McGraw-Hill's Evolve Reach (HESI) A2 Nursing Practice Tests PDF

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 Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-180058-7 MHID: 0-07-180058-1 The material in this eBook also appears in the print version of this title: ISBN: 978-0- 07-180057-0, MHID: 0-07-180057-3. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. 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This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Dedicated to the extraordinary nurses at Memorial Sloan-Kettering.  Contents Chapter 1 Introduction to the A2 A2 Versus Other Nursing School Exams Planning to Take the A2 Scoring the A2 Parts of the Test Chapter 2 Tips and Strategies for Test Takers How to Use This Book Strategies for Top Scores A2 Training Schedule Chapter 3 A2 Practice Test 1 Reading Comprehension Vocabulary and General Knowledge Grammar Basic Math Skills Biology Chemistry Anatomy and Physiology Physics Answer Key Explanatory Answers Chapter 4 A2 Practice Test 2 Reading Comprehension Vocabulary and General Knowledge Grammar Basic Math Skills Biology Chemistry Anatomy and Physiology Physics  Answer Key Explanatory Answers Chapter 5 A2 Practice Test 3 Reading Comprehension Vocabulary and General Knowledge Grammar Basic Math Skills Biology Chemistry Anatomy and Physiology Physics Answer Key Explanatory Answers  1 CHAPTER Introduction to the A2 This book contains three practice tests for the Evolve Reach (formerly HESI) A2 (Admission Assessment Exam). They follow the format used in the A2 online exam. Taking these practice tests will give you a good idea of what you’ll encounter when you take the real exam. As you complete the tests, you’ll become familiar with the directions, structure, and content that you’re likely to see at the testing site. A2 VERSUS OTHER NURSING SCHOOL EXAMS Who Takes the A2 Exam? The A2 Exam is used for admission to certain nursing schools. It is a product of Evolve Learning Systems, a division of Elsevier Publishing. Different nursing programs require different exams; for example, some schools expect applicants to take the Nursing Entrance Test (NET) or the Test of Essential Academic Skills (TEAS). Other schools give you a variety of entrance exams from which to choose. Still others require the A2 exclusively. How Do I Know Whether I Should Take the A2 Exam? To know whether the school or schools of your choice require the A2, visit their websites or call their admissions offices. They may call this particular test the HESI A2 test, the Evolve Reach A2 test, or the Admission Assessment Exam. Before you begin to study, make sure that you are studying for the correct test. You may need to use McGraw-Hill’s 5 TEAS Practice Tests or Nursing School Entrance Exams instead. PLANNING TO TAKE THE A2 When Is the A2 Given, and How Do I Register for It? The exam is given at a variety of sites, often at nursing schools or community colleges. The dates of the exam may depend on the application dates for the nursing school where you take the test. Some schools offer the test every few weeks throughout the year. You may also take the exam at one of more than 350 Prometric™ testing sites around the country. To register for an exam, send this information in an e-mail to exam- [email protected]: school, first name, middle name, last name, address, city, state, zip code, phone number, and e-mail address. You will receive a confirmation notice and eligibility ID by return e-mail within three days. Check this material carefully and e-mail Elsevier immediately if there is an error.  To take the exam at the nursing school or community college of your choice, log on to that school’s website to learn how to sign up for the next available test. To take the exam at a Prometric site, log on to http://www.prometric.com/Elsevier. Plugging in your state, clicking “Admission Assessment,” and typing your zip code lets you locate the testing site and date that best suit your needs. From there, you may use your confirmation notice to help schedule the test at a time convenient for you. The cost of the test will vary depending on where you take it. You will pay either the business office of your school or Prometric when you set up your test date. When Should I Take the A2? Check with your chosen nursing programs to find out when they need score transcripts. Then work backward from that date to determine when you should take the test. If you take the test at the nursing school that you hope to attend, the date of the test will be designed to mesh with that school’s application dates. Which Modules of the A2 Must I Take? The A2 contains several modules in the areas of English language, mathematics, and science. Not all nursing programs require every module. If you take the test at a nursing school or community college, the school will probably only test you on the modules that its nursing program requires. For example, some programs do not require any of the science modules. Some require Reading Comprehension and Grammar, but not Vocabulary and General Knowledge. If you wish to send transcripts to several schools, visit their websites to learn which modules they require. Then make sure that the site where you are taking the test offers all of those modules. What Do I Need on the Day of the Test? The A2 is only available online. You must present one form of government-issued identification. Passports, driver’s licenses, or green cards are fine; credit cards or student IDs are not. You may need your payment or a copy of your payment receipt. You will definitely need the username and password assigned to you by Elsevier when you registered for the test. You may not use any resources such as calculators or reference books. A basic calculator is included in the software. You may not carry in a cell phone, tablet, or other electronic device. You may not bring food or beverages into the testing site. SCORING THE A2 How Is the A2 Scored? The A2 consists of eight academic modules (physics, the eighth module, is currently a pilot program and may not be offered until some future date). Your scores may be reported in three ways—as a percentage score for each module administered; as a subject-area composite score (for all science modules, for example); and as a composite score (the average score for all the modules you complete). When Will I Receive My Score? As soon as you complete your online test, you will receive a printed score report from the proctor. How Do I Submit My Score to Nursing Programs? Your testing fee automatically includes the submission of scores to the school where you took the test. If you took the test at a Prometric center, or if you want your transcript sent to additional schools, order transcripts from Elsevier via its website or by calling 1- 800-950-2728. Elsevier will charge a processing fee for each transcript sent. Is My Score Good Enough? Whether your score is acceptable depends on the program to which you are applying. Some nursing programs have specific cutoff points for each module. Others require a certain composite score. Some nursing programs allow you to take the A2 two or three times if your first scores are unacceptable. They may require you to wait several weeks or months between exams. Again, the rules vary from program to program. PARTS OF THE TEST The A2 is divided into eight academic modules within three broad content areas: English language, mathematics, and science. In addition, the A2 may include a section on critical thinking, which may be graded or ungraded, plus one or two ungraded tests under the heading “Learner Profile.” This chart shows the number of items (which may vary year to year) and time suggested for each section. Because the test is given online, the times given are only suggestions that will allow you to complete the entire test within a reasonable time.  FORMAT TIP Rarely will anyone be administered every module on the A2. Check with your preferred nursing program to see which modules it requires. Depending on the modules required, the typical test may run from three to four hours. Reading Comprehension Reading items test your comprehension of informational reading passages. You will be asked to read a short, multiparagraph passage and answer a variety of questions about it. Some of the most common skills tested involve the following: Main idea Supporting details Meanings of words in context Author’s purpose Fact and opinion Drawing conclusions and making inferences Summarizing Author’s tone The passages used for A2 all have a science or health theme and may be typical of the type of reading you will do in your professional life.  FORMAT TIP With the exception of some math questions, all questions on the A2 are multiple choice and give you four possible choices from which to pick. Here is an example of an A2 reading comprehension question. On the test itself, most reading passages will be longer than this one. Counterfeit medicine may be contaminated, or it may contain the wrong or no active ingredient. Counterfeit medicine is illegal and may be dangerous. The quality, safety, and efficacy of counterfeit medicines are not known. Counterfeit medicine is often sold illegally over the Internet or by illegal operators posing as licensed pharmacies. 1. What is the author’s primary purpose in writing this passage? A. To inform B. To persuade C. To entertain D. To analyze Explanatory Answer: This question tests your understanding of the author’s purpose or intent. This author defines counterfeit medicine and presents some facts about it, which indicates that the purpose is to inform (choice A). The author makes no judgments or calls to action, as might take place in a persuasive essay (choice B), and there is no analysis or in-depth investigation of the topic (choice D). Vocabulary and General Knowledge This section of the test includes vocabulary terms that appear regularly in health care contexts as well as in general and academic use. You may be asked to select a word or phrase that defines an underlined word in a sentence or to identify a synonym for a given word. Here are two examples of A2 vocabulary questions. 1. Select the correct definition of the underlined word. The patient received a potent dose of sleeping medication. A. Average B. Invasive C. Powerful D. Initial  Explanatory Answer: Potent means “strong,” so a potent dose is a strong, or powerful, dose (choice C). 