TEST- 4 i.

Sedentary lifestyle (contributes to obesity and reduced HDL)

ANGINA PECTORIS j. Type 2 diabetes

k. Stress; an innate, competitive, aggressive type A personality seems less

Text A
important than amount of stress and client’s psychologic response)
Cardiovascular disease is the leading cause of death in the United States for men
l. Metabolic syndrome: cluster of signs including hyperlipidemia, low HDL level,
and women of all racial and ethnic groups.
abdominal obesity, increased BP, insulin resistance, increased levels of C-reactive
Angina pectoris is a clinical syndrome usually characterized by episodes or protein, and increased fibrinogen level
paroxysms of pain or pressure in the anterior chest. The cause is insufficient
coronary blood flow, resulting in a decreased oxygen supply when there is
increased myocardial demand for oxygen in response to physical exertion or Text C
emotional stress.

Text B
Risk factors

a. Family history

b. Increasing age, particularly women

c. Gender: men; women, especially after menopause (estrogen seems to

providesome protection)

d. Race; risk appears higher in African-Americans

e. Cigarette smoking contributes to vasoconstriction, platelet activation,

arterialsmooth muscle cell proliferation, and reduced oxygen availability

f. Hypertension; widened QRS complex (bundle branch block)

g. Hyperlipidemia: increased total cholesterol; increased LDL (high: 130 to150

mg/dL; very high: 160 mg/dL or more); increased ratio of total cholesterol orLDL
to HDL; low HDL (less than 40 mg/dL); HDL greater than 60 mg/dL seems tohelp
protect against coronary artery disease (CAD); increased triglycerides (high:200 to
499 mg/dL; very high: 500 mg/dL or more)

h. Obesity (particularly abdominal obesity)

