Cigarette Smoking and Lung Cancer Oet Reading Test Practice

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Cigarette

Smoking and Lung Cancer: Texts



Text A
Smoking and the Risk of Lung Cancer
For a life-long smoker, the risk of lung cancer is 20 times
higher than a non-smoker.
As with many of the health facts about smoking, this is an
alarming statistic – but you can make a real difference to your
health outcomes by choosing to quit smoking. Evidence
shows that:
If you quit smoking by the age of 40, you reduce your
risk of lung cancer by up to 90%
Quitting by the age of 50 reduces your risk by up to
65%
After 10 years of being smoke-free, you’ll have avoided
around 40% of the risk of ever getting lung cancer
Even for someone newly diagnosed with early stage
lung cancer, quitting smoking improves prognosis and
reduces the chance of tumour progression
Source: Cancer Institute of NSW
Text B

Cigarette packaging representations


Source: Australian Government Department of Health




Text C
Effect of Smoking on the Lungs
What does smoking do to my lungs?
It paralyses and can destroy cilia, which line your upper
airways and protect you against infection. It destroys the
alveoli, or air sacs, which absorb oxygen and get rid of carbon
dioxide. It destroys lung tissue, making the lungs less able to
function, and irritates the lungs which creates phlegm and
narrows the airways, making it harder to breathe.
How does that affect me?
It makes you short of breath, it makes you cough, it gives you
chronic bronchitis and repeated chest infections, it worsens
your asthma and it can give you lung cancer. That's apart from
effects on your heart, fertility, pregnancy and your children.
But most people who smoke don't get lung cancer.
No. Most people die of other things first, often because they
smoked.
If I give up, will my lungs improve?
Yes. Cilia that are paralysed, but not destroyed, can recover.
You will have less asthma and fewer chest infections. The
sooner you stop, the better your chances of improved lung
function.
Source: Australian Government

Text D
Passive Smoking: Summary
In Victoria, it is illegal to smoke in cars carrying children
who are under 18 years of age.
If a person who smokes can’t give up for their own health,
perhaps the health of their partner or children, or other
members of their household, will be a stronger motivation.
Passive smoking increases the risk of respiratory illness in
children, e.g. asthma, bronchitis and pneumonia.
People who have never smoked who live with people who
do smoke are at increased risk of a range of tobacco-
related diseases, including lung cancer, heart disease and
stroke.
Source: Victoria State Government





END OF PART A
THIS ANSWER BOOKLET WILL BE COLLECTED
Test 1
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.
_____________________________________________________________________

Cigarette Smoking and Lung Cancer: Questions
Questions 1-7
For each of the questions, 1 – 7, decide which text (A, B, C or D) the
information comes from. You may use any letter more than once.
In which text can you find information about

The effects of passive smoking?


1 __________
The chances of a smoker getting lung cancer?
2 __________
The benefits to the respiratory system of quitting
3 smoking? __________
Ways to get help with quitting
4 smoking? __________
The reduction in lung cancer risk if a smoker
5 quits? __________
Recommended websites or phone numbers for
6 smokers? __________
How smoking leads to particular
7
symptoms? __________



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. Your answers should be
correctly spelled.
8 How much of the lung cancer risk is avoided by being smoke-free for 10
years?
____________________________________________________________

9 What is the phone number for Quitline?


____________________________________________________________

10 What is normally expelled by the alveoli in the lungs?


____________________________________________________________

11 What effect can smoking have on asthma?


____________________________________________________________
12 What type of cancer can be improved by quitting smoking?
____________________________________________________________
13 Which two (2) cardiovascular diseases are associated with passive
smoking?
____________________________________________________________

14 In which state is it illegal to smoke in cars carrying children under 18?


____________________________________________________________
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. Your answers should be
correctly spelled.
Cigarette smoke damages the lungs by destroying the _______ (15) that absorb
oxygen.
Eventually, the destruction of lung tissue can render a smoker unable to _______
(16) normally.
Cigarette packets now feature depictions of its health effects, such as _______
(17).
The effect of previous smoking can be reversed in some ways, as the _______
(18) lining the upper airways can recover from damage.
Passive smoking increases the risk of _______ (19) in children.
The good news is that if people _______ (20) smoking before the age of 40, they
can significantly reduce their cancer risk.
Part B

