Essay on A Raisin in the Sun Character Analysis - 712 Words

The play â€Å"A Raisin in the Sun† by Lorraine Hansberry has many interesting characters. In my opinion, the most fascinating character is Ruth because of her many emotions and captivating personality. She goes through extreme emotions in the play such as happiness, sadness, anger, stress, and confusion. Ruth is very independent, firm, kind, witty, and loving. nbsp;nbsp;nbsp;nbsp;nbsp;Ruth has an intriguing personality. She is very loving towards her family. She will do all in her power to improve the lifestyle of her family. When it appears that the deal for the house in Clybourne Park will fall through, she promises to dedicate all of her time to make the investment work. â€Å"Lena-I’ll work†¦ I’ll work 20 hours a day in all the kitchens†¦show more content†¦Ruth stresses the importance of maintaining a good image of her family. When George arrives to take Beneatha out, Walter and Beneatha are not being well mannered, so Ruth takes control and tries to make-up for their behavior. â€Å"Beneatha, you got company-what’s the matter with you? Walter Lee Younger, get down off that table and stop acting like a fool†¦(80)† Ruth is also independent and kind. nbsp;nbsp;nbsp;nbsp;nbsp;Ruth’s dream is to improve her family’s lifestyle and move into a house where she can raise Travis and the new baby. To realize her dreams she should not put everyone else’s wants and needs in front of hers all of the time. She should express her feelings more often so that her family will listen and help her to reach her goals. The play supports this view by showing how Ruth often neglects her feelings and pays great attention to her family’s feelings, wants, and needs. nbsp;nbsp;nbsp;nbsp;nbsp;Ruth compares with two people I know personally. My mom and my grandma remind me of her very much. My mom is very similar to Ruth because they are both independent, witty, loving, and kind. My mom keeps my family on track everyday just as Ruth does. Both my mother and Ruth crack jokes often to lighten the mood. My mom and Ruth care about the well being of their families more than anything. My Grandma is also very similar to Ruth in many ways. My grandma is loving, kind, and firm. My grandma and Ruth bothShow MoreRelatedCharacter Analysis Of A Raisin Of The Sun Essay845 Words   |  4 PagesWriting Assignment 4: Character Analysis of â€Å"A Raisin in the Sun† The male protagonist of this story is Walter Lee Younger, an African American, who plays the roles of a son, husband, father, and brother. The story is set in a Chicago Southside apartment, â€Å"sometime between World War II and the present [1959]† (Hansberry 919). Walter is physically described as â€Å"a lean, intense young man in his middle thirties, inclined to quick nervous movements and erratic speech habits—and always in his voiceRead MoreA Raisin In The Sun Character Analysis1322 Words   |  6 PagesIn the play â€Å"A Raisin in the Sun† written by Lorraine Hansberry, she is able to take us to place to see what it was like for an African American family to survive in the mid-twentieth century. The play details how the main characters are going through an evolving social and economic position, as well as the evolving gender roles. Hansberry uses the characterization of Beneatha, Ruth, and Walter in order to show the expectations and assigned gender roles for the characters in the story. In shortRead MoreA Raisin In The Sun Character Analysis902 Words   |  4 PagesGordon: Segregation vs. Southern Pride Lorraine Hansberry’s â€Å"A Raisin in the Sun† touches on many issues African Americans faced in the early to mid-twentieth century. One can analyze Hansberry’s â€Å"A Raisin in the Sun† from many angles, and come away with different meanings. While Michelle Gordon focuses more on segregation and housing discrimination that plagued African Americans on Chicago’s Southside in Hansberry’s â€Å"A Raisin in the Sun†, William Murray emphasizes on Southern Pride and heritage. ThisRead MoreA Raisin In The Sun Character Analysis917 Words   |  4 PagesIn the play A Raisin in the Sun by Lorraine Hansberry the Younger family faces many conflicts. This is mainly because they are living in Chicago in the 1950’s. This was a time where many African Americans were discriminated, which caused the family to have many issues with money, jobs, and family. Two characters from the pay that help influence the plot would be Mama and Ruth. This i s because of the roles they play, their conflicts, and their actions towards other character. Without the roles ofRead MoreA Raisin In The Sun Character Analysis1026 Words   |  5 PagesIn A Raisin in the Sun by Lorraine Hansberry, one of the featured characters is outgoing and ambitious Beneatha Younger, sister of Walter and daughter of Mama. Beneatha, commonly referred to as Bennie by her family, is an aspiring doctor and currently in medical school. In addition to these desires, she also acquires relationships with Asagai and George Murchinson, two prominent male characters, throughout the course of the play. Although her career choice and relations with these men are completelyRead MoreA Raisin In The Sun Character Analysis1592 Words   |  7 Pagesacquisitiveness have always had the ability to turn people into someone they are not. Greed can tear apart families and friendships when a person neglects others for their own benefit. This is depicted perfectly in Lorraine Hansbe rry’s play A Raisin in the Sun which follows the lives of the Youngers, an African-American family living in 1950’s South Side Chicago. The focus is on a man named Walter Younger, who has the difficult decision of choosing between his personal dream and the progression ofRead MoreCharacter Analysis Of Beneatha In A Raisin In The Sun1487 Words   |  6 PagesCharacter Analysis â€Å" A Raisin in the Sun† is a play written by Lorraine Hansberry about the life of an African American family during the era of segregation. The play starts off with the Younger family receiving a 10,000 dollar check from Mr. Younger’s insurance policy. The family argues over what they are going to do with it. Mama wants to buy a house with it, Walter wants to invest in a liquor store, and Beneatha wants to use the money to go to medical school. The contrast of the characters’ personalitiesRead MoreA Raisin In The Sun Character Analysis1052 Words   |  5 PagesName Instructor Name Class Date Walter Lee Younger in A Raisin in the Sun Lorraine Hansberry’s play, A Raisin in the Sun, tells the story of the Younger family, an African-American family living in poverty in 1950s Chicago. The family patriarch, Walter, is a limousine driver struggling to make ends meet and desperate to find a way to propel his family toward wealth. With his father’s death comes an insurance check for $10,000 and each member of the family has different ideas on what to do withRead MoreA Raisin In The Sun Character Analysis1322 Words   |  6 Pages Lorraine Hansberry’s play, A Raisin in the Sun, depicts the lives of the Younger family, an African American family living in the Southside of Chicago during the 1950s. The play takes place in their cramped apartment offering the reader insight into the arguments, discussions, and conversations that take place between the characters. In one scene, Hansberry specifically offers the reader a conversation between Asagai, an influential companion, and Beneatha to show us how disparate the Younger siblingsRead MoreCharacter Analysis Of Raisin In The Sun798 Words   |  4 PagesIn the play a Raisin in the Sun, Walter Lee Younger is an African American man who portrays the role of a father, son, and husband. He has a dream to invest the incoming inherence into something that may help his family in the future. Once this idea comes to him it takes over his mind, and he cannot stop thinking about it. It acts as though its a drug, he addicted to talking about it. Also, when it is broug ht up in a conversation and someone disagrees he become very defensive. In addition, he is