 PART A
TIME: 15 minutes
Text D  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
Management of acute MI
information.
A. Improvement of perfusion  Write your answers on the spaces provided in this Question Paper.
 Answer all the questions within the 15-minute time limit.
(1) Administration of aspirin immediately
ANGINA PECTORIS
(2) Beta blockers or angiotensin II receptor blockers for left ventricular systolic
dysfunction (LVSD) 1. How to assess chest pain? ............................................................................
2. The major cause of angina pectoris ..............................................................
(3) Thrombolytic therapy within 30 minutes of arrival; anticoagulants 3. Metabolic syndrome may also contribute to angina …………….…………..
4. It is required to take ECG for patients with chest pain
(4) IV nitroglycerin
………………….……….
(5) ACEIs 5. How acute MI can be managed? ………………………………...
6. Importance of pain medications in management of chest pain
(6) Antidysrhythmics to maintain cardiac function
…………………..
(7) PCI within 90 minutes of arrival at emergency department 7. Greater levels of high density lipoprotein in the body protects from cardiac
illness. …………………………………………
(8) Intraaortic balloon pump that inflates during diastole and deflates during
systole to decrease cardiac workload by decreasing after load and increasing Questions 8-14
myocardial perfusion for cardiogenic shock
Answer each of the questions, 8-4, with a word or short phrase from one of the
(9) Aspirin, beta blocker, and possible antilipidemic prescribed at discharge texts. Each answer may include words, number of the both. Your answers should
be correctly spelled.
B. Promotion of comfort and rest
8. What is the main symptom of angina pectoris?
(1) Analgesics (e.g., IV morphine) to reduce pain, anxiety, and cardiac Work load
……………………………………………….
by decreasing preload and after load 9. What contributes to obesity and reduced HDL?
…………………………………………………..
(2) Oxygen to improve tissue oxygenation
10. Which is the leading cause of death in the US for both the genders?
(3) Maintenance of bed or chair rest to decrease oxygen tissue demands ………………………………………………………………………..
11. What should be administered within half an hour of arrival of client with
(4) Diet therapy: 2g sodium diet or clear liquids, depending on presence of nausea angina?
……………………………………………
 12. What should be avoided if the client exhibits chest pain which is angina
unlikely?
…………………………………………………..
13. What is recommended in order to reduce oxygen tissue demands?
…………………………………………………..
14. What is the next step involved in the angina assessment protocol, if the
client’s resting ECG is normal?
……………………………………………….
Questions 15-20
Complete each of the sentences, 15- 20, with a word or short phrase from one of
the texts. Each answer may include words, number or both. Your answers should
be correctly spelled
15. ……………… should be administered within one and half hour of arrival.
16. Beta blockers or angiotensin II receptor blockers to be administered for
……………..
17. The risk of angina appears higher in……………..
18. ………… is used to reduce cardiac workload which works by decreasing
after load and increasing myocardial perfusion.
19. ……………contributes to vasoconstriction and platelet activation
20. …………… sodium diet or clear liquids are recommended depending on
presence of nausea
Part B
In this part of the test, there are six short extracts relating to the work of health
professionals. For questions 1-6, choose answer (A, B, or C) which you think fits
best according to the text.
1) Living will-2
1. According to the paragraph, a living will covers certain situation, except,
a) during the need of resuscitation, ventilation and dialysis
b) to receive only pain medication
c) when there is no life threatening injury is present
1. A living will addresses many of the medical procedures common in life-
threatening situations, such as resuscitation via electric shock, ventilation and
dialysis. One can choose to allow some of these procedures or none of them. One
can also indicate whether he or she wishes to donate his or her organs and tissues
after death. Even if he or she refuses life-sustaining care, he or she can express the
desire to receive pain medication throughout his or her final hours.
In most states, one can extend his or her living will to cover situations where he or
she has no brain activity or where doctors expect him or her to remain unconscious
for the rest of his or her life, even if a terminal illness or life-threatening injury
isn’t present. Because these situations can occur to any person at any age, it’s a
good idea for all adults to have a living will.
 2. The passage says regarding suprapubic catheter that
a) It is better than indwelling catheters
b) It is preferred for short-term urinary drainage
c) It may cause damage to the urethra, if it is not secured with sutures or
tape
2. Suprapubic catheter
A suprapubic catheter may be used for long-term continuous urinary drainage. This
type of catheter is surgically inserted through a small incision above the pubic area.
Suprapubic bladder drainage diverts urine from the urethra when injury, stricture,
prostatic obstruction, or gynecologic or abdominal surgery has compromised the
flow of urine through the urethra. A suprapubic catheter is often preferred over
indwelling urethral catheters for long-term urinary drainage. Suprapubic catheters
are associated with decreased risk of contamination with organisms from fecal
material, elimination of damage to the urethra, a higher rate of patient satisfaction,
and lower risk of catheter-associated urinary tract infections. The drainage tube is
secured with sutures or tape. Care of the patient with a suprapubic catheter
includes skin care around the insertion site; care of the drainage tubing and
drainage bag is the same as for an indwelling catheter.
3. Evaluation of breast cancer by using PET/CT scan
a) provides accurate results than the PET scan alone
b) to be compared with PET or CT scan alone
c) has been receiving no attention because it’s results to be compared with
the PET or CT scan alone.
3.The Role of PET/CT for Evaluating Breast Cancer
Positron emission tomography combined with computed tomography (PET/CT)
has been receiving increasing attention during the recent years for making the
diagnosis, for determining the staging and for the follow-up of various
malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34 79
years old, mean age: 50 years) were retrospectively compared with the PET or CT
scans alone. PET/CT was found to be better than PET or CT alone for detecting
small tumors or multiple metastases, for accurately localizing lymph node
metastasis and for monitoring the response to chemotherapy in breast cancer
patients.
 4. The purpose of the guidelines is;
a) To conduct competitions in environmental health, between the health
care providers regarding management of pediatric asthma
b) Merge environmental management of asthma with child health care
c) To provide environmental instructions to the patients