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

1. The treatment guidelines below recommend that
A All patients receive parathyroid hormone monitoring
B All patients receive 6-weekly monitoring
C All patients receive baseline blood tests

Table: Medical Monitoring Guidelines for High Risk Patients on Very Low
Energy Diets
Assessment Baseline 6 weeks Completion
Measures of Intensive
Phase
Electrolytes/Creatinine Yes If Yes
required
Liver function tests Yes If Yes
required
Fasting glucose Yes If Yes
required
Cholesterol, triglycerides Yes If Yes
and HDL required
Uric acid Yes If Yes
required
Full blood count Yes If Yes
required
Iron studies Yes If Yes
required
Vitamin D Yes If Yes
required
Calcium and Parathyroid Yes If Yes
hormone (in patients on required
long term
anticonvulsants)
Source: Nestle Health Science. Optifast VLCD Clinical Treatment Protocol. In: Ltd NA, ed. Notting Hill
VIC, Australia, 2013.
2. This notice is giving information about
A The differential management of infants using glucose
B How to check an infant’s blood glucose level
C The ideal glucose concentration in infants with clinical signs

Management of documented hypoglycemia in


breastfeeding infants
A. Infant with no clinical signs
1. Continue breastfeeding (approximately every 1–2 hours)
or feed 1–5 mL/kg of expressed breastmilk or substitute
nutrition.
2. Recheck blood glucose concentration before subsequent
feedings until the value is acceptable and stable.
3. Avoid forced feedings (see above).
4. If the glucose level remains low despite feedings, begin
intravenous glucose therapy.
5. Breastfeeding may continue during intravenous glucose
therapy.
6. Carefully document response to treatment.
B. Infant with clinical signs or plasma glucose levels < 20–
25mg/dL (<1–1.4mmol/L)
1. Initiate intravenous 10% glucose solution with a
minibolus.
2. Do not rely on oral or intragastric feeding to correct
extreme or clinically significant hypoglycemia.
3. The glucose concentration in infants who have had
clinical signs should be maintained at > 45 mg/dL (> 2.5
mmol/L).
4. Adjust intravenous rate by blood glucose concentration.
5. Encourage frequent breastfeeding.
6. Monitor glucose concentrations before feedings while
weaning off the intravenous treatment until values
stabilize off intravenous fluids.
7. Carefully document response to treatment.
Source: Wight, N. and Marinelli, K.A. ABM Clinical Protocol #1: Guidelines for Blood Glucose
Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014.
Breastfeeding Medicine. 20014, 9:4(173-9)

3. This information sheet recommends
A Regular auditing to ensure pain management program efficacy
B Indicators to use in pain management program audits
C At least 50% change as being clinically important

Audit of Pain Management Programs: Methods
It is recommended to conduct an audit of 20 or more
sequential patients undertaking a pain management program.
Data collection should include simple demographic and
program data as well as data (pre and post program with a
minimum three month interval between data sets) regarding
changes in:
Healthcare utilisation.
Depression/anxiety/stress.
Pain self-efficacy.
Pain catastrophising.
Percentage change in individual patients has been suggested
(rather than average percentage change across the population
audited) as average percentage change is very sensitive to
outliers and small audits may therefore be significantly
influenced by average percentage change.
The Initiative on Methods, Measurement, and Pain
Assessment in Clinical Trials (IMMPACT) recommends
considering clinical important change (as distinct from
statistically significant change) on the following basis:
Minimal benefit: 10-20 per cent change.
Moderately important benefit: at least 30 per cent change.
Substantially important benefit: at least 50 per cent change
Source: Cartwright, S. and Thomas, C. (2014) Clinical audit guide: Interdisciplinary pain management
programs. Accessed from: http://www.anzca.edu.au/documents/pmp-interdisciplinary-clinical-audit-guide-
v1-2014.pdf
4. This regulatory statement instructs healthcare professionals to
A Admit all patients to NSW public hospitals within 48 hours
B Assess all patients in the Emergency Department for VTE
C Initiate VTE prophylaxis for all patients identified to be at risk

