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READING SUB-TEST – QUESTION PAPER: PARTS B & C

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TIME: 45 MINUTES
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INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper until you are told to do so.
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One mark will be granted for each correct answer.

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Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the test, hand in this Question Paper.
DO NOT remove OET material from the test room.

HOW TO ANSWER THE QUESTIONS

Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C

©Cambridge Boxhill Language Assessment Pty Ltd 2020

 Part B
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In this part of the test, there are six 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. A
B
Fill the circle in completely. Example: C

1. What do the guidelines say about halo-vest pin sites?

A They should be dealt with in the same way as other pin sites.

B They are particularly susceptible to infection.

C They need to be assessed regularly.

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3.5.1: Care of halo-vest pin sites

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A patient may be fitted with a halo vest to immobilize and protect the cervical spine and neck after

surgery or accident. Halo-vest pin sites require twice-daily inspection for signs of infection and any pain or

discomfort, and their condition must be documented. It is important to be able to recognise the difference
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between the normal healing process and the development of an infection. Pin site infections can cause

discomfort and pain and if not promptly identified can lead to loosening of the pin site, deeper infection and
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osteomyelitis. Unlike the recommendation for other pin sites, halo-vest pin sites are not routinely cleaned.

If they do require cleaning, sterile normal saline and gauze are utilised. If a pin site infection is suspected,
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the medical team should be informed, swabs sent to microbiology and antibiotics should be prescribed as

appropriate.
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2. What does this policy statement say about use of clinical images?

A Medical research is the most usual primary purpose for images.

B Patients are consulted in relation to the primary purpose of images.

C Images intended for training purposes don’t require patient consent.

Clinical images

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A clinical image may be a photo, video, or audio recording. An image may be of the patient’s body - such

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as an injury or skin lesion - or an image of a pathology report or diagnostic image. Clinical images should

only be used and/or disclosed:

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for the primary purpose for which they were collected;
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• for a secondary purpose closely related to the primary purpose;

• in accordance with the patient’s consent (if the use and disclosure is different from the primary or
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secondary purpose); or

• where permitted by law.

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The primary purpose is the purpose the patient was informed about when he or she provided consent for
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the image to be collected. In the health context, this would normally be related to the provision of clinical

care and treatment, but it could be for medical research or training if this was explained to the patient when
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the image was collected.

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©Cambridge Boxhill Language Assessment Pty Ltd 2020

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3. What is the purpose of this memo to nursing staff?

A to remind them of their responsibilities

B to point out any mistakes they have made

C to give them advance warning of an inspection

MEMO

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To: Nursing staff

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Secure storage of medicines

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• To ensure medicines are safe to be administered, they must be stored at the right temperature. If
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they are stored incorrectly, they could pose a potential risk to the health and wellbeing of our patients.

• Nursing staff should be monitoring the fridges daily to ensure that they are working properly, and that
temperature logs are regularly audited to check that medicines are being kept properly.
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• The use of controlled drugs is bound by legislation to make sure that they are securely stored, stock
levels are correct, and each administration is accurately and clearly recorded. Pharmacists monitor
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controlled drugs every three months to check stock balances and check that all entries in the
controlled drug record book are legally correct and legible. All medicines on our wards need to be
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stored safely and securely and we all have a role to play in that.
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©Cambridge Boxhill Language Assessment Pty Ltd 2020

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4. This guideline warns staff about the risks of using antiseptic handwash for

A day-to-day care of hospitalised patients.

B surgical interventions in the operating theatre.

C fitting medical devices which enter the patient’s body.

Use of antiseptic solutions for hand disinfection e.g. Hibiscrub

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Antiseptic solutions may be a combination of a detergent and a micro-biocide such as chlorhexidine

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and povidine-iodine. Resident microorganisms can only be inhibited by the use of antiseptic solutions:
therefore they can be used in clinical areas where resistant bacteria could cause infection if introduced

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during an invasive procedure, e.g. theatres and ITU. Antiseptics solution should not routinely be used in
ward situations, as frequent washing with antiseptics can damage the skin, but they should be used prior
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to performing any invasive procedure, such as siting a urinary catheter or intravenous canulae.
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5. According to this extract, some nurses are allowed to wear their uniform

A on the wards with a sweatshirt.

B at social events within the hospital.

C on their way to and from work under a coat.

Extract from Uniform Policy for Nurses

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• Clinical staff should not socialise outside the workplace or undertake social activities while wearing

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their work uniform.