4. Extract from “Environmental Management of Pediatric Asthma: Guidelines for
Health Care Providers”
These guidelines are aimed at integrating environmental management of asthma
into pediatric health care. These documents outline competencies in environmental
health relevant to pediatric asthma that should be mastered by health care
providers, and outlines the environmental interventions that should be
communicated to patients. The guidelines contain three components: Competencies
(Competencias en Espanol): An outline of the knowledge and skills that health care
providers and health professional students should master and demonstrate in order
to incorporate management of environmental asthma triggers into pediatric
practice. Environmental History Form: A quick, user-friendly document that can
be used as an intake tool to help determine pediated patients' environmental asthma
triggers. Environmental Intervention Guidelines: Follow-up questions and
intervention solutions to environmental asthma triggers.
5. While dispensing dangerous drugs
a) RN must document the preparation and performance time
b) RN must follow the written drug dispersing procedure as well as nurse
protocol
c) Pharmacist and physician may need to sign the procedure
5. Subject: DISPENSING DANGEROUS DRUGS
RNs are authorized to dispense dangerous drugs only under the following
conditions: The dispensing is in accordance with a written drug dispensing
procedure and under the authority of an order issued in conformity with a nurse
protocol. There must be documented preparation and performance (i.e., ability to
perform) specific to dispensing dangerous drugs based on a written dispensing
procedure. Documentation should include that each RN has read and understands
the drug dispensing procedure. A copy of the drug dispensing procedure must be
accessible in each of the specific settings where RNs dispense under nurse
protocols and be available upon request. The procedure must be signed by the
pharmacist and physician who have established it.
 6. A metabotropic receptors
a) form an ion channel pore
b) are coupled with G-proteins
c) are directly linked with ion channels on the plasma membrane
6.A metabotropic receptor
A metabotropic receptor is a type of membrane receptor of eukaryotic cells that
acts through a second messenger. It may be located at the surface of the cell or in
vesicles. Based on their structural and functional characteristics, the
neurotransmitter receptor can be classified into two broad categories: metabotropic
and ionotropic receptors. Ionotropic receptors form an ion channel pore. In
contrast, metabotropic receptors are indirectly linked with ion channels on the
plasma membrane of the cell through signal transduction mechanisms, often G
proteins. Hence, G protein-coupled receptors are inherently metabotropic. Other
examples of metabotropic receptors include tyrosine kinases and
guanylylcyclasereceptors. Both receptor types are activated by specific
neurotransmitters. When an ionotropic receptor is activated, it opens a channel that
allows ions such as Na+, K+, or Cl− to flow. In contrast, when a metabotropic
receptor is activated, a series of intracellular events are triggered that can also
result in ion channels opening or other intracellular events, but involve a range of
second messenger chemicals
Part C
In this part of the test, there are two tests about different aspects of health care. For
questions 7 – 22, choose the answer (A, B, C , or D) which you think fits best
according to the text
Text 1: Ebola Virus and Marburg Virus
The Ebola virus and Marburg virus are related viruses that cause hemorrhagic
fevers — illnesses marked by severe bleeding (hemorrhage), organ failure and, in
many cases, death. Both the Ebola virus and Marburg virus are native to Africa,
where sporadic outbreaks have occurred for decades.
The Ebola virus and Marburg virus both live in animal hosts, and humans can
contract the viruses from infected animals. After the initial transmission, the
viruses can spread from person to person through contact with bodily fluids or
contaminated needles.
No drug has been approved to treat the Ebola virus or Marburg virus. People
diagnosed with the Ebola or Marburg virus receive supportive care and treatment
for complications. Scientists are coming closer to developing vaccines for these
deadly diseases.
In both the Ebola virus and Marburg virus, signs and symptoms typically begin
abruptly within the first five to 10 days of infection. Early signs and symptoms
include: fever, severe headaches, joint and muscle aches, chills, sore throat and
weakness. Over time, symptoms become increasingly severe and may include:
nausea and vomiting, diarrhea (may be bloody), red eyes, raised rash, chest pain
and coughing, stomach pain, severe weight loss, bleeding from the nose, mouth,
rectum, eyes and ears.
Ebola virus has been found in African monkeys, chimps and other nonhuman
primates. A milder strain of Ebola has been discovered in monkeys and pigs in the
Philippines. The Marburg virus has been found in monkeys, chimps and fruit bats
in Africa.
The virus can be transmitted to humans by exposure to an infected animal's bodily
fluids, including blood. Butchering or eating infected animals can spread the
viruses; scientists who have operated on infected animals as part of their research In particular, caregivers should avoid contact with the person's body fluids and
have also contracted the virus. tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or
Marburg are most contagious in the later stages of the disease.
Infected people typically don't become contagious until they develop symptoms.
Family members are often infected as they care for sick relatives or prepare the If you're a health care worker, wear protective clothing — such as gloves, masks,
dead for burial. Medical personnel can be infected if they don't use protective gear gowns and eye shields. Keep infected people isolated from others. Carefully
such as surgical masks and latex gloves. Medical centers in Africa are often so disinfect and dispose of needles and other instruments. Injection needles and
poor that they must reuse needles and syringes and some of the worst Ebola syringes should not be reused.
epidemics have occurred because contaminated injection equipment wasn't
Scientists are working on a variety of vaccines that would protect people from
sterilized between uses. There's no evidence that the Ebola virus or Marburg virus
Ebola or Marburg viruses. Some of the results have been promising, but further
can be spread via insect bites.
testing is needed.
Ebola and Marburg hemorrhagic fevers are difficult to diagnose because many of
Text 1: Questions 7-14
the early signs and symptoms resemble those of other infectious diseases, such as
typhoid and malaria. But if doctors suspect that you have been exposed to the 7. The Ebola and Marburg Viruses are native to
Ebola virus or Marburg virus, they use laboratory tests that can identify the viruses A. America
within a few days. B. Japan