MANDATORY REQUIREMENTS:
All adult patients admitted to NSW public hospitals must
be assessed for the risk of VTE within 24 hours and
regularly as indicated / appropriate.
All adult patients discharged home from the Emergency
Department who as a result of acute illness or injury, have
significantly reduced mobility relative to normal state,
must be assessed for risk of VTE.
Patients identified at risk of VTE are to receive the
pharmacological and / or mechanical prophylaxis most
appropriate to that risk and their clinical condition.
All health services must comply with the Prevention of
VTE Policy.
All Public Health Organisations must have processes in
place in compliance with the actions summarised in the
VTE Prevention Framework (Appendix 4.1 of the
attachment). A VTE risk assessment must be completed
for all admitted adult patients and other patients identified
at risk, and decision support tools made available to guide
prescription of prophylaxis appropriate for the patient’s
risk level.
Source: NSW Health. Policy Directive: Prevention of Venous Thromboembolism. In: Clinical Excellence
Commission, ed. Sydney, Australia: Ministry of Health, 2014.

5. The advice below can best be applied to a healthcare setting by
A The inclusion of nurses in governance structures
B Providing information to patients in their native language
C Redesigning projects according to advisory group
recommendations

Partnerships with consumers can come in many forms. Some


examples include:

working with consumers to check that the health


information is easy to understand
using communication strategies and decision support tools
that tailor messages to the consumer
including consumers in governance structures to ensure
organisational policies and processes meet the needs of
consumers
involving consumers in critical friends’ groups to provide
advice on safety and quality projects
establishing consumer advisory groups to inform design or
redesign projects
Source: Australian Commission on Safety and Quality in Health Care. Patient and Consumer Centred Care
2018 [Available from: https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/.]

6. The purpose of the document below is to
A Prevent Medicare claims being paid for public patients
B Specify when services can be billed to Medicare
C Ensure healthcare professionals don’t falsify claims

Guideline for substantiating claims for diagnostic imaging


and pathology services rendered to emergency department
patients of public hospitals
Public hospitals are funded under an arrangement with the
Australian Government to provide free public hospital
services to eligible patients. This includes diagnostic imaging
and pathology services provided to public hospital emergency
department patients. A patient who presents to a public
hospital emergency department should be treated as a public
patient. If that patient is subsequently admitted they may elect
to be treated as a private patient for those admitted services.
For a Medicare claim to be paid for a patient in a public
hospital, the patient must be admitted as a private patient at
the time the service was rendered.
Where a service for a patient in a public hospital has been
billed to Medicare, the hospital or rendering practitioner may
be asked to substantiate these claims.
Documents you may use include:
the form which the patient (or next of kin, carer or
guardian) - has signed indicating that the patient has
elected to be admitted as a private patient, and
patient records - that show the patient was admitted as a
private patient at the time the service was rendered
Source: Department of Health. Guideline for substantiating claims for diagnostic imaging and pathology
services rendered to emergency department patients of public hospitals 2018 [Available from:
http://www.health.gov.au/internet/main/publishing.nsf/Content/hpg-di-path-emerg-pub-hosp.]
Part C

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

Text 1: Scope of Practice for Healthcare Professionals

A "scope of practice" refers to the procedures, actions, and processes that a
healthcare practitioner is allowed to undertake according to their professional
certification. The scope of practice is limited to that which is legally permitted
for a healthcare professional with a certain level of education and experience, as
well as their level of competency. Each level of jurisdiction has their specific
laws, policies and licensing bodies, which define and regulate scope of practice.
Different facilities, such as hospitals, may have different policies with regards to
the clinical responsibility afforded to a healthcare professional.

There are two types of scope of practice. Core scope of practice refers to the
everyday expectations of a clinician in practice, within that particular unit. These
reflect the clinician's qualifications and training and are considered to be "usual
practice". Advanced scope of practice refers to additional allowances or
responsibilities, and usually specify particular treatments/procedures or
categories of treatments/procedures to be included in the individual's scope of
practice.

Three categories may be useful in identifying a healthcare professional's scope
of practice. The first is education and training – has the person received formal
or on-the-job training and have documentation to prove this? The second relates
to the state or federal government that oversees the individual’s place of
employment – does it allow the skill in question and not explicitly disallow it?
Finally, the particular institution of employment is also relevant – does it also
allow the skill in question and not explicitly disallow it?

Some examples of how scope of practice differs are useful. All states and
provinces who recognise the licensing of registered respiratory therapists (RRTs)
allow them to carry out extracorporeal membrane oxygenation (ECMO) support.
However, some institutions do not allow this. In this case, it is within the
institution’s rights to refuse to allow RRTs working there to perform ECMO.
Therefore, RRTs working at these institutions are not allowed to include ECMO
as part of their scope of practice.