2. A person who is compliant is _________. A. flexible B. obedient C. whiny D. appreciative Explanatory Answer: To comply is to act in accordance with a rule or request, so someone who is compliant is obedient (choice B). Grammar The grammar section requires you to locate sentences that are grammatically correct, words or phrases that are not used correctly, and words that best complete a sentence to make it grammatically correct. Questions might focus on any of the following topics, among others: Subject-verb agreement Pronoun-antecedent agreement Misplaced modifiers Pronoun case Serial commas Sentence fragments Run-on sentences Troublesome word pairs (between/among, good/well, fewer/less, its/it’s, lie/lay, etc.) Here are two examples of A2 grammar questions. 1. Select the word or phrase that makes this sentence grammatically correct. Could you please hand ___________ the tongue depressors? A. myself B. me C. I D. ourselves Explanatory Answer: The pronoun required is an object pronoun (it receives the action of the verb), so only me (choice B) completes the sentence correctly.  2. Select the correct order of words to fit the sentence structure. The students placed __________ finished essays over __________; __________ glad to be done. A. there, their, they’re B. they’re, there, their C. their, there, they’re D. their, they’re, there Explanatory Answer: The essays belong to the students and thus are their essays. They placed them in that spot, there. They are (they’re) glad to be done. The correct answer is choice C. FORMAT TIP For questions with multiple answers like the preceding one, all answers must be correct. There is no partial credit. Basic Math Skills The mathematics section of the A2 focuses on the sort of math you may need to use on the job. For that reason, there is an unusual emphasis on measurements and fractions. Here are some of the subskills that you might see on the test: Computation (addition, subtraction, multiplication, division) with whole numbers Computation with decimals Computation with fractions Fractions, decimals, and percentages Ratios and proportions Money Military time Roman numerals Measurement conversions FORMAT TIP A few items in the math section may be short answer—you must compute the answer rather than choosing from four possible responses. Here are two examples of A2 basic math questions.  1. Multiply: (4.3)(3.4) = A. 146.2 B. 14.62 C. 12.12 D. 7.7 Explanatory Answer: Many questions of this sort may be easily answered by estimating. 4.3 × 3.4 will be somewhere midway between 4 × 3 and 4 × 4, so choices A and D are clearly incorrect. The answer is choice B. 2. How many fluid ounces are in a pint? (Enter numeric value only.) _____________ Explanatory Answer: There are 8 ounces in a cup and 2 cups in a pint, so the answer is 16. TIPS FROM TEST TAKERS Know your conversions, especially liquid measurements. Study a chart of metric-to-standard conversions, too! No conversion chart appears with the test, so you must have these memorized. Biology The biology tested on the A2 is basic, which does not mean that it is easy. Expect to see questions on any of these topics: Scientific method Taxonomy Molecules Cells Photosynthesis Cellular reproduction Genetics Here are two examples of A2 biology questions. 1. What is the result of meiosis II? A. Two secondary sex cells B. Four haploid daughter cells  C. Two primary sex cells D. Duplication of primary sex cells Explanatory Answer: Mitosis results in two primary sex cells (choice C), and meiosis I leads to two secondary sex cells (choice A). In meiosis II, the resulting four cells have half the chromosomes of the parent cell. The answer is choice B. 2. Which organelle in animal cells is most similar in function to the chloroplast in plant cells? A. Cell membrane B. Vacuole C. Ribosome D. Mitochondrion Explanatory Answer: Chloroplasts are the site of photosynthesis, or energy conversion, in plants. Mitochondria are the site of respiration, or energy conversion, in animals. The answer is choice D. Chemistry Organic and inorganic chemistry are tested on the A2. All health professionals should have a basic understanding of chemistry. You may find questions on any of these topics: States of matter Atomic structure Chemical equations Chemical reactions Acids and bases Radioactivity Chemical bonds Molarity Stoichiometry Reaction rates Redox reactions Electron configurations TIPS FROM TEST TAKERS  Review the periodic table of elements, and know the basics! Unlike some tests, the A2 doesn’t show you the table. Here are two examples of A2 chemistry questions. 1. What is the expected pH of orange juice? A. Between 3.0 and 4.0 B. Between 6.0 and 7.0 C. Between 8.0 and 9.0 D. Between 11.0 and 12.0 Explanatory Answer: Orange juice is fairly acidic, meaning that it would fall toward the lower end of the pH scale. The answer is A. 2. Sodium’s ground state electron configuration may be represented as 1s22s22p63s. How many energy levels does sodium have? A. 1 B. 2 C. 3 D. 6 Explanatory Answer: The first energy level of any atom contains just an s subshell. The second may include an s and a p subshell. Looking at sodium in table form may make this easier to solve: 1s2 2s22p6 3s Explanatory Answer: Sodium, in other words, has electrons in three energy levels, so the answer is C. In the first level, it has two electrons in subshell s. In the second level, it has two electrons in subshell s and six electrons in subshell p. In the third level, it has one electron in subshell s. Adding up the electrons, , gives you the total number of electrons in sodium, or sodium’s atomic number, 11. Anatomy and Physiology  This is the part of biological sciences that applies specifically to nursing—the human body and its systems, organs, and processes. You may see any of these topics on the A2: Cells and tissues Body planes and directions Skeletal system Muscular system Nervous system Endocrine system Circulatory system Respiratory system Digestive system Urinary system Reproductive system TIPS FROM TEST TAKERS Review basic anatomical directions (proximal, distal, and so on) and know your organs and functions! Here are two examples of A2 anatomy and physiology questions. 1. Which arm bone is most proximal to the shoulder? A. Radius B. Ulna C. Humerus D. Carpal Explanatory Answer: To be proximal is to be close to the point of attachment. The radius (choice A) and ulna (choice B) are forearm bones, and the carpal (choice D) is in the wrist. Of the four bones listed, the humerus (choice C) is the arm bone that is closest to the shoulder. 2. Somatotropin is secreted by the __________. A. pituitary gland B. adrenal glands C. hypothalamus D. thyroid  Explanatory Answer: Somatotropin is also known as growth hormone. It is secreted by the pituitary, which regulates growth. The answer is choice A. Physics At present, physics is an experimental part of the A2. This section of the test focuses specifically on those skills a radiologist or other imaging scientist might need. Most of the physics section is set up as problems. Tested topics may include: Speed and acceleration Momentum Linear and rotational motion Newton’s laws Kinetic and potential energy Gravitation Wave classification and theory Optics Static electricity Coulomb’s law Electric fields and charges Currents, voltage, and resistance Ohm’s law Here are two examples of A2 physics questions. 1. A go-kart is set into motion with an initial speed of 5 m/sec. It moves for 20 seconds. At the end of that time, its speed is 25 m/sec. What is the magnitude of the go-kart’s acceleration? A. 1.0 m/sec2 B. 2.5 m/sec2 C. 15 m/sec2 D. 20 m/sec2 Explanatory Answer: Find acceleration by dividing the change in velocity by the length of time the object is in motion: The answer is A.  2. In one minute, 15 waves break onto the shore. What is the frequency of the waves? A. 0.15 Hz B. 0.2 Hz C. 0.25 Hz D. 0.4 Hz Explanatory Answer: To find frequency, first find period, the time in seconds between one crest and the next. In this case, Frequency is the reciprocal of period, expressed in seconds –1, or Hertz. The answer is choice C. TIPS FROM TEST TAKERS Review all your basic formulas—especially those for motion, force and work, power, gravitation, and electricity. Most physics questions will be problems that require those equations. Critical Thinking You have not yet worked as a nurse, but your program administrators may want to know how well you are able to apply common sense and critical thinking to specific nursing situations. This section may set up scenarios and ask you to choose among four strategies to triage patients or to deal with a specific medical or ethical situation. It looks at your ability to solve problems, to prioritize, to dissect arguments, to interpret data, and to overcome biases. Some nursing programs use the Critical Thinking section as a pre- and posttest to see how well students improve over the course of training. Others require a particular score for entry. There is no way to study for this section, although some students recommend reading through a practical nursing guide if you know that your chosen nursing program requires a high score on this section. Learning Style This part of the test, which is not graded, assesses your preferred learning style and provides you with study tips based on your responses. Because you cannot study for this part of the test, which is purely subjective, we will not cover it in this book. Personality Profile This ungraded part of the A2 determines your level of introversion or extroversion and classifies your personality type. It is primarily to be used by your teachers in your chosen nursing program. We will not discuss this part of the test in this book.  2 CHAPTER Tips and Strategies for Test Takers HOW TO USE THIS BOOK Preparing for the A2 ahead of time is worth the effort. This book will help you to do the following: Familiarize yourself with the test format Recognize the skills tested on the A2 Practice your test-taking skills using sample A2 exams Here is a practical study program that will help you make the best use of this book. The amount of study and review you do between tests will depend on what weaknesses you discover as you assess your responses and compare them to the explanatory answers that follow each test. Step 1: Think About Your Weaknesses If it has been a long time since you took biology or thought about parts of speech or algebraic equations, you might want to brush up on those long-lost skills. Chapter 1 of this book lists the major skills that are covered on the A2. If your preferred nursing program requires some of the science sections of the A2, you may need to review formulas, anatomy, the periodic table, and so on—even before you take your first practice test. Build some review time into your test-prep schedule. Pull out your old textbooks, go to the library, or do some online review. Step 2: Take the Practice Tests There are three practice tests, and each contains eight modules, just as the real A2 does. If you know which modules are required by your chosen school or schools, focus on those and ignore the others. As you take each test, try to simulate actual test conditions. Sit in a quiet room, time yourself, and work through as much of the test as time allows. If you wish, take a break after each section of the test. When you are done, check your answers against the explanatory answers that follow the test you took. Use the explanatory answers to figure out where you went wrong on any questions you did not answer correctly. The practice tests in this book are parallel. This means that in most cases, similarly numbered questions on tests 1, 2, and 3 will measure the same sort of skill. This fact will help you to determine where your problem areas are. For example, if you consistently miss question number 3 in the Basic Math Skills section of practice tests 1, 2, and 3, you will know that you need to study up on the concept of ratios.  