Reading test

Deep Vein Thrombosis : Texts

Text A

Descriptors

Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the
body, usually in the legs. It can cause leg pain or swelling, but may occur without any symptoms. Deep vein
thrombosis is a serious condition because blood clots in the veins can break loose, travel through the
bloodstream, and obstruct the lungs, blocking blood flow. Although it usually affects the leg veins, DVT can
occur in the upper extremities, cerebral sinuses, hepatic, and retinal veins.

Common symptoms include pain, especially throbbing cramp like feeling, swelling and tenderness in one of
your legs (usually your calf), a heavy ache in the affected area, warm skin in the area of the clot, red skin,
particularly at the back of your leg below the knee.

Text B

Causes of Deep Vein Thrombosis

Anyone can develop DVT, but it becomes more common in those with age above 40. As well as age, there
are also a number of other risk factors, including:

• having a history of DVT or pulmonary embolism

• having a family history of blood clots

• being inactive for long periods – such as after an operation or during a long journey

• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot

• having certain conditions or treatments that cause your blood to clot more easily than normal –
such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombo-
philia and Hughes syndrome

• being pregnant – your blood also clots more easily during pregnancy

• being overweight or obese

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hor-
mone oestrogen, which causes the blood to clot more easily. If taking either of these, the risk of develop-
ing DVT is slightly increased.
…

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Text C

Nursing Intervention for Deep Vein Thrombosis:

Various nursing intervention for deep-vein thrombosis are in the following:

1. Assess for and reports sign and symptoms of Deep Vein Thrombosis.
2. Keep the affected leg elevated and comfortable position.
3. Keep the head up of bed.
4. Immobilize the patient and initiate bed rest to reduce risk of clot mobilization.
5. Administer anticoagulants as ordered to reduce the risk of additional clotting.
6. Carefully calculate heparin dose.
7. Use infusion pump to administer intravenous heparin.
8. Do not mix the heparinized solution with other medications.
9. Discourage positions that compromise blood flow.
10. Administer analgesics (Morphine) as ordered to manage pain.
11. Apply warm compress to affected leg using a 2-hour-on, 2-hour-off schedule around the clock.
12. Provide elastic compression stocking as it not only increase blood flow, but also reduce swelling and
pain.
13. Administer oxygen as ordered in order to maintain tissue perfusion.
14. Check and monitor any sign of bleeding.
15. Check any sign of complication (Pulmonary embolism).
16. Obtain lab orders to monitor APTT, PT and INR.
17. Ensure intake of vitamin-k rich food including green, leafy vegetable.
18. Instruct patient to keep nasal mucosa hydrate and moist.
19. Ensure a minimum intravenous fluid intake of 2500ml per day for proper hydration unless contraindi-
cated to prevent increase blood viscosity.
20. Provide adequate knowledge to patient pertaining to warfarin therapy.
21. Check any sign of excessive bleeding complication of warfarin therapy.
22. Be aware of the signs of excessive bleeding, such as frequent and bilateral epitasis, hematuria (blood
in the urine) and deep tissue bruising (purpura).
23. Advise the patient to take care when brushing teeth in order to reduce risk of bleeding gums.

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 Text D

Pharmacological Therapy
AMost DVT medications are anticoagulant drugs. Anticoagulants interfere with some part of the body’s
process that causes blood clots to form. This process is called the clotting cascade.

Newer anticoagulants

Drug name Brand name Oral pill or injectable solution

Apixaban Eliquis Oral

Dabigatran Pradaxa Oral

Dalteparin Fragmin Injectable

Edoxaban Savaysa Oral

Enoxaparin Lovenox Injectable

Fondaparinux Arixtra Injectable

Rivaroxaban Xarelto Oral

Two older anticoagulants used to help prevent and treat DVT are heparin and warfarin. If a patient takes
either of these drugs, the healthcare provider will need to monitor the patient often.

END OF PART A

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 Part A
Time: 15 minutes
Look at the four texts, A-D, in the separate Text Booklet.
For each question, 1-20, look through the texts, A-D, to find the relevant information.
Write your answers on the spaces provided in this Question Paper.
Answer all the questions within the 15-minute time limit. Your answers should be correctly spelt.

Deep Vein Thrombosis : Questions

Questions 1-7

For each of the questions 1-7, decide which text (A,B, C or D) the information comes from. You may use any
letter more than once.