Some environments require alterations to be made to a scope of practice. For


example, allied health professionals who work in a rural or remote area have a
broader scope of practice than those who work in metropolitan areas. They may
be required to undertake activities or procedures that are outside the scope of
practice generally accepted for their profession. This allows them to better meet
the needs of communities in which they work.

Apart from geographical differences, certain significant events may also result in
alterations being made to the scope of practice. For example, during the 2009
H1N1 influenza pandemic, a number of states expanded the scope of practice for
a number of healthcare professions in order to increase the number of clinicians
eligible to provide vaccinations. This was a temporary measure that lasted for
the duration of the emergency and was legally permitted. Other states did not
employ this measure, primarily because the capacity of clinicians to vaccinate
the public in these areas was sufficient.

State governments annually review the scope of practice for routine (non-
emergency) activities to make sure they are meeting the population needs.
Changes to scope of practice must be considered with caution, as they can affect
people in both positive and negative ways. Changes may be seen as a way to
protect the public and give broader access to competent healthcare professionals,
but can also result in turf battles between two or more different professions over
the exclusive rights to perform an activity.

Considering this, healthcare professionals must understand their professional and
individual scope of practice. Some tasks, while they are within the scope of
practice for a profession, may not be permitted under the scope of practice of an
individual. This is often an issue for allied health staff who move from rural or
remote areas to metropolitan areas, where their scope of practice is more limited.
Conversely, allied health staff who formerly worked in a metropolitan area may
find themselves without the skills or experience to meet their scope of practice in
a rural or remote area. In the team environment of the healthcare system, it is
key that each team member can clearly identify and communicate their
professional and individual scope of practice.
Text 1: Questions 7 to 14

7. In the first paragraph, the meaning of the phrase “afforded to” is:
A The clinical responsibility that is paid for by healthcare
professionals.
B The clinical responsibility that can be afforded by healthcare
professionals.
C The clinical responsibility that is given to healthcare
professionals.
D The clinical responsibility that is acceptable to healthcare
professionals.

8. In the second paragraph, core scope of practice refers to:
A The clinician’s expectations of what their work involves.
B The things that a member of the public can expect from the
clinician.
C The things that the unit can expect from the clinician.
D The qualifications and training of the clinician.

9. All of the following are categories that can be applied to identify scope of
practice except:
A The formal or on-the-job training received by the healthcare
professional.
B The state or federal government’s allowance or non-allowance of
an activity.
C The institution’s allowance or non-allowance of an activity.
D A proven history of formal or on-the-job training.

10. The situation for paramedics is similar to that for registered respiratory
therapists because:
A They are both involved in emergency patient care.
B They both have varying scopes of practice.
C They can both perform a percutaneous cricothyrotomy.
D They are both procedures used to help a patient breathe more
effectively.

11. According to the fifth paragraph, the benefit of changes to scope of
practice is:
A The communities in which healthcare professionals work can
have their needs met more effectively.
B The services provided by allied health professionals in rural or
remote areas can be better than those provided in metropolitan
areas.
C Allied health professionals can better serve rural or remote
communities.
D Healthcare professionals can rely more on their judgment when
treating patients, rather than being restricted by their scope of
practice.

12. In the sixth paragraph, the author implies that:
A Some states and provinces were better equipped to prevent the
spread of H1N1 influenza in 2009 than others.
B Healthcare professionals should have their scope of practice
extended permanently to provide vaccinations in case of another
influenza pandemic.
C There was a knee-jerk reaction by some states to contain the
spread of H1N1 influenza in 2009 by expanding their capacity to
deliver vaccinations.
D In some states, healthcare professionals have been allowed to
provide vaccinations since 2009 to prevent the spread of
pandemic influenza.

13. According to the seventh paragraph, the author's opinion on changes to
scope of practice is that:
A Such changes are necessary to protect the public and provide
access to a broader range of competent healthcare professionals.
B Such changes can be politically controversial and have an
ambiguous benefit.
C Such changes lead to conflict between two or more healthcare
professions over the exclusive rights to perform an activity.
D Such changes should be reviewed more frequently than they are
currently.