Keep in mind that you will be taking the real test online. That may affect the speed with which you read questions or respond. Step 3: Review and Improve Each time you take a practice test, review the explanatory answers. Give yourself a break of a few days. Then take the next practice test and see whether you do better. Look for patterns. Did you miss the same kinds of questions on practice tests 1 and 2? Make a list of skills to review, and do some serious studying before you take practice test 3. If you have kept track of your weaknesses and studied those skills in depth, you should see a noticeable improvement in your score. TIPS FROM TEST TAKERS No review book or sample test will provide you with all the material you need to study, especially when it comes to the Anatomy and Physiology (A&P) section of the test. Pull out your old anatomy books and spend some time reviewing before you take a practice test. STRATEGIES FOR TOP SCORES As with any test, you can use certain strategies to improve your A2 score. You already know whether you are better at math or at science, or whether you understand grammar well enough to score high on that part of the test. STUDY STRATEGIES Get to know the format of the exam. The practice tests in this book are designed to be similar to what you will see on the A2. Get to know the test directions. The A2 is not different from other multiple- choice tests you have taken over the years. There are always four choices, and most questions are stand-alone or refer to a given passage or problem. Only in the math section are there occasional short-answer questions where choices are not given. Get to know what topics are covered. Chapter 1 lists the major skills that are covered on the A2. Test and review. If possible, give yourself time to take each of the practice tests in this book. These are long tests, so you will need to map out big chunks of time with breaks in between. Do not plan to take more than one test in a day. Study the answers, look for patterns, and review those skills that consistently cause problems for you. TEST-TAKING STRATEGIES Answer all the questions! Your time is limited across the entire test, but depending on where you take the exam, you may be able to spend more time on chemistry and less on reading comprehension if you prefer. Unfortunately, the A2 is  given in a format that does not allow you to go back and review questions you may have had trouble on, so do your best with each question as it is presented. Use the process of elimination. Even if you feel completely stumped, you will probably be able to eliminate one or more choices simply by using common sense. That improves your odds of getting the right answer. When in doubt, guess. On the A2, every question has the same value, and no points are taken off for guessing. Use the process of elimination, but if you’re baffled, go ahead and guess. On multiple-choice questions with four possible responses, you have a 25 percent chance of getting the answer right by guessing. If you leave the answer blank, your chance drops to zero. Beware of answer choices that look reasonable but are not correct. Because most questions on the A2 are multiple choice, the test makers have many chances to mislead you with tricky distracters (wrong answers). Focus, use scratch paper to solve problems if it is allowed, and use the process of elimination to help narrow your choices. TIPS FOR TEST DAY Get a good night’s sleep. You need energy to face a test that is more than three hours long, and you won’t have energy if you’re exhausted from worry or from excessive last-minute review. If you have taken all three practice tests, reviewed those skills that troubled you, and improved your scores on your final test, you have done what you need to do to succeed. Arriving at the test site well rested and alert will improve your chances dramatically. Be careful as you indicate your answers. The computer-based A2 does not allow you to go back and fix questions. Make sure that you answer questions as they are presented. If you use the calculator provided in the software, double-check your answers. TIPS FROM TEST TAKERS Buttons on the online calculator can occasionally “stick,” so be sure to estimate your answers and not rely entirely on the calculator. Watch the time. Wear a watch and check yourself from time to time. If you have timed yourself on the practice tests, you should be pretty good at estimating the time you have left as you progress through the A2. Individual sections may not be timed, but you may have an overall time deadline; you will be told this as you begin the exam. A2 TRAINING SCHEDULE Are you ready to get started? Use this sample schedule to plan your attack.  CHAPTER 3 A2 Practice Test 1 READING COMPREHENSION 47 items Suggested time: 60 minutes High Fructose Corn Syrup Lately, there has been a lot of discussion—within the medical community as well as across the kitchen table—about the supposed harmful effects that high fructose corn syrup (HFCS) has on the human body. Many people wonder if its use as a sweetener is contributing to the population’s overall rate of obesity. In the late 1970s, many of the largest food manufacturers in the United States shifted away from using refined table sugar to using the much cheaper HFCS. Soon HFCS was used to sweeten many products including cereal, steak sauce, soft drinks, bread, baked beans, and yogurt. Table sugar and HFCS share a similar biochemical structure: both contain the simple sugars glucose and fructose, though HFCS is produced from corn and undergoes additional processing to increase the amount of fructose. The American Medical Association does not take the view that one sweetener is better or worse than another. However, researchers at Princeton University have recently released a study showing that rats who consumed HFCS gained more weight, especially in the abdominal area, than rats who consumed table sugar. Other medical professionals say that more research is needed before conclusive results can be drawn. Meanwhile, nearly everyone can agree that both table sugar and HFCS are high in calories—nearly 50 per tablespoon—and that neither form of sweetener provides any measurable nutritional value. 1. What is the main idea of the passage? A. The American Medical Association has identified preferred sweeteners. B. High fructose corn syrup may be contributing to obesity in America. C. Refined table sugar is a natural product, whereas corn syrup is manufactured. D. Rats show a decided preference for high fructose corn syrup over other sweeteners. 2. Which of the following is not listed as a detail in the passage? A. HFCS and sugar share a biological structure.  B. HFCS is cheaper to use than sugar is. C. HFCS is now used to sweeten a variety of products. D. HFCS contains more calories than aspartame does. 3. What is the author’s primary purpose in writing this essay? A. To inform B. To persuade C. To entertain D. To analyze 4. Choose the best summary of the passage. A. After extensive studies of HFCS and its effect on humans, scientists recommend its removal from grocery products. B. A recent study on rats seems to confirm doctors’ suspicions that HFCS is contributing to people’s unhealthful weight gains. C. Until more research is done on HFCS, people are better off using it than replacing it with refined sugar. D. The AMA suggests that avoiding HFCS can have immediate, healthful results on overweight patients. Hypertension The term hypertension is used to describe the condition of chronically high blood pressure. People who are obese, experience a lot of stress, smoke tobacco products, have a diet with too much salt in it, or have diabetes are often at a higher risk for hypertension. As well, African Americans are more likely to have hypertension than other population groups. Hypertension often develops over many years. Older people are most often diagnosed with hypertension. One reason for this is that blood vessels lose elasticity and stiffen as a person ages. This creates more resistance to the blood flowing through the body and elevates blood pressure. Symptoms of hypertension can include blurred vision, headaches, a buzzing in the ears, fatigue, an irregular heartbeat, and nosebleeds. Hypertension that goes untreated over a period of time can lead to serious complications such as kidney disease, heart disease, loss of vision, heart attack, brain damage, and even early death. Fortunately, treating hypertension reduces blood pressure and can lower the risk of complications. For many people, losing weight can result in a significant decrease in blood pressure. For others, physicians may prescribe one or more medications to help bring blood pressure down into a safe range. One thing is certain: physicians believe that people over the age of 20 should monitor their blood pressure by having it checked at least once a year. Those with a history of hypertension in the immediate family should have it checked more frequently. 5. What does the term elasticity mean, as used in the second paragraph?  A. Firmness B. Compactness C. Flexibility D. Rigidity 6. Which is the best title for this passage? A. “How to Manage Hypertension Successfully” B. “Doctors Discover the Hidden Dangers of Hypertension” C. “Doctors Work to Understand the Causes of Hypertension” D. “Causes, Symptoms, Complications, and Management of Hypertension” 7. Which of the following statements is an opinion? A. Obese people are at risk for hypertension. B. Losing weight can decrease blood pressure. C. Older people must pay attention to their blood pressure. D. Blurred vision or dizziness may be a sign of hypertension. 