Analysis of Sophocles Oedipus the King - 1110 Words

Oedipus the King (Order #A2063917) Sophocles Oedipus the King is a tragedy in which fate is the culprit in destroying the lives of several people. It tells the tragic story of Oedipus, a man who unknowingly murdered his own father and then married and fathered children with his own birthmother. But for a long period of time, Oedipus was ignorant of his true actions, until a plague descended on the city where Oedipus was king: Thebes. When Oedipus sent to the oracle at Delphi for aid in ending the terrible plague, the answer he received was that the murderer of the previous king of Thebes, Laius, must be found and punished. And since Oedipus had arrived in the city of Thebes only after the previous king was murdered, Oedipus was beyond suspicion and consequently the appointed person to carry out the divine command. (Ramphos, 39) In a speech to the citys populace, Oedipus informed them of the oracles message and made a personal plea for information leading to the capture of the murderer. Then he made his own prophecy as to what he would personally do to aid the capture of the cause of Thebes plague. In the following 20 lines, Oedipus then went on to prophesize about the discovery of his own past actions, his fate and what would ultimately turn out to be his own future. Oedipus began his statement with a curse: And on the murderer this curse I lay (On him and all the partners in his guilt). (285-86) Although he does not know the identity of the murderer or even ifShow MoreRelatedAnalysis Of Oedipus The King By Sophocles819 Words   |  4 PagesSophocles’ plays are among some of the best-written performances of the 5th century, and they have evolved into several modern theatrical productions and movies. Although not written as part of a trilogy, Sophocles’ three interconnected plays focus on the same dysfunctional family: Antigone, Oedipus Rex (Oedipus the King) and Oedipus at Colonus. His second play Oedipus the King continues to awe the audiences today as much as it entertained Soph ocles’ audience. There existed then and now a fascinationRead MoreSexism In Oedipus The King1395 Words   |  6 Pages Sophocles’ Theban tragedy, Oedipus the King, is not sexist. The prominent play portrays both men and women justly. The events presented by Sophocles exemplifies a level of admiration and respect for women that was not ordinary in ancient Greece. This is predominantly achieved through the dialogue of Jocasta and Oedipus, illustrating a corresponding relationship. In addition, the behavior of Jocasta, analysis of other literature, as well as the bad fortune of the male characters reaffirm that theRead MoreOedipus : The King Of Thebes And Tragic Hero Essay728 Words   |  3 PagesOedipus: The King of Thebes and Tragic Hero Ancient Greek Literature encompasses an assortment of poetry and drama to include the great masterpieces of tragedy. In Classic Literature, tragedies were commonly known for their elaboration of a protagonist fitting the classification of a tragic hero. This type of a tragic hero often collectively described as a character of noble birth, facing an adversity of some nature and a fate of great suffering. The characteristics of what encompassed a tragic heroRead MoreReligion In Oedipus The King1012 Words   |  5 PagesIn Oedipus, the King, the main character, Oedipus, starts the play in the highest prestige, he is the King of Thebes and is held in high regard to almost all citizens for his prosperous reign. By the end of the play, Oedipus is vilified by his citizens and almost all the people of Thebes. I argue that Oedipus’ downfall is directly linked to his rejection of religious guidance and omens; namely, the Gods and the oracle. One could argue that no divine entity openly acts out toward Oedipus, howeverRead MoreOedipus-a Tragic Hero706 Words   |  3 PagesRunning head: Oedipus-A Tragic Hero Research Paper ENGL 102: Literature and Composition) Fall 2015 Melinda Meeds L26683811 APA Outline Thesis: In Sophocles’ â€Å"Oedipus†, Oedipus is exemplified as a tragic hero according to Aristotle’s definition because his story appeals to the reader’s humanity in the way he maintains his strengths after inadvertently causing his own downfall. I. Oedipus A. The noble birth. B. Describe Oedipus’ character. II. Tragedy A. DescribeRead MoreSophocles The King And Antigone Essay1566 Words   |  7 Pages Sophocles wrote about kings. Mythological, or at least long dead, the regal protagonists of fraction of Sophocles’ surviving work embody the political realities of the ancients’ time. By examining and analyzing the origins and nature of kingship in Sophocles, one can glean a sliver of insight into a civilization that has all but disappeared. Sophocles’s kings were great human leaders, reaching their position through impressive deeds or standing in the community. Although they wielded great powerRead MoreAnalysis Of The Play Oedipus Tyrannous By Sophocles 1749 Words   |  7 PagesKwa LITR201 August 19, 2016 Dear Dr. Kwa, I chose to write about the play Oedipus Tyrannous by Sophocles, I found this play to be very encapsulating to the very end. I really enjoyed the suspense, as well as the turn of direction that the play took in the end as the plot thickened. In this essay, I will describe why I personally believe that this play was not just a tragic event and the many reasons why I believe that Oedipus can be viewed as a tragic hero by his actions throughout the play. I believeRead MoreOedipus As A Tragic Hero1724 Words   |  7 PagesIn the story of Oedipus, Oedipus is considered a â€Å"Tragic Hero† because of the tragic fate and effect that he had upon his life. My definition of a tragedy is a great loss that has a unhappy ending to which concluded me to state that Oedipus falls under that category. Throughout the book, Oedipus is leading himself to his own destruction when trying to find the killer of the late King Laios. So when a journal article I found published by The John Hopkins Univ ersity Press stated that a â€Å"tragic heroRead MoreAnalysis Of Oedipus The King 1127 Words   |  5 Pages For A Life Of Regrets Oedipus the King is a play written by Sophocles. Oedipus is the main figure and legend of Sophocles play. After Oedipus birth into the world, his father King Laius of Thebes heard from a prophet that his own child was destined to kill him. Sophocles play begins from past to present and starts to unravel the journeys Oedipus goes through. Oedipus isn t an evil character as one would think while reading the story. He neverRead MoreAn Analysis of Fate vs. Free Will in the Theban Plays1392 Words   |  6 PagesAn Analysis of Fate vs. Free Will in the Theban Plays When Teiresias asks in Antigone (line 1051), What prize outweighs the priceless worth of prudence? he strikes (as usual) to the heart of the matter in Sophocles Theban Plays. Sophocles dramatizes the struggle between fate and free will, in one sense, but in another sense the drama might be better understood as the struggle between the will of the goods (which it is prudent to follow, according to Teiresias) and mans will (which is often

Pyramids and Ziggurats free essay sample

Pyramidal construction is as old as Egyptian history itself, going back to the beginning of the 3rd millennium B. C. , when the first monarchs were buried in large brick tombs called mastabas. These can be seen as evoking the primeval hill related to the conceptions of the very beginnings of life. In the 3rd dynasty (c. 2660-2600 B. C. ) king Netjerirkhet Djoser introduced the pyramidal shape with a great monument fashioned as a Step Pyramid, built with stone by his genius architect Imhotep within a vast funerary complex in the Sakkara area, close to Memphis, the capital. The innovation was not only its shape – six overlaying mastabas – but also it made ample use of stone and was placed at the centre of an enormous walled complex. This complex also contained a cenotaph or subsidiary tomb on the south side, evoking the holy city of Abydos especially noted for the cult of Osiris, god of Eternity. This concept of a subsidiary tomb would later evolve into the small satellite pyramids built next to the Royal Tombs, to the south. The 4th dynasty (c. 2600-2500 B. C. registers remarkable advances, not only in terms of architectural splendour but also as far as technical innovation is concerned, most evident in the internal layout of the Royal Tombs and in the surrounding complexes. The transition between the Step Pyramid and the Pure Pyramid which will become the standard can be seen in the unfinished and much damaged Meidum pyramid which was probably commissioned by the pharaoh Huni, last monarch of the 3rd dynasty, and to Sneferu, founder of the 4th . Sneferu ordered the construction of the two pyramids at Dashoor, which show a marked architectural evolution of the royal tomb: one is of the rhomboid type and the other, known as the â€Å"Red Pyramid†, is the first Pure Pyramid. Later on, on the Giza Plateau the three most famous pyramids in Egypt (and in the whole world) were erected for kings Khufu, Khafre and Menkaure (also known by their Greek names Cheops, Chephren and Mycerinus, although these onomastic forms are losing ground). The Khufu pyramid, known as the Great Pyramid, is remarkable not only on account of its size (it originally stood 147 metres high) and of the â€Å"astronomic† precision of its implantation (the four sides face the four cardinal directions with almost perfect precision) but also for the originality of its internal structure and layout. Contrary to previous usage, the Royal Chamber was moved towards the interior, after a first attempt, left unfinished, of placing it underground and slightly off-centre. The central position would be occupied at a later stage by the â€Å"Queen’s Chamber†, but this option too would be abandoned. Finally, the most spectacular of pyramidal architectural solutions would be devised: a great ascending gallery leading to the Royal Chamber, the construction of which bespeaks of high technical skills in adjusting the huge stones and of a perfect mastery in finishing them. The Khafre pyramid originally stood 143 metres high, and the Menkaure pyramid, the smallest one at Giza, stood at 65 metres. The relative simplicity of the interiors of the pyramids built for Khafre and Menkaure both antedates and announces the organisation typical of the 5th and 6th dynasties’ pyramids while maintaining the funerary complex’s typical layout. The number of the small surrounding pyramids built for the royal wives varies. During the 5th dynasty (c. 2500-2300 B. C. ) the favoured location for erecting pyramids was the Abusir area, although the first monarch (Userkaf) and the last (Unas) had their tombs built in Sakkara. The smaller scale of the royal pyramids is obvious when compared to those of the previous dynasty, but the funerary complexes were still impressive, particularly on account of their excellent and varied mural decoration both in the funerary temples and along the paved processional causeways. An example of this is Sahure, the complex of which can be considered a paradigm of its epoch: the entrance of the pyramid faces north, the internal structure is stepped, and the architecturally simple royal chamber is positioned in the centre, level with the ground. The Unas pyramid is decorated internally with magical texts, which will later become customary (the famous  «Pyramid Texts »). In the 6th dynasty (c. 2300-2180 B. C. ) pyramids were built with approximately 50 metres in height. In spite of its poor present condition, the funerary complex of Pharaoh Pepy II can give us an idea of the spatial distribution typical of the period. It has a cult pyramid, located by a canal leading to the Nile, an ascending, paved processional causeway linking the cult pyramid to the funerary temple. The latter, after the first annexes, gave onto an elegant hypostyle patio and a chapel with several niches containing statues of the king. Beyond the encircling wall delimiting the Royal Pyramid, there is a series of small pyramids built for his consorts, each pyramid with its own funerary temple. After Pepy II, many decades elapsed before anything deserving the name of pyramid was erected. This would only happen during t he Middle Kingdom – after the First Intermediate Period – when traces of pyramid construction are scant: we know of a modest pyramid built in Sakkara for king Qakare Ibi, of the 8th dynasty (under 20 metres high), and although no traces of such a monument have reached our day and age, literary tradition speaks of a pyramid, built for Merikare, of the 10th dynasty, located by the Teti funerary complex, in Sakkara. In the Middle Kingdom (c. 2040-1750 B. C. the mighty monarchs of the 12th dynasty have pyramids erected in the Fayum area (Meidum, Lahun, Licht and Hawara), notably the tombs of Senuseret I at Licht and Amenemhat III at Hawara. The average height of 12th dynasty pyramids is 100 metres, but they are mainly composed of an amass of rubble, loose stone blocks and brick, capped with polished limestone facing slabs, and they have long disinte grated into an inexpressive heap of ruins. The building of pyramids for pharaohs was abandoned during the New Kindgom (c. 1550-1070 B. CB. ), in favour of tombs excavated in rock hillsides (Valley of the Kings, in West Thebes). And when the habit of hollowing-out hillsides to build tombs died out, some officials erected small brick pyramids over their funerary chapels thus appropriating some of the pharaonic symbology. Obelisks, those elegant monoliths of solar evocation, were topped by pyramid-shaped points, capped with metal. The kings of the 25th dynasty (c. 715-660 B. C. ), of Nubian origin (present-day Sudan), had their tombs built in the shape of pyramids, smaller in size and thinner. This archaic practice was continued further south by the kings of Meroe who, over a period of 1,000 years, would build pproximately 180 pyramids where some remnants of artistic production of the merotic kingdom were found. Besides the scientific study of ancient Egypt’s pyramids (pyramidology) there is a parallel approach best described as â€Å"pyramid mania†, which has produced many distorted, even appalling interpretations of the pharaonic pyramids and their purpose. One of the most non-sensical and inco nsistent has to do with the purported relationship between Egypt and Central America, which apparently led to the construction of pyramids in both regions. The truth is that there is a long-established practice of calling pyramids to the stepped constructions built in stone in Central America until the 16th century, the date of Spanish penetration. The oldest is the Cuicuilco pyramid, close to Mexico City (the old Tenochtitlan), which may well date from the end of the 2nd millennium B. C.. It has five stories topped by a sanctuary accessed by the exterior. This long access stairway petrifies a magical conception, evoking a link between the world of the gods and that of Man. Along the stairs, the celestial gods descend, and the infernal gods climb. And so does the priest who was to officiate atop the monument in one of the most characteristic ceremonies of the different Mexican civilisations: the offering of the human heart to the gods. Thousands of captives were killed each year at the top of those pyramid-shaped temples, their hearts torn out while they still lived and their bodies thrown down the stairs. The sacred connotation of the stairs themselves is echoed in the number of steps of the great stairway of the Kukulcan pyramid at Chichen Itza: 364, plus the upper platform where the sanctuary stood, which was considered day 365. As for the number of stories, they could be between seven and thirteen figures with celestial and symbolic significance. The Paleo-Mexican pyramids, erected by several peoples in the region (from the Mayas to the south, to the Toltecs, the Olmecs, the Zapotecs, the Totonacs and the Aztecs, among others) are massive structures, which in some cases were successfully added in height. A good example of this is the Aztec pyramid of Tenayuca, which reveals at least six stages in vertical and horizontal extension. In an impressive contrast of vertical and horizontal lines, the pyramids can look massive and immense such as the Temple of the Sun at Palenque, or rise in steep verticality as in the Great Tikal Plaza (Guatemala). The highest Mexican pyramid was erected at Cholula (in its initial stages, an Olmec site), and was consecrated to Quetzalcoatl, wise and beneficial god. There are important zones of pyramid concentrations at Chichen Itza (pyramid of Kukulcan, the Maya name of the Aztec god Quetzalcoatl, the Feathered Serpent), at Palenque, Teopalzolco, Monte Alban,  «city of pyramids » in Teotihuacan, an urban centre, which started out as Olmec. The Temple of the Inscriptions at Palenque proved to be an eight-story pyramid after the thick overgrowth was removed (1949). It also revealed in its interior, through a staircase that ran from the top of the structure to the underground level, a funerary chamber with a sarcophagus containing what was thought to be the body of a king. Several valuables had been buried with the personality and thus this vast pyramid-shaped tomb is the exception confirming the rule: Mexican pyramids are places of cult, while the Egyptian ones are clearly royal tombs. In point of fact, there is no relationship between the concepts presiding over the construction of pyramidshaped structures in the two opposite sides of the Atlantic. Indeed, there is no correspondence, whether in time or in space, between two worlds of such clearly distinct cultures. Furthermore, the function of the Egyptian and the Mexican pyramids are completely different, the latter seeming to have served some of the purposes achieved by the great towers erected in Mesopotamia by the Sumerians, the Assyrians and the Babylonians between 3000 and 500 B. C. , known as ziggurats. Hence we can state that, functionally and culturally, the Mexican pyramid is closer to the Mesopotamian ziggurat than to the Egyptian pyramid.

