Sampl

e Test10
DEEP VEIN THROMBOSIS

Text A
Deep vein thrombosis is a part of a condition called venous thromboembolism.
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.
Deep vein thrombosis 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.

Text B

Clinical Manifestations

A major problem associated with recognizing DVT is that the signs and symptoms are nonspecific.

Edema: With obstruction of the deep veins comes edema and swelling of the extremity because the
outflow of venous blood is inhibited

Phlegmasiaceruleadolens: Also called massive iliofemoral venous thrombosis, the entire extremity
becomes massively swollen, tense, painful, and cool to the touch.

Tenderness: Tenderness, which usually occurs later, is produced by inflammation of the vein wall and can
be detected by gently palpating the affected extremity.

Pulmonary embolus: In some cases, signs and symptoms of a pulmonary embolus are the first indication
of DVT

Medical Management

The objectives for treatment of DVT are to prevent thrombus from growing and fragmenting, recurrent
thromboemboli, and post thrombotic syndrome.
Endovascular management; Endovascular management is necessary for DVT when anticoagulant or
thrombolytic therapy is contraindicated, the danger of pulmonary embolism is extreme, or venous
drainage is so severely compromised that permanent damage to the extremity is likely.
Vena cava filter: A vena cava filter may be placed at the time of thrombectomy; this filter traps late
emboli and prevents pulmonary emboli.

Discharge and Home Care Guidelines

The nurse must also promote discharge and home care to the patient.

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Text C

Heparin (Rx)

Drug Strength Route of Recommended Dosagge First PTT Check

Administration

Heparin 1 unit/mL Sc/IV 80 units/kg IV bolus, THEN 6 hours after

continuous infusion of 18 starting infusion
2 units/mL units/kg/hr, OR 5000 units IV
bolus, THEN continuous
10 units/mL
infusion of 1300 units/hr, OR
100 units/mL 250 units/kg (alternatively,
17,500 units) SC, THEN 250
units/kg q 12hr.

Drug education: The nurse should teach about the prescribed anticoagulant, its purpose, and the need to
take the correct amount at the specific times prescribed.
Blood tests: The patient should be aware that periodic blood tests are necessary to determine if a change
in medication or dosage is required.
Avoid alcohol: A person who refuses to discontinue the use of alcohol should not receive anticoagulants
because chronic alcohol intake decreases their effectiveness.
Activity: Explain the importance of elevating the legs and exercising adequately.

Text D
Nursing Care Planning & Goals
The major goals for the patient include:
Demonstrate increased perfusion as individually appropriate.
Verbalize understanding of condition, therapy, regimen, side effects of medications, and when to contact
the healthcare provider.
Engage in behaviors or lifestyle changes to increase level of ease.
Verbalize sense of comfort or contentment.
Maintain position of function and skin integrity as evidenced by absence of contractures, foot drop,
decubitus, and so forth.
Maintain or increase strength and function of affected and/or compensatory body part.
Nursing Interventions
The major nursing interventions that the nurse should observe are:
Provide comfort; Elevation of the affected extremity, graduated compression stockings, warm application,
and ambulation are adjuncts to the therapy that can remove or reduce discomfort.
Compression therapy: Graduated compression stockings reduce the caliber of the superficial veins in the
leg and increase flow in the deep veins; external compression devices and wraps are short stretch elastic
wraps that are applied from the toes to the knees in a 50% spiral overlap; intermittent pneumatic
compression devices increase blood velocity beyond that produced by the stockings.
Positioning and exercise: When patient is on bed rest, the feet and lower legs should be elevated
periodically above the level of the heart, and active and passive leg exercises should be performed to
increase venous flow.

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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 question, 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

Questions 1-7

For each question, 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 Endovascular management is for DVT _____________

2 Outflow of venous blood causing extreme swelling _____________

3 The person receiving anticoagulants should avoid alcohol. _____________

4 Deep vein thrombosis is asymptomatic sometimes _____________

5 Compression therapy reduces the caliber of the superficial

veins in the leg

6 The importance of keeping legs elevated _____________

7 The nursing interventions

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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 route of administration of heparin?

