' would be present perfect, implying an ongoing condition, which is inaccurate for a single recorded fever.
19. During the handover, the charge nurse said the wound ___ cleaned and a new dressing applied before the afternoon shift.
Answer: A. Clinical notes require the passive form 'was cleaned' to focus on the action, not the doer. 'Is' and 'has been' are incorrect tenses, and 'were' does not agree with singular 'wound'.
20. The patient told the nurse that she ___ her inhaler because it caused a sore throat.
Answer: C. Reported speech about a past action uses past perfect 'had stopped using' to show the action was completed before the time of speaking. 'Has stopped' is present perfect, and 'stopped' lacks the needed past perfect context.
21. If the physiotherapy team ___ the patient earlier, she ___ less difficulty mobilising after surgery.
Answer: A. A third‑conditional sentence is required for unreal past situations: 'had assessed' (past perfect) and 'would have experienced' (perfect conditional) correctly express the missed opportunity and its likely result.
22. The patient was admitted _____ acute abdominal pain and was commenced on IV fluids within thirty minutes.
Answer: B. Admitted WITH a presenting complaint; admitted FOR a planned procedure. Acute abdominal pain is the reason for presentation, so WITH is correct. FOR would imply a planned admission, OF is not used after admitted, and BY indicates the admitting clinician.
23. The discharge summary states that Mrs Patel, who has a background of type 2 diabetes, _____ to her GP for ongoing monitoring of her blood glucose levels.
Answer: A. In a discharge or referral letter, the action that has already happened to the patient is written in the passive, so was referred. HAS REFERRED would mean Mrs Patel herself did the referring, which is not the case here. REFERRED alone is an incomplete verb form. IS REFERRING is present continuous and implies the action is still in progress.
24. The community nurse documented that Mr Hughes, together with his wife and daughter-in-law, _____ expressed concerns about his wound management since discharge.
Answer: A. The subject is the compound Mr Hughes together with his wife and daughter-in-law. When a subject is joined by together with, the verb agrees with the FIRST noun, which here is a singular noun of address followed by additional people, but the true subject is plural (three people). HAVE agrees with the plural compound subject. HAS would treat Mr Hughes alone as the subject, IS HAVING is singular present continuous, and HAD would only be correct in past context, which the since-discharge phrase here does not require.
25. On examination, the patient ____ an obvious tremor in both hands, which was most pronounced when he attempted to reach for a cup of water.
Answer: D. The narrative past (a finding on a one-off examination) takes simple past: 'demonstrated'. 'Was demonstrating' would only work if the context framed an action in progress at a stated past moment; 'has demonstrated' wrongly shifts to a present perfect result relevant now; 'had been demonstrating' would need an earlier past reference. The signal is 'on examination', which anchors the action in a single completed past event.
26. The discharge letter recommended that the patient ____ his warfarin dose if he noticed any signs of bruising or bleeding while at home.
Answer: A. After 'recommended that the patient', the verb takes the bare infinitive because 'recommend' is a recommending verb (subjunctive-style). 'Reduces' is third-person present and would be wrong after 'the patient' only if no 'that' clause existed; here the mandative subjunctive rules. 'Would reduce' would be correct after a past reporting verb such as 'recommended he would', which is not standard. 'Has reduced' is past participle and cannot follow 'that the patient'.
27. The patient told the nurse that she ____ her warfarin the previous evening because she had run out and was unable to obtain a further supply from her local pharmacy.
Answer: A. Reported speech shifts the patient's original past simple ('I did not take') back one tense, to past perfect ('had not taken'). 'Has not taken' stays in present perfect and breaks the back-shift required after 'told'. 'Did not took' mixes base 'did' with past participle, a common learner error. 'Had not been taken' makes the warfarin the agent of its own non-taking, which is nonsensical here.
28. The wound ___ dressed by the senior nurse before the patient was transferred to the theatre.
Answer: C. In a clinical report the preferred passive form for a completed action is the simple past passive: 'the wound was dressed'. 'Had been dressed' implies a prior action relative to another past event, which is not needed here. 'Is dressing' is incorrect tense and voice, and 'dressed' lacks the auxiliary needed for the passive.
29. The patient’s condition has improved significantly since the initiation of the new antibiotic regimen. The doctor believes that the infection ___ resolved within the next few days if the treatment continues as planned.
Answer: C. The correct choice is 'is likely to be' because the sentence describes a future prediction based on current circumstances. 'Will be' (A) is too direct and lacks the nuance of probability, while 'would be' (B) implies a hypothetical or conditional scenario, which is not the case here. 'Has likely been' (D) incorrectly uses the present perfect tense for a future prediction. The phrase 'is likely to be' correctly conveys the doctor’s assessment of the infection's probable resolution in the near future.
30. The patient’s blood glucose levels were monitored closely after the administration of insulin. The nurse noted that the patient ___ hypoglycaemic episodes if the insulin dose was not adjusted properly.
Answer: A. The correct choice is 'would experience' because the sentence describes a conditional scenario—what would happen if the insulin dose was not adjusted. 'Would experience' (A) fits the second conditional structure (if + past simple, would + base verb), indicating a hypothetical situation. 'Experienced' (B) and 'has experienced' (C) are past or present-perfect tenses, which do not fit the conditional context. 'Experiences' (D) is present simple and does not convey the hypothetical nature of the statement.