The Adventures of Hucleberry Finn free essay sample

African Americans were known as slaves in many parts of the world, The author of the novel The True Adventures Of Huckleberry Finn was very passionate when it came down to allowing African Americans to be free as well as annihilating racism and all the strong accumulations surrounding it. Mark twain believed in justice he believed that he wasn’t of the society because society believed in many atrocious accounts of going against African Americans so he believed he would stand up for what’s right. The lessons that radiated from this novel is that society is highly corrupted, that you shouldn’t discriminate against an African American just because of their race and the color of their skin, as well as the strong stereotypes of African Americans are substantially wrong. In the novel The True Adventures of Huckleberry Finn the author Mark Twain uses satirical accumulations and irony to state his opposition against society and what it’s come about as well as discrimination against African Americans. We will write a custom essay sample on The Adventures of Hucleberry Finn or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page This is the prime reason as to why Mark twain uses satire, he uses satire in order to demonstrate his urge or drive in exposing our corrupt society: going from discrimination against African Americans, explaining how the parents of today are as well as showing who the human race is as a whole. Mark twain uses his writing to simply degrade the people of today using his writing using satire and irony. Doing this, this opens up a whole new slate of showing the reader who mark twain is and how he uses his writing to voice out his opinions of the world and the people in it. Mark Twain is a very clever writer He uses Satire to criticize or to show his opposition against society. In the novel Mark Twain states â€Å"Pap he hadn’t been seen more than a year and that was comfortable for me; I didn’t want to see him no more he used to always whale me when he was sober and could get his hands on me† (Twain 13) This quote allows us to see the satirical coverage over the true identity of Mark Twain’s way of saying that in today’s society drunk parents are bluntly disgusting and a true detriment towards their children and society. This quote demonstrates the actual relationship towards Huck and his father. This doesn’t have a big effect on Huck Finn because he believes that his father is already a dead beat who just gets at him due to his mental state. Overall this quote demonstrates what is actually taking part in today’s society because there are numerous cases of alcoholic parents who misuse and abuse their children. The author Mark twain uses satire to portray the true meaning of Huck and pap’s relationship. In the novel it states â€Å"Pap went to judge thatcher’s and bully ragged him and tried to make him give up money but he couldn’t† (twain 3) This quote presented shows how Mark Twain uses satire to comment on the laziness of Americans and how they take advantage of the government and welfare instead of doing their part and helping themselves and their families. This quote shows how pap is a really underdeveloped parent who just wants to get the easy way out instead of actually working hard. The Satire of this quote explains the lack of care and understanding in some of the people in society, it portrays the lack of care and morality in people nowadays leaving them in the state of not caring and trying to allow someone else to take care and aid them for the rest of their lives. Mark Twain also uses irony when explaining â€Å"African Americans†, it states â€Å"Oh yes this is a wonderful government, wonderful, why looky here there was a nigger there from Ohio†(twain 35) The author is using satire to show how pap is the typical white man hating the government and black people. This quote is important due to the fact that during the 1800’s there were many people such as â€Å"pap† plotting and ready to exploit African Americans and the government. The consequence of this quote seems to show that it is true that African Americans were highly discriminated against due to their skin color and race. The author uses satire to actually provide the reader an understanding of what African Americans dealt with in the 1800’s. As well as explain the hatred they went through because of the people who neglected them all because of their color of their skin and race. Mark twain also states â€Å"Well what’s the use of learning to do right when its troublesome to do right and it isn’t no trouble to do wrong and the wages is just the same† (twain 16). This strong quote explains WHO Huckleberry Finn is, this quote explains who Huck Finn is a person on the inside and out, it explains how his morality has changed and how he is shaped now due to his partner Jim. Huck Finn believes in doing the right thing even though his society believes that it isn’t, Huck realizes that though he may be discriminated against and hated he feels as if he isn’t of society so he should do whatever he seems to do whether it be right or wrong or if it goes against society’s beliefs and morals. In its entirety Huck Finn overcomes many adventures and battles not necessarily on the outside as well as battling against internal mishaps that truly identifies and shapes who he really is. In the novel, Mark twain uses the quote â€Å"some think old Finn done it to himself†¦.. but before night they changed around and judged it was done by a runaway nigger named Jim† (twain 83) to demonstrate irony. This quote shows how easily people began to believe that Huck Finn was kidnapped by Jim all because of the fact that Jim was black. This shows how African Americans were easily blamed whenever crimes happened they were easily blamed just because of the color of their skin. This shows how ironic it is that Jim was easily blamed for the disappearing of Huck Finn, because he was Black. Mark twain uses this quote to demonstrate another example of how African Americans were heavily discriminated against. Mark twain uses this quote to not only depict the injustice faced by African Americans , but also he uses this quote to provide the stupidity behind the fact that African Americans were easily blamed for pointless crimes all because of the fact that there is a difference in skin. In conclusion, being that Mark twain shows his true colors revolving around society and African Americans, he doesn’t reveal it through a simplistic way as in telling us rather he demonstrates this through the strong use of satire and irony. Mark twain indubitably explains how messed up our society is and how corrupt our minds are when it comes down to things such as â€Å"Caring for our children† and â€Å"Working hard†. He also challenges or states the biased way of us Americans discriminating against African Americans and how we believe that they don’t deserve freedom and the right to a new and sacred life. Mark twain uses these different techniques to not necessarily sway the reader as to getting them to see the big picture, he’s using satire and irony to demonstrate what our world/ society is. What we do on a daily basis, how we act towards other people despite their differences as well as whom we are as a human race.

Photography Is A Technique Of Producing Permanent Images On Sensitized

Photography is a technique of producing permanent images on sensitized surfaces by means of the photochemical action of light or other forms of radiant energy. In today's society, photography plays important roles as an information medium, as a tool in science and technology, and as an art form, and it is also a popular hobby. It is essential at every level of business and industry, being used in advertising, documentation, photojournalism, and many other ways. Scientific research, ranging from the study of outer space to the study of the world of subatomic particles, relies heavily on photography as a tool. In the 19th century, photography was the domain of a few professionals because it required large cameras and glass photographic plates. During the first decades of the 20th century, however, with the introduction of roll film and the box camera, it came within the reach of the public as a whole. Today the industry offers amateur and professional photographers a large variety of cameras and accessories. See also Motion Picture. The Camera and Its Accessories Modern cameras operate on the basic principle of the camera obscura (see Historical Development, below). Light passing through a tiny hole, or aperture, into an otherwise lightproof box casts an image on the surface opposite the aperture. The addition of a lens sharpens the image, and film makes possible a fixed, reproducible image. The camera is the mechanism by which film can be exposed in a controlled manner. Although they differ in structural details, modern cameras consist of four basic components: body, shutter, diaphragm, and lens. Located in the body is a lightproof chamber in which film is held and exposed. Also in the body, located opposite the film and behind the lens, are the diaphragm and shutter. The lens, which is affixed to the front of the body, is actually a grouping of optical glass lenses. Housed in a metal ring or cylinder, it allows the photographer to focus an image on the film. The lens may be fixed in place or set in a movable mount. Objects located at variou s distances from the camera can be brought into sharp focus by adjusting the distance between the lens and the film. The diaphragm, a circular aperture behind the lens, operates in conjunction with the shutter to admit light into the lighttight chamber. This opening may be fixed, as in many amateur cameras, or it may be adjustable. Adjustable diaphragms are composed of overlapping strips of metal or plastic that, when spread apart, form an opening of the same diameter as the lens; when meshed together, they form a small opening behind the center of the lens. The aperture openings correspond to numerical settings, called f-stops, on the camera or the lens. The shutter, a spring-activated mechanical device, keeps light from entering the camera except during the interval of exposure. Most modern cameras have focal-plane or leaf shutters. Some older amateur cameras use a drop-blade shutter, consisting of a hinged piece that, when released, pulls across the diaphragm opening and exposes the film for about 1/30th of a second. In the leaf shutter, at the moment of exposure, a cluster of meshed blades springs apart to uncover the full lens aperture and then springs shut. The focal-plane shutter consists of a black shade with a variable-size slit across its width. When released, the shade moves quickly across the film, exposing it progressively as the slit moves. Most modern cameras also have some sort of viewing system or viewfinder to enable the photographer to see, through the lens of the camera, the scene being photographed. Single-lens reflex cameras all incorporate this design feature, and almost all general-use cameras have some form of focusing system as well as a film-advance mechanism. Camera Designs Cameras come in a variety of configurations and sizes. The first cameras, ?pinhole? cameras, had no lens. The flow of light was controlled simply by blocking the pinhole. The first camera in general use, the box camera, consists of a wooden or plastic box with a simple lens and a drop-blade shutter at one end and a holder for roll film at the other. The box camera is equipped with a simple viewfinder that shows the extent of the picture area. Some