14. The main message of the article is:
A Scope of practice varies within each profession, so healthcare
professionals should be informed of what their scope of practice
is.
B Scope of practice is dynamic and depends on geographical
factors, individual states or institutions, and significant events.
C Different healthcare professions have different scopes of practice.
D Each member of a healthcare team should be aware of their
individual, as well as professional, scope of practice.

Text 2: Advanced Dementia

Dementia is a significant cause of morbidity and mortality worldwide. In 2014,
approximately 5 million people in the United States had a diagnosis of
Alzheimer's disease, with an estimated 14 million being affected by 2050. Once
diagnosed, patients can survive with the condition for an average of 3 to 12
years. The majority of this time will be spent in the most severe stages of the
disease. As nursing homes are the site of death in most cases, these are an
important factor to consider when studying Alzheimer's disease.

At the moment, no cure exists for dementia or the progression of its disabling
symptoms. The Global Deterioration Scale, which ranges from 1 to 7, is used to
describe the level of disability in patients with dementia. Stage 7 characterises
advanced dementia: profound memory deficits, a virtual absence of the ability to
verbalise, inability to ambulate independently or perform activities of daily
living, and urinary and fecal incontinence. These manifestations result in
complications such as eating problems, episodes of fever and pneumonia.

In order to provide an estimate of survival time for patients with dementia, the
Functional Assessment Staging Tool is commonly used. Although impossible to
quantify accurately in 100% of cases, this tool allows a general prognosis to be
made. This is important because a patient's eligibility for the hospice benefit is
assessed based on their projected survival time as well as history of dementia-
related complications. Some clinicians prefer to use a risk score to predict
survival, as this has slightly better predictive ability. Many consider that the
eligibility of patients for nursing home care should be based on the desire for
such care, rather than prognosis.

The care of patients with advanced dementia revolves around advanced care
planning. This includes educating the patient's family about the prognosis of the
disease and its manifestations, counseling about proxy decision making, and
recording the patient's wishes regarding treatment through an advanced care
directive. Some observational studies have shown that patients with advanced
care directives have better palliative care outcomes: reduced incidence of tube
feeding, fewer hospitalisations during the final stages, and greater likelihood of
enrollment in a hospice.

Decisions about the care of patients should also reflect the goals of such care.
These goals should be agreed upon between the provider, the primary carers, and
ideally, the patient themselves. The goals of treatment, and therefore the
treatment decisions themselves, should be aligned with the patient's wishes as far
as possible. An example of how treatment preferences may vary is whether the
patient would like all medical interventions deemed necessary, only certain
medical interventions, or comfort measures only. In 90% of proxies interviewed
in prospective studies, the latter was reported to be the primary goal of care.

Out of the most common complications of advanced dementia, eating problems
are the most prevalent. These may include oral dysphagia ("pocketing" of food
in the cheek), pharyngeal dysphagia (inability to swallow, leading to the risk of
aspiration), inability to eat independently and refusal. When eating problems
occur, acute causes should always be considered (e.g. dental pathology). The
reversal of such causes should be guided by the previously agreed goals of care.
Chronic or sustained eating problems are most often managed by hand feeding,
tube feeding, or encouragement of food intake through smaller meals, different
textures or high-calorie supplementation.

Infections are another common clinical problem in patients with advanced
dementia, most commonly relating to the urinary or respiratory tract. In 362
nursing home residents with advanced dementia, the Study of Pathogen
Resistance and Exposure to Antimicrobials in Dementia (SPREAD) found that
two thirds were diagnosed with suspected infections within a 12 month period.
Approximately 50% of patients with advanced dementia are diagnosed with
pneumonia in the last 2 weeks of life, and such patients experience a high rate of
death from this cause. However, the use of antimicrobials to treat infections has
been found to increase length of survival but also the level of discomfort in
patients with advanced dementia. Therefore, such treatment may not necessarily
align with the patient's preferences or goals of care.

Improving the care of patients with advanced dementia is becoming an
increasingly recognised issue amongst healthcare providers. Studies of the
experiences of patients with advanced dementia have shown that care which is
focused on patient-centred goals and adherence to patient preferences is most
effective in improving outcomes. In order to achieve this, providers need to be
better equipped to engage patients and their families in advanced care planning,
reduce the use of invasive treatments of limited benefit (such as tube feeding)
and better address distressing clinical symptoms.
Text 2: Questions 15 to 22

15. The Global Deterioration Scale is most useful for providing healthcare
professionals with information about:
A The patient's ability to recall memories, verbalise, ambulate
independently, attend to activities of daily living and control urine
and fecal output.
B A quantification of the patient's degree of disability.
C The likelihood of dementia-related complications.
D The patient's predicted survival time.