8. Which statement would not be inferred by the reader? A. Maintaining a healthy weight may help to prevent hypertension. B. There is presently no reliable treatment for hypertension. C. Your ethnicity may contribute to your risk for hypertension. D. A 60-year-old is more likely to have hypertension than a teenager is. Concussion A concussion is a traumatic injury to the brain that can interfere with the way the brain processes information and functions. A concussion often results in severe headaches, diminished alertness, and even unconsciousness. While more than one million people in the United States suffer concussions every year, many believe that, like people, no two concussions are identical. Recently two professional baseball players suffered concussions. The first player was injured early in the season and tried twice to return to regular play, but was not medically cleared to play until the following year. Even after eight months, this player reported a recurring condition of “fogginess” that seemed to linger. The second player had brief symptoms of sleepiness and involuntary movement, or “shakiness.” A few days later, and after several tests, the second player reported that the effects of the concussion had subsided, and he was cleared to play. No matter the duration of a person’s recovery, refraining from trying to do too much, too soon is vital. A specialist at Boston University’s Center for the Study of Traumatic Encephalopathy believes that someone who suffers a second concussion while still recovering from the first risks an even longer recovery. Full recovery from concussions is possible. Problems are seldom permanent, and for most people who have had a concussion, the long-term prognosis is typically excellent. The first baseball player recently returned to his team. And though he was told by his physician that he has no greater risk than anyone else of suffering another concussion, other physicians believe that suffering one sports-related concussion increases the likelihood of suffering another. 9. Which of the following is not listed as a detail in the passage? A. Football and lacrosse players suffer the most concussions. B. More than a million Americans a year suffer concussions. C. Concussions may result in diminished alertness. D. It may take longer to recover from a second concussion. 10. What is the meaning of the word diminished as used in the first paragraph? A. Miniature B. Reduced C. Recurrent D. Hollow 11. Choose the best summary of the passage. A. No two concussions are alike. Some people may recover easily from concussion, while others may take weeks or months. In any case, receiving a second concussion too soon may mean a lengthy recovery. B. When baseball players receive concussions, some take a long time to recover. Some may try to return to play too soon and receive a second concussion that ends their careers. C. Although most athletes shrug off concussions, they would be wise to take them seriously. Multiple concussions can cause serious harm to the brain, which is rattled around in the skull with each injury. D. Recovery from concussion is possible, but it is not always a good idea to return to play too soon. Some head injuries are called concussions but do not really qualify as such. 12. What is the author’s primary purpose in writing this essay? A. To entertain B. To analyze C. To reflect D. To inform 13. Which statement would not be inferred by the reader? A. Athletes should be careful after a first concussion. B. Severe headache after a fall may be a sign of concussion. C. Sports-related concussions are riskier than other kinds. D. Symptoms of concussion may linger for more than six months.  Sickle-Cell Anemia Healthy red blood cells are shaped like a disc. Each cell contains the protein hemoglobin, which carries oxygen throughout the body. In some people, a crescent- shaped cell forms instead of the normal discshaped cell. The crescent-shaped cells contain abnormal hemoglobin. These sickle-shaped cells are fragile and are unable to carry oxygen properly throughout the body. Sickle-cell anemia is an inherited disease that affects about 72,000 people in the United States. It is more common among people of South American or African descent. The genes for sickle-cell anemia are inherited from both parents. When both parents carry a gene for the trait for sickle-cell, there is a one in four chance that they will pass the disease on to their children. Symptoms of sickle-cell anemia can include sudden occurrences of extreme abdominal and back pain, bone pain, fever, fatigue, and a rapid heart rate. One patient compared the pain in his back to a jackhammer and said the pain could take over his entire body. Another patient, an eight-year-old girl, described fevers and the feeling of someone squeezing her arms and legs. Cycles of symptoms are often unpredictable and can occur infrequently or almost constantly. Some people who are affected report weekly occurrences of persistent pain, while others report occurrences once a month. Some report that relief comes only by using powerful painkillers. For others, relief comes with bed rest and a hot-water bottle. Most agree that while the challenges of managing sickle-cell anemia are great, with diligent care, it can be managed. 14. What is the main idea of the passage? A. Bone pain is a typical sign of sickle-cell anemia. B. Without enough oxygen, the body can break down. C. Genetically inherited diseases affect thousands. D. Sickle-cell anemia is a painful, inherited disease. 15. What is the meaning of the word diligent as used in the last paragraph? A. Dispersed B. Incensed C. Painstaking D. Demanding 16. Identify the overall tone of the essay. A. Informal B. Insensitive C. Grim D. Uplifting 17. Which of the following is not listed as a detail in the passage? A. People of African descent may be prone to sickle-cell anemia.  B. Symptoms of sickle-cell anemia may include abdominal pain. C. The red blood cells of sickle-cell patients are unusually shaped. D. Vitamin and mineral deficiencies may result in some anemia. Toxins and Your Health Lie out in the sun too much today—and get skin cancer 20 years from now. Smoke too many cigarettes now—and get lung cancer decades down the road. Now there is potentially a third danger to add to this list: be exposed to too much lead, pesticides, or mercury now and have your aging brain become seriously confused during your senior years. “We’re trying to offer a caution that a portion of what has been called normal aging might in fact be due to ubiquitous environmental exposures like lead,” says Dr. Brian Schwartz of Johns Hopkins University. “The fact that it’s happening with lead is the first proof of the principle that it’s possible.” A new area of medical research is one that studies how exposure to toxic elements in younger years can result in serious health problems in senior years. It is difficult to research these problems because the only way to do so is to observe people over many years. Physicians test for lead amounts by seeing how much has accumulated in a person’s shinbone. Testing the blood also often reveals amounts of lead, but that is a sign of recent, not lifelong, exposure. The higher the lifetime lead dose, according to the study, the worse the performance of mental functions, including verbal and visual memory and language ability. 18. A reader might infer from this passage that __________. A. most dangerous lead exposure happens later in life B. doctors are concerned about what happens to the brain during aging C. shinbones are good indicators of many health ailments or conditions D. blood tests are the best way to measure individuals’ lifetime lead exposure 19. Which of the following statements is an opinion? A. Smoking cigarettes today may lead to lung cancer later. B. Doctors are studying the results of exposure to toxic elements. C. People with dementia should be tested for lead exposure. D. Researchers test the shinbone to look for built-up toxins. 20. What is the meaning of the word exposed as used in the first paragraph? A. Uncovered B. Subjected C. Visible D. Divulged  21. What is the main idea of the passage? A. Environmental toxins may have dire health effects over time. B. Of three toxins studied, lead has the worst effect on health. C. Toxins may accumulate in the bones of older patients. D. Johns Hopkins University has discovered a new use for lead. Yoga Yoga is an exercise that everyone should try. Yoga was first practiced thousands of years ago. It helps connect the mind and body by taking a person through a series of poses while emphasizing controlled breathing and meditation. Every year hundreds of thousands of people enjoy the benefits of yoga by treating the movements and postures as exercise. Yoga works by safely stretching muscles, ligaments, and tendons. This helps release the buildup of lactic acid in the muscles that can often cause stiffness, tension, and even pain. Yoga helps develop the body’s range of mobility and increases the ease of everyday movements. Many participants report improved flexibility, especially in the trunk and shoulders, after only two months of practice. Yoga improves posture, balance, and sleep, and it also helps with weight control. Physically, many yoga poses help build upper-body strength, which is increasingly important as the body ages. Other poses help strengthen the muscles in the lower back, and when properly practiced, nearly all of the poses strengthen the body’s abdominal, or core, muscles. This helps improve the circulation of blood that increases the delivery of nutrients and oxygen to the body and also removes wastes produced by the body. When combined with yoga’s benefit of lowering a person’s heart rate, the result is increased cardiovascular endurance. The University of Maryland School of Nursing recently published a study that showed yoga was especially effective at reducing stress. In addition, researchers found that yoga surpassed traditional aerobic exercise, often significantly, in improving flexibility, pain tolerance, and daily energy levels. One enthusiast says that her advice to skeptics is simple, “Take a deep breath, stretch, and indulge in a few poses. You’ll feel better.” 