Government of France

Government of France The government of France is a semi-presidential system based on the French Constitution of the fifth Republic, in which the nation declares itself to be "an indivisible, secular, democratic, and social Republic". The constitution provides for a separation of powers and proclaims France's "attachment to the Rights of Man and the principles of national sovereignty as defined by the Declaration of 1789."The national government of France is divided into an executive, a legislative and a judicial branch. The President has a degree of direct executive power, but most executive power resides in his appointee, the Prime Minister. The President's choice for Prime Minister must have the confidence of the National Assembly, the lower house of Parliament; also the Prime Minister is always from the majority party in that house.Parliament comprises the National Assembly and the Senate. It passes statutes and votes on the budget; it controls the action of the executive through formal questioning on the floor of the houses of Parliament and by establishing commissions of enquiry.President Wilson and President Poincare of FranceThe constitutionality of the statutes is checked by the Constitutional Council, members of which are appointed by the President of the Republic, the President of the National Assembly, and the President of the Senate. Former Presidents of the Republic also are members of the Council.The independent judiciary is based on a civil law system which evolved from the Napoleonic code. It is divided into the judicial branch (dealing with civil law and criminal law) and the administrative branch (dealing with appeals against executive decisions), each with their own independent supreme court, the courts of cassation. The French government includes various bodies that check abuses of power and independent agencies.France is a unitary state. However, the various legal subdivisionsthe r ©gions, d ©partements and communeshave various attributions, and the nationa l government...

Research methods Assignment Example | Topics and Well Written Essays - 2250 words

Research methods - Assignment Example The USASuperCars signed a new contract, which would allow it to sell its batch of 27 luxury cars to various customers around the globe, primarily in the UK, Japan, Canada, South Africa and the USA. The contract states that the selling price of the products are fixed and in local currencies at the exchange rates at the time of the delivery. In the real economic world set up, the exchange rate is marked with high level of precariousness. Therefore, one, particularly a businessman, cannot simply overlook the idea about the linked benefits and risks to the stated contract. In this event, the HSBC offered to pay a sure sum of $2,150,000 in return for revenue in local currencies. It is at this point that the work at hand seeks to come up with a decision whether to accept or reject the offer by weighing up the associated benefits and risks. In addition, in the event that the HSBC’s offer is accepted, finding for which payment schedule is better based on the point of view of USASuperC ars and HSBC, searching for other potential risks HSBC will be exposed to, and finally understanding the measures that can be taken in order to at least minimize the exchange rate risk beyond converting all currencies into dollars. Profit analysis for USASuperCars is vital for this case, prior to deciding which payment option is necessary provided that the offer of HSBC is accepted. Recommendations are provided, which are associated with HSBC’s offer. The justification behind the profit analysis is based on the information of the worldwide order, the quantity and the selling price of luxury cars in the local currencies. To ensure the information about exchange rate is properly considered, the mean and standard deviation rate for converting each currency into dollars are included based on the historical data. Based on the assumption that the rates are normally distributed and independent with each other, the profit has the assumption that it is normally distributed as well. As

Impact of External Environment on Apple Operations Essay

Impact of External Environment on Apple Operations - Essay Example On the other hand, the company internal factors that arise from external effects include strong brand name, diversified product portfolio, strong management team and mergers. To remain competitive and address the weaknesses of the poor relationship with the major competitor, it is imperative for the company to form more mergers with a large company such as Dell. In the same way, the company should utilize the available market opportunities by advertising its products through social sites such as facebook and twitter. This is in addition to establishing more sales outlets in the developing countries. One of the vital strategies that firms adapt to face off stiff competition in the contemporary business arena is the use of well-designed marketing plan that takes into consideration the effects of external environment on the operations of a firm. One of the companies that have attained a competitive advantage due to its effective marketing strategies is Apple Incorporation. Apple Inc. is an international company that deals with marketing and designing of computers hardware and software as well as household electronics products. Earlier on, the company was referred to as Apple computer incorporation (Adam, 2012). Apple Inc. which is headquartered in the US is well known for the quality and high-tech brands that have revolutionized communication. This marketing audit analyzes the impact of external environment on Apple operations by reflecting the current market situation of the company.The company is focused on becoming the market leader in the electronic and technology industry glob ally. According to the former chief executive officer, Mr. Steve Jobs, computers provided by Apple should be on every desk in the next 8 years. Apple Company will persist in offering innovative and revolutionized brands to its customer to meet their short term and long term demands.  

Maria Montessori Language Arts Rationale Essay Example | Topics and Well Written Essays - 750 words

Maria Montessori Language Arts Rationale - Essay Example A child learns to listen by hearing the various sounds that the adults around him and also learns to speak by imitating the various sounds that the adults make around him.as Maria Montessori said: There are three main areas where children are prepared for reading and writing. The first is physical skills where a child learns to balance using their hands and coordination of the hand and the eye works. The child also learns to concentrate and focus on the practical issues of life, recognizing sizes and shapes, working with paints, crayons, pencils and practice in talking. The second skill that a child learns is the mental skills where the child learns to absorb and how to use language and how to learn the sounds that each letter of the alphabet makes. This can be made easy by playing games to break up words into sounds (Montessori, 2010). The third skills are the social skills where people living in homes sit down and have conversations instead of watching the television or using the computer to learn language. A directress would know that a child is ready to learn a sound if they try to repeat what has been said to them by an adult around them. The child will also be making sounds on their own that they have heard before. Sounds are taught to children by repeating the sounds over and over until the child is able to differentiate it from other sounds. In learning the different sounds, he child is taught the various sounds of the different letters of the alphabet. There are different rules for the letters and children are very receptive towards rules. Therefore, they are first taught the rules than the different sounds of the letters of the alphabet (Montessori, 1909). The child is taught the phonetic words first and once they have mastered the phonetic part of the alphabets, they are next taught the non-phonetic part of the language where there are no rules whatsoever. A child learns to blend sounds by learning the individual

Types of Waste

Types of Waste Waste is known as a matter which current users have no purpose of, or it is known as a matter which can be harmful to humans, animals or the environment. Waste can be divided into two categories, general and hazardous waste. General waste is waste that does not harm humans, animals or the environment. For example household waste, garden waste, building rubble, dry industrial and commercial waste. Hazardous waste is more likely to cause danger to humans, animals and the environment. This waste is based on the chemical reactivity, explosives, corrosive and radioactive. Waste Found In the Community of Edenvale There is many different waste found in the community which affect the community. The types of waste found in my community are agricultural waste which comes from animal products and the production of crops. This waste can be recycled. Biodegradable waste is a type of waste that will go back into the soil and nature. This may include garden waste, animal waste, fruit and vegetable leftovers. This waste can be composted. Garden waste is known as grass clippings, weeds, tree branches and this can all be composted. Bulk waste is large waste, such as broken appliances, furniture and outer parts. Almost all of this waste can be reused or recycled. Trade waste is waste is generated by shops, offices, or commercial places. Construction waste is found on residential premises. This waste includes batteries, empty paint and pesticide containers. Some of the household waste is recyclable. Industrial waste is waste that comes from industrial and manufacturing processes. Some of this waste is haza rdous. Intuitional waste is found in schools, hospitals, research institutions and public buildings. Medical waste is known as any solid or liquid waste which is generated in treatments. The Waste plan in my Community In my community the waste management plan for households is that waste is collected once a week. Businesses are different and get waste removed twice a week depending on how much waste is generated. Industrial waste is also collected once a week. It has been working effectively because the municipality has had no complaints and customers are happy with the system. The community also stays clean by means of the council collecting waste around bins so that the community will stay clean. Hazardous waste containers are also being provided and specialized companies deal with this waste. People that dump illegally get high fines. Public roads are being taken care of by litter being picked up by services five times a week. In the CBD litter gets picked up seven days a week. Free standing pole bins get emptied daily. Informal Settlements around my Community Some informal settlements where waste is not managed well is in the CBD, Hillbrow, New Town, Alexandra Township, and Jeppestown. The pollution comes in the form of dust from gravel roads, lack of clean running water, lack of regular refuse removal, broken and non-maintained sewerage pipes, absence of toilet facilities and ignorant littering. Due to the overcrowding of the informal settlements with migrants who are unemployed, and are not able to pay housing rent leads to a decay of flats and houses. In Alexandra some people still use the bucket system which increases the contamination from sewerage in the environment, and some people can get a wide range of illnesses. The organic waste attracts rodents and insects infestations. Poverty and lack of knowledge in these areas lead to littering, overflow of broken sewerage systems and unmanaged waste. A waste management plan for the informal settlements is that refuse is removed twice a week by means of bulk containers and street hawkers are issued with refuse bags weekly. â€Å"The metropolitan council wants a waste disposal strategy; identification of waste disposal sites, establishments, operation and control of waste disposal sites.† The community water supply and sanitation programs aims to ensure all South Africans have access to clean water. The metropolitan also wants to prevent invasion of industrial sites. Some solutions that can help reduce waste are: Waste Avoidance, Prevention and Minimization: system to ensure the appropriate design promotion, optimizing operating procedures and good house keeping for all waste generating processes. Forecasting potential situations in which accidents and spills can cause unscheduled waste emissions. Recovering, Recycling and Reuse: Reduction in the waste stream. Recycle materials such as taxes on waste or subsides for waste cycling, and also extraction and utilization of landfill gas. Treatment and handling: Ensuring that waste is appropriately treated and processed to their disposal in accordance with laws, regulations and guidelines. Storage and Final Disposal: Timely identification investigation and construction of environmentally and socially acceptable waste disposal facilities. New innovative ways of managing waste in disadvantaged communities are required. We can move towards collection by paying people to collect litter and involve the community in programs. We can improve the awareness to the public with regard to waste. Allow people living in informal settlements to regain their dignity by providing sustainable, affordable sanitation. Polokwane Declaration The aim of the Polokwane Declaration is to reduce waste by 50 % respectively by 2012 and have a plan for zero waste by 2022. In order to achieve their goals they must engage more closely in a realistic and practical manner. Conclusion In Gauteng waste management is lacking it appears there has been an increase in waste per year between 1998 and 2003. It also appears that Polokwane Declaration of zero waste remains optimistic. Hazardous waste has decreased as a result of improvement in industrial activities. Recycling initiatives are being adopted and are successful. The importance of the public awareness of waste and recycling should be made aware and action plans formulated.