C .Africa
Most people with Ebola or Marburg hemorrhagic fever have high concentrations of D. China
the virus in their blood. Blood tests known as enzyme-linked immunosorbent assay
’(ELISA)’ and reverse transcriptase polymerase chain reaction ‘(PCR)’ can detect 8. According to the passage(s), the Ebola and Marburg viruses
A. spread from person to person only
specific genes or the virus or antibodies to them.
B. spread from animals to humans
No antiviral medications have proved effective in treating Ebola virus or Marburg C. spread from animals to animals
virus infection. As a result, treatment consists of supportive hospital care. This D. spread person to person after initial transmission from the infected animals
includes providing fluids, maintaining adequate blood pressure, replacing blood
9. One of these statements is true, according to the information given in the
loss and treating any other infections that develop. passage(s)
A. scientists have developed vaccines for the treatment of Ebola and Marburg
As with other infectious diseases, one of the most important preventive measures
diseases
for Ebola virus and Marburg virus is frequent hand-washing. Use soap and water, B. scientists are closer to developing an effective vaccine for the treatment
or use alcohol-based hand rubs containing at least 60 percent alcohol when soap C. it is not possible to fight the diseases caused by Ebola and Marburg
and water aren't available. In developing countries, wild animals, including D. scientists have discovered the causes of the transmission of the viruses from
nonhuman primates, are sold in local markets. Avoid buying or eating any of these animal to human
animals.
10. Symptoms are typically seen within
A. five days
B. ten days
C. five to seven days
D. five to ten days
11. In the Philippines, Ebola was discovered in
A. chimpanzees
B. human primates
C. non-human primates
D. monkeys
12. Most known Ebola diseases occur due to
A. contamination
B. bodily fluids
C. contaminated needles and syringes
D. none
13. People with hemorrhagic fever show
A. high number of viruses in their blood
B. low concentrations of virus
C. high concentrations of antibodies
D. low concentrations of antibodies
10. As a health care worker, you
A. should keep infected people totally isolated from others
B. should not reuse needles and syringes for the second time
C. should wear clothing such as gowns and eye shields
D. none of the above
Text 2: A Chronic Disease - Atopic Dermatitis
Atopic dermatitis is a common chronic skin disease. It is also called atopic eczema.
‘Atopic’ is a term used to describe allergic conditions such as asthma and hay
fever. Both dermatitis and eczema mean inflammation of the skin. People with
atopic dermatitis tend to have dry, itchy and easily irritated skin. They may have
times when their skin is clear and other times when they have rash.
In infants and small children, the rash is often present on the skin around the knees
and elbows and the cheeks. In teenagers and adults, the rash is often present in the
creases of the wrists, elbows, knees or ankles, and on the face or neck.
Atopic dermatitis usually begins and ends during childhood, but some people
continue to have the disease into adulthood. If you have ever had atopic dermatitis,
you may have trouble with one or more of these: dry, sensitive skin, hand
dermatitis and skin infections.
The exact cause of atopic dermatitis is unknown. Research suggests that atopic
dermatitis and other atopic diseases are genetically determined; this means that you
are more likely to have atopic dermatitis, food allergies, asthma and/or hay fever if
your parents or other family members have ever had atopic dermatitis. These
diseases may develop one after another over a period of years. This is called the
―atopic march‖.
Recognizing that a person with atopic dermatitis is at a higher risk of developing
one of these diseases is important for parents, patients and health care providers.
Knowing that a child with a slight wheeze has had a history of atopic dermatitis,
for example makes it easier to diagnose the subtle onset of asthma. There are many
things that make the itching and rash of atopic dermatitis worse. When you learn
more about atopic dermatitis and how to avoid things that make it worse, you may
be able to lead a healthier life.
If you have a reaction to something you touch, breathe or eat, you might have an
allergy. Allergies can trigger or worsen your atopic dermatitis symptoms. Common
causes of allergy are: dust mites, furry and feathered animals, cockroaches, pollen,
mold, foods, chemicals.
Your health care provider may recommend allergy testing and food challenges to Text 2: Questions 15 to 22
see if allergies worsen itching or rashes. Allergy testing may include skin testing,
blood tests or patch tests. Many measures can be taken to avoid things to which 15. People with atopic dermatitis suffer from
A. hay fever
you are allergic. Although many of the measures can be done for the entire home,
B. asthma
the bedroom is the most important room to make skin friendly. Talking with health C. dry, itchy and irritated skin
care provider about what measures you can take to avoid your allergens can be D. rashes
very beneficial.
16. In small children, a rash is seen
Food allergies may be the cause of itching or rashes that occur immediately after A. around elbows
eating, especially in children. Some common food allergens include milk, eggs, B. on the face
peanuts, wheat, nuts, soy and seafood. Most people are allergic to only one, two or C. on the neck
at the most three foods. Be aware that diet restrictions can lead to poor nutrition D. around the knees
and growth delay in babies and children. Talk with your health care provider about
17. People with atopic dermatitis have
maintaining a well-balanced diet.
A. dry skin
Emotions and stress do not cause atopic dermatitis, but they may bring on itching B. skin infections
and scratching. Anger, frustration and embarrassment can cause flushing and C. hand dermatitis
D. all of the above
itching. Day to day stresses as well as major stressful events can lead to or worsen
the itch-scratch cycle. The medications used in atopic dermatitis include: Topical
steroids, Topical immuno modulators, Tar products, Antiinfectives, 18. The term atopic in the passage 1 refers to
Antihistamines. A. allergic diseases
B. asthma and hay fever
Steroid medicines that are applied to the skin are called topical steroids. Topical C. allergic conditions like hay fever
steroids are drugs that fight inflammation. They are very helpful when rash is not D. allergic conditions like asthma
well controlled. Topical steroids are available in many forms such as ointments,
creams, lotions and gels. It is important to know that topical steroids are made in 19. ………….can worsen dermatitis symptoms
low to super potent strengths. Steroid pills or liquids, like prednisone, should be A. allergies
B. pollen
avoided because of side effects and because the rash often comes back after they
C. dust
are stopped. D. mold