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• Where changing facilities exist for hospital-based staff, uniforms must not be worn outside the place
of work. For staff who work only in the hospital environment, and if no changing facilities exist, hospital
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uniforms should only be worn outside the hospital premises when travelling to and from work and tops
should be fully covered. Staff who work in the community setting, or who move between the hospital and
community setting during the course of their work, should also ensure their uniform tops are covered
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when travelling.
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• Staff who wish to wear cardigans/sweatshirts: Only black or navy may be worn. They must never be
worn in the immediate clinical area when delivering direct clinical care to patients.
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6. What is the email about pressure ulcers telling ward staff?

A These must be treated as soon as they are discovered.

B Patients on the ward have complained of discomfort from them.

C There may be challenges in dealing with patients who have them.

To: Ward staff

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Subject: Pressure ulcers

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We’ve recently had several cases of pressure ulcers in patients newly admitted to the ward.
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As you know, pressure ulcers are a serious problem that in most cases could have been

avoided. For any new admissions, please assess the patient’s risk factors (referring to the

attached checklist). Once identified as at risk of or with pressure ulcers, patients should
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be educated about their risk and encouraged and/or assisted to move themselves where

possible. However, be aware that many patients will be reluctant to move due to pain or
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anticipation of pain, the effects of sedation or analgesia, or their inability to appreciate their

level of risk due to confusion or dementia. It is the nurse’s responsibility to ensure that
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patients are repositioned in a way that is not only therapeutic, but also acceptable to them.
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©Cambridge Boxhill Language Assessment Pty Ltd 2020

 Part C
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In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22, choose the
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answer (A, B, C or D) which you think fits best according to the text. B
C
Fill the circle in completely. Example: D

Text 1: Generalist doctors and specialist nurses

New medical technologies and treatments over the past few decades have led to remarkable improvements
in treating older patients. The annual death rate in Australia for an 80-year-old male fell last year to just 5.6%,
compared with 10% thirty years earlier. But healthcare costs are rising inexorably due to our ageing population.
The elderly use hospitals at three times the rate of middle-aged patients. Costs of hospitalisation rise steeply with

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age as sicker patients need to stay longer in hospital. Hospital resources can only be stretched so far. As more

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and more patients arrive in emergency departments and need admission, the capacity to perform elective surgery
is reduced, and waiting times increase. So, how will our hospitals cope with the inevitable influx of large numbers

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of elderly patients? Hospital reforms have focused on efficiency gains and ‘doing more with less’. But this alone
won’t enable hospitals to respond to these new challenges. We need to redesign the workforce so hospitals are
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staffed by general physicians and nurses who take on more specialist roles.

As we age, our risk of developing chronic diseases – such as heart disease, cancer, diabetes, osteoporosis,
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depression and dementia – increases. And because we’re living longer, we’re more likely to have multiple chronic
diseases; in fact, this is becoming the norm, rather than the exception. Hospitals traditionally treated patients with
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one disease who were seen by doctors who specialised in a particular part of the body or type of treatment. But
patients with multiple illnesses need a generalist to manage their care.
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In the United Kingdom, the Royal College of Physicians recently recommended a radical overhaul of the purpose
and role of hospitals. The college argues that, in future, hospitals will need more generalist physicians and fewer
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specialists. The same is true for Australia. Luckily, with an anticipated oversupply of medical graduates in Australia
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over the next few years, there is an opportunity to alter the structure of medical training to promote flexibility and
generalism for medical careers.

The increasing pressure of chronic diseases on hospitals and increased demand for beds will require nurses and
doctors to work very differently to the way they have in the past. Nurses will need to be better utilised, in more
specialist roles. With the right support and development pathways, for instance, nurses can safely take over
medical procedures such as endoscopies and colonoscopies which use a long tube with a video camera and light
on one end to examine the inside of the body. Nurses can also oversee patients’ chronic disease management
programmes for illnesses such as diabetes and heart disease.

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Economist Stephen Duckett of the Australian Department of Human Services and Health has previously proposed
up-skilling hospital-based nurses to ease the pressure on hospitals. By employing nursing assistants to undertake
more administrative tasks, nurses would be free to take on more complex roles. This could help create more
rewarding jobs and a more sustainable healthcare system. However, the cultural barriers to nurses increasing their
scope of practice span legislative, administrative, professional and societal domains. The argument for innovation
will require a challenging of stereotypes and an attention to fear as much as logic and evidence.