Internship in Public Relations Department of an Advertising Agency Essay

Section I Introduction 1.1 Background Internship is one of the essential parts required for the completion of MBA program. It is to provide first hand exposure to the students about the real work scenarios in business organizations. It allows students to imply their theoretical knowledge in the real workplace by enhancing their ability and confidence level in the dynamic business world. Besides, one of the objectives of this program is to enhance student’s interpersonal, communication, report writing skills as well as presentation skills and to understand different viewpoint of the staff and the customer of the organization. 1.2 Objective of the internship The objectives of my internship at Prisma Advertising agency are: To fulfill the requirement of MBA program of Pokhara University. To understand importance Public Relations in corporate world. To understand how public relations enhances brand image. To comprehend successful events. 1.3 Placement For the purpose of internship, the trainee was allowed to perform internship in the organization where she was actively working for past two years. The organization is an advertising agency named Prisma Advertising located in Kalikastha, Kathmandu. The internee had been working in Public Relations Department (PR) as an Executive. 1.4 Expected Learning Experiencing the real life working environment Expand the boundaries of theoretical learning Develop better public relation skills with media as well as in corporate sector Section II Industry and Organization Profile 2.1 Industry Profile There are no records of any kind that tell us about the origin and history of Nepali advertisements. The earliest form of advertising may thus be taken as the trumpet blowing tradition of kings and maharajas to disperse royal messages. The advent of Mass Communication in Nepal can be said to have been through such official proclamations, which were usually accompanied by the use of musical instruments like drums or trumpets. The age-old oral tradition of promotion by vendors selling their wares in the market can also be taken as another early form of advertising. With the national daily  Gorkhapatra churning out advertisements on a regular basis, the advertising sector caught momentum, and the next major development came in the form of an advertising agency, Laxman Upadhaya’s Nepal Advertisers. The main objective of the agency was to publish flashy and attractive advertisements in the print media. Three years later, following in the footsteps of Upadhaya, Keshav Lamichane started Nepal Printing and Advertising Agency owned by Keshav Lamichane. This agency held the accounts of prime clients like Janakpur Cigarette Factory, Royal Nepal Airlines Corporation and Nepal Bank Limited. 2.2 Prisma Advertising Profile Prisma Advertising is the franchisee of Mathew and Ogilvy in Nepal. It is one of the most creative agencies which established in 1991. It is a full service office with team of 47 people which has been growing as creative leader and 360 degree brand stewardship. It provides wide range of services from media, branding, and sales promotion to advertisement. They continuously thrive to provide creative products by giving a consumer touch to what they deliver, also offer fully integrated marketing communication solutions as well as focus on building brand relationship with the consumers. It has been awarded as The Best Agency of the Year 2004-05, 2005-06, 2006-07 & 2007-2008 (four years in a row). In addition to it also has won the only international advertising award for Nepal – â€Å"Bell Ringer 2000† from Johnson &Johnson, USA. Prisma approach to communication: These activities are part of the prisma advertisement agency which is provided to the clients according to the promotion they required for their products and services. 2.3 Importance of Public Relation Department Why does Brand or an Organization need a Public Relation Department? Unless one is a celebrity, good public relation just does not happen on its own. It takes lots of skill and consistent hard work, over a period of time. It’s part art, part science and when practiced correctly the results can be very rewarding. Here are few reasons why Public Relations is important: Media coverage increases credibility Paid advertising increases name recognition; media relations increases credibility. When people read a story about the excellence of a particular organization in a newspaper or see a story praising the company on television, they are much more likely to have a favorable opinion of that particular organization. Media coverage helps to attract â€Å"quality† prospects  Because a public relations increases credibility, it helps to attract those who want the best. When people have heard of the organization or brand and have a favorable impression of it, it is easier to attract and hold their attention while the organization or the brand tell their story. Media coverage makes you a player  Coverage in important publications or on TV can make the organization or brand look much larger than it is. Public relations help to avoid price competition  If people believe that the particular brand is the best, they will understand why it is worth paying the price. A public relations program stretches the marketing budget  Because the media does not charge for news coverage, the relative cost of a good program is a lot less than for paid media or a direct mail campaign. Best way to launch a brand  Public relations are also considered by many as the best way to launch a brand or new product. When something is new the media often will write about it because of its news value. Section III Critical Analysis of Job Performed 3.1 Function of Public Relation Department PR Department functions to maintain and enhance mutual understanding/relationship between its clients and public. The core responsibility of the PR Department is to build and protect the brand. PR communicates client’s views, objectives and purposes to the general mass and at the same time monitors feedback and correcting the public attitudes/ reactions. For this, department focuses on major areas: Crisis Management: To avoid any crisis and its adverse effects to its clients, the PR Department prepares press releases and makes them public through media vehicle. Corporate Social Responsibility (CSR): Also known as corporate responsibility, corporate citizenship, responsible business and corporate social performance that forms of corporate self-regulation integrated into a business model. To fulfill these responsibilities the company’s want to conduct events, and any such social events are organized for the client by this department. For example: charity program. Further, they also create social awareness for NGOs and INGOs and other organizations working for the welfare of the society at discount rates. Event Management: Various events such as press conference, product launching events etc. are organized either to provide new information or introduce a new product. In such events, various media houses, guests are invited and are provide with the press release which gives details about the event. Monitoring and tracking current scenario: Either it be country’s current happenings or competitor’s activities, PR Department tracks the entire essential data with the help of media and reports to the internal staff members as well as the client in daily basis as well as a monthly reports. 3.2 Activities Performed The internee was part of a PR Team and there were five members in this team. Public Relation Head, Senior Public Relation Supervisor, Copy Writer and PR Executives are the designations of this team. The internee was working under direct assistance of Senior Public Relation Supervisor. Each team members  had their specific task that they were assigned to and those were mentioned in their job description. Following were the job assigned to the intern. 1. Everyday internee had to make a daily update on country’s news update regarding political, business and social happenings and send it to the clients. 2. Track on competitor’s activities like press ad, news and send it to respective clients. 3. Make Share of Expense (SOE) respective to the competitor’s and send it to clients on monthly basis. 4. Make regular interactions with media as well as clients to enhance better public relation. 5. Make press releases, news articles on client’s activities and send it to media for the coverage. 6. Organized events like Press Conferences, Formal meetings with government bodies, and Cocktail parties as per the clients need. 7. Crisis management of the clients. Bajaj Pulsar 200 NS Launch, Coca-Cola Inter-School National Football Tournament, Coca-Cola ‘Live Positively ‘and Western Union’s collaboration with Mercy Corps to empower 1200 women to be financially literate were some of the major events organized as an internee under PR Department. The major task of the PR Department during these events was to highlight the program as much as possible with the help of media as well as word of mouth publicity. Few of the coverage of these events are attached below. Coverage of the Events Bajaj Pulsar 200 NS launch Coca-Cola Inter-School National Football Tournament Coca-Cola ‘Live Positively’ Western Union’s collaboration with Mercy Corps Activities Performed Working as an intern in PR Department, internee had to face several crisis situations where various brand reputation damaging news were covered by  newspapers and television. To tackle with those situations, crisis management was done. Few examples of Crisis Management are as follows: Nepal Samachar Patra and Sagarmatha Television were continuously showcasing various news regarding faulty products of Bottler’s Nepal Limited. To surpass those negative news, internee with the PR team had undergone the crisis management by flowing the positive news of the company in The Kathmandu Post. This is a technique where PR people do not counter the negative news directly but highlights the positive aspect of the company, person or the brand to put the positive news in the top of the publics mind. Negative News covered by Nepal Samachar Patra Positive News published in The Kathmandu Post 3.3 Public Relation Department Analysis As an internee under PR Department of an advertising agency, 3.4 Problem Identification and Solution Alternatives As every best effort does have a loop hole, PR Department also has to face certain problems at times.