9. In which part of the body DVT normally occurs?

10. When vena cava filler is used?

11. Which management is preferred for DVT if anticoagulant or thrombolytic therapy is contraindicated?

12. Which is the term used to describe the massive iliofemoral venous thrombosis?

13. Which symptom usually occurs late in DVT?

14. DVT is a part of a condition called?

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, numbers or both.

15. A major problem is associated with recognizing DVT is that the signs and symptoms are
.

16. Tenderness which usually occurs later is produced by of the vein wall.

17. In some cases, signs and symptoms of a are the first indication.

18. First PPT check is hours after starting infusion.

19. 5000 units IV bolus, then continued infusion of units/hr.

20. The patient should be aware of periodic blood tests which are necessary to determine if a change in

or dosage is required..
END OF PART A

THIS QUESTION PAPER WILL BE COLLECTED. 4

 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. The manual informs us that;

PMDD is used to prevent the incidence of assisted suicide and euthanasia

PMDD is a protective durable power of attorney for International Task Force on

euthanasia and assisted suicide

In PMDD the signer names a trusted person to make health care

PROTECTIVE MEDICAL DECISIONS DOCUMENT (PMDD)

The PMDD is a protective Durable Power of Attorney for Health Care which is available from the
International Task Force on Euthanasia and Assisted Suicide. In the PMDD the signer names a
trusted person to make health care decisions in the event that the signer is temporarily or
permanently unable to make such decisions. The PMDD, which specifically prohibits assisted
suicide and euthanasia, is available in a Multi-State version for use in most states. It is also
available in state-specific versions for states where particular requirements make a state- specific
version necessary.

2. The paragraph is giving information about;

Types of bronchodilators

Uses of bronchodilators

Definition of bronchodilator

Bronchodilator
A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in
the respiratory airway and increasing airflow to the lungs. Bronchodilators may be endogenous
(originating naturally within the body), or they may be medications administered for the treatment
of breathing difficulties. They are most useful in obstructive lung diseases, of which asthma and
chronic obstructive pulmonary disease are the most common conditions. Although this remains
somewhat controversial, they might be useful in bronchiolitis and bronchiectasis. They are often
prescribed but of unproven significance in restrictive lung diseases.

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3. Use of ICD’S is;

Delivers an electric shock.

Prevents cardiac arrest in high risk patients.

It is a battery powered device

Implantable Cardioverter Defibrillator (ICD)?

An ICD is a battery-powered device placed under the skin that keeps track of your heart rate. Thin
wires connect the ICD to your heart. If an abnormal heart rhythm is detected the device will deliver
an electric shock to restore a normal heartbeat if your heart is beating chaotically and much too
fast.ICDs have been very useful in preventing sudden death in patients with known, sustained
ventricular tachycardia or fibrillation. Studies have shown that they may have a role in preventing
cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular
arrhythmias.

4. Overhead radiant warmers

Minimize the oxygen and calories of infant

Is used to all neonates and infants

Provide neutral thermal environment for the patient

Monitoring Temperature Using an Overhead Radiant Warmer

Neonates, infants who are exposed to stressors or chilling (e.g., from undergoing numerous
procedures), and infants who have an underlying condition that interferes with thermoregulation
(e.g., prematurity) are highly susceptible to heat loss. Therefore, radiant warmers are used for
infants who have trouble maintaining body temperature. In addition, use of a radiant warmer
minimizes the oxygen and calories that the infant would expend to maintain body temperature,
thereby minimizing the effects of body temperature changes on metabolic activity. An overhead
radiant warmer warms the air to provide a neutral thermal environment, one that is neither too
warm nor too cool for the patient. The incubator temperature is adjusted to maintain and anterior
abdominal skin temperature of 36.5C (97.7F), but at least 36C (96.8F), using servocontrol
(automatic thermostat)