In which text can you find information about

1. Warning signs of deep vein thrombosis
2. Hormone that increases the risk of DVT
3. Definition for clotting cascade
4. What does it feel when there is a blood clot
5. Care for DVT patients
6. Common drug regimen
7. Factors that increase the danger of DVT

Questions 8-14

Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
8. What is the drug used for pain management?

9. What is the complication of warfarin therapy?

10. Which age group is at the risk of developing DVT more?

11. What does the DVT pain feel like?

12. Where does thrombus most commonly form?

13. Which category does heparin and warfarin belong to?

14. Which type of drugs are used to treat deep vein thrombosis?

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Questions 15-20

Complete each of the sentences, 15-20, with a word or a short phrase from one of the texts. Each answer may
include words, numbers or both.

15. Improving the flow of blodd and decreasing swelling and pain is the advantage of
.

16. The complication of DVT is

17. Blood clot obstructs the lungs and thereby block the .

18. The female hormone present in contraceptive pill and HRT is .

19. Injectable solution of dalteparin is available by the name .

20. Deep tissue bruising is termed as .

END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED

 Part B
In this part of the test, there are four short extracts relating to the work of health professionals. For questions
1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. What is the primary purpose of obtaining a patient’s consent for the review?

A to give patients the liberty to participate or withdraw from the service

B to enable the accredited pharmacist to access relevant information
C to ensure that the information is safeguarded with security measures

Patient’s rights, confidentiality and consent

It is the consumer’s decision to participate in the Home Medicines Review (HMR) process and they may
elect to withdraw from the service at any time. Consent of the consumer is obtained by the GP when
initiating the HMR referral. The consent allows consumer information to be given to the accredited pharma-
cist conducting the HMR. All information gathered throughout the HMR service should be respected and
safeguarded acknowledging the consumer’s right to privacy and confidentiality. This includes all informa-
tion acquired in the course of providing the HMR service, exchanged with other health professionals,
discussed on the phone or in the pharmacy or stored as a result of the review. Confidentiality needs to be
maintained through the development of secure files (either electronic or in a secure filing cabinet). This
includes ensuring that any consumer information that is transmitted electronically uses encrypted or
secure electronic messaging to enhance security. At no time should consumer information be shared with
unauthorised people, relatives or other health care providers without the consent of the consumer or their
representative. Consumer consent needs to be obtained for medication reviews to be conducted and the
associated sharing of necessary information between health care providers. The HMR service provider
should confirm that appropriate consent has been obtained from the consumer before the HMR service is
commenced.
2. What does the guideline try to regulate

A the number of hours of work permissible

B uneven working hours for different professions
C intensity of the work done in stipulated time

Working time regulations

As a general guide, these regulations state that workers cannot be forced to work for more than 48 hours
on average, and limits young workers’ hours to 8 hours a day or 40 hours a week. From 1 August 2018,
junior doctors’ hours will also be restricted. The number of hours should be averaged out over a 17-week-
period. Besides working time limits, the regulations cover working at night, health assessments for night
workers, time off, rest breaks at work and paid annual leave. There are provisions for workers to come to an
‘opt-out’ agreement with their employers for defined periods, should the nature of the work make this
necessary. These guidelines are governed by the Department of Trade and Industry and also the National
Health Service.
3. The note emphasises the significance of the difference by

A indicating the contrasting purposes

B highlighting the informational value
C exhibiting the distinction in outcome

Aggregated versus disaggregated data

To ensure that services reach people in need and that no one is left behind, strategic information needs to
be usable in a way that helps the people, places and situations where interventions are needed. As building
blocks of strategic information, data can be combined or separated for different uses. Aggregated data are
combined from many sources (for example, client records, registers and surveys) and summarized for a
specific purpose, such as reporting or statistical analysis. When aggregated data are separated again
according to a specific variable they become disaggregated. Disaggregated data can inform decision-
making and planning so that interventions more effectively reach targeted groups.
4. The standard procedure for health surveillance must include

A tests that require biological monitoring

B formulation of tests for close scrutiny
C constant testing to check for irregularities