Nitric Oxide Therapy in infants with pulmonary hypertension

The benefits of nitrogen oxide (NO) therapy as used in the treatment of infants with persistent pulmonary hypertension (PPHN) can be best appreciated if the reader is familiar with the pathophysiology of PPHN and the previous methods used in treating the disease. The function of NO has evolved in the minds of the scientific community from being a mere noxious gas emitted by vehicles to a wonder compound in the field of medicine. In the area of pulmonology, its vasodilatory effect in the blood vessels is now being used to assist PPHN patients in rerouting blood flow in infants whose blood circulation fails to shift from fetal to normal circulation.Such nature of the compound, being the main ingredient in NO therapy allows for a less invasive procedure which in effect reduces risks of complications during and after treatments, expected in previous treatment methods. This reduced risks account for the relatively more cost-effective character of NO therapy as a treatment method in PPHN p atients.There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.Persis tent Pulmonary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.   To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.Nitric Oxi de is a gaseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology. In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels.This effect can be explained by the mechanism involving the compound's diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.   This vasodilatory effect signals the mech anism to modulate blood flow and vascular tone.Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellingt on, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.The efficiency of the treatment procedure can be determined by observing its effect on the patient's ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation a nd partial pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant's trachea.In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among other methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.ReferencesAngus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.  Ellington Jr, Marty, O'Reilly, et. al. (2001). C hild Health Status, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111. Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.   340, 819–820.Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet. 340, 818–819.Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.  Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.   23, (2).98

Home Treatment for Jellyfish and Man of War Stings

Home Treatment for Jellyfish and Man of War Stings You can apply common household chemistry to treat jellyfish and Portuguese man-of-war stings. However, jellyfish and Portuguese man-of-war are two different animals. Heres a look at how to tell them apart and how the chemistry of treating the stings differs depending on what stung you. Key Takeaways: Jellyfish and Portuguese Man-of-War Stings A jellyfish can sting you even if its dead.Vinegar, ammonia, meat tenderizer, or heat can inactivate the toxin in jellyfish venom. However, if there is a risk a sting is from a Portuguese man-of-war, using a chemical can cause all of the stinging cells to fire at once and worsen the injury.Another method of treating a sting is to lift off the tentacle (like with a credit card or seashell) and rinse the area with water.An antihistamine can help reduce allergic response. Hydrocortisone can relieve inflammation. An over-the-counter pain reliever can help reduce pain. Dont Make the Sting Worse Do you know what to do if you or someone youre with finds a jellyfish or is stung by one? You should know the answer to these questions before you go to the beach since an encounter with a jellyfish can be a painful or possibly lethal experience. As a matter of practical chemistry, your biggest risk from a jellyfish or Portuguese man-of-war sting may come from improper first aid intended to deal with the venom, so pay attention... What Should You Do If You See a Jellyfish? Best Answer: Leave it alone. If its in the water, get away from it. If its on the beach and you need to walk around it, walk above it (dune side) rather than below it (surf side), since it may be trailing tentacles. Keep in mind a jellyfish does not need to be alive in order to sting you. Detached tentacles are capable of stinging and releasing venom for several weeks. Other Answer: It depends what kind of jellyfish it is. I realize if it looks like floating jelly, its considered a jellyfish, but there are different types of jellyfish and also animals that look like jellyfish but are something else entirely. Not all jellyfish can hurt you. Some jellyfish are either nonvenomous or else their stinging cells cant penetrate your skin. What do you do when you see one of these jellyfish? If you are a kid, youll probably pick it up and throw it at another kid (unless its alive, then be kind and let it be). Most parts of the world have nonvenomous jellyfish. They tend to be easy to spot. Its the ones you dont see that present the biggest threat. Many jellyfish are transparent (but glow under a black light). You probably wont see them in the water, so if you are stung, you wont know exactly what got you. If you see a jellyfish and dont know what type it is, treat it like a venomous species and get away from it. How Do I Treat a Jellyfish Sting? Answer: If you know the victim is allergic to insect stings, seek medical attention immediately. People who are allergic to bees and wasps may experience a dangerous allergic reaction to a jellyfish sting. Otherwise, act quickly and calmly to remove the tentacles, stop the stinging, and deactivate any toxin. Here is where people get confused because the best steps to take depend on what type of animal caused the sting. Use these good basic strategies, especially if you dont know what caused the sting: Get out of the water. Its easier to deal with the sting, and it takes drowning out of the equation.Rinse the affected area with seawater. Do not use fresh water. Fresh water will cause any stinging cells that havent fired (called nematocysts) to do so and release their venom, possibly worsening the situation. Do not rub sand on the area (same reason).If you see any tentacles, carefully lift them off the skin and remove them with a stick, shell, credit card, or towel (just not your bare hand). They will stick to swimwear, so use caution touching clothing.Keep an eye on the victim. If you see any signs of an allergic reaction, call 911 immediately. Symptoms could include difficulty breathing, nausea, or dizziness. Some redness and swelling is normal, but if it spreads outward from the sting or if you see hives on other parts of the body, that could indicate an allergic response. If you suspect a reaction, do not hesitate to seek medical attention.Now, if you are sure the sting is from a jellyfish and not a Portuguese man-of-war (not a true jellyfish) or any other animal, you can use chemistry to your advantage to inactivate the toxin, which is a protein. (Technically, the venom tends to be a mixture of polypeptides and proteins including catecholamines, histamine, hyaluronidase, fibrolysins, kinins, phospholipases, and assorted toxins). How do you inactivate proteins? You can change the temperature or acidity by applying heat or an acid or base, such as vinegar or baking soda or diluted ammonia, or even an enzyme, such as the papain found in papaya and meat tenderizer. However, chemicals may cause the stinging cells to fire, which is bad news for someone allergic to jellyfish toxin or anyone stung by a Portuguese man-of-war. If you do not know what caused the sting, or if you suspect it is from a Portuguese man-of-war, do not apply fresh water or any chemical. Your best course of action is to apply heat to the affected area since it penetrates the skin and inacti vates the toxin without causing more venom to be injected. Also, heat quickly helps alleviate the pain of the sting. Hot seawater is great, but if you dont have that handy, use any warmed object. Some people carry aloe vera gel, Benadryl (diphenhydramine) cream, or hydrocortisone cream. Im not sure how effective the aloe is, but Benadryl is an antihistamine, which may help limit an allergic response to the sting. Hydrocortisone can help reduce inflammation. If you seek medical attention and used Benadryl or hydrocortisone, be sure to alert the medical professionals. Acetaminophen, aspirin, or ibuprofen are commonly used to relieve pain.

Pet Overpopulation & The Importance of Spaying & Neutering essays

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Module Questions Law Coursework Example | Topics and Well Written Essays - 750 words

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Hybrid Cultural Object Essay Example | Topics and Well Written Essays - 1250 words

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Stork Removals has a modern fleet of vehicles ranging from 3.5 Tonnes Luton vans to large furniture vans to cope wit any size of removals. Marketing and Promotion: Provides testimonials on their website, has name of business and contact details on their removals vehicles listed in the yellow pages with details of their services. 2. Name: Falcon Move www.falconmove.co.uk Address of Competitor: Falcon Move 135A, Town Road, London, N9 ORL Products Offered By Competitor: Removals, Storage, Light Haulage Services, Packing. Features of Customers Services: Provide consultants to work with customers to design and implement a relocation plan customized to their individual needs that is cost effective, efficient and stress free. Provide a free quotation page on their website where customers can fill in their details of what they are moving and where they want to move. The company will email the customer with an estimate. Provide an online form for customers to send a message to Falcon Move or make enquiries. Customers can contact by phone or email. Quality of Service Offered by competitors: Use state-of-the-art equipment to provide a truly exceptional service, the mission of Falcon Move, through quality, reliability, consistency of services and innovation, to achieve the goal of customer satisfaction. Aim to provide the best possible removal and storage service that ensures all customers obtain value for money. They offer full packing service with trained packers to help customers wrap and protect their precious items ready for removal. The staffs at Falcon Move have specialist knowledge to pack everything. Falcon Move uses purpose made plywood storage containers for maximum protection of customers possessions. Everything will remain safe in their warehouses because all the warehouses are under 24-hour security surveillance utilizing CCTV technology. Marketing and Promotion: Listed in the yellow pages with details of their service. 3. Name: Smart Removals www.smartremovals.com/index.htm Address of Competitor: Building 8 Argon Road London N18 3BW Products Offered By Competitor: Domestic Moves, Commercial Moves, Storage, Overseas Moves, Excess Baggage, Packing (complete or part packing) Features of Customer Service: 0800 number, free insurance cover, free no obligation quotation can be done online or over the phone, free expert advice, contact via telephone, fax or email, full range of packing options to meet customers needs, open-ended contract on storage. Quality of Service Offered by Competitor: Members of the British Association of Removers (BAR), Members of the National Guild of Removers and stores (NGRS) staff are efficient and courteous. A representative will visit the customer at home to discuss what the customer require, Office removals teams consists of experienced furniture removers and IT packers Modern 24 hour manned secure storage units Marketing and Promotion: Listed in the yellow pages with details of their service 4. Name: Easy Shift www.Easyshift.co.uk Address of Competitor: 106, Priory Rd, London, N8 7HR Products Offered By Competitor: Removals, Self- Storage, Packing Features of Customers Services: Free quotes. Either personally, over the phone or via email. Free goods in transit insurance with all work performed to à ¯Ã‚ ¿Ã‚ ½10,000. Easy payment methods, Contact via telephone or email, free word robe boxes for all moves, free advice, Weekend and bank holidays office relocation, boxes can be provided on a sale or return basis and any unused boxes collected on the day of moving. Customers can pack all or some of their possessions and Easy shift will part-pack on request. Open-ended contract on self storage. Quality of Service Offered by Competitor: Reliable, honest and punctual staff, Trained staff, professionally maintained and insured vehicles, wide range of packaging materials to protect customers goods whilst in transit. Flexible solutions to individual relocation requirements, provides top 10 tips on removals on their website, terms and condition are clearly stated on their website, can cater for moves of all sizes to all locations within Greater London, UK and Europe. Customers can check packaging price list on their website or ask staff to recommend how many boxes the job will require. All goods are safely stored and fully insured whilst in storage. Marketing and Promotion: Provides testimonials on their website, has name of business and contact details on their removal vehicles, listed in the yellow pages with details of their service. Part B What Falconi Removal Need to do to be more competitive: Productive/Service Storage Packing Options: Full or part packing Light Haulage Domestic Move Overseas Moves Excess Baggage Commercial Moves Easy payment methods Open-ended contract on self storage Marketing and Promotion Set up a website Put Testimonials on website contact details on their removals vehicles listed in the Yellow Pages Quality of Service A representative to visit customers homes in order to provide an accurate quotation. estimators visit at a time convenient to the customer Customers goods are automatically covered during loading Trained Staff All staffs wear the companys uniform and are easily recognisable plywood storage containers for maximum protection of customers The warehouse are under 24-hour security surveillance utilizing CCTV technology Show association that their part of Office removals teams consists of experienced furniture removers and IT packers Modern 24 hour manned secure units Customers can check packaging price list on their website or ask staff to recommend how many boxes the job will require All goods are safely stored and fully insured whilst in storage Flexible solutions to individual relocation requirements, provides top 10 tips on removals on their website. Customer Service Free Insurance cover 0800 number Free expert advice Contact via telephone, fax or email Provide consultants to work with customers to design and implement a relocation plan customized to their individual needs that is cost effective, efficient and stress free Provide a free quotation page on their website where customers can fill in their details of what they are moving and where they want to move. Free quotes Free goods in transit insurance with all work performed to à ¯Ã‚ ¿Ã‚ ½10,000 Weekend and bank holidays office relocation Price Falconi Removals have to find this information themselves e.g. Mystery shoppers