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5. What should be done if the patient is not able to maintain flat position till the end of Doppler
ultrasound?
Elevate the legs of patient

Provide flat position according to patients comfort and document the position
given

Educate the patient regarding the importance of maintaining flat position

throughout the procedure

To All Staff

Subject: PROCEDURE FOR VASCULAR ASSESSMENT BY DOPPLER ULTRASOUND

The procedure should be explained to the patient and informed and understood consent
gained. Although it is not invasive it can be uncomfortable and for some painful because the
blood pressure cuff may squeeze the leg over existing ulceration and/or oedema. Patients
need to know what to expect so they can stop the nurse from continuing should the pain
become unbearable. This information and patient’s comments on the procedure must be
recorded in the patient health record. Before carrying out the procedure the patient should
rest for 10 to 20 minutes (Carter 1969 et al). The emphasis is upon obtaining the resting
systolic pressure. Time should be allowed within the nursing schedule for the patient to be
rested. The patient should also lie flat in order to minimize hydrostatic pressure variables
(Vowden and Vowden 2001). However, many patients will not be able to lie flat and for some
having their legs elevated is difficult e.g. in the case of patients with breathing problems or
arthritis. In these cases lie the patients as flat as comfortably tolerated and/or with legs
elevated as much as possible. The patient’s position should be documented. This will
contribute to consistency for future readings and put the ABPI within a context which relates
to patient positioning.

6. Antibiotics
Are used to treat viral infections.

Act by killing bacteria.

Are used to treat common cold or influenza.

Antibiotic

An antibiotic (from ancient Greek αντιβιοτικά, antibiotiká), also called an antibacterial, is a type of
antimicrobial drug used in the treatment and prevention of bacterial infections. They may either
kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal
activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs
which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics.

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 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: Viral Infection – Yellow Fever

Yellow fever is a viral infection spread by a particular species of mosquito. It's most common in areas of Africa and South
America, affecting travellers to and residents of those areas. In mild cases, it causes fever, headache, nausea and
vomiting. But it can become more serious, causing heart, liver and kidney problems along with bleeding
(haemorrhaging). Up to 50 percent of people with the more severe form of yellow fever die of the disease.
There's no specific treatment for yellow fever. But getting a yellow fever vaccine before travelling to an area in which
the virus is known to exist can protect you from the disease. During the first three to six days after you've contracted
yellow fever — the incubation period — you won't experience any signs or symptoms. After this, the virus enters an
acute phase and then, in some cases, a toxic phase that can be life threatening.
Once the yellow fever virus enters the acute phase, you may experience signs and symptoms including: Fever, Headache,
Muscle aches, particularly in your back and knees, Nausea, vomiting or both, Loss of appetite, Dizziness, Red eyes, face
or tongue These signs and symptoms usually improve and are gone within several days.
Although signs and symptoms may disappear for a day or two following the acute phase, some people with acute yellow
fever then enter a toxic phase. During the toxic phase, acute signs and symptoms return and more-severe and life-
threatening ones also appear. These can include: Yellowing of your skin and the whites of your eyes (jaundice),
Abdominal pain and vomiting, sometimes of blood, Decreased urination, Bleeding from your nose, mouth and eyes,
Heart dysfunction (arrhythmia), Liver and kidney failure, Brain dysfunction, including delirium, seizures and coma. The
toxic phase of yellow fever can be fatal.
Make an appointment to see your doctor four to six weeks before travelling to an area in which yellow fever is known
to occur. If you don't have that much time to prepare, call your doctor anyway. Your doctor will help you determine
whether you need vaccinations and can provide general guidance on protecting your health while abroad.
Seek emergency medical care if you've recently travelled to a region where yellow fever is known to occur and you
develop severe signs or symptoms of the disease. If you develop mild symptoms, call your doctor.
Yellow fever is caused by a virus that is spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near
human habitations where they breed in even the cleanest water. Most cases of yellow fever occur in sub-Saharan Africa
and tropical South America.
Humans and monkeys are most commonly infected with the yellow fever virus. Mosquitoes transmit the virus back and
forth between monkeys, humans or both. When a mosquito bites a human or monkey infected with yellow fever, the
virus enters the mosquito's bloodstream and circulates before settling in the salivary glands. When the infected
mosquito bites another monkey or human, the virus then enters the host's bloodstream, where it may cause illness.
You may be at risk of the disease if you travel to an area where mosquitoes continue to carry the yellow fever virus.
These areas include sub-Saharan Africa and tropical South America. Even if there aren't current reports of infected
humans in these areas, it doesn't mean you're risk-free. It's possible that local populations have been vaccinated and
are protected from the disease, or that cases of yellow fever just haven't been detected and officially reported. If you're
planning on travelling to these areas, you can protect yourself by getting a yellow fever vaccine at least 10 to 14 days
before travelling. Anyone can be infected with the yellow fever virus, but older adults are at greater risk of getting
seriously ill.
Diagnosing yellow fever based on signs and symptoms can be difficult because early in its course, the infection can be
easily confused with malaria, typhoid, dengue fever and other viral hemorrhagic fevers. 8
To diagnose your condition, your doctor will likely: Ask questions about your medical and travel history Collect a blood
sample for testing
If you have yellow fever, your blood may reveal the virus itself. If not, blood tests known as enzyme-linked immuno
sorbent assay (ELISA) and polymerase chain reaction (PCR) also can detect antigens and antibodies specific to the virus.
Results of these tests may not be available for several days.

