OET Writing practice · Nursing
Febrile neutropenia during chemotherapy – oncology nurse specialist
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral letter in 40 minutes, about 180–200 words in the body.
Write this letter and get feedback
Case notes
NURSING — WRITING TASK (practice)
Time allowed: Reading time 5 minutes, Writing time 40 minutes
Read the case notes below and complete the writing task which follows.
Notes:
Today's date: 13/09/2026
Patient: Mrs Mariam Haddad, DOB 12/10/1974 (51 yrs)
Medical Ward 9, Kingsmere General Hospital, Kingsmere
Admission date: 08/09/2026 Discharge date: 13/09/2026
Social background:
- Secondary school maths teacher, on sick leave since June 2026
- Married (Karim, taxi driver, works evenings). 3 children (16, 14, 9); youngest frequently has colds from school
- Lives approx. 40 min from Kingsmere Cancer Centre; does not drive
- Non-smoker, no alcohol
- Volunteers at community food bank (paused since diagnosis)
Medical history:
- L breast invasive ductal carcinoma, dx 05/2026. Wide local excision + sentinel node biopsy 06/2026
- Adjuvant chemotherapy: docetaxel + cyclophosphamide, 3-weekly × 4 cycles. Cycle 1 11/08, cycle 2 01/09 (outpatient)
- Hypothyroidism, levothyroxine 100 mcg daily
- 3 × caesarean sections
- Allergy: penicillin (rash)
Nursing management and progress:
06/09 At home: shivery, temp 38.4°C. Took paracetamol, waited 2 days ("thought it was a cold from my daughter", "didn't want to bother anyone")
08/09 ED: T 38.9°C, HR 118, BP 96/60. Neutrophils 0.3 × 10⁹/L → febrile neutropenia. Sepsis pathway: blood cultures, IV meropenem (penicillin allergy), IV fluids. Protective isolation
09/09 Blood cultures: no growth. Mouth ulcers (grade 2 mucositis) → mouthwash, soft diet. Oral intake poor
10/09 Afebrile 24 hrs. Neutrophils 0.9
11/09 Neutrophils 1.8. Changed to oral ciprofloxacin 500 mg BD until 15/09
12/09 Tearful: fearful about next cycle and children bringing infections home; unsure when to call hotline. Does not own thermometer. Asked about wig options
13/09 Neutrophils 3.2. Mucositis improving. Wt 68 kg (pre-chemotherapy 72 kg). BP 118/74
Discharge plan:
- Complete ciprofloxacin until 15/09
- Continue levothyroxine; salt-water mouthwash QID
- Oncologist informed: cycle 3 due 22/09; dose reduction and G-CSF prophylaxis to be considered at pre-chemotherapy review 21/09
- Digital thermometer and 24-hr oncology hotline card given
- Advised to call hotline immediately if temp ≥38°C, shivering or feeling unwell, even after paracetamol
- Referral to breast oncology CNS: reinforce neutropenic sepsis education, emotional support, assess transport needs (and support if G-CSF injections needed at home)
Writing Task:
Using the information in the case notes, write a letter to Ms Tamsin Kerr, Breast Oncology Clinical Nurse Specialist, Kingsmere Cancer Centre, 5 Beacon Street, Kingsmere, referring Mrs Haddad for education and support before her next cycle.
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.
How to approach this referral letter
- The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
- Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
- End with what you are asking the reader to do, and any action you have already taken.
Members also get the model answer, the note-selection table and task-specific tips for this task.