Health Surveillance
As part of the monitoring system, health surveillance should be undertaken if appropriate. The health of
employees exposed to hazardous substances can be affected through absorption into the body. The
absorption route can be inhalation, by ingestion, through the skin or a combination of these. When inside
the body the substances are metabolised. Metabolites can target various organs of the body which can
thereby be harmed. Health surveillance therefore requires biological monitoring. At its simplest this could
be a skin inspection ensuring no dermatitic changes have occurred as a result of exposure to an irritant,
through to lung function tests and urine, breath or blood analysis. The criteria used to decide which type of
surveillance is appropriate depend on whether a test is available. Tributyl tin oxide was once used as a
timber preservation treatment; however, it was not known how it was metabolized in the body and therefore
no appropriate test existed. The potential for it to cause harm could not be eradicated and, as many
occupational diseases have a long latency period - up to 40 years for asbestosis, for example - tributyl tin
oxide was withdrawn from use.
5. Needle stick injuries must be handled by

A following the laid out steps for complete care

B primarily completing any critical procedures
C exercising caution and refraining from routine

What to do if there is a needle-stick (sharps) injury

Despite best efforts, needle-stick (sharps) injuries do occur. The injured health care worker must balance
his/ her risks with the safety of the client. The following guidelines can help health care workers address
needlestick (sharps) injuries: As soon as it is safe to do so (with regard to client safety), the health care
worker with the needle-stick (sharps) injury should stop what he/she is doing, remove gloves, and wash
both hands and the area of the needle-stick (sharps) injury with soap and plenty of water. No antiseptics or
scrubbing brushes should be used. If the provider is in the middle of a procedure, then another qualified
provider should take over and complete the procedure. If no other qualified provider is present, then the
injured provider should ensure that any critical step is complete, wash both hands and the area of the
needle-stick injury, change gloves, and then complete the procedure. Should inform senior staff or manag-
ers at the clinic and follow clinic protocols for managing the needle-stick (sharps) injury.
6. What does the circular convey?

A information on managing blood borne pathogens

B the policy implementation required for personnel
C preventative measures to reduce pathogenic risk

Managing Occupational Exposure To Blood Borne Pathogens,

Hepatitis And Hiv Through Post-Exposure Prophylaxis

Health care workers are at increased risk of accidental exposure to bloodborne pathogens—such as
hepatitis B and C viruses and HIV. A minimum approach to health and safety practices for health care
providers and waste workers includes the following:
• implementation of standardized management approaches
• compulsory vaccination for the hepatitis B virus for all health care workers, including cleaners and staff
who handle medical waste
• provision of sharps disposal boxes for safe disposal of used needles, syringes and other sharps •
compliance with hand hygiene standards
• availability of appropriate personal protective equipment—mask, face shield or goggles, rubber apron and
utility gloves (at the bare minimum, every health care worker handling waste should have a face shield and
utility gloves)
• appointment of a clinic staff member or designated staff to additional or dedicated responsibility for
infection control, including waste management
Immediately after any needle-stick (sharps) injury, the person injured should—as soon as it is safe to do
so—hand over his/her duties to another provider and wash the area with plenty of soap and water. Antisep-
tics or caustic agents, such as bleach, should not be used. Flush any exposed mucous membranes with
plenty of water. The clinic should have a system to quickly report any needle-stick (sharps) injuries to the
nearest health facility that provides post-exposure prophylaxis services so that this can be given to the
injured health care worker according to the national guidelines.
 Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
answer (A, B, C or D) which you think fits best according to the text..

Text 1: Non-invasive prenatal testing: the new era in reproductive medicine

In some countries, it is routine practice to offer pregnant women screening for foetal chromosomal and
structural abnormalities, and, if serious anomalies are diagnosed, the option of terminating the pregnancy.
Screening for chromosomal abnormalities commenced in the 1960s and was initially restricted to women
whose pregnancies were considered to be of increased risk because of an obstetric history of aneuploidy or
advanced maternal age. Over the past five decades, prenatal chromosome screening (PCS) has been expanded
to encompass the entire obstetric population. However, the commonly used aneuploidy screening tests are
plagued by high false-positive rates, typically 4%–5%. Confirmation of an increased screening risk for aneuploidy
involves diagnostic tests such as amniocentesis or chorionic villus sampling, each associated with low but
definite risks of pregnancy loss.

Many women are reluctant to proceed with a diagnostic test after a positive aneuploidy screening result, and
the ability to assess foetal genetic material without directly sampling the amniotic fluid or placenta has long
been a goal of prenatal diagnosis. The recent development of non-invasive prenatal testing (NIPT), a high-level
screening test using cell-free foetal DNA, offers the opportunity to markedly reduce the requirement for invasive
testing while potentially also increasing detection rates of chromosomal anomalies, in particular of trisomy
21. In addition, NIPT may be offered earlier in pregnancy than standard aneuploidy screening and diagnostic
techniques.