So what progress is being made? In New Zealand, the KP Awatea Centre in Aukland is changing the stance and
perspective taken by healthcare workers as a first step to co-design of services, and Monash Health in Australia
has reorganised its general medicine model of care across three acute hospital sites. Senior nurses and allied

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health practitioners now work in specified roles to co-ordinate integrated care, while general physicians focus on

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providing timely appropriate care across the hospital. The increase in patient admissions under general medicine
over the last five years has been accompanied by a reduction in length of stay. It has been estimated that 120

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additional beds would have been required without this saving, which provides a handy measure of the operating
efficiency gain.
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In order to create the radically different hospital to meet the needs of the rapidly ageing population over the next
twenty years, we need to create new roles for healthcare workers and challenge traditional compartmentalised
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professional practice. Health services must bring design thinking and systems thinking together to create truly
innovative healthcare services that make patient and frontline team experience the priority. In doing so, we must
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see the patient journey as an integrated whole and focus on providing effective care for our patients. This, of
course, will require effective care teams and clinical leadership. To achieve this, enlightened hospital decision-
making boards will need to challenge service providers to take this radical design approach. And governments will
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need to support a more strategic approach to workforce training for doctors, nurses and other health providers.
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©Cambridge Boxhill Language Assessment Pty Ltd 2020

 Text 1: Questions 7-14
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7. In the first paragraph, what does the phrase ‘doing more with less’ refer to?

A sicker patients needing to spend longer in hospital

B a reduction in the capacity to perform elective surgery

C the idea that hospital resources can only be stretched so far

D the elderly using hospitals far more than middle-aged patients

8. What is the main issue highlighted in the second paragraph?

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A the shortage of hospital staff trained in aged care

B the growing number of patients with complex needs

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C the need to expand the capacity of hospital geriatric wards
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D the rising prevalence of certain conditions associated with the elderly
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9. What does the third paragraph describe?

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A factors that are an underlying cause of a problem

B changes that can be made to help address a problem

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C disagreements about the best approach to a problem

challenges which may arise when attempting to solve a problem

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D
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10. What would be an effect of the proposals outlined in the fourth paragraph?

A relieving doctors of certain tasks

B making chronic disease care more accessible

C allowing patients choice regarding forms of treatment

D enabling staff to conduct procedures at convenient times

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11. What benefit of a proposed change is mentioned in the fifth paragraph?

A a higher standard of patient care

B increased levels of job satisfaction for nurses

C more flexibility regarding allocation of nursing duties

D an improvement in the way that hospital administration is carried out

12. In the fifth paragraph, the writer suggests that it may be necessary to

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A persuade nurses of the career benefits of acquiring additional skills.

B alter nursing practices in different ways according to the cultural context.

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C present the authorities with data justifying the extension of nurses’ roles.
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D address people’s concerns about changes to the traditional image of nursing.
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13. The words ‘this saving’ in the sixth paragraph refer to

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A the ratio of physicians to nurses.

B the number of new beds provided.

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C the time patients spend in hospital.

the rate of increase in patient admissions.

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D
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14. When describing his vision in the final paragraph, the writer emphasises the need to

A accommodate a rise in patient numbers over the next two decades.

B design new hospital buildings suitable for delivering holistic healthcare.

C introduce innovative therapies for treating a range of age-related conditions.

D ensure the commitment of professional people at a number of different levels.

©Cambridge Boxhill Language Assessment Pty Ltd 2020

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Text 2: Children with nut allergies

A comprehensive review suggests that when it comes to the management of peanut and tree nut allergies in
children, treatment plans need to be individualised to make sure that all nutritional needs are met whilst still
providing protection from allergic food reactions. In the review, researchers tried to synthesise current evidence on
how best to manage a child with limited allergies to nuts as well as what to do with pre-packaged foods that carry
precautionary allergy labelling (PAL).

As the researchers say: ‘What we’re trying to do is make sure healthcare professionals are well informed,
because if they’re in a better position as regards information and knowledge, they’re going to be better able to
provide information to parents. What might be appropriate for one child to eat might not be the case for the next

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child, and it's really important at a healthcare professional level to be educated. it's far more difficult to undo the
consequences of bad advice than it is to give the correct facts in the first place.’

