The task
Original independent practice. The patient details, observations and individual discharge orders are fictional. Assume that today's date is 3 November 2026. Mr Burns is returning to his aged care facility today. Allow 45 minutes: 5 minutes reading and 40 minutes writing.
You are a registered nurse on the medical ward. Using the case notes, write to Ms Humaira Bangash, the residential care nurse, handing over Mr Burns's current medicine and fluid plan, ordered blood tests and follow-up after resolved acute kidney injury. Address the letter to Ms Humaira Bangash, Residential Care Nurse, Residential Care Nursing Office, 34 High Street, SW19 1AA, United Kingdom. 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?
Resolved acute kidney injury: discharge
You are a registered nurse on the medical ward. Using the case notes, write to Ms Humaira Bangash, the residential care nurse, handing over Mr Burns's current medicine and fluid plan, ordered blood tests and follow-up after resolved acute kidney injury. Address the letter to Ms Humaira Bangash, Residential Care Nurse, Residential Care Nursing Office, 34 High Street, SW19 1AA, United Kingdom. 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: Mr Darnell Burns
- DOB: 05/02/1944 (82 yrs)
- Admitted 26/10/26; discharge 03/11/26
- Resident: aged care facility, 34 High Street, SW19 1AA, UK
Social background
- Staff administer all medicines; able to drink independently when prompted
- Mild memory difficulties; often forgets to ask for drinks
- Usual mobility: independent with walking frame
- Daughter can accompany him to GP appointment
- Retired accountant; likes discussing former colleagues
- Daughter disclosed private inheritance dispute; unrelated to care
Medical history
- Hypertension; ramipril taken before admission
- Knee osteoarthritis; PRN ibuprofen used before admission
- No known chronic kidney disease or heart failure
Admission and inpatient chronology
- 26/10: vomiting/diarrhoea, poor intake and ↓ urine
- AKI attributed to dehydration by treating team
- IV fluids given; renal function improved progressively
- Ramipril and ibuprofen withheld on admission
- 28/10: temporary fluid restriction during oliguria with oedema
- 30/10: oedema resolved; restriction explicitly cancelled
- 02/11: creatinine back to baseline; team documents AKI resolved
- 03/11: eating/drinking normally; no vomiting/diarrhoea for 48 hrs
- Urine output usual; no swelling or breathlessness
Current documented discharge orders
- Discharge order: ramipril remains withheld; GP decides restart after blood-result review
- Ibuprofen ceased; do not restart; medical advice before other NSAIDs
- Current plan: no fluid restriction; offer drinks regularly, record intake/urine
- Renal function/electrolytes ordered 06/11; facility arranges collection; request supplied; results to GP
- GP appointment 09/11: blood results, BP and ramipril decision
- Urgent GP assessment: ↓ urine, poor intake, recurrent vomiting, new confusion, swelling/breathlessness
- Call ambulance for severe breathing difficulty
- Record BP for GP review; no other medicine changes
- Pharmacist confirmed updated medication supply matches discharge orders
Other recorded information
- Renal ultrasound: no obstruction during admission
- Previous cataract operation; no current visual concerns
Who is reading, and what do they need?
Ms Bangash is the residential care nurse receiving Mr Burns back on 3 November, and facility staff already administer his medicines. She needs the current fluid and medicine orders, responsibility for collecting bloods and reviewing results, and deterioration thresholds. His memory difficulties make regular drink prompts practical; biographical detail contributes little to this handover.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Ramipril remains withheld; GP decides restart after reviewing blood results. | Prevents routine resumption before the designated clinician has reviewed the ordered results. |
| Ibuprofen ceased; do not restart; obtain medical advice before other NSAIDs. | Distinguishes a cessation instruction from ramipril's temporary withholding and preserves the related medicine precaution. |
| No fluid restriction; offer drinks regularly and record intake and urine. | Communicates the current hydration plan and monitoring rather than the cancelled inpatient restriction. |
| Renal function/electrolytes, 6 November; facility arranges collection using supplied request; results to GP. | Identifies the ordered tests, timing, collection responsibility and destination of results. |
| GP review 9 November: blood results, blood pressure and ramipril decision. | Explains the purpose of the booked review and links it to the preceding blood collection. |
| Urgent GP: reduced urine, poor intake, recurrent vomiting, new confusion, swelling or breathlessness. | Preserves the complete documented set of deterioration triggers requiring urgent assessment. |
| Call an ambulance for severe breathing difficulty. | Keeps emergency escalation distinct from the urgent GP pathway. |
| Staff administer medicines; prompt drinks, record blood pressure; no other medicine changes. | Connects existing staff responsibilities with practical hydration support and information needed for GP review. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Usual frame mobility; previous cataract operation without current visual concerns. | These unchanged functional and surgical details do not affect the requested renal follow-up handover. |
| Retired accountant; enjoys discussing former colleagues. | Occupational interests do not help staff implement the current discharge orders. |
| Daughter's private inheritance dispute. | The unrelated confidential disclosure has no place in this clinical transfer. |
| Temporary restriction for oliguria/oedema on 28 October; cancelled on 30 October. | Usually omit or compress solely to clarify cancellation; presenting the earlier restriction as current would misdirect care. |
| No known CKD/heart failure; renal ultrasound showed no obstruction. | These contextual findings can be omitted when resolution and current orders are clear; they do not exclude future problems. |
A paragraph plan for this case
Open with brief name and birth-date identification, admission on 26 October for vomiting/diarrhoea, poor intake and reduced urine, and the team's dehydration-related AKI diagnosis, documented as resolved with baseline creatinine on 2 November; compress IV fluids, restored eating/drinking, 48 hours without vomiting/diarrhoea and usual urine without swelling or breathlessness. Use the main paragraph for the current medicine and unrestricted fluid plan, contextualising hypertension and knee osteoarthritis only if useful and optionally noting that the pharmacist confirmed the updated supply. Close with the 6 November blood collection, 9 November GP review, blood-pressure recording, possible accompaniment by his daughter and both escalation pathways.
Where candidates slip on this task
- Ramipril and ibuprofen were both withheld on admission, but their discharge instructions differ: ramipril awaits a GP restart decision after blood review, whereas ibuprofen must not restart.
- The restriction imposed on 28 October was explicitly cancelled on 30 October; retain the current unrestricted plan without inventing a daily fluid target or advising unlimited intake.
- Blood collection on 6 November precedes GP review on 9 November; the facility must arrange collection and send results to the GP, who also reviews blood pressure.
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
Does resolved AKI mean the earlier medicines can simply resume?
No. Separate clinical recovery from the explicit discharge orders. Ramipril remains withheld pending the GP's decision after blood-result review; ibuprofen has been ceased and must not restart. Medical advice is required before other NSAIDs. Do not add replacement analgesia, a ramipril dose or an automatic restart date.
How should the deterioration instructions be organised?
Keep the complete urgent GP list together: reduced urine, poor intake, recurrent vomiting, new confusion, swelling or breathlessness. Then distinguish severe breathing difficulty as requiring an ambulance. These instructions remain relevant despite documented AKI resolution; avoid substituting vague advice to seek help if unwell.
Sources
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