Although initially used in pregnancies at high risk for aneuploidy, recent data indicate that NIPT is also a
robust screening test in lower-risk pregnancies. NIPT is now the most sensitive and specific screening test for
the common trisomies, with detection rates greater than 99% for trisomy 21 and false-positive rates of less
than 0.5%. The performance characteristics for trisomies 13 and 18 and the sex chromosome anomalies are
lower than for trisomy 21, although the sensitivity is still typically greater than 90%.

NIPT is not without its limitations. Failure to obtain a result occurs in routine clinical practice in about 3%–4%
of tests, usually due to a low cell-free foetal DNA fraction, which is detectable in the maternal bloodstream,
typically because the sample was collected too early in the pregnancy or because of maternal obesity. False-
positive results have been associated with confined placental mosaicism, the death of a co-twin, maternal
malignancy and maternal mosaicism. Detection rates appear to be lower and the chances of not obtaining a
result are higher in twin than in singleton pregnancies.

Ethical questions, ever present and never fully resolved when discussing prenatal testing, will come more
sharply into focus with the broader introduction of NIPT into obstetric practice. A woman and her partner have
two options after trisomy 21 has been diagnosed: continuation or termination of the pregnancy. The option of
termination is widely regarded in our society as part of the couple's reproductive health rights. If the diagnosis
is made earlier, and termination methods that are less stressful and safer for the woman and more acceptable
to medical staff are available, there could be greater pressure to undergo testing (and termination, when
abnormalities are detected) than is currently the case.
What message does this then send to people with trisomy 21 in our community and their families? The same
arguments would apply to other non-lethal chromosomal anomalies, such as Turner syndrome. Of even
greater consequence would be the ability to discover the sex of the foetus at an early stage. Sex-based
termination, widespread in some parts of Asia, is believed to be uncommon in developed countries, but this
situation could change were the sex known much earlier in pregnancy. The wider introduction of NIPT must be
accompanied by appropriate increases in the provision of genetic counselling services for women and of
education for health care providers.
Text 1: Questions 7 - 14

7. Paragraph one indicates that termination of pregnancy is

A commonly practised in some countries

B a possibility in some countries
C routine practice in most countries
D often carried out for serious anomalies

8. Prenatal chromosome screening has

A confirmed an increase in screening risk

B resulted in significant loss of fetal life
C been observed to be used in all pregnancies
D commonly shown an increased sign of abortion

9. Paragraph two concludes that NIPT may

A slightly lessen the requirement for invasive testing

B marginally increase requirement for invasive testing
C dramatically decrease the need for invasive testing
D significantly increase the need for invasive testing

10. Paragraph three suggests that for lower-risk aneuploidy detection

A NIPT is proving reliable for finding strong and durable lower-risk rates
B NIPT is considered to be a strong and reliable screening process
C NIPT is considered a significantly reliable robotic testing format
D NIPT mainly finds aneuploidy in lower-risk screening processes
11. In paragraph four, it is assumed that carrying twins

A may lead to false-positive results, as can maternal mosaicism

B is included in the list of concerns involving false-positive readings
C gives a substantial drop in NIPT data of singleton pregnancies
D proves a greater risk in acquiring unreliable detection rates from NIPT

12. The phrase ‘will come more sharply into focus,’ in paragraph 5 means ethical questions

A will be visually clear and free from debate for all people.
B will become a topic of greater discussion and debate among people.
C will become a topic of much hostile criticism among the community.
D will rise quickly into focus and force complacency among the community

13. Which of the following best describes the author’s use of the term non-lethal in paragraph six?

A unimpressive
B dangerous
C unintentional
D nonnoxious

14. The final paragraph professes

A NIPT will cause sex-based termination to increase in developed countries.

B Counselling and education must be given prior to introducing NIPT.
C Sex-based termination is an obsolete problem throughout Asia.
D Education and counselling services should coincide with introducing NIPT
Text 2: Caring means Curing

In the paediatric intensive care unit at the University of California San Francisco (UCSF) Medical centre, four
nurses are clustered around the bed of an unconscious 7-year-old Cambodian boy who was hit by a truck
several days earlier. A plastic respirator tube snakes out of his mouth, and other tubes and wires connect him
to IV drips, evacuation bags, and a series of monitors that provide second-by-second displays of his heart and
respiratory rhythms. His right leg, bent at the knee, is held up in traction. His face is so swollen that visitors
find it too grueling to stare for too long. He is sedated to shield him from what would be excruciating agony and
to stave off any further threat of injury.

