The task
Original independent practice. Assume that today's date is 3 November 2026. Ms Freaney is being discharged home today. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse on a postnatal ward. Using the case notes, write a discharge letter to Ms Hue Luong, Child and Family Health Nurse, Postnatal Community Service, 18 High Street, SW1A 2AA, United Kingdom. Request maternal follow-up for Ms Caragh Freaney following pre-eclampsia. Under the agreed team plan, Ms Luong will assess maternal symptoms and blood pressure at the home visit and report her findings to maternity triage the same day. Explain the scheduled reviews and symptom escalation advice; the obstetric team retains responsibility for treatment decisions and subsequent blood pressure monitoring arrangements. 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: Discharge letter.
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Which case notes belong in this letter?
Recovery following pre-eclampsia: discharge
You are a registered nurse on a postnatal ward. Using the case notes, write a discharge letter to Ms Hue Luong, Child and Family Health Nurse, Postnatal Community Service, 18 High Street, SW1A 2AA, United Kingdom. Request maternal follow-up for Ms Caragh Freaney following pre-eclampsia. Under the agreed team plan, Ms Luong will assess maternal symptoms and blood pressure at the home visit and report her findings to maternity triage the same day. Explain the scheduled reviews and symptom escalation advice; the obstetric team retains responsibility for treatment decisions and subsequent blood pressure monitoring arrangements. 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 Caragh Freaney
- DOB: 12/02/1995 (31 yrs)
- Address: 6 Church Road, SW8 2AB, United Kingdom
- Discharge: 03/11/26; first baby born 30/10
Social background and routine postnatal information
- Lives with partner; available to accompany her to appointments and provide transport
- Anxious after unexpected admission; accepts support; sleep interrupted by infant care
- Breastfeeding established; routine infant follow-up already arranged through postnatal service
- Baby's hearing screen completed; no concerns recorded
- Baby received vitamin K after birth
- Complained that night staff were slow answering her bell
Medical history
- No hypertension or kidney disease before pregnancy
- Allergies: nil known
- Previous wrist fracture healed; no functional limitation
Admission and birth
- 29/10: hypertension + proteinuria + persistent headache → pre-eclampsia diagnosed
- 30/10: labour induced at 37+2/40
- Vaginal birth; baby remained with mother
Postnatal progress
- 31/10: headache resolved; no subsequent visual symptoms
- 01/11: platelet count, renal and liver blood results improving
- 02/11: obstetric team stopped antihypertensive treatment; none prescribed at discharge
- 03/11: BP 128/82, then 132/84 mmHg
- Today: no headache, visual disturbance or pain below ribs
- Mobilising independently; eating and drinking
Documented discharge plan and education
- Agreed team plan: Ms Luong (child and family health nurse), 04/11 home visit → assess maternal symptoms/BP; report findings + BP to maternity triage same day
- Maternity review booked 05/11; obstetric team retains responsibility for treatment decisions + subsequent BP monitoring arrangements
- GP postnatal review booked 15/12
- Team advice: severe persistent headache/visual disturbance/pain below ribs/sudden swelling/very unwell → immediate maternity-triage assessment
- Do not wait for scheduled review if warning symptoms develop
- Seizure or collapse → call 999
- Initially thought delivery removed all risk and further checks were unnecessary; explanation provided
- Written symptom advice supplied; can now repeat main warning signs
- Partner will provide transport for booked maternity review
Who is reading, and what do they need?