GentleHands by M.E. Kerr :: essays research papers

What would you do if your Grandfather were accused of being a sadist in WWII? That’s exactly what happened to Buddy Boyle. Gentlehands by M.E. Kerr is about Buddy Boyle, a lower class man who lives year-round in Seaville, and Skye Pennington, a rich girl who only spends her summer there. Skye and Buddy fall in love. On one of their dates, Buddy decides that they should go to his grandfather’s house. Near the end of the summer, Buddy’s grandfather is accused of torturing people during WWII. Buddy and Skye’s love leads into many events in this book. One of the events that Buddy and Skye’s love causes, is Buddy getting in trouble with his parents. At dinner one night, Buddy keeps tell his family about how wonderful Skye’s house is. His father gets annoyed and asks him to step outside for a talk. Once outside, Buddy’s dad starts to beat him. â€Å"What is was a punch to my neck, so hard I fell down from the weight of it.† Although he knows what will happen when he goes out with Skye, he still goes out. Another event that their love leads to is Buddy getting to know his grandfather. On one of their first dates he wants to go somewhere special, so he chose to go to his grandfather’s house. After that day, he becomes close to his grandfather. He starts to live with his grandfather. If Buddy never met Skye, he probably wouldn’t have became close to his grandfather. Despite the relationship between Buddy and his Skye, Buddy’s little brother was suffering. Buddy promised Streaker, his brother that he would go to the bay with him. Instead, he told him that he would turn the sprinkler on for him. â€Å"Then I stuck two dimes in his piggy bank because I felt like a real rat.