20. According to the information given in the passage(s), avoiding allergens is

A. easy
B. difficult
C. sometimes easy and sometimes difficult
D. can’t say
21. Allergic conditions like asthma in patients who have had a history of atopic
dermatitis can be easily diagnosed by health professionals,‖ this statement is ANSWER KEY
A. out of the paragraphs given
B. false ANGINAPECTORIS
C. true
D. can be true or can be false 1 C
2 A
22. According to information given, common food allergens can be in 3 B
A. milk, egg, fish 4 C
B. fish, nuts, soya been 5 D
C. nuts, eggs, wheat 6 D
7 B
D. milk, cereals, sea food
8 CHEST PAIN
9 SEDENTARY LIFESTLYE
10 CARDIOVASCULAR DISEASE
11 THARRUBOLYTIC THERAPY / ANTICOAGULANTS
12 UNNECESSARY TESTS.
13 BEDREST/CHAIR REST
14 EXERCIRE ECG
15 PIC
16 LVSD
17 AFRICAN – AMERICAN
18 INTRAORTIC BALLON PUMP
19 CIGERETTE SMOKING
20 2G
READING SUB – TEST – ANSWER KEY

LIVING WILL -2

1. C
2. A
3. A
4. B
5. B
6. B

PART C: QUESTIONS 7-14

Ebola Virus and Marburg Virus

7. C
8. D
9. B and D
10. D
11. D
12. C
13. A
14. B

PART C: QUESTIONS 15-22

A Chronic Disease - Atopic Dermatitis

15. C
16. D
17. D
18. B
19. A
20. A
21. C
22. C