22. Identify the overall tone of the essay. A. Earnest B. Negative C. Self-satisfied D. Skeptical 23. What is the meaning of the word tolerance as used in the last paragraph? A. Open-mindedness B. Approval C. Endurance  D. Generosity 24. The passage lists all of these benefits of yoga EXCEPT. A. improved circulation B. strengthening of core muscles C. stress reduction D. fortification of immune system 25. What is the author’s primary purpose in writing this essay? A. To persuade B. To entertain C. To analyze D. To reflect Super Foods Super foods are whole, unprocessed foods such as blueberries, walnuts, beans, oats, and broccoli. Spinach, yogurt, and pomegranates are also super foods. They are classified as such because they contain high levels of essential nutrients, are low in calories, and can often help prevent—and even reverse—some of the common effects of aging including cardiovascular disease, type 2 diabetes, high blood pressure, and certain types of cancer. Super foods help lower cholesterol levels in the blood and, some researchers believe, even improve a person’s mood. High on the list of super foods are blueberries, fresh or frozen, which are loaded with vitamin C, antioxidants, and potassium. Blueberries are also an anti-inflammatory, which many researchers and nutritionists believe is beneficial. Lentils are a super food that helps prevent a spike in insulin levels that can increase body fat. Lentils are high in both fiber and protein, each of which contributes to stabilizing blood sugar levels and reducing excess fat, especially in the stomach area. Walnuts are a plant-based source of essential unsaturated omega-3 fatty acids, which can improve cholesterol and lower the risk of heart disease by as much as 50 percent. All oats are healthful. Oats, even instant oatmeal, are digested slowly while providing up to five grams of fiber per serving. As physicians and nutritionists continue to study super foods and their effects, consumers continue to educate themselves about the variety of benefits. In an era when consumers question the origin and nutritional value of much of the food on store shelves, super foods are some of the most healthful and natural whole foods available. 26. The passage mentions all of the following claims for the health benefits of super foods EXCEPT __________. A. lowering cholesterol B. stabilizing insulin levels C. building muscle mass  D. reducing blood pressure 27. What is the meaning of the word unprocessed as used in the first paragraph? A. Natural and untreated B. Made of vegetable matter C. Home grown D. Uncirculated or undigested 28. Which statement would not be inferred by the reader? A. Instant oatmeal can be part of a healthful breakfast. B. Blueberries are an especially healthful food. C. Certain grains and dairy products are super foods. D. Super foods are more expensive than processed foods. 29. Which of the following statements is an opinion? A. Walnuts contain omega-3 fatty acids. B. Lentils are high in both protein and fiber. C. Pomegranates are delicious and healthful. D. Oats move slowly through the digestive tract. 30. What is the main idea of the passage? A. Super foods are low in calories but provide essential nutrients that have enormous health benefits. B. U.S. supermarkets should make a point of stocking up on powerful super foods. C. Blueberries are a super food that contains a natural inflammatory as well as important vitamins and minerals. D. Doctors now believe that daily inclusion of super foods in the diet can reverse the aging process. Aromatherapy—Fact or Fiction? For years, aromatherapy has been touted as a safe and natural way to relax and even heal. Essential oils from a variety of scents have been added to candles and sprays to help people feel better. However, a recent study performed at Ohio State University says that these smells, as nice as they may be, do not do a thing to improve people’s health. To find out if aromatherapy actually works, the researchers tested two of the most popular scents: lemon and lavender. First, test subjects had their heart rate, blood pressure, stress hormones, and immune function measured and noted. Next, they were subjected to mild stress-ors and then told to sniff one of the scents to see if the scent would help them to relax. Finally, all the subjects were tested again to look for improvement. No significant changes were noted—even in people who had previously stated they were true believers in the power of aromatherapy.  Of course, this does not necessarily prove that aromatherapy is worthless, either. It was just one small study, pitted against the opinions of thousands of consumers who swear by peppermint on their pillow for an upset stomach or vanilla for a headache. More tests will be done, but in the meantime, a whiff of lavender, lemon, or other scents will certainly do no harm—and can be quite pleasant at the same time. 31. Which of the following is a conclusion that a reader can draw from this passage? A. Aromatherapy is not a legitimate therapy by anyone’s standards. B. Lemon and lavender are not healthy scents to inhale or use. C. More studies are needed to determine if aromatherapy is truly beneficial. D. Adding aromatherapy to regular treatment will help speed healing. 32. What is the meaning of the word touted as used in the first paragraph? A. Revealed B. Glorified C. Overcome D. Deceived 33. Identify the overall tone of the essay. A. Congratulatory B. Uncertain C. Annoyed D. Distressed 34. Which of the following is not listed as a detail in the passage? A. Subjects were given mild stressors. B. Lemon and lavender scents were tested. C. Vanilla worked better than lemon for stress. D. The study took place at Ohio State University. An Old Form of Running Is New Again Barefoot running is a rapidly growing movement that encourages people to leave their shoes at home and take to the streets in only their bare feet. Barefoot running advocates are quick to point out that while shoe technology has advanced significantly since the advent of the modern running shoe, there has been little decline in the number of injuries that occur from running. Humankind has been running for millions of years, and modern running shoes have existed for less than 50 years. By wearing larger shoes with excessive cushioning we are changing the biomechanics of how we run, thereby increasing the likelihood for injury. Early humans ran with a “forefoot strike,” landing closer to the balls of their feet and using their foot’s natural arch as a spring to store and release energy. Modern shoe designs encourage a “heel strike,” landing on the heel and rolling forward to the toe. Barefoot running advocates believe “heel striking” replaces your reliance on the natural mechanics of your feet with the cushioning provided by your shoes, and that this is what causes many of the injuries affecting runners today. Critics assert that while our feet may have been designed for barefoot running, our road surfaces were not. Concrete and asphalt are much firmer than any surface where our human ancestors would have been running. Broken glass and debris also may make barefoot running a significant challenge. There is little consensus when it comes to the safety and effectiveness of barefoot running, but even the most skeptical of podiatrists will agree that wearing heavily padded shoes too often can result in a weaker foot and leg structure. Spend some extra time walking barefoot around your house; aside from building up the muscles and tendons that strengthen your feet, you may just find yourself tempted to go for a run. 35. Which might be a good title for this passage? A. “Everyone Should Run Barefoot” B. “How to Prevent Running Injuries” C. “Modern Road Surfaces Versus Barefoot Running” D. “The Debate over Barefoot Running” 36. What is the meaning of the word consensus as it is used in the last paragraph? A. Investigation B. Purpose C. Trepidation D. Unanimity 37. Which statement would not be inferred by the reader? A. Runners who take their shoes off may face some hazards. B. Modern running shoes may increase the odds for injury. C. Walking barefoot is good for the muscles and tendons. D. Before 1950, even Olympic runners ran barefoot. 38. Which of the following statements is an opinion? A. Running barefoot is natural and advantageous. B. The cost of modern running shoes keeps increasing. C. Concrete sidewalks are harder than dirt paths. D. The arch of the foot gives a spring to the step. The Sleep Workout Developing muscle growth is an effective way to stay healthy as we get older, but many people find it difficult to develop this muscle growth, even after modifying their exercise routine and food intake. What many people may not realize is that getting the proper amount of uninterrupted sleep plays a major role in the development of muscle. The hard work of developing muscle is done in the gym, on a track, or on the court, but the actual growth takes places during the rest periods that follow a workout. Your body immediately begins rebuilding the muscle fibers that were broken down during the course of your workout. Much of this process is carried out while you are sleeping, so without a full night of sleep, muscle fibers will not have the opportunity to rebuild. Human growth hormone (HGH) is an amino acid that is central to regulating metabolism, building muscle, facilitating calcium retention, and stimulating the immune system. The amount of HGH in your body spikes significantly during deep sleep, which makes getting at least 7 to 10 hours of sleep every night imperative to anyone hoping to develop additional muscle growth. Recent studies have linked inadequate amounts of sleep to lowered levels of leptin, a hormone in the brain that controls appetite. Test subjects who received less sleep, or frequently interrupted sleep, would crave carbohydrates even after their caloric needs reached satiety. This can contribute to obesity and negatively affect any good habits people may have developed with regard to food intake. 39. What is the main idea of the passage? A. Insufficient sleep can lead to obesity. B. Insufficient sleep inhibits the natural release of human growth hormone in the human body. C. Getting the proper amount of uninterrupted sleep plays a major role in the development of muscle. D. Developing muscle growth is an effective way to stay healthy as we get older. 40. The term satiety, as used in the last paragraph, can best be defined as __________. A. a state of tiredness B. a state of being satisfied C. a state of being overloaded D. a state of confusion 41. In this passage, which of the following is not mentioned as a role of HGH in the human body? A. Regulating the metabolism B. Stimulating the immune system C. Regulating leptin, an appetite-controlling hormone D. Facilitating calcium retention 42. What conclusion can the reader draw after reading this passage? A. Getting uninterrupted sleep is more important than getting enough sleep.  