16. According to the third paragraph, the main reason for making a general
prognosis about survival time is:
A To provide family members with some idea of the trajectory of
the disease.
B To inform decisions that providers must make about treatment.
C To determine eligibility for nursing home care.
D To determine eligibility for the government subsidy of hospice
care.

17. The best replacement for the word "proxy" in the fourth paragraph would
be:
A substitute
B additional
C carer
D treatment

18. In the fifth paragraph, the author's main argument is that:
A Decisions about care should be guided by its goals, which most
often means comfort care rather than medical interventions.
B Most patients with advanced dementia prefer comfort care to
medical interventions.
C The goals of care should be agreed upon in consultation with the
provider, the family and the patient themselves.
D Treatment preferences vary between individual patients with
advanced dementia.

19. According to the sixth paragraph, eating problems in advanced dementia
may be caused by:
A inappropriate eating practices.
B recent dental procedures.
C aspiration of food.
D refusal to eat independently.

20. In the seventh paragraph, the author suggests that:
A About 50% of people with advanced dementia will suffer from
pneumonia during the last 2 weeks of their life.
B Infections in people with advanced dementia should not always
be treated.
C Within a 12 month period, approximately two thirds of nursing
home residents with advanced dementia are suspected to have an
infection.
D Urinary and respiratory infections are the most common clinical
problem in advanced dementia.

21. Ways in which the care of patients with advanced dementia can be
improved include all the following except:
A Adherence to patient preferences for treatment.
B Better treatment of distressing symptoms.
C Engaging patients and families in advanced care planning.
D Hand feeding instead of tube feeding.

22. The author's approach to the care of patients with advanced dementia
could best be described as:
A practical.
B patient-centred.
C analytical.
D utilitarian.





















END OF READING TEST
Test 1: Answer Key
Part A
Questions 1 to 20
1 D
2 A
3 C
4 B
5 A
6 B
7 C
8 around 40%
9 131 848
10 carbon dioxide
11 worsens
12 early stage lung cancer
13 heart disease and stroke
14 Victoria
15 alveoli
16 breathe
17 lung cancer
18 cilia
19 respiratory illnesses
20 quit

Part B
Questions 1 to 6
1 C All patients receive baseline blood tests
The differential management of infants using
2 A
glucose
Indicators to use in pain management program
3 B
audits
Initiate VTE prophylaxis for all patients identified
4 C
to be at risk
Providing information to patients in their native
5 B
language
Prevent Medicare claims being paid for public
6 A
patients
Part C

Questions 7 to 14

7 C The clinical responsibility that is given to healthcare
professionals.
8 B The things that a member of the public can expect
from the clinician.
9 A The formal or on-the-job training received by the
healthcare professional.
10 B They both have varying scopes of practice.
11 C Allied health professionals can better serve rural or
remote communities.
12 A Some states and provinces were better equipped to
prevent the spread of H1N1 influenza in 2009 than
others.
13 B Such changes can be politically controversial and
have an ambiguous benefit.
14 AScope of practice varies within each profession, so
healthcare professionals should be informed of what
their scope of practice is.
Questions 15 to 22

15 B A quantification of the patient's degree of disability.
16 D To determine eligibility for the government subsidy
of hospice care.
17 A Substitute.
18 A Decisions about care should be guided by its goals,
which most often means comfort care rather than
medical interventions.
19 A Inappropriate eating practices.
20 B Infections in people with advanced dementia should
not always be treated.
21 D Hand feeding instead of tube feeding.
22 B Patient-centred.