No antiviral medications have proved helpful in treating yellow fever. As a result, treatment consists primarily of
supportive care in a hospital. This includes providing fluids and oxygen, maintaining adequate blood pressure,
replacing blood loss, providing dialysis for kidney failure, and treating any other infections that develop. Some
people receive transfusions of plasma to replace blood proteins that improve clotting. If you have yellow fever, you
may also be kept away from mosquitoes, to avoid transmitting the disease to others.

Text 1: Questions 7-14

7. Yellow fever is common in

Africa

South America

Both

Not given

8. Signs of yellow fever doesn’t include one of this

Back pain

Vomiting

Nausea

Dry Tongue

9. Signs in toxic phase

Loss of appetite

Yellowness of eyes

Brain dysfunction

B and C

10. Seizures may occur during

Acute phase

Toxic phase

Sometimes in both the phases

Not given
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11. Yellow fever which is a viral disease, is spread by
Aedes agypti mosquito

Aedes aegypti mosquito

female mosquito

contamination

12. Mosquito transmits virus from

human to monkeys

monkeys to human

human to human

none

13. Taking vaccine ________ days before travelling to areas where the disease is common is recommended
10 days

12 days

14 days

10-14 days

14. “It does not mean you are risk free” in paragraph 8 refers to
there is a greater chance of infection in some areas even though there is no recent report
of infection

even though there are no current reported cases of yellow fever in some areas, there is still
a risk of getting infection

it is always recommended to take vaccines before travelling to Africa and South America

local population is not affected by yellow fever because of vaccination

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 ] A compilation of OET
Materials