B. Insufficient sleep may result in an increased risk for obesity. C. Human growth hormone is not essential for muscle development. D. Leptin is essential for building muscle. Sunny-Side Up Most people are familiar with the damaging effects of the sun on unprotected skin, but not enough attention is paid to the many positive effects of receiving direct exposure to sunlight on a regular basis. The most compelling argument for increased exposure to sunlight is the need for vitamin D in the human body. Vitamin D is integral for maintaining healthy bones and preventing diseases like rickets and osteoporosis. It is synthesized by the skin when it comes into contact with the UVB rays found in sunlight. In order to ensure you are receiving the proper amount of vitamin D, it is recommended to get 15 minutes of direct exposure to sunlight at least two or three times a week. UVB rays are made less intense when passing through clouds and pollution, and they will not transmit through glass or sunscreen. UVB rays are also less effective the farther you are from the equator. People with darker skin require more exposure to the sun to receive the same amount of vitamin D. In addition to vitamin D, sunlight will help regulate the circadian rhythms that ensure you get a good night’s sleep. Sunlight helps to prevent an overactive immune system, which may prove useful in preventing autoimmune diseases like psoriasis and lupus. Recent studies have even shown that sunlight can help lessen the symptoms of Alzheimer’s disease. The negative impacts of excess exposure to sunlight should not be ignored; cancers resulting from skin damage are a real concern that must be taken seriously. But the importance of vitamin D and the other positive impacts of sunlight make a compelling argument for making sure we are spending enough time every week in direct sunlight. 43. What is the main idea of the passage? A. There are many positive effects of receiving direct exposure to sunlight. B. The negative impacts of sunlight should not be ignored. C. Vitamin D is integral for maintaining healthy bones and preventing diseases. D. Vitamin D is synthesized by our bodies in reaction to direct sunlight. 44. The term compelling, as used in the second paragraph, can best be defined as __________. A. reasonable B. convincing C. common D. worthwhile 45. What is the author’s primary purpose in writing this essay?  A. To persuade B. To reflect C. To entertain D. To analyze 46. Identify the overall tone of the essay. A. Confused B. Confident C. Disheartened D. Disapproving 47. Choose the best summary of the passage. A. Light-skinned people need a maximum of 15 minutes a day in direct sunlight to achieve the benefits of the sun’s rays. Dark-skinned people may need far more time in the sun to reap the same benefits. B. Spending too much time indoors can wreak havoc with your circadian rhythms, leach vitamin D from your bones, and damage your immune system. Exercising outdoors in direct sunlight or in a room with clear glass is recommended. C. Although negative effects of sunlight are well known, people should be aware that some sunlight is necessary and beneficial. Exposure to sunlight increases vitamin D, improves sleep, and prevents hyperactivity of the immune system. D. You can avoid direct sunlight but still reap the benefits of a day in the sun by using sunscreen or tinted glass. The effects of vitamin D are beneficial, so it is wise to spend some time outdoors while being fully protected from the dangerous rays. STOP. IF YOU HAVE TIME LEFT OVER, CHECK YOUR WORK ON THIS SECTION ONLY. VOCABULARY AND GENERAL KNOWLEDGE 50 items Suggested time: 50 minutes 1. Select the meaning of the underlined word in the following sentence. Due to his mercurial temperament, Justin did not work well with others. A. Continuous B. Unpredictable C. Mercenary  D. Miraculous 2. What is another word for elated? A. Edified B. Confused C. Flabbergasted D. Delighted 3. What is the meaning of disregard? A. Have no opinion about B. Pay attention to C. Care for D. Ignore 4. Select the meaning of the underlined word in the following sentence. People with weakened immune systems should avoid exposure to flu. A. Disclosure B. Pretense C. Contact D. Display 5. If a patient’s condition is deteriorating, he is __________. A. getting worse B. improving gradually C. resisting medication D. failing to eat or drink 6. Precipitous is best defined as being ___________. A. damp B. gentle C. swift D. dull 7. Select the meaning of the underlined word in the following sentence. Being overweight may predispose a person to diabetes. A. Make susceptible B. Bring to light C. Save from harm D. Pass over 8. A condition that is ongoing is ___________.  A. rapid B. continuous C. partial D. complete 9. A paroxysm is a sudden spasm. Another word for this might be ___________. A. convulsion B. symptom C. efficacy D. embolism 10. A restricted diet is ___________. A. low in fat B. vegetarian C. banned D. limited 11. What is another word for cicatrix? A. Beetle B. Scalpel C. Antidote D. Scar 12. Select the meaning of the underlined word in the following sentence. Calcium pills may be used to supplement your diet. A. Replace B. Add to C. Reflect D. Parallel 13. Select the meaning of the underlined word in the following sentence. The patients are under quarantine until further notice. A. A specialist’s care B. Experimental drug therapy C. Imprisonment in a rehabilitation unit D. Confinement away from the general population 14. Which word names a medicine whose purpose is to induce vomiting? A. Opiate B. Narcotic C. Emetic  D. Prophylactic 15. What is another word for panacea? A. Clinician B. Painkiller C. Vista D. Cure 16. What is the meaning of principally? A. Mostly B. Clearly C. In our opinion D. Royally 17. What is the best description for the term selected plants in the following sentence? Saturated fat comes principally from animal food products and selected plants. A. Plants that have been chosen B. Particular plants C. Top quality plants D. Restricted plants 18. What is the best description for the abbreviation LDL? A. A group of denominations B. A type of lipoprotein C. Self-care mobility skills D. A certain digital value 19. The outer bone in the lower leg is the ___________. A. fascia B. fibrous C. filial D. fibula 20. Select the meaning of the underlined word in the following sentence. It disintegrates in the mouth within seconds after placement on the tongue, allowing its contents to be swallowed with or without water. A. Evaporates B. Fizzes C. Deviates  D. Fragments 21. The jawbone may be called the ___________. A. mantis B. mantua C. mandible D. manganite 22. Select the meaning of the underlined word in the following sentence. Step-by-step, the doctor explained the rationale for the treatment. A. Reasoning B. Prescription C. Procedure D. Necessity 23. What is the meaning of qualms? A. Misgivings B. Habits C. Serenity D. Dispatches 24. Select the meaning of the underlined word in the following sentence. The capsule remains intact even when placed in water. A. Viable B. Operational C. Tinted D. Whole 25. Anterior refers to which part of the human body? A. Top B. Bottom C. Front D. Back 26. What is the best description for the term gravid? A. Deadly serious B. Expecting a child C. Germ-free D. Diseased 27. Select the meaning of the underlined word in the following sentence.  The cavity, once opened, proved to be riddled with infection. A. Challenged B. Overrun C. Separated D. Complete 28. What does alimentary mean? A. Related to nourishment B. Related to outflow C. Related to simplicity D. Related to protection 29. Select the meaning of the underlined word in the following sentence. A single dose will suppress even the nastiest cough. A. Subdue B. Cure C. Restore D. Affect 30. What is the best description for the term septic? A. Infected B. Odorous C. Terminal D. Vigorous 31. Another word for the kneecap is the ___________. A. patina B. patella C. pastel D. pathogen 32. What is another word for paltry? A. Insignificant B. Punitive C. Prolonged D. Economical 33. Select the meaning of the underlined word in the following sentence. A tube is used to vent the gases to the outside. A. Block B. Trade  C. Emit D. Inhale 34. Medicine that is given in inhalant form is ___________. A. dissolved B. injected C. taken orally D. breathed in 35. Select the meaning of the underlined word in the following sentence. This medication works by inhibiting the action of a certain enzyme. A. Occupying B. Speeding C. Hindering D. Enhancing 36. A symptom that is exacerbated is ___________. A. not dangerous B. disfiguring C. painful D. made worse 37. To critique something is to ___________. A. appraise it B. condemn it C. extol it D. berate it 38. The abbreviation YOB on a medical form refers to a patient’s ___________. A. weight B. ethnicity C. symptoms D. birthdate 39. Select the meaning of the underlined word in the following sentence. This is a disease that is likely to recur in a patient’s progeny. A. Chest B. Hormones C. Offspring D. Lifetime 40. The crystalline compound that is a product of protein metabolism is known as ___________. A. uracil B. urine C. ureter D. urea 41. Select the meaning of the underlined word in the following sentence. Too many potential job choices put Martin in a quandary. A. A place where rocks are mined B. A journey of discovery C. A state of uncertainty D. A major attempt or trial 42. What is a diagnostic test? A. One that locates a cure B. One that looks for a cause C. One that examines the skin D. One that is performed on doctors 43. What is the best description for the word establish in the following sentence? Physicians use patch tests to establish the specific causes of contact dermatitis. A. Launch B. Introduce C. Endorse D. Determine 44. Contact dermatitis occurs through the sense of ___________. A. smell B. taste C. touch D. sight 45. A UTI is likely to involve the ___________. A. bones B. throat C. stomach D. bladder 46. Select the meaning of the underlined word in the following sentence.  Treatment is projected to last three months or more. A. Protruded B. Guaranteed C. Estimated D. Alleged 47. To cauterize a wound is to ___________. A. soothe it B. cover it C. stitch it D. burn it 48. A patient who is heedless is ___________. A. unlucky B. careless C. no longer in care D. hard of hearing 49. When directions are convoluted, what is wrong with them? A. They are erroneous. B. They are incomplete. C. They are confusing. D. They are unethical. 