The task
Assume that today's date is 5 November 2026. You have reviewed Ms Alwine Naser at home. This is original independent practice material with fictional patient details and care arrangements.
You are a registered nurse in the stoma service. Using the case notes, write to Ms Alwine Naser's agreed adult son, Mr Brian Melvin, confirming his agreed support, explaining her individual written hydration plan and outlining when to seek help. A copy of the plan will accompany your letter; its complete instructions are recorded below. Address the letter to Mr Brian Melvin, Flat 2, 18 Orchard Road, N1 7AB. 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.
Free · no sign-up · nursing
Which case notes belong in this letter?
Ileostomy with a written hydration plan: advice
You are a registered nurse in the stoma service. Using the case notes, write to Ms Alwine Naser's agreed adult son, Mr Brian Melvin, confirming his agreed support, explaining her individual written hydration plan and outlining when to seek help. A copy of the plan will accompany your letter; its complete instructions are recorded below. Address the letter to Mr Brian Melvin, Flat 2, 18 Orchard Road, N1 7AB. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Ms Alwine Naser
- DOB: 14/03/1961 (65 yrs)
- Discharged 02/11/26; home review today, 05/11/26
- Agreed helper: adult son, Mr Brian Melvin (38)
Social background
- Lives alone; independent with personal care
- Son nearby; available evenings, not during working hours
- Patient consents to son receiving these instructions and helping with diary
- Retired administrator; enjoys collecting old postcards
- Son already knows operation details; attended discharge teaching
- Complained that ward staff took too long answering bells
Medical history
- Ulcerative colitis diagnosed 2014
- 22/10/26: subtotal colectomy and end ileostomy
- Appendicectomy 1989; uncomplicated recovery
Home assessment
- Alert, comfortable; eating regularly; urine unchanged from usual
- Stoma pink; surrounding skin intact; pouch secure
- Soft output; no recent ↑; no vomiting or abdominal pain
- Demonstrated independent pouch emptying and changing
- Occasionally forgets drinks when busy; requests reminders, not takeover
Individual plan and agreed support
- Treating-team written plan supplied: regular drinks throughout day; record drinks and output amount/consistency; no fixed litre target set
- Son agrees evening visits for first week: check supplies, prompt plan adherence, help complete diary
- Ask stoma team before changing hydration plan; no independent fluid targets
- Measuring jug, diary and spare pouches available
Safety advice reinforced
- Contact stoma team via hospital switchboard promptly: markedly ↑/watery output, repeated leakage or sore surrounding skin
- Dry mouth, unusual tiredness or ↓ urine → urgent GP/NHS 111 advice; inform stoma team
- Severe abdominal pain OR vomiting → immediate GP/NHS 111 advice; either symptom alone sufficient, even without ↓ output; do not await routine review
- Confusion or difficult to wake → call 999
Follow-up
- Stoma review 09/11/26; bring diary for individual reassessment
- Patient requests written reminder for son; plan copy enclosed
- Son has arranged transport to review
- Prefers reading newspaper before breakfast
Who is reading, and what do they need?
Mr Brian Melvin is Ms Alwine Naser’s adult son and agreed helper. He already knows the operation details from discharge teaching and can visit evenings, not working hours. He needs practical guidance on consented support, hydration monitoring and seeking help. Her independence with personal care and pouch management means reminders and diary assistance need more emphasis than detailed surgical history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Patient consents to her son receiving instructions and helping with the diary. | Establishes the agreed scope of information sharing and assistance while keeping the patient’s choices central. |
| Regular drinks throughout day; record drinks/output amount and consistency; no fixed litre target. | Provides the practical instructions the son needs to reinforce without inventing a fluid prescription. |
| First-week evening visits: check supplies, prompt plan adherence and help complete the diary. | Defines his agreed responsibilities and their duration without implying daytime availability or complete care. |
| Markedly increased/watery output, repeated leakage or sore surrounding skin: promptly contact stoma team via switchboard. | Connects every listed stoma-related concern with the designated service and appropriate urgency. |
| Dry mouth, unusual tiredness or reduced urine: urgent GP/NHS 111 advice; inform stoma team. | Preserves all listed warning signs and both required contact actions. |
| Severe abdominal pain or vomiting: immediate GP/NHS 111 advice, even without reduced output; do not await routine review. | Either symptom alone needs immediate medical advice; waiting for both symptoms or reduced output could delay care. |
| Confusion or difficult to wake: call 999. | Clearly separates the emergency response from the other contact pathways. |
| Stoma review 09/11/26; bring diary for individual reassessment. | Gives the recording activity a practical purpose and supports continuity; this follow-up detail is useful rather than independently essential. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired administrator; collects old postcards; reads the newspaper before breakfast. | These personal details do not change the agreed support, hydration instructions or help-seeking decisions. |
| Complained that ward staff took too long answering bells. | The ward complaint requires no action from her son within this home-support task. |
| Ulcerative colitis diagnosed 2014; uncomplicated appendicectomy in 1989. | These historical details add little to instructions for implementing the current hydration plan. |
| Son already knows operation details and attended discharge teaching. | Use this to judge the explanation level; avoid retelling familiar surgical information in the letter. |
| DOB 14/03/1961; patient aged 65; son aged 38. | Full demographic detail can crowd out practical advice when the recipient already knows the patient. |
| Son has arranged transport to the review. | Although connected to follow-up, transport is already organised and needs no further instruction. |
A paragraph plan for this case
Use the opening for the advice purpose and brief ileostomy/home-review context; current comfort, intake, urine, stoma, skin, pouch and output findings are optional reassurance. Build the support paragraph around consent, first-week evening visits, reminders rather than takeover, the complete hydration and recording instructions, available equipment and consultation before plan changes. Keep all four help-seeking pathways together in the final paragraph, then mention the enclosed plan and 9 November review with the diary.
Where candidates slip on this task
- Do not invent a daily litre target or replace the individual plan with generic drinking advice; any proposed hydration-plan change needs consultation with the stoma team.
- Treat the 9 November review as follow-up, not a reason to delay urgent assessment; the first-week evening arrangement does not imply daytime supervision or ongoing dependence.
- Keep the card’s UK contact routes distinct: GP/NHS 111 for the specified urgent problems and 999 for confusion or difficulty waking; do not substitute Australian numbers. Severe abdominal pain or vomiting alone requires immediate medical advice, even without reduced output.
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
More Nursing letter tasks
- Advice to a carer: managing newly diagnosed heart failure at home advice letter
- Cataract surgery recovery: advice advice letter
- New epilepsy safety plan: advice advice letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How much of the enclosed hydration plan needs explaining?
The enclosure does not replace explanation of the core instructions: regular drinks throughout the day, recording drinks and output amount and consistency, and no fixed litre target. Consultation before changes is useful additional guidance. The son’s role remains prompting and diary assistance, consistent with her requested independence.
Which help-seeking details must stay together?
Keep all four pathways together: markedly increased/watery output, repeated leakage or sore surrounding skin—prompt stoma-team contact through hospital switchboard; dry mouth, unusual tiredness or reduced urine—urgent GP/NHS 111 advice and inform stoma team; severe abdominal pain or vomiting—immediate GP/NHS 111 advice without awaiting routine review; confusion or difficult waking—999. Severe pain or vomiting alone is enough to seek immediate advice: do not wait for both symptoms or reduced output.
Sources
Last checked . Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.