The task
Original independent practice. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today's date is 5 November 2026. Cahal Cousins is going home with his mother today.
You are a registered nurse on the surgical ward. Using the case notes, write a letter to Ms Nicola Gillen, Cahal Cousins's mother and agreed carer, explaining his home care. Address her questions about whether worsening pain requires an ambulance and whether she can keep him at home if bleeding stops. Address the letter to Ms Nicola Gillen, 24 Cedar Road, NSW 2000, Australia. 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.
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Which case notes belong in this letter?
Tonsillectomy recovery: advice
You are a registered nurse on the surgical ward. Using the case notes, write a letter to Ms Nicola Gillen, Cahal Cousins's mother and agreed carer, explaining his home care. Address her questions about whether worsening pain requires an ambulance and whether she can keep him at home if bleeding stops. Address the letter to Ms Nicola Gillen, 24 Cedar Road, NSW 2000, Australia. 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: Cahal Cousins
- DOB: 12/03/2017 (9 yrs)
- Mother: Ms Nicola Gillen; agreed home carer
- Home: 24 Cedar Road, NSW 2000, Australia
Social background
- Mother taking leave; available at home throughout initial recovery
- Enjoys astronomy books and drawing planets
- Mother complained that receptionist was rude during admission
Medical history
- Recurrent tonsillitis over 2 yrs → elective surgery
- Allergies: nil known; no regular medicines before admission
- Wrist fracture 2022; healed, no ongoing problems
Treatment/Progress
- 04/11/26: tonsillectomy; uncomplicated procedure
- Postoperative nausea yesterday; resolved before breakfast today
- Inpatient continuous SpO2 monitoring overnight; discontinued following review
- Hourly airway observations on ward; ceased before discharge
- 05/11: alert; breathing comfortably on room air
- No fresh bleeding seen overnight or this morning
- Drinking freely; breakfast tolerated; passed urine
- Throat discomfort improved after oral paracetamol
- Paracetamol supplied; mother demonstrated correct label-based dosing
- Mother asks: worsening pain alone → ambulance? Visible bleeding stops → safe to stay home?
Plan — documented treating-team instructions for Cahal
- Team instruction: supplied paracetamol as labelled; no additional paracetamol-containing products; no codeine
- Team: pain uncontrolled by supplied medicine → GP review same day; do not increase dose
- Team: unable to drink at all → urgent nearest ED assessment
- Team: fresh blood from mouth/nose, bloody vomit or repeated swallowing → nearest ED immediately, even if bleeding stops
- Team: heavy bleeding or breathing difficulty → call 000 for ambulance
- Team: encourage frequent fluids; chilled drinks may soothe throat
- Team: check for bleeding/breathing difficulty at least twice tonight; second postoperative night
- Team: throat/ear pain may temporarily worsen without bleeding; quiet activities for distraction
- Team: fever → prompt medical review
- Discharge approved today; mother requests brief written instructions to refer to at home
Who is reading, and what do they need?
Ms Nicola Gillen is nine-year-old Cahal's mother and agreed home carer, available throughout initial recovery. She asks whether worsening pain needs an ambulance and whether she can keep him at home after visible bleeding stops. Answer these questions with clear actions rather than repeating her concerns. His age, no known allergies and absence of previous regular medicines need little space; compress reassuring hospital details to leave room for practical advice.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Supplied paracetamol as labelled; no additional paracetamol-containing products; no codeine. | Retain all three restrictions so home pain relief follows the treating team's instructions without duplicate medication or an unsuitable alternative. |
| Pain uncontrolled by supplied medicine: same-day GP review; do not increase dose. | Answer her question about worsening pain with a clear review timeframe and prevent her increasing the dose. |
| Unable to drink at all: urgent nearest ED assessment. | Distinguish this urgent assessment threshold from pain that requires same-day GP review. |
| Fresh mouth/nose blood, bloody vomit or repeated swallowing: nearest ED immediately, even if bleeding stops. | Answer her question about staying home after bleeding stops; a temporary improvement does not remove the need for immediate assessment. |
| Heavy bleeding or breathing difficulty: call 000 for an ambulance. | Identify both ambulance triggers so she can distinguish these emergencies from uncontrolled pain alone. |
| Fever: prompt medical review. | Useful additional safety advice; retain its documented urgency without inventing a temperature threshold. |
| Check for bleeding/breathing difficulty at least twice tonight, the second postoperative night. | Translate ward discharge into a specific home observation responsibility, preserving both checks and the minimum frequency. |
| Frequent fluids; chilled drinks; throat/ear pain may temporarily worsen without bleeding; quiet activities. | Useful comfort measures and context for her pain question; keep them concise. Familiar quiet activities may briefly personalise the advice. |
| Alert and breathing comfortably on room air; drinking freely, breakfast tolerated and urine passed; throat discomfort improved after oral paracetamol. | These observations offer optional discharge context. Select and compress useful details rather than listing them all; current recovery does not replace clear instructions for new bleeding, breathing difficulty, inability to drink or uncontrolled pain. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys astronomy books and drawing planets. | Omit this as a separate account of his interests, or briefly suggest these familiar quiet activities for distraction. Personalising the advice is optional. |
| Mother complained about the receptionist's rudeness. | The admission complaint does not help her provide postoperative care or decide when to seek help. |
| Two years of recurrent tonsillitis; healed wrist fracture in 2022. | The surgical indication looks relevant but does not guide home recovery; the resolved fracture has no ongoing care implications. |
| Yesterday's postoperative nausea resolved before breakfast. | A resolved inpatient symptom does not require management in this letter and should not displace current action thresholds. |
| Continuous overnight SpO2 monitoring discontinued following review. | This ward procedure can misleadingly suggest equipment is needed at home; the actual home checks are separately documented. |
| Hourly ward airway observations ceased before discharge. | The inpatient schedule is a plausible trap: it must not replace or complicate the specific twice-tonight home instruction. |
A paragraph plan for this case
Open briefly with Cahal's discharge after the 4 November tonsillectomy. Explain labelled medication and what to do if it does not control his pain, using concise pain expectations or comfort advice if helpful. Clearly separate urgent assessment for inability to drink, immediate assessment for possible bleeding even after it stops, and the two ambulance triggers. Finish with tonight's checks for bleeding and breathing difficulty. Her request for written instructions needs no retelling, and the supplied recipient name and address belong in standard letter positions.
Where candidates slip on this task
- Keep the 4 November operation and 5 November discharge distinct: tonight is the second postoperative night, requiring at least two checks for bleeding and breathing difficulty.
- Keep label-based dosing unchanged: no extra paracetamol-containing products, no codeine and no dose increase; demonstrated dosing does not replace clear medicine restrictions in this home-care advice.
- Answer both questions without blanket reassurance: worsening pain alone does not establish bleeding, but bleeding signs still require immediate assessment even if visible bleeding stops.
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 should the mother's questions shape the letter?
Give her usable decisions: pain uncontrolled by the supplied medicine needs same-day GP review without a dose increase; possible bleeding needs immediate emergency-department assessment even after it stops. Explain that heavy bleeding or breathing difficulty requires an ambulance. Pain expectations can support this explanation without recounting her questions. General recovery guidance is available from the Royal Children's Hospital: https://www.rch.org.au/kidsinfo/fact_sheets/Tonsillectomy_and_adenoidectomy_discharge_care/.
How much inpatient progress should be retained?
Allow only brief discharge context if space permits: the uncomplicated operation, comfortable breathing, tolerated drinks or food, and response to paracetamol can support the purpose. None needs an individual sentence. Exclude discontinued ward monitoring and resolved nausea, which do not tell his mother what to do at home.
Sources
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