50. Select the meaning of the underlined word in the following sentence. Children not adequately responding to 55 mcg may use 110 mcg once daily. A. Without delay B. Willingly C. Satisfactorily D. Expectantly STOP. IF YOU HAVE TIME LEFT OVER, CHECK YOUR WORK ON THIS SECTION ONLY. GRAMMAR 50 items Suggested time: 50 minutes 1. Which sentence is written correctly?  A. Because she was uncertain of her abilities, Renee asked for help. B. Because she was uncertain of her abilities; Renee asked for help. C. Because she was uncertain of her abilities Renee asked for help. D. Because she was, uncertain of her abilities, Renee asked for help. 2. Select the phrase that will make the following sentence grammatically correct. Three days from now, the horses ___________. A. performing in a show B. performed in a show C. will perform in a show D. have performed in a show 3. Which word is not spelled correctly in the context of the following sentence? The iterate teacher moved continually from one school to another within the district. A. iterate B. continually C. within D. district 4. Which sentence is grammatically correct? A. When I noticed Dave coming inside with a bundle in his arms, I ran to help him. B. Dave, coming inside with a bundle in his arms, was noticed and helped by me. C. Having noticed Dave coming inside, I ran to help him with a bundle in his arms. D. After Dave came inside with a bundle in his arms, I ran to help him, having noticed him. 5. Which word is used incorrectly in the following sentence? Dr. Leo lay the paperwork out upon the table for us to view. A. lay B. upon C. us D. view 6. Select the correct word for the blank in the following sentence. Nurse Junko and ___________ will review the patient’s chart. A. me B. she  C. them D. him 7. What word is best to substitute for the underlined words in the following sentence? The nurse told Silvio’s family that visiting hours were over, but Silvio’s family could come back early tomorrow morning. A. them B. us C. they D. those 8. Which word is used incorrectly in the following sentence? For who was that e-mail intended? A. For B. who C. that D. intended 9. Which of the following words fits best in the following sentence? The meteorologist had forecast rain, ___________ Sheila brought her umbrella to work. A. because B. yet C. so D. nor 10. What punctuation is needed in the following sentence to make it correct? Harvey please make sure that the patient is resting comfortably. A. Period B. Question mark C. Comma D. Colon 11. Which of the following is spelled correctly? A. Embarassing B. Embarrasing C. Embarrassing D. Emberassing 12. Select the word or phrase that makes the following sentence grammatically correct. The wheelchair started ___________ down the corridor without assistance. A. roll B. to roll C. rolled D. will roll 13. Select the word in the following sentence that is not used correctly. Collecting personal and vital datum is one of the roles of an intake nurse. A. personal B. vital C. datum D. roles 14. Select the word or phrase that makes the following sentence grammatically correct. After ___________ for an entire afternoon, the resident felt revitalized. A. having rest B. resting C. rested D. rest 15. Which sentence is grammatically correct? A. We quickly consumed the picnic lunch she had made. B. We consumed the picnic lunch she had made quickly. C. We consumed the picnic lunch quickly she had made. D. Quickly the picnic lunch she had made we consumed. 16. Select the word that makes the following sentence grammatically correct. The nursing staff ___________ to serve their patients well. A. hope B. hopes C. hoping D. does hope 17. What word is best to substitute for the underlined word in the following sentence? Roseanne was sent to the lab to collect Roseanne’s results.  A. she B. their C. her D. hers 18. Which word is not spelled correctly in the context of the following sentence? The pharmacist seemed to disagree with the proscription designated by the physician. A. pharmacist B. proscription C. designated D. physician 19. What punctuation is needed in the following sentence to make it correct? Have you finished reading the lab results so we can schedule an appointment with the patient A. Period B. Question mark C. Comma D. Semicolon 20. Which of the following is spelled correctly? A. Discipline B. Disipline C. Discapline D. Dicipline 21. Which sentence is written correctly? A. Whenever we meet at a party or dance he invariably kisses my hand. B. Whenever we meet, at a party, or dance, he invariably kisses my hand. C. Whenever we meet at a party or dance, he, invariably, kisses my hand. D. Whenever we meet at a party or dance, he invariably kisses my hand. 22. Select the word that makes the following sentence grammatically correct. The intern had to select ___________ three specialties. A. among B. between C. with D. along 23. Which word is not spelled correctly in the context of the following sentence?  Their chairs were stationery, but the interns seated in them were agitated. A. Their B. stationery C. seated D. agitated 24. Select the word that makes the following sentence grammatically correct. It is important that one is able to self-motivate and work by ___________. A. oneself B. oneselves C. hisself D. themselves 25. Which sentence is the clearest? A. At the age of seven, my mother moved me to a new school. B. When I was seven, my mother moved me to a new school. C. At the age of seven, I moved my mother to a new school. D. My mother, at the age of seven, moved me to a new school. 26. Select the word or phrase that is misplaced in the following sentence. The book is in my locker at school that is long overdue. A. The book B. in my locker C. at school D. that is long overdue 27. Select the word or phrase that makes the following sentence grammatically correct. Miguel and I are waiting to ___________ with the doctor. A. be met B. meeting C. met D. meet 28. Select the phrase in the following sentence that is not used correctly. He had never had to been on his own in the past. A. had never B. never had C. to been  D. on his own 29. Select the word that makes the following sentence grammatically correct. If you are ___________ uncomfortable, I will bring you another pillow. A. to B. too C. much D. lesser 30. What punctuation is needed in the following sentence to make it correct? Follow my lead I have been performing this procedure for years. A. Period B. Comma C. Exclamation point D. Semicolon 31. Select the phrase that will make the following sentence grammatically correct. When the lecture was over, two students ___________. A. raise their hands to ask questions B. raised their hands to ask questions C. have raised their hands to ask questions D. are raising their hands to ask questions 32. Which word is used incorrectly in the following sentence? He received an oral dose initial, followed by an IV drip. A. received B. dose C. initial D. followed 33. Select the sentence that is grammatically correct. A. Dr. Chu told me and her to take a break for lunch. B. Dr. Chu told her and me to take a break for lunch. C. Dr. Chu told her and I to take a break for lunch. D. Dr. Chu told she and I to take a break for lunch. 34. What word is best to substitute for the underlined words in the following sentence? Francesca, Bill, and I enjoy using the hospital pool. A. They  B. We C. Them D. Us 35. Which sentence is grammatically correct? A. Hector helped me to complete my application. B. Hector helped myself to complete my application. C. Hector helped me to complete mine application. D. Hector helped me to complete myself application. 36. What punctuation is needed in the following sentence to make it correct? After you complete your rounds please check in at the station. A. Period B. Comma C. Colon D. Semicolon 37. Which of the following is spelled correctly? A. Judgmental B. Judgmentle C. Judgemental D. Judgementle 38. Which word is used incorrectly in the following sentence? Jack practices piano while Sidney study for the exam. A. practices B. while C. study D. exam 39. Which of the following words or phrases fits best in the following sentence? The radiology department sends Troy to pick up lunch ___________ it isn’t too busy at the office. A. as long as B. as if C. after D. unless 40. Which word is not spelled correctly in the context of the following sentence? The counselor expected me to accept her advise without question. A. counselor  B. expected C. accept D. advise 41. Which sentence is grammatically correct? A. Having finished the meal, the check was called for by Mr. Innes. B. The check, having finished the meal, was called for by Mr. Innes. C. Having finished the meal, Mr. Innes called for the check. D. Mr. Innes called for the check, having finished the meal. 42. Select the word that makes the following sentence grammatically correct. The hockey team ___________ traveling to Albany for the semifinals. A. is B. are C. be D. were 43. What punctuation is needed in the following sentence to make it correct? She purchased a notebook and a small handmade coffee mug. A. Period B. Comma C. Colon D. Hyphen 44. Which of the following is spelled correctly? A. Never the less B. Never-the-less C. Never-theless D. Nevertheless 45. What word is best to substitute for the underlined words in the following sentence? Stu often regarded his roommates’ housekeeping as sloppy and careless. A. his B. hers C. them D. their 46. Which word is used incorrectly in the following sentence?  If you calculate too speedy, you may possibly fail to get the right answer. A. calculate B. speedy C. possibly D. right 47. Which sentence is the clearest? A. Resting in its well-built cage, I admired the lovely parrot. B. Resting in its well-built cage, the lovely parrot was admired by me. C. I admired the lovely parrot resting in its well-built cage. D. I admired in its well-built cage the lovely parrot that was resting. 48. Select the phrase or clause that is misplaced in the following sentence. I did not see the open carton of orange juice on the shelf standing with the refrigerator door open. A. I did not see B. of orange juice C. on the shelf D. standing with the refrigerator door open 49. Select the word that will make the following sentence grammatically correct. Do not be afraid to consult ___________ your peers. A. with B. from C. by D. in 50. Which sentence is grammatically correct? A. The soup was hot and made of tomatoes; Dan burned his tongue and gulped some cold water. B. After burning his tongue on the hot tomato soup, Dan gulped some cold water. C. Dan gulped some cold water when the tomato soup that was hot burned his tongue. D. Gulping some cold water, Dan burned his tongue on the hot tomato soup. STOP. IF YOU HAVE TIME LEFT OVER, CHECK YOUR WORK ON THIS SECTION ONLY. BASIC MATH SKILLS 50 items Suggested time: 50 minutes 1. Multiply and simplify: A. ⅝ B. C. D. 2. 