The task
Assume that today's date is 21 October 2026.
You are the heart failure nurse at Riverbend Heart Clinic. Mr Russo has agreed that you may write to his daughter, who is his main carer. Using the information in the case notes, write a letter to Ms Teresa Russo advising her on how to help her father manage his condition at home. Address the letter to Ms Teresa Russo, 31 Olive Grove, Riverbend. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Advice letter.
Case notes
Patient details
- Name: Mr Vincent Russo
- DOB: 12/12/1946 (79 yrs)
- Retired builder
Social background
- Lives with daughter (Teresa, 52), who is his main carer; she works part-time (3 days/wk)
- Mr Russo has consented to information being shared with his daughter
- Daughter describes father as 'stubborn and difficult'
- Daughter going through a divorce — 'very stressed'
- Has a dog; enjoys walking it to the local park
Medical history
- Heart failure with reduced ejection fraction — diagnosed 10/26 (echocardiogram: ejection fraction 35%)
- Hypertension (since 2005)
- Gout — takes ibuprofen (bought over the counter) during flare-ups
- Inguinal hernia repair 1998
- Brother died of a heart attack aged 70
- Allergies: nil known
Clinic review 20/10/26
- Presented to GP with breathlessness and swollen ankles; referred to cardiology
- Now breathless climbing one flight of stairs; sleeping on 2 pillows
- Mild ankle swelling; weight today 84.2 kg (was 87.5 kg 2 wks ago)
- BP 112/68; HR 76
- ECG: sinus rhythm
Medications (cardiologist)
- Furosemide (fluid tablet) 40 mg each morning
- Perindopril 2.5 mg daily; bisoprolol 1.25 mg daily (dose to be increased slowly at clinic visits)
- Avoid ibuprofen and other anti-inflammatories — GP to advise alternative gout treatment
- May feel dizzy when standing — stand up slowly
- Cardiologist plans to add spironolactone and dapagliflozin at later visits if kidney function and potassium allow
- Baseline bloods 20/10: creatinine 98 µmol/L, eGFR 64, Na 139 mmol/L, K 4.4 mmol/L
- Repeat blood test in 1 wk at local pathology collection centre (form given)
Self-care advice
- Weigh every morning after using toilet, before breakfast, same scales, similar clothing; record in diary
- Contact clinic if weight increases by > 2 kg in 2 days, or breathlessness/ankle swelling worsens, or needs more pillows to sleep
- Individual fluid allowance prescribed: 1.5 L/day, including drinks and liquid foods (tea, soup, ice cream); review at next clinic
- Reduce salt — no added salt; avoid processed foods
- Take furosemide in the morning to avoid passing urine at night; plan outings accordingly
- Call ambulance for chest pain, severe breathlessness at rest or fainting
- Gentle daily walking encouraged
- Influenza vaccine given 20/10
Plan
- Heart failure clinic review 03/11/26 — bring weight diary
- Clinic phone: 5550 1234 (Mon–Fri 8:30 am–4:30 pm); after hours — GP after-hours service
Who is reading, and what do they need?
Ms Russo is a lay carer who works part-time and is not a health professional. Her father has agreed to information being shared. She needs clear, practical instructions and exactly when to contact the clinic or an ambulance. Use plain language, explain the purpose of each step, and avoid test results and drug plans she does not need.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Mr Russo consented to information being shared with her | Confirms why the letter can be written to her and sets a respectful tone. |
| Heart failure diagnosed 10/26; breathless on one flight of stairs | A brief explanation of the condition and current symptoms gives context for the advice. |
| Weigh each morning after toilet, before breakfast; record in diary | Daily weights are the main monitoring task she can help with, and the diary is needed at review. |
| Contact clinic if weight up >2 kg in 2 days, worse breathlessness or swelling, or more pillows | These are the listed triggers for calling the clinic and should be given in full. |
| Fluid allowance 1.5 L/day including tea, soup and ice cream | She needs the limit and what counts toward it so she can help him keep to it. |
| No added salt; avoid processed foods; furosemide in the morning | Practical diet and timing advice that she can support, including planning outings around the fluid tablet. |
| Avoid ibuprofen and other anti-inflammatories; may be dizzy when standing | He buys ibuprofen over the counter for gout, so she should know to avoid it, and dizziness is a safety point. |
| Ambulance for chest pain, severe breathlessness at rest or fainting; review 03/11 | Gives the complete ambulance triggers listed, the date to bring the diary, and the clinic phone and after-hours arrangements. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter describes him as 'stubborn and difficult'; her divorce stress | Personal and sensitive; acknowledge her carer role kindly at most, without repeating these comments. |
| Weight 84.2 kg today versus 87.5 kg two weeks ago | Looks like a weight change to act on, but the contact rule is a rise of more than 2 kg in 2 days; give that rule instead. |
| Spironolactone and dapagliflozin planned later | A cardiologist plan dependent on tests, not something the carer needs to manage now. |
| Creatinine, eGFR, Na, K, ECG, BP and HR | Detailed results are not useful to a lay carer; only the repeat blood test in 1 week matters. |
| Hernia repair 1998; brother died of a heart attack | Unrelated or distressing history that adds nothing to home advice. |
A paragraph plan for this case
Open by stating the purpose and that her father agreed to the letter, with a short explanation of his condition. Then cover daily weights, fluids and salt, medicines and safety, and gentle activity. End with when to call the clinic, the ambulance triggers, the review date and the blood test.
Where candidates slip on this task
- Give the clinic contact triggers in full and keep them separate from the ambulance triggers; stating only the weight rule would leave out the breathlessness, swelling and pillow signs.
- Use lay terms such as fluid tablet, and explain the reason for each instruction. Keep a respectful tone toward both of them and do not repeat the 'stubborn' remark.
- Include the instruction to avoid ibuprofen with the note that the GP will advise an alternative gout treatment, and add the blood test in 1 week and the review date of 03/11.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should I tell her about the planned new medicines?
No. Spironolactone and dapagliflozin depend on later kidney and potassium results and are a cardiologist decision. Mention only the bisoprolol and dose-increase detail if it helps her understand clinic visits.
How do I treat her stress and his behaviour?
Do not repeat the 'stubborn' comment or refer to her divorce. A short, kind acknowledgement of her role as carer is fine, then keep to clear practical advice and contact details.
Sources
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