END OF KEY
Test 1: Answer Guide

Part A

Text A


Text B
Text C


Text D







Part B

1. The treatment guidelines below recommend that
A Incorrect: this is only recommended for patients taking long term
anticonvulsants
B Incorrect: this is only recommended “if required”.
C Correct: this is the general idea of the text, since it is common
to all patients.
2. This notice is giving information about
A Correct: this is the general idea of the text, since it covers
different management approaches for different glucose levels.
B Incorrect: the instructions for checking an infant’s blood glucose
level are not found in the text.
C Incorrect: In infants with clinical signs, the glucose levels given
are an alternative criterion for following the corresponding
management approach.
3. This information sheet recommends
A Incorrect: the recommended regularity of auditing is not stated.
B Correct: indicators are mentioned several time throughout the
text, and are therefore a main point.
C Incorrect: at least 30% change is also mentioned as being
clinically important, but only moderately.
4. This regulatory statement instructs healthcare professionals to
A Incorrect: patients who are already admitted must be assessed for
VTE risk within 24 hours.
B Incorrect: this only applies to patients discharged home.
C Correct: this is stated in the third dot point.
5. The advice below can best be applied to a healthcare setting by
A Incorrect: consumers refers to patients, not nurses.
B Correct: this would address the example of “using
communication strategies that tailor messages to the
consumer”.
C Incorrect: this doesn’t address partnerships with consumers.
6. The purpose of the document below is to
A Correct: the document outlines ways in which patients can be
proved to be private patients, before Medicare claims are
paid.
B Incorrect: the document goes further than this.
C Incorrect: the document guides healthcare professionals but
doesn’t prevent falsification of claims.
Part C

7. In the first paragraph, the meaning of the phrase “afforded to” is:
A Incorrect: healthcare professionals cannot purchase clinical
responsibility.
B Incorrect: “afforded by” refers to the money that healthcare
professionals can pay for clinical responsibility.
C Correct: “afforded” can mean “allowed” or “given”.
D Incorrect: “afforded” does not mean “acceptable”.
8. In the second paragraph, core scope of practice refers to:
A Incorrect: the clinician’s expectations are not mentioned. Rather,
the expectations OF the clinician are mentioned.
B Correct: “expectations of a clinician in practice” is broad,
therefore it refers to the public in general.
C Incorrect: the unit’s expectations are not mentioned. Rather,
expectations are in the context of working at a particular unit.
D Incorrect: expectations reflect the clinician’s qualifications and
training.
9. All of the following are categories that can be applied to identify scope of
practice except:
A Correct: this can’t be applied to identify scope of practice
unless these are documented.
B Incorrect: this is mentioned as a category in the paragraph: “state
or federal government that oversees the individual’s place of
employment”
C Incorrect: this is mentioned as a category in the paragraph: “does
it also allow the skill in question and not explicitly disallow it?”
D Incorrect: this is mentioned as a category in the paragraph:
“formal or on-the-job training and have documentation to prove
this.
10. The situation for paramedics is similar to that for registered respiratory
therapists because:
A Incorrect: not the reason for their situation being similar.
B Correct: passage states “A similar situation exists for
paramedics. In some states and provinces, paramedics are
allowed to carry out a percutaneous
cricothyrotomy….However, in the states and provinces which
do not allow paramedics to carry out this procedure...”
C Incorrect: this is not similar to the situation for respiratory
therapists, which depends on the institution (not the
state/province) in which they work.
D Incorrect: not the reason for their situation being similar.
11. According to the fifth paragraph, the benefit of changes to scope of
practice is:
A Incorrect: this benefit refers to the scope of practice of ALLIED
health professional.
B Incorrect: they can be different, but not necessarily better due to
limited resources.
C Correct: passage states “Some environments require
alterations to be made to a scope of practice. For example...in
a rural or remote area...better meet the needs of the
communities”
D Incorrect: this is not the reason stated for alternations being
beneficial.
12. In the sixth paragraph, the author implies that:
A Correct: some states were better equipped because “the
capacity of clinicians to vaccinate the public in these areas
was sufficient”
B Incorrect: the author states that this only happened because it was
necessary. Therefore, the answer is too broad.
C Incorrect: “knee-jerk” describes something that is unplanned or
disorganised. The author doesn’t state anything that suggests this.
D Incorrect: this was only for the duration of the pandemic, not
“since 2009”, which implies it is still the case today.
13. According to the seventh paragraph, the author's opinion on changes to
scope of practice is that:
A Incorrect: the passage states “may be seen (meaning “may be
perceived”) as a way to protect the public”.
B Correct: ambiguous benefit is mentioned (“they can affect
those affected by the changes in both positive and negative
ways”) and so is political controversy (“may be seen as a way
to protect the public...but can also result in turf battles
between two or more different professions”)
C Incorrect: the passage states “can result in turf battles”, not “will
result in turf battles”. Therefore, this answer is too broad.
D Incorrect: the author doesn’t criticise the frequency of the
changes.
14. The main message of the article is:
A Correct: this is mentioned in the first (“Each level of
jurisdiction has their specific laws, policies and licensing
bodies...Different facilities, such as hospitals, may have
different policies”) and last (“it is key that each team member
can clearly identify and communicate their...scope of
practice”) paragraph, and supported throughout the article.
B Incorrect: this is factually true, but not really a message to the
reader.
C Incorrect: this is factually true, but not really a message to the
reader.
D Incorrect: this is factually true, but not really a message to the
reader and only mentioned once.
15. The Global Deterioration Scale is most useful for providing healthcare
professionals with information about:
A Incorrect: it is MORE useful for describing the level of disability,
which is based on these factors.
B Correct: the passage states that it can “describe the level of
disability in patients with dementia”.
C Incorrect: it doesn’t predict how likely these complications are.
D Incorrect: not mentioned in the passage.
16. According to the third paragraph, the main reason for making a general
prognosis about survival time is:
A Incorrect: not mentioned as a reason for making a prognosis.
B Incorrect: not mentioned as a reason for making a prognosis.
C Incorrect: eligibility for the hospice benefit, not nursing home
care, is determined.
D Correct: the passage states it is “important because a
patient's eligibility for the hospice benefit is assessed based on
their projected survival time”.
17. The best replacement for the word "proxy" in the fourth paragraph would
be:
A Correct: “proxy” means a substitute, delegate, agent or
representative.
B Incorrect: “proxy” doesn’t mean additional
C Incorrect: “proxy” doesn’t mean carer (a carer is one example of
a proxy)
D Incorrect: “proxy” doesn’t mean treatment