15 is 20% of what number? A. 3 B. 45 C. 75 D. 300 3. If a train travels 270 miles in 3 hours, how far will it travel in 4.5 hours? A. 300 miles B. 350 miles C. 405 miles D. 425 miles 4. At the bake sale, Josie bought 3 brownies for $1.35 apiece. She paid with a $5 bill. What change did she receive? A. $0.85 B. $0.95 C. $1.05 D. $1.15 5. Express 20% as a fraction in lowest terms. A. B. C. D. ½ 6. How many pounds are there in 8 kilograms? A. 3.6 pounds B. 16 pounds C. 16.6 pounds D. 17.6 pounds 7. Which of these dates is represented by the Roman numeral MDXVI? A. 1106 B. 1116 C. 1506 D. 1516 8. Multiply: A. 0.00875 B. 0.0875 C. 0.875 D. 8.75 9. Multiply: A. 0.00208 B. 0.0208 C. 0.208 D. 2.08 10. A farmer has a flock of sheep. He has 15 white sheep, 4 brown sheep, and 1 black sheep. What is the percentage of brown sheep in his flock? (Enter numeric value only. If rounding is necessary, round to the whole number.) ________________________ 11. Which numeric system does not use place value? A. Roman B. Arabic C. Decimal D. Binary 12. What is the least common denominator of and ? (Enter numeric value only.) ____________________ 13. Sergeant Kellogg had his men line up at 3:40 p.m. What would that be in military time? A. 0340 B. 3040 C. 1500 D. 1540 14. Solve for x. 3 : 5 :: 81 : x A. 48  B. 123 C. 135 D. 405 15. Divide and simplify: A. 4½ B. 4¼ C. 2¾ D. 2¼ 16. Mr. Sanders takes $100 from the ATM. He spends $8.45 on lunch and buys a newspaper for $2.25. Later he spends $20 on bus tokens. How much is left from his original $100? A. $49.30 B. $69.30 C. $79.30 D. $89.30 17. Frederica worked 7 hours on Monday and 6½ hours each day from Tuesday through Friday. If she makes $10.45 an hour, what was her gross income for the week? (Enter numeric value only. If rounding is necessary, round to the whole number.)_____________ 18. Donald earns 8% of the selling price of each house he sells. If he sells a house for $152,000, how much does he earn? A. $12,160 B. $14,040 C. $19,000 D. $21,600 19. How many millimeters are there in 25 centimeters? (Enter numeric value only.) __________________________ 20. A plan for a house is drawn on a 1:40 scale. If the length of the living room on the plan measures 4.5 inches, what is the actual length of the built living room? A. 45 feet B. 25 feet C. 15 feet D. 12 feet 21. Add: A. 70.2 B. 230.72  C. 234.74 D. 259.74 22. The number 4 is 20% of what number? (Enter numeric value only.) _______________________ 23. Add and simplify: A. B. C. D. 9 24. Tamison bought 20 stamps for 29¢ each and 40 stamps for 42¢ each. If she gave the postal worker $25, how much change did she receive? A. $2.40 B. $2.80 C. $3.20 D. $3.60 25. Convert this military time to regular time: 0705 hours. A. 7:05 A.M. B. 7:05 P.M. C. 5: 07 A.M. D. 5:07 P.M. 26. Teresa began collecting baseball cards exactly 8 months ago, and in that time she has collected 144 cards. On average, how many baseball cards has she collected per month? A. 12 B. 16 C. 18 D. 22 27. What is 70% of 110? A. 77 B. 79 C. 81 D. 83 28. Divide: 5, A. 109 r3 B. 115 r14  C. 133 r5 D. 165 r2 29. Gus is making a chili recipe that calls for three parts beans to five parts ground beef. If he is using 8 cups of ground beef for a big family dinner, how many cups of beans will Gus need? A. 3.6 cups B. 4 cups C. 4.6 cups D. 4.8 cups 30. 98 is 175% of what number? A. 48 B. 52 C. 54 D. 56 31. Express as a decimal. A. 1.25 B. 1.45 C. 1.75 D. 1.95 32. How many feet are in 6 meters? A. 1.83 feet B. 18.48 feet C. 18.8 feet D. 19.68 feet 33. Express the ratio of 25:80 as a percentage. A. 31.25% B. 34% C. 41.25% D. 43.75% 34. A package of 10 pencils is divided between every 2 students in class. If there are 20 students in class, then how many pencils are needed? A. 20 B. 40 C. 80 D. 100 35. What date in Arabic numerals is Roman numeral MCCIV? (Enter numeric value only.) ______________________ 36. A certain number is 7 less than the product of 18 and 4. What is the value of that number? A. 63 B. 65 C. 72 D. 79 37. Multiply: A. 0.0078 B. 0.078 C. 0.78 D. 7.8 38. Multiply: A. 1.008 B. 10.08 C. 10.8 D. 18 39. If the outside temperature on a sunny day is 82 degrees on the Fahrenheit scale, what is the approximate temperature on the Celsius scale? A. 18°C B. 24°C C. 28°C D. 50°C 40. In a scale drawing for a garden,. If the garden measures 8 cm by 10 cm in the drawing, how large will it be in reality? A. 2 m by 3 m B. 4 m by 5 m C. 8 m by 10 m D. 16 m by 20 m 41. Gerald can bake 3 dozen cookies in 30 minutes. How long will it take him to bake 12 dozen cookies? A. 90 minutes B. 1 hour 40 minutes C. 2 hours  D. 4 hours 42. Divide: A. 1.424 B. 1.622 C. 1.672 D. 1.724 43. Subtract and simplify: 44. The Soap Factory is selling 3 bars of almond-scented soap for $2.58. What would it cost to buy 5 bars of soap? A. $3.30 B. $3.80 C. $4.30 D. $4.80 45. Subtract and simplify 46. Express as a decimal. A. 0.2 B. 0.25 C. 0.4 D. 2.5 47. 18 is 25% of what number? (Enter numeric value only.) ______________________ 48. Callie makes 2% interest quarterly on a deposit of $100. After a year, about how much is in her account? A. $102 B. $104 C. $106 D. $108  49. Patient X usually ingests about 2,000 calories daily. If Patient X is placed on a regimen that cuts that daily intake by 20%, how many calories will Patient X consume in a week? (Enter numeric value only.) ______________________ 50. How many teaspoons are there in 3 tablespoons? A. 9 teaspoons B. 10.5 teaspoons C. 12 teaspoons D. 18 teaspoons STOP. IF YOU HAVE TIME LEFT OVER, CHECK YOUR WORK ON THIS SECTION ONLY. BIOLOGY 25 items Suggested time: 25 minutes 1. Which organelle is responsible for protein synthesis? A. Mitochondrion B. Vacuole C. Cell membrane D. Ribosome 2. Why is yeast used to make bread rise? A. It engages in photosynthesis, which produces oxygen gas. B. Carbon dioxide forms while yeast carries out photosynthesis. C. Yeast carries out fermentation, producing ethanol and carbon dioxide. D. Yeast breathes in oxygen and produces carbon dioxide through aerobic respiration. 3. How is mitosis different from meiosis? A. Mitosis is the process by which sex cells are formed. B. Meiosis creates cells with half the chromosomes of the parent cell. C. Telophase does not take place in mitosis. D. Spermatogenesis and oogenesis occur via mitosis. 4. Which statement is untrue? A. RNA is single-stranded. B. RNA contains uracil.  C. DNA codes for proteins. D. DNA cannot be altered. 5. Imagine that two parents both carry the recessive gene for cystic fibrosis. Any homozygous recessive offspring will manifest the disease. What percentage of the offspring is predicted to be carriers but not manifest the disease? A. 0% B. 25% C. 50% D. 100% 6. A cell is in a solution in which the concentration of solutes is higher inside the cell than outside the cell. What would you expect to happen to the cell? A. It will swell and possibly burst. B. It will shrivel and shrink. C. It will maintain its current size. D. It will grow a supportive cell wall. 7. What is the purpose of phloem tissue in plant stems? A. It conducts water up through the stem. B. It conducts the energy of light to leaves. C. It conducts food throughout the plant. D. It conducts carbon dioxide throughout the plant. 8. Physical factors such as temperature and pH can alter enzyme activity because they have an effect on the enzyme’s ___________. A. acidity B. shape C. chemistry D. substrate 9. Which part of a plant’s reproductive system is of a different “gender” than the others? A. Stamen B. Pistil C. Stigma D. Style 10. What kind of symbiosis exists between a pneumonia bacterium and a human? A. Mutualism B. Parasitism C. Commensalism  D. Competition 11. The scientific name for a house cat is Felis catus. This indicates the house cat’s ___________ and ___________. A. kingdom; family B. order; subspecies C. phylum; class D. genus; species 12. Beeswax is an example of what kind of molecule? A. Lipid B. Carbohydrate C. Protein D. Nucleic acid 13. What takes place in a lysosome? A. Ribosomes are made. B. Food is produced. C. Water is stored. D. Food is digested. 14. Which organism reproduces via binary fission? A. Mushroom B. Blue whale C. Rainbow trout D. Salmonella 15. In which phase of cell division do the chromosomes replicate? A. Prophase B. Interphase C. Anaphase D. Telophase 16. In a strand of DNA, you would expect to see adenine paired with ___________. A. cytosine B. uracil C. thymine D. guanine 17. Hemophilia is a sex-linked trait carried on the X chromosome. In an example of a male with hemophilia and a female carrier, what ratio of the offspring is predicted to have the disease?  A. 0 female : 2 male B. 1 female : 0 male C. 1 female : 2 male D. 2 female : 1 male 18. What is represented by this formula: A. Glycolysis B. Cellular respiration C. Photosynthesis D. Electronic transport 19. Three students measured the mass of a product of combustion. They recorded measurements of 5.14 g, 5.16 g, and 5.17 g. If the known mass of the product is 5.30 g, how would you describe the students’ measurements? A. Accurate B. Precise C. Both accurate and precise D. Neither accurate nor precise 20. Which statement regarding energy content is true? A. Decomposers > secondary consumers B. Primary consumers > producers C. Producers > secondary consumers D. Secondary consumers > primary consumers 21. How should a researcher test the hypothesis that eating chocolate leads to acne in teenagers? A. Take 100 teenagers and feed each one a different amount of chocolate daily for 60 days; then test for acne. B. Take 100 teenagers and feed 50 two bars of chocolate daily for 60 days while the other 50 eat no chocolate; then test for acne. C. Take 1 teenager and feed him or her two bars of chocolate for 30 days and no chocolate for 30 days; then test for acne. D. Take 100 teenagers and feed them no chocolate for 30 days and two bars of chocolate apiece for 30 days; then test for acne. 22. Which is not a step in the water cycle? A. Condensation B. Transpiration C. Nitrification D. Absorption  23. Why do we perceive chlorophyll as green? A. It absorbs yellow and blue light. B. It primarily absorbs green light. C. It fails to absorb green light. D. It primarily absorbs red light. 24. Why are bacteria and blue-green algae often classified together? A. Both are gymnosperms. B. Both are prokaryotes. C. Both are autotrophs. D. Both are pathogens. 25. Which of these molecules contains glucose? A. Proteins B. Lipids C. Nucleic acids D. Carbohydrates STOP. IF YOU HAVE TIME LEFT OVER, CHECK YOUR WORK ON THIS SECTION ONLY. CHEMISTRY 25 items