READING TEST 29

READING SUB-TEST : PART A

 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.

PART A -TEXT BOOKLET - 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.
Text C

Heparin (Rx)
Strengt Route of Recommende FIRST PTT
Drug
h Administration d dosage CHECK
80 units/kg IV bolus,
THEN continuous
infusion of 18
units/kg/hr,
1unit/mL OR
2units/mL 5000 units IV bolus, 6 hours after
10units/mL Sc/IV THEN continuous starting
100units/m infusion of 1300 infusion
L units/hr, OR
250 units/kg
(alternatively, 17,500
units) SC, THEN 250
units/kg q12hr

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.
PART A -QUESTIONS AND ANSWER SHEET

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. 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 &&&&&&&

Questions 8-14

Answer each questions, 8-4, with a word or short phrase from one of the texts.
Each answer may include words, number or the both. Your answers should be correctly spelled.

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, number or both. Your answers should be correctly spelled

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 QUESTIONS PAPER WILL BE COLLECTED

READING SUB-TEST : 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 the answer (A, B or C) which you think fits best according to the text. Write
your answers on the separate Answer Sheet

Questions 1-6

1. The manual informs us that;

a. PMDD is used to prevent the incidence of assisted suicide and euthanasia
b. PMDD is a protective durable power of attorney for International Task Force on euthanasia
and assisted suicide
c. In PMDD the signer names a trusted person to make health care decisions

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 statespecific versions for states
where particular requirements make a state-specific version necessary.
2. The paragraph is giving information about;
a. Types of bronchodilators
b. Uses of bronchodilators
c. 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.

3.Use of ICD is;

a. Delivers an electric shock .
b. Prevents cardiac arrest in high risk patients.
c. 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
a. Minimize the oxygen and calories of infant
b. Is used to all neonates and infants
c. 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)
5. What should be done if the patient is not able to maintain flat position till the end of
Doppler ultrasound?
a. Elevate the legs of patient
b. Provide flat position according to patients comfort and document the position given
c. Educate the patient regarding the importance of maintaining flat position throughout the
procedure

To ALL staff
Subj: 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 patient9s 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 patient9s 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
a. Are used to treat viral infections.
b. Act by killing bacteria.
c. Are used to treat common cold or influenza.

Antibiotic

An antibiotic (from ancient Greek ³ντι³ιοτικ¯ 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.
READING SUB-TEST : 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.
Write your answers on the separate Answer Sheet

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.

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

A. Africa
B. South America
C. both
D. not given

8. Signs of yellow fever doesn9t include one of this

A. back pain
B. vomiting
C. nausea
D. dry tongue

9. Signs in toxic phase

A. loss of appetite
B. yellowness of eyes
C. brain dysfunction
D. B and C

10. Seizures may occur during

A. acute phase
B. toxic phase
C. sometimes in both the phases
D. not given

11. Yellow fever which is a viral disease, is spread by

A. Aedes agypti mosquito
B. Aedes aegypti mosquito
C. female mosquito
D. contamination
12. Mosquito transmits virus from
A. human to monkeys
B. monkeys to human
C. human to human
D none

13.Taking vaccine &&&&& days before travelling to areas where the disease is common is
recommended
A. 10 days
B. 12 days
C .14 days
D. 10-14 days

14. <It does not mean you are risk free in paragraph 8 refers to?
A. there is a greater chance of infection in some areas even though there is no recent report of
infection
B. even thought there are no current reported cases of yellow fever in some areas, there is still a
risk of getting injection
C. it is always recommended to take vaccines before travelling to Africa and South America
D. local population is not affected by yellow fever because of vaccination
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 more 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. 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

A. outer layer of aorta
B. inner layer of aorta
C. middle aorta
D. a blood vessel branching off the heart

16. Dissecting aneurysm is common among

A. men
B. women
C. both
D. children

17. Symptoms of aortic dissection include

A. chest pain and swelling
B. weak pulse in both arms
C. loss of consciousness
D. all of the above

18. Aortic dissection can also be caused due to

A. high BP
B. weak aortic wall
C. inborn symptoms
D. traumatic injury to chest during accidents

19. The most dangerous type of aortic dissection is

A. Type A
B. Type B
C. aortic aneurism
D. aortic coarctation
20. A condition in which connective tissue is weak
A. Turner9s syndrome
B. Loeys-Dietz syndrome
C. Ehlers-Danlos syndrome
D. Marfan9s syndrome

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

A. aneurysms
B. ruptured blood vessels
C. twisted arteries in the neck
D. aortic complications

22.In paragraph 6 which9 refers to?

A. type B aortic dissection
B. the lower aorta
C. abdomen
D. a tear

END OF READING TEST, THIS BOOKLET WILL BE COLLECTED

Reading test 29 : Answer Key

Part A - Answer key 1 – 7

1 B
2 B
3 C
4 A
5 D
6 C
7 D

Part A - Answer key 8 – 14

8 SC/IV
9 Legs
10 Thrombectomy
11 Endovascular management
12 Phlegmasiaceruleadolens
13 Tenderness
14 Venous thromboembolism

Part A - Answer key 15 – 20

15 Nonspecific
16 Inflammation
17 Pulmonary embolus
18 6
19 1300
20 medication
Reading test - part B – answer key

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

Reading test - part C – answer key

Text 1 - Answer key 7 – 14

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

Text 2 - Answer key 15 – 22

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