The task
Original independent practice. Time allowed: 45 minutes (5 minutes reading and 40 minutes writing). Assume that today's date is 3 November 2026. Nathaniel Mulrain has attended a follow-up asthma appointment.
You are a registered nurse in a primary care clinic. Using the case notes, write a referral letter to Ms Sorcha Fitzgibbons, School Nurse, School Health Service, 14 School Road, SW1P 3BT, United Kingdom. Request coordination of Nathaniel's written asthma action plan and practical arrangements enabling participation in school sport. 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: Referral letter.
Free · no sign-up · nursing
Which case notes belong in this letter?
Adolescent asthma: referral
You are a registered nurse in a primary care clinic. Using the case notes, write a referral letter to Ms Sorcha Fitzgibbons, School Nurse, School Health Service, 14 School Road, SW1P 3BT, United Kingdom. Request coordination of Nathaniel's written asthma action plan and practical arrangements enabling participation in school sport. 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: Nathaniel Mulrain
- DOB: 12/02/2011 (15 yrs); Year 11
- Attends recipient's school; next PE lesson 05/11/26
Social background
- Lives with mother; she supervises home medicines
- Enjoys football; wishes to rejoin school sport
- Embarrassed using inhaler before peers; requests discreet support
- Nathaniel and mother consent to GP–school information sharing
- Mother discussed another parent's alleged affair during consultation
Medical history
- Asthma diagnosed aged 9; seasonal hay fever
- No previous asthma admissions; no known drug allergies
- Childhood ear grommets; no current hearing difficulty
- Daily inhaled preventer prescribed for home use only
- Salbutamol pMDI + spacer: his reliever; carries neither at school
19/10/26 — initial review
- Cough/wheeze during running; occasional night waking over preceding fortnight
- Reported missed preventer doses; no acute attack during consultation
- School reliever stored in office; delays accessing it during PE
- Mother requested permanent sport exemption; GP deferred pending review
27/10/26 — follow-up
- Inhaler technique corrected; mother established regular home preventer routine
- Agreed symptom diary; school access problem remained unresolved
03/11/26 — current review
- Adherence improved; no night waking or resting symptoms during past week
- Chest clear today; avoiding PE despite improved symptoms
- GP supports sport when well, with reliever/spacer readily accessible
- School nurse: agree discreet access arrangements with Nathaniel/PE staff before 05/11
- School nurse: obtain updated written action plan directly from GP
Interim instructions and follow-up
- GP's interim attack instructions: sit upright; salbutamol via spacer, 1 puff every 30–60 seconds until symptoms improve, maximum 10; shake inhaler between puffs
- Call 999 if worsening, unimproved after 10 puffs, or attack without inhaler
- If unimproved after 10 minutes awaiting ambulance, repeat up to 10 puffs
- Inform GP of recurrent exercise symptoms or ↑ reliever use
- GP review booked 17/11/26; bring symptom diary
- Prefers the earlier bus because friends travel on it
- Mother complained about PE teacher's spelling in newsletter
Who is reading, and what do they need?
Ms Fitzgibbons works at Nathaniel's school but needs his current clinical instructions and the practical barriers affecting PE. Brief identifiers, Year 11, asthma with seasonal hay fever, and his wish to resume sport establish context. Consent supports GP–school coordination. His mother's supervision of home medicines is useful background, while the detailed primary-care chronology has less value than an actionable school arrangement.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| GP supports sport when well, with reliever and spacer readily accessible. | Defines the conditions for participation and directs planning towards supported access to sport. |
| Agree discreet access with Nathaniel and PE staff before 05/11. | Makes the requested action, participants and deadline clear while addressing his stated embarrassment. |
| Obtain the updated written asthma action plan directly from the GP. | Identifies the authoritative source and gives the school nurse a concrete coordination task. |
| Sit upright; spacer salbutamol, 1 puff every 30–60 seconds until symptoms improve, maximum 10; shake inhaler between puffs. | Gives the initial response, technique and stopping condition needed to follow the GP's interim instructions safely. |
| 999 if worsening, unimproved after 10 puffs, or an attack without an inhaler. | Preserves all three recorded ambulance triggers so escalation is actionable. |
| If unimproved after 10 minutes awaiting ambulance, repeat up to 10 puffs. | Retains treatment while emergency help is awaited; repeat using the same technique and stop additional puffs when symptoms improve. |
| Salbutamol pMDI/spacer not carried; office storage delays access during PE. | Explains the practical problem the school nurse must resolve. |
| Improved adherence; no night waking/resting symptoms this week; clear chest; still avoiding PE. | Supports the current participation discussion without implying that asthma has resolved. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mother discussed another parent's alleged affair. | Third-party gossip has no bearing on asthma management and should not enter the referral. |
| Childhood ear grommets; no current hearing difficulty. | The resolved ear history does not affect the requested school arrangements. |
| Prefers the earlier bus because friends travel on it. | This transport preference does not explain or resolve the documented PE access problem. |
| Mother complained about the PE teacher's newsletter spelling. | Mentioning the teacher does not make this complaint relevant to clinical coordination. |
| Mother requested permanent sport exemption; GP deferred pending review. | Usually omit or compress this earlier request because the current GP recommendation supplies the operative participation guidance. |
| No previous asthma admissions; no known drug allergies. | Optional background; neither detail resolves the immediate access problem or replaces the current attack instructions. |
A paragraph plan for this case
Open with the referral purpose, supported sport participation and the discreet arrangements needed before the next PE lesson on 5 November. Briefly contrast earlier running-related cough/wheeze and night waking, missed preventer doses, corrected technique, the home-only daily preventer routine and symptom diary with today's improvement and continuing access barrier. Close with direct GP coordination, all three interim attack steps together, reporting recurrent exercise symptoms or increased reliever use, and the 17 November GP review with the diary.
Where candidates slip on this task
- Treat 5 November as the deadline for school arrangements and 17 November as the GP review; neither date authorises a permanent exemption from sport.
- Preserve the case's UK emergency number and exact interim salbutamol sequence, including shaking between puffs, stopping additional puffs when symptoms improve, every ambulance trigger and the repeat-treatment step; do not substitute a different protocol.
- Use Nathaniel's stated embarrassment to justify discreet support, without inventing refusal or another motive; distinguish symptom improvement from unrestricted participation or resolved asthma.
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
- Referral to pulmonary rehabilitation after a COPD admission referral letter
- Referral to a falls prevention program after a fall at home referral letter
- Referral to hospital-in-the-home for intravenous antibiotics referral letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How should the interim attack instructions be handled?
Keep them together: sit upright; salbutamol through a spacer, one puff every 30–60 seconds until symptoms improve, maximum ten. Shake the inhaler between puffs and stop additional puffs when symptoms improve. Call 999 if worsening, unimproved after ten puffs, or an attack without an inhaler. If unimproved after ten minutes awaiting the ambulance, repeat up to ten puffs in the same way. These are the supplied UK case instructions.
Does the earlier request for permanent sport exemption need inclusion?
Usually it can be omitted or briefly compressed. The current decision is GP-supported participation when well, with ready reliever and spacer access. The referral should help the school implement that decision and address Nathaniel's embarrassment, rather than suggest that his mother's earlier request remains the agreed plan.
Sources
Last checked 22 Oct 2026. 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.