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‘In tree-nut allergic children, introduction of specific nuts to which the child isn’t allergic may improve quality of life
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and should be considered for patients with multiple food allergies, vegan or ethnic-specific diets, for whom nuts
are an important source of protein,’ the researchers write. They also point out that healthcare providers may need
to clarify which nuts are potentially allergenic and which aren’t. It’s common for some people to also restrict foods
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which they believe to be nuts, the authors suggest, but which rarely if ever cause allergies. Peanut and tree-nut
allergies may be the most common cause of life-threatening food allergic reactions, they add, but a peanut is
actually a legume and is botanically quite distinct from nuts, which grow on trees.
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Moreover, it used to be accepted that a child with a history of a significant reaction to a very small amount of peanut
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had a higher risk for future anaphylaxis. ‘However, this doesn’t appear to be the case,’ the researchers write, ‘and
the severity of future peanut and tree-nut allergic reactions is difficult to determine.’ Whether or not nut avoidance
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is helpful in terms of preventing nut allergies is also under question. For example, the prevalence of peanut allergy
has increased significantly in both the UK and the USA during recent years, despite the fact that organisations such
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as the American Academy of Pediatrics have long recommended that children with a parent or a sibling with an
atopic disease avoid nuts until the age of three years. ‘These observations...imply that nut avoidance may not be
helpful as a means of primary prevention,’ the researchers write.

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Then there is the whole issue of precautionary allergy labelling (PAL). As the researchers point out, the absence
of PAL doesn’t indicate that a food is free of potential cross-contaminants. In one study of more than five-hundred
pre-packaged foods, investigators found there was no significant difference in the frequency of significant peanut
contamination between foods with a PAL and those without a PAL. Another factor to consider is flagged up by
recent data from the UK which indicates that very few allergic reactions are caused by traces of allergens in pre-
packaged food. ‘Most reactions are due to food eaten from takeaways or food produced by others, and not pre-
packaged food,’ they said.

Sources of food that can contain sufficient peanut to trigger a reaction can be classified as ‘snack’ foods, the
researchers indicate. These include foods such as chocolates, cookies/biscuits, cereal bars and cakes, and are

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what children with peanut or tree-nut allergies really need to avoid, they stress. In contrast, significant peanut

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contamination hasn’t been documented in other categories of food, including breakfast cereals, frozen desserts, or
pasta, which may come as a surprise to many.

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According to Dr Carina Venter from the University of Portsmouth, UK, dietary advice is now a far cry from what it
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was before. ‘When I started working in allergies ten years ago, advice was very simple. Everybody was just told to
avoid the foods they were allergic to, so we used to say, if you're allergic to any one nut, avoid all nuts,’ Dr Venter
said. 'However, allergy specialists now know that people become tolerant to baked forms of foods to which they are
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allergic. For example, people can eat cake before they can have a boiled or scrambled egg. It's the same with nuts.
We've come to realise that many people could be allergic to one nut or a few nuts, but safely eat the other nuts
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they’re not allergic to. And enabling a child to eat cashew nuts, for example, to which they aren’t allergic, allows
them to vary their diet so much more and may help them to interact socially much more easily.’
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©Cambridge Boxhill Language Assessment Pty Ltd 2020

 Text 2: Questions 15-22
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15. What is said about children with allergies in the first paragraph?

A There is too little information available about how to protect them.

B Ensuring that they have a healthy diet is an important consideration.

C They need to learn how to understand labels on some pre-packaged food.

D Research has been done into the effect of allergies on physical development.

16. In the second paragraph, the researchers say that they hope to

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A improve the general level of understanding.

B encourage further investigations in their field.

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C measure the extent of parents' knowledge of allergies.
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D discover the differences between children with allergies.
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17. What point is made about nuts in the third paragraph?

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A In some cultures, people avoid eating them.

B Most of them risk provoking allergic reactions.

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C What people mean when they use the word can vary.

Their effect on allergic children needs testing regularly.

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D
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18. What is the writer's main point about anaphylaxis in the fourth paragraph?

A Far too many mistakes have been made.

B Action needs to be taken to improve the situation.

C It is becoming harder to make accurate predictions.

D A number of long-held assumptions are being challenged.

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19. What does the writer suggest about precautionary allergy labelling (PAL)?

A It may not adequately reflect the danger that a particular food represents.

B It doesn’t seem to have had the intended effect on food manufacturers.

C Its adoption by the food industry hasn’t been sufficiently publicised.

D Its use should be extended to wider variety of food products.

20. In the sixth paragraph, the word which refers to

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A a need to avoid foods like chocolate

B the way researchers classify food categories

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C snack foods which are likely to trigger reactions
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D a lack of information about certain categories of food
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21. In the final paragraph, the words a far cry from are used to stress the idea that compared to the past,
dietary advice is now
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A better known.

B much clearer.
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C completely different.

easier to comply with.

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D
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22. What is Dr Ventner doing in the final paragraph?

A explaining the impact of the new findings

B suggesting useful topics for future studies

C emphasising the need for more information

D justifying decisions made based on the research

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED
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