Janet Craig, a nurse educator based in the paediatric intensive care unit is comforting the boy’s family as they
keep an anxious bedside vigil. As they talk, a sudden commotion diverts Craig’s attention. She rushes
towards the room of another patient, hastily explaining that this 17-year-old girl has been a frequent visitor to
the ICU. She was born with a congenital heart defect that has required a number of surgeries, and recently
she may have suffered a heart attack. Five days earlier surgeons had implanted a permanent pacemaker, but
also decided that a heart transplant would be necessary if she were to survive over the long term.

In such an hour of intense activity, and in the time she spends each day attending to complex cases such as
those in the ICU, Janet Craig, an intensive care nurse for over 14 years, tries her utmost to embody the very
heart of the nursing profession – that unique relationship between caring and curing. In hospitals and communities
throughout the world, nursing staff are treating not only the patient’s complex physical needs but their interlinked
emotional needs as well. While doctors focus on limb, heart, or lung, nurses carry out the medical regimens
that physicians prescribe, as well as monitoring intricate human needs.

Nurses take care of patients 24 hours a day, 7 days a week. If a patient with a broken leg complains of chest
pain, it is the nurse’s duty to inform the physician of a suspected pulmonary embolism. If a patient with
metastatic breast cancer comes in for chemotherapy and complains of dizziness, shivering, and simply not
feeling like herself, the nurse will alert the oncologist to the possibility that the cancer may have travelled to
the brain. In addition to following the physicians’ treatment plan, nurses establish treatment plans of their
own. They assess patients’ basic needs and do for them what they cannot do alone; they help educate
people about how to cope with a disease or the aftermath of surgery; they become deeply involved – as
patient advocates – in helping patients and families make informed decisions about major surgery and
termination of life-support systems. All of these responsibilities should make nurses major participants in the
evolving debate about national health care. Yet to most of the public and policy-makers, they remain almost
invisible.

Real health care involves far more than paying physicians to intervene when disease is well established or
financing dazzling research into potential ‘cures.’ It involves education in disease prevention and health
maintenance from childhood through old age, as well as providing skilled nursing care in hospitals when
patients are acutely ill. A truly humane system would not push futile treatment on patients with terminal
diseases, but would permit them to die in comfort and with dignity. A genuinely economical health-care
system would finance a cohesive network of long-term care to be provided outside of big hospitals in the home
and the community.
To create a new health-care system, nurses need to be far more assertive in promoting their profession and its
achievements. They also need advocates and allies – among patients, families, politicians and businessmen
– who understand that high-quality health care is dependent not only on technology, surgery and the promise
of cure but also on the efforts of those nurses providing the care necessary for cure to be possible at all.
Text 2: Questions 15 - 22

15. In paragraph one, what is meant by the use of the word ‘clustered’?

A Anxious
B Silent
C Motionless
D Gathered

16. the use of sedatives as mentioned in paragraph one are

A given needlessly for the particular situation

B to immobilise him and numb the pain
C to prevent the respiratory tube from moving
D not needed as he is unconscious

17. The objective of nurse educator is to

A keep a bedside vigil with the patient’s relatives

B maintain a level of support befitting the situation
C take charge of the emergency situation taking place
D remedy the immediate danger to the 17-year-old-girl

18. In paragraph three, the author’s view is that

A doctors should solely treat the physical needs of the patient

B nurses only focus on the emotional and human needs of patients.
C nurses undergo a grueling regimen of physical prescriptions.
D doctors tend to deal with the physical aspects of the patient.
19. According to paragraph four, current debates on health care have

A completely excluded nurses and their insight into the health industry.
B left policy-makers and the public no alternative but to exclude nurse
C evolved without proper input from nurses
D remained nearly invisible to policy-makers and the public

20. As per paragraph five, complete healthcare involves

A disease prevention and humane system

B providing funds for probable cure
C permitting people to die with dignity
D health education and skilled care

21. The opinion put forth by the final paragraph is that

A Confident nurses are unnecessary for a positive view of their profession.

B Nurses need politicians support for new technological advancements.
C The promise of cure does not guarantee successful surgeries.
D Nursing as a whole is as imperative as other dependent factors.

22. Which word can be best described for the term “futile” in paragraph five?

A expensive
B flashy
C needless
D unprofitable

END OF READING TEST

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