18. In the fifth paragraph, the author's main argument is that:
A Correct: the author states “decisions about the care of
patients should also reflect the goals” and “comfort measures
only. In 90% of proxies ...the latter was reported to be the
primary goal of care”
B Incorrect: most proxies prefer comfort care to medical
interventions.
C Incorrect: this is true, but not the MAIN argument.
D Incorrect: this is true, but not the MAIN argument.
19. According to the sixth paragraph, eating problems in advanced dementia
may be caused by:
A Correct: inappropriate eating practices include “oral
dysphagia”.
B Incorrect: dental pathology is mentioned, but not dental
procedures.
C Incorrect: this is an outcome, not a cause, of eating problems.
D Incorrect: the passage states “refusal to eat”, not “refusal to eat
independently”.
20. In the seventh paragraph, the author suggests that:
A Incorrect: this is too broad, as the passage only states:
“Approximately 50% of patients with advanced dementia are
diagnosed with pneumonia in the last 2 weeks of life” - more
might suffer, but are undiagnosed.
B Correct: the passage states that “such treatment may not
necessarily align with the patient's preferences or goals of
care” and that goals of care should guide treatment decisions
(paragraph 5).
C Incorrect: “two thirds were diagnosed with suspected infections
within a 12 month period” (Diagnosed with, not suspected to
have, infections).
D Incorrect: the passage states that infections are “another common
clinical problem” not the “most common clinical problem”.
21. Ways in which the care of patients with advanced dementia can be
improved include all of the following except:
A Incorrect: the passage mentions this (“care which is focused on
patient-centred goals and adherence to patient preferences”)
B Incorrect: the passage mentions this (“better address distressing
clinical symptoms”)
C Incorrect: the passage mentions this (“better equipped to engage
patients and their families in advanced care planning”)
D Incorrect: this is mentioned as one form of management of
eating problems, but not necessarily an improvement to care.
22. The author's approach to the care of patients with advanced dementia
could best be described as:
A Incorrect: the author’s approach isn’t always practical, such as
when not treating infections.
B Correct: throughout the article, the author refers to patient-
centred care being the best (e.g. “focused on patient-centred
goals and adherence to patient preferences”).
C Incorrect: the author doesn’t analyse all the aspects of care, but
rather, presents an argument that it should be patient-centered.
D Incorrect: this means that the needs of society should be more
important than the needs of the individual. The author argues the
opposite.
Test 2
Part A

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