Text 2: Aortic Dissection or Dissecting Aneurysm

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large
blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing
the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside
aortic wall, aortic dissection is often fatal.
Aortic dissection, also called dissecting aneurysm, is relatively uncommon. Anyone can develop the condition,
but it most frequently occurs in men between 60 and 70 years of age. Symptoms of aortic dissection may
mimic those of other diseases, often leading to delays in diagnosis. However, when an aortic dissection is
detected early and treated promptly, your chance of survival greatly improves.
Aortic dissection symptoms may be similar to those of other heart problems, such as a heart attack. Typical
signs and symptoms include: Sudden severe chest or upper back pain (often described as a tearing, ripping or
shearing sensation, that radiates to the neck or down the back), Loss of consciousness (fainting), Shortness of
breath, Sweating, Weak pulse in one arm compared to the other etc.
If you have signs or symptoms such as severe chest pain, fainting, sudden onset of shortness of breath or
symptoms of a stroke then taking medical assistance is of preliminary importance. While experiencing such
symptoms doesn't always mean that you have a serious problem, it's best to get checked out quickly. Early
detection and treatment may help save your life.
An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood pressure may stress the
aortic tissue, making it more susceptible to tearing. You can also be born with a condition associated with a
weakened and enlarged aorta, such as Marfan syndrome or bicuspid aortic valve. Rarely, aortic dissections
may be caused by traumatic injury to the chest area, such as during motor vehicle accidents.
Aortic dissections are divided into two groups, depending on which part of the aorta is affected:
Type A: This is the most common and dangerous type of aortic dissection. It involves a tear in the part of the
aorta just where it exits the heart or a tear extending from the upper to lower parts of the aorta, which may
extend into the abdomen.
Type B: This type involves a tear in the lower aorta only “ which” may also extend into the abdomen.
Risk factors for aortic dissection include: Uncontrolled high blood pressure (hypertension), found in at least
two-thirds of all cases Hardening of the arteries (atherosclerosis) Weakened and bulging artery (pre-existing
aortic aneurysm) An aortic valve defect (bicuspid aortic valve) A narrowing of the aorta you're born with (aortic
coarctation)
People with certain genetic diseases are more likely to have an aortic dissection than are people in the general
population. These include: Turner's syndrome. High blood pressure, heart problems and a number of other
health conditions may result from this disorder.
Marfan syndrome; This is a condition in which connective tissue, which supports various structures in the
body, is weak. People with this disorder often have a family history of aneurysms of the aorta and other blood
vessels. These weak blood vessels are prone to tears (dissection) and rupture easily.
Ehlers-Danlos syndrome; This group of connective tissue disorders is characterized by skin that bruises or tears
easily, loose joints and fragile blood vessels.
Loeys-Dietz syndrome; This is a connective tissue disorder marked by twisted arteries, especially in the neck.

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 ] A compilation of OET
Materials

People who have Loeys-Dietz syndrome are thought to be at risk for developing aortic dissections and
aneurysms.
An aortic dissection can lead to death, due to severe internal bleeding, including into the lining around the
heart (pericardial sac), Organ damage, such as kidney failure or life-threatening damage to the intestines,
Stroke, possibly including paralysis, Aortic valve damage, such as causing the aortic valve to leak (aortic
regurgitation)

Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health
problems. Doctors often suspect an aortic dissection if the following signs and symptoms are present: Sudden
tearing or ripping chest pain, Widening of the aorta on chest X-ray, Blood pressure difference between right
and left arms.

Text 2: Questions 15 to 22

15. In aortic dissection a tear develops in

outer layer of aorta

inner layer of aorta

middle aorta

a blood vessel branching off the heart

16. Dissecting aneurysm is common among

Men

Women

Both

Children

17. Symptoms of aortic dissection include

chest pain and swelling

weak pulse in both arms

loss of consciousness

all of the above

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Materials

18. Aortic dissection can also be caused due to

high BP

weak aortic wall

inborn symptoms

traumatic injury to chest during accidents

19. The most dangerous type of aortic dissection is

Type A

Type B

aortic aneurism

aortic coarctation

20. A condition in which connective tissue is weak

Turner’s syndrome

Loeys-Dietz syndrome

Ehlers-Danlos syndrome

Marfan’s syndrome

21. People with Loeys-Dietz syndrome are likely to develop

aneurysms

ruptured blood vessels

twisted arteries in the neck

aortic complications

22. In paragraph 6 ‘which’ refers to?

type B aortic dissection

the lower aorta

abdomen

a tear

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

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