Ms Luong, the child and family health nurse, needs a maternal handover for her agreed home symptom and blood pressure assessment, with findings reported to maternity triage the same day. The obstetric team retains responsibility for treatment decisions and subsequent monitoring arrangements. Routine infant follow-up is already arranged, so neonatal details add little. Identifiers, partner transport and accepted emotional support can assist follow-up, while the main detail should explain monitoring, medication status, review dates and the complete documented escalation advice.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 29 October: hypertension, proteinuria and persistent headache; pre-eclampsia diagnosed. | Establishes the maternal condition requiring follow-up rather than presenting this as routine postnatal discharge. |
| 2 November: obstetric team stopped antihypertensives; none prescribed at discharge. | Clarifies current treatment and prevents an assumption that antihypertensive medication must continue at home. |
| 3 November: BP 128/82, then 132/84 mmHg. | Provides a recent monitoring baseline without implying that further checks are unnecessary. |
| 4 November: Ms Luong, child and family health nurse, to assess maternal symptoms/BP at home under the agreed plan; report findings and BP to maternity triage the same day. | Defines this nurse's agreed maternal assessment and reporting duties, including the destination and timing. |
| 5 November: maternity review; obstetric team retains responsibility for treatment decisions and subsequent BP monitoring arrangements. | Links the home assessment to specialist review and makes clear who decides treatment and arranges later monitoring. |
| 15 December: booked GP postnatal review. | Adds the scheduled later review without substituting it for the immediate maternity follow-up. |
| Severe persistent headache/visual disturbance/pain below ribs/sudden swelling/very unwell: immediate maternity-triage assessment; seizure/collapse:999. | Keeps every documented warning sign and both escalation routes together; warning symptoms must not wait for a scheduled review. |
| Believed delivery ended risk; explanation and written advice provided; main warning signs now recalled. | Explains the educational need and recorded understanding without assuming that further reinforcement is unnecessary. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Baby's hearing screen completed; vitamin K given after birth. | These routine infant details do not guide the requested maternal monitoring. |
| Night staff reportedly slow to answer her bell. | The complaint does not identify a current community follow-up need. |
| Healed wrist fracture without functional limitation. | No ongoing consequence is recorded that affects maternal assessment or appointment attendance. |
| Breastfeeding established; routine infant follow-up arranged. | Compress if needed to distinguish existing infant arrangements from this maternal request; an infant-care narrative is unnecessary. |
| Allergies: nil known. | Optional clinical context; the letter chiefly requests monitoring and no new prescribing. |
| Vaginal birth; baby remained with mother. | Brief birth context may help orientation, but these uncomplicated details do not determine the maternal follow-up actions. |
A paragraph plan for this case
Open with today's maternal discharge, identification and pre-eclampsia diagnosis, making clear that Ms Luong's agreed role is maternal symptom/BP assessment and same-day reporting to maternity triage. Add brief induction or birth context and absent pre-pregnancy hypertension or kidney disease only if useful. Summarise current recovery and stopped antihypertensives, using the BP readings as a baseline; resolved symptoms, improving blood results and independent mobility are optional supporting detail. Give the dated home visit, maternity review and complete escalation advice, preserving the obstetric team's treatment decisions and subsequent monitoring arrangements. The later GP review, education and partner support can help explain continuity and attendance.
Where candidates slip on this task
- The reader is a child and family health nurse whose maternal symptom/BP assessment and same-day reporting duties are explicitly agreed in this case. Keep the maternal follow-up purpose clear; routine infant milestones do not replace these actions.
- Antihypertensives were stopped by the obstetric team on 2 November, with none prescribed at discharge. Treatment decisions and subsequent monitoring arrangements remain with that team; do not invent a medicine, dose, restart threshold or titration plan.
- Improving blood results and absent current symptoms do not establish complete resolution; preserve the dated monitoring arrangements and all documented warning signs, urgency and emergency instructions.
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
- Discharge to the community nursing service: new insulin and diabetic foot ulcer discharge letter
- Postnatal discharge to a child and family health nurse: feeding concerns after gestational diabetes discharge letter
- Discharge to the community nurse: new colostomy in an older man living alone discharge letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should routine baby information take priority because the reader is a child and family health nurse?
No. The agreed team plan specifically assigns Ms Luong maternal symptom and blood pressure assessment, with same-day reporting to maternity triage. Routine infant follow-up is already arranged. Hearing screening and vitamin K can be omitted, and birth or feeding context can remain brief. Treatment decisions and later monitoring arrangements remain with the obstetric team.
Can the letter rely on the written symptom advice already supplied?
No. Present all documented warning signs with immediate maternity-triage assessment, and retain the separate 999 instruction for seizure or collapse. Mentioning written advice and recalled warning signs supports the education handover but does not replace the escalation content or scheduled monitoring.
Sources
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