Med-Surg Success a Course Review Applying Critical Thinking

Med-Surg Success A Course Review Applying Critical Thinking to Test Taking Med-Surg Success KATHRYN CADENHEAD COLGROVE RN, MS, CNS, OCN Trinity Valley Community College Kaufman, Texas A Course Review Applying Critical Thinking to Test Taking JUDY CALLICOATT RN, MS, CNS Trinity Valley Community College Kaufman, Texas Consultant: Ray A. Hargrove-Huttel RN, PhD Trinity Valley Community College Kaufman, Texas F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www. fadavis. com Copyright  © 2007 by F. A. Davis Company Copyright  © 2007 by F. A. Davis Company. All rights reserved. This book is protected by copyright.No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Robert G. Martone Content Developm ent Manager: Darlene D. Pedersen Project Editor: Thomas A. Ciavarella Art and Design Manager: Carolyn O’Brien As new scienti? c information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes.The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation.The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administerin g any drug. Caution is especially urged when using new or infrequently ordered drugs. ISBN 13: 978-0-8036-1576-2 ISBN 10: 0-8036-1576-0 Authorization to photocopy items for internal or personal use, or the internal or personal use of speci? c clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $. 0 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1576/07 $. 10. Dedication The authors would like to dedicate this book to the Trinity Valley Community College Associate Degree nursing students who graduated in 2005 and 2006. Thank you for giving of your time to pilot the questions and provide us constructive feedback.We would like to thank Bob Martone for giving u s the opportunity to embark on this endeavor. Our appreciation goes to Barbara Tchabovsky for her assistance in editing the book and answering our numerous questions via e-mail, which is a wonderful invention. Our thanks go to Tom Ciavarella for supporting us through the maze of publishing this book. This book would not be possible without the unbelievable computer skills of Glada Norris. —The Authors I would like to dedicate this book to the memory of my mother, Mary Cadenhead, and grandmother, Elsie Rogers.The Cardiovascular SystemThey always told me that I could accomplish anything I wanted to accomplish. I would like to dedicate this book to my husband, Larry, daughter Laurie and son-in-law Todd, and son Larry Jr. and daughter-in-law Mai, and grandchildren Chris, Ashley, Justin C. , Justin A. , and Connor. Without their support and patience, the book would not have been possible. —Kathryn Colgrove This book is dedicated to my husband, George; my family, and my frie nds, who love and support me. Many thanks are given to the students who teach me and inspire me by persevering through the difficulties of nursing school.I want to extend my gratitude to members of the profession of nursing, both faculty and staff who share their art with nursing students. —Judy Callicoatt This book is dedicated to the memory of my husband, Bill, and my parents, T/Sgt. Leo and Nancy Hargrove, who are the rocks on which my life is built. I would like to thank my sisters, Gail and Debbie; my nephew Benjamin; and Paula for their support and encouragement through the good times and the bad. My children, Teresa and Aaron, are the most important people in my life and I want to thank them for always believing in me. —Ray Hargrove-Huttel v ReviewersFreda Black, MSN, RN, ANP-BC Assistant Professor Ivy Tech State College Gary, Indiana Anne Dunphy, RN, MA, CS Nursing Instructor Delaware Technical & Community College Newark, Delaware Judy R. Hembd, RN, BSN, MSN As sistant Professor Montana State University-Northern Department of Nursing Havre, Montana Linda Ann Kucher, BSN, MSN Assistant Professor of Nursing Gordon College Barnesville, Georgia Regina M. O’Drobinak, MSN, RN, ANP-BC Assistant Professor, Associate of Science in Nursing Ivy Tech State College Gary, Indiana Elizabeth Palmer, PhD, RN Assistant Professor of Nursing Indiana University of Pennsylvania Indiana, Pennsylvania ii Editors and Contributors Joan L. Consullo, RN, MS, CNRN Advanced Clinical Nurse, Neuroscience St. Luke’s Episcopal Hospital Houston, Texas Michelle L. Edwards, RN, MSN, ACNP, FNP Advanced Practice Nurse, Cardiology Acute Care Nurse Practitioner/Family Nurse Practitioner St. Luke’s Episcopal Hospital Houston, Texas Gail F. Graham, APRN, MS, NP-C Advanced Practice Nurse, Internal Medicine Adult Nurse Practitioner St. Luke’s Episcopal Hospital Houston, Texas Elester E. Stewart, RRT, RN, MSN, FNP Advanced Practice Nurse, Pulmonary Family N urse Practitioner St.Luke’s Episcopal Hospital Houston, Texas Leslie Prater, RN, MS, CNS, CDE Clinical Diabetes Educator Associate Degree Nursing Instructor Trinity Valley Community College Kaufman, Texas Helen Reid, RN, PhD Dean, Health Occupations Trinity Valley Community College Kaufman, Texas ix Contents 1 Fundamentals of Critical Thinking Related to Test Taking: The RACE Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GUIDELINES FOR USING THIS BOOK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PREPARING FOR LECTURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PREPARING FOR AN EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 TAKING THE EXAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 U NDERSTANDING THE TYPES OF NURSING QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . 5 THE RACE MODEL: THE APPLICATION OF CRITICAL THINKING TO MULTIPLE-CHOICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 Neurological Disorders †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Cerebrovascular Accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Head Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Brain Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Amyotrophic Lateral Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . . 24 COMPRE HENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . 54 3 Cardiac Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Congestive Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Angina/Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Valvular Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Dysrhythmias and Conduction Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 In? ammatory Cardiac Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . . 72 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 90 4 Peripheral Vascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Arterial Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Arterial Occlusive Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Abdominal Aortic Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Deep Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Peripheral Venous Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 xi xii CONTENTS PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 104 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 120 5 Hematological Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Bleeding Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Blood Transfusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Sickle Cell Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 134 COMPREHENSIV E EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 152 6 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Upper Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Lower Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Chronic Pulmonary Obstructive Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Reactive Airway Disease (Asthma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Cancer of the Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Pulmonary Embolus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Chest Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Acute Respiratory Distress Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 174 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 202 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Gastroesophageal Re? ux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 In? ammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Peptic Ulcer Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Colorectal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Diverticulosis/Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Gallbladder Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Abdominal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Constipation/Diarrhea Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 229 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 262 7 8 Endocrine Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 Cancer of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274 Adrenal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276 Pituitary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 Thyroid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 CONTENTS PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . 282 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 301 xiii 9 Genitourinary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Chronic Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Fluid and Electrolyte Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Urinary Tract Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310 Benign Prostatic Hypertrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Renal Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 Cancer of the Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 317 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 336 Reproductive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 Breast Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 Pelvic Floor Relaxation Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 Uterine Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Ovarian Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 Prostate Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348 Testicular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349 Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 353 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . 372 10 11 Musculoskeletal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Degenerative/Herniated Disc Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 Amputation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382 Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384 Joint Replacements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 388 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 404 Integumentary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 Pressure Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Skin Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Bacterial Skin Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 Viral Skin Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Fungal/Parasitic Skin Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 420 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 437 12 13 Immune System Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442 Guillain-Barre Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444 xiv CONTENTS Myasthenia Gravis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 Systemic Lupus Erythematous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447 Acquired Immunode? ciency Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448 Allergies and Allergic Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450 Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 454 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 473 14 Sensory De? cits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 Eye Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 Ear Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 481 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 489 15 Emergency Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 Bioterrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495 Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497 Disaster/Triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498 Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 Violence, Physical Abuse, Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 504 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . 522 16 Perioperative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 Preoperative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 Intraoperative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529 Postoperative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531 Acute Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 534 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 546 17 Cultural Nursing and Alternative Health Care . . . . . . . . . . . . . . . . . . . . . 549 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 554 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 563 18 End-of-Life Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567 PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 568 Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 568 Death and Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569 Chronic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571 Ethical/Legal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 Organ/Tissue Donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 PRACTICE QUESTIONS ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . . . . . . . . . . 576 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 591 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595 TEST-TAKING HINTS FOR PHARMACOLOGY QUESTIONS . . . . . . . . . . . . . . . . . . . . . . 595 COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 COMPREHENSIVE EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . . . . . . . 614 19 Pharmacology CONTENTS xv 20 Comprehensive Final Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627 COMPREHENSIVE FINAL EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628 COMPREHENSIVE FINAL EXAMINATION ANSWERS AND RATIONALES . . . . . . . . . . 642 Glossary of English Words Commonly Encountered on Nursing Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 655 Index †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 659 Fundamentals of Critical Thinking Related to Test Taking: The RACE Model This book is the second in a series of books, published by the F. A. Davis Company, designed to assist the student nurse in being successful in nursing school and in taking examinations, particularly the NCLEX-RN examination for licensure as a registered nurse. Med-Surg Success: A Course Review Applying Critical Thinking to Test Taking focuses, as its name implies, on critical thinking as it pertains to test-taking skills for examinations in the nursing ? ld. It c ontains the usual practice test questions found in review books, but it also provides important test-taking hints to help in analyzing questions and determining the correct answers. It follows book one of this series— Fundamentals Success: A Course Review Applying Critical Thinking to Test Taking by Patricia Nugent, RN, MA, MS, EdD, and Barbara Vitale, RN, MA—which de? nes critical thinking and the RACE model for applying critical thinking to test taking, but it does not repeat the same speci? c topics.Rather, it focuses on how to use the thinking processes and test-taking skills in answering questions on topics speci? cally addressed in the NCLEX-RN exam and in other nursing exams. Test-taking skills and hints are valuable, but the student and future test taker must remember that the most important aspect of taking any examination is to become knowledgeable about the subject matter the test will cover. There is no substitute for studying the material. 1 GUIDELINES FOR USING THIS BOOK This book contains 19 chapters and a ? nal comprehensive examination. This ntroductory chapter on test taking focuses on guidelines for studying and preparing for an examination, speci? cs about the nature of the NCLEX-RN test and the types of questions contained in it, and approaches to analyzing the questions and determining the correct answer using the RACE model. Thirteen chapters (Chapters 2–14) focus on disorders affecting the different major body systems. Each of these chapters is divided into four major sections: Practice Questions, Practice Questions Answers and Rationales, a Comprehensive Examination, and Comprehensive Examination Answers and Rationales.Key words and abbreviations are also included in each chapter. Different types of multiple-choice questions about disorders that affect a speci? c body system help the test taker to more easily identify speci? c content. The answers to these questions, the explanations for the correct answers, and th e reasons why other possible answer options are wrong or not the best choice reinforce the test taker’s knowledge and ability to discern subtle points in the question. Finally, the test-taking hints provide some clues and tips for answering the speci? c question.The Comprehensive Examination includes questions about the disorders covered in the practice section and questions about other diseases/disorders that may affect the particular body system. Answers and rationales for these examination questions are given, but test-taking hints are not. Chapters 15–18 follow the same pattern but focus on emergency nursing, perioperative nursing, cultural nursing and alternative health care, and end-of-life issues. Chapter 19, the pharmacology chapter, deals speci? cally with what the student nurse should know about the administration of medications, provides test-taking tips speci? to pharmacology questions, and provides questions and answers. A ? nal 100-question comprehensive examination completes the main part of the book. 1 2 Test Taking MED-SURG SUCCESS PREPARING FOR LECTURE To prepare for attending a class on a speci? c topic, students should read the assignment in the textbook and prepare notes to take to class. Highlight any information the test taker does not understand so that the information may be clari? ed during class or, if the instructor does not cover it in class, after the lecture. Writing a prep sheet while reading (studying) is very useful.A single sheet of paper divided into categories of information, as shown in the following, should be sufficient for learning about most disease processes. If students cannot limit the information to one page, they are probably not being discriminatory when reading. The idea is not to rewrite the textbook; the idea is to glean from the textbook the important, need-to-know information. Sample Prep Sheet Medical Diagnosis: Diagnostic Tests: (List normal values) De? nition: Signs and Symptoms Nursing Inte rventions: (Include Teaching)Procedures and Nursing Implications: Medical Interventions: Complete the prep sheet in one color ink. Take the prep sheet to class along with a pen with different color ink or a pencil and a highlighter. Highlight on the prep sheet whatever the instructor emphasizes during the lecture. Write in different color ink or with a pencil any information the instructor emphasizes in lecture that the student did not include on the prep sheet. After the lecture, reread the information in the textbook that was included in the lecture but not on the student’s prep sheet.By using this method when studying for the exam, the test taker will be able to identify the information obtained from the textbook and the information obtained in class. The information on the prep sheet that is highlighted represents information that the test taker thought was important from reading the textbook and that the instructor emphasized during lecture. This is need-to know-informat ion for the examination. Please note, however, that the instructor may not emphasize laboratory tests and values but still expect the student to realize the importance of this information.Carry the completed prep sheets in a folder so that it can be reviewed any time there is a minute that is spent idly, such as during children’s sports practices or when waiting for an appointment. This is learning to make the most of limited time. The prep sheets also should be carried to clinical assignments to use when caring for clients in the hospital. If students are prepared prior to attending class, they will ? nd the lecture easier to understand and, as a result, will be more successful during examinations.Being prepared allows students to listen to the instructor and not sit in class trying to write every word from the overhead presentation. Test takers should recognize the importance of the instructor’s hints during the lecture. The instructor may emphasize information by hi ghlighting areas on overhead slides, by repeating information, or by emphasizing a particular fact. This usually means the instruc- CHAPTER 1 FUNDAMENTALS OF CRITICAL THINKING RELATED TO TEST TAKING 3 Test Taking tor thinks the information is very important. Important information usually ? nds its way onto tests at some point.PREPARING FOR AN EXAMINATION There are several steps that the test taker should take in preparing for an examination— some during the course of the class and some immediately before the day of the test. Study, Identify Weaknesses, and Practice The test taker should plan to study three (3) hours for every one (1) hour of class. For example, a course that is three (3) hours of credit requires nine (9) hours of study a week. Cramming immediately prior to the test usually places the test taker at risk for being unsuccessful. The information acquired during cramming is not really learned and is quickly forgotten.And remember: Nursing examinations include mate rial required by the registered nurse when caring for clients at the bedside. The ? rst time many students realize they do not understand some information is during the examination or, in other words, when it is too late. Nursing examinations contain highlevel application questions requiring the test taker to have memorized information and to be able to interpret the data and make a judgment as to the correct course of action. The test taker must recognize areas of weakness prior to seeing the examination for the ? rst time.This book is designed to provide assistance in identifying areas of weakness prior to the examination. Two to 3 days prior to the examination the test taker should compose a practice test or take any practice questions or comprehensive exams in this book that have not already been answered. If a speci? c topic of study—say, the circulatory system and its disorders—proves to be an area of strength, as evidenced by selecting the correct answers to the questions on that system, then the test taker should proceed to study other areas identi? ed as areas of weakness because of incorrect answers in those areas.Prospective test takers who do not understand the rationale for the correct answer should read the appropriate part of the textbook and try to understand the rationale for the correct answer. However, test takers should be cautious when reading the rationale for the incorrect answer options because during the actual examination, the student may remember reading the information and become confused about whether the information applied to the correct answer or to the incorrect option. The Night Before the Exam The night before the examination the test taker should stop studying by 6:00 P.M. or 7:00 P. M. and then do something fun or relaxing until bedtime. Don’t make bedtime too late: A good night’s rest is essential prior to taking the examination. Studying until bedtime or an all-night cram session will leave the test taker tired and sleepy during the examination, just when the mind should be at its top performance. The Day of the Exam Eat a meal before an examination. A source of carbohydrate for energy, along with a protein source, make a good meal prior to an examination. Skipping a meal before the examination leaves the brain without nourishment.A glass of milk and a bagel with peanut butter is an excellent meal; it provides a source of protein and a sustained release of carbohydrates. Do not eat donuts or other junk food or drink soft drinks. They provide energy that is quickly available but will not last throughout the time required for an examination. Excessive ? uid intake may cause the need to urinate during the examination and make it hard for students to concentrate. 4 Test Taking MED-SURG SUCCESS Test-Taking Anxiety Test takers who have test-taking anxiety should arrive at the testing site 45 minutes prior to the examination.Find a seat for the examination and place books there to reserve the desk. Walk for 15 minutes at a fast pace away from the testing site and then turn and walk back. This exercise literally walks anxiety away. If other test takers’ getting up and leaving the room is bothersome, try to get a desk away from the group, in front of the room or facing a wall. Most schools allow students to wear hunter’s earplugs during a test if noise bothers them. Most RN-NCLEX test sites will provide earplugs if the test taker requests them. TAKING THE EXAM The NCLEX-RN examination is a computerized exam. Tests given in nursing schools in speci? subject areas may be computerized or pen and pencil. Both formats include multiple-choice questions and may include several types of alternate questions: a ? ll-in-theblank question that tests math abilities; a select-all-that-apply question that requires the test taker to select more than one option as the correct answer; a prioritizing question that requires the test taker to prioritize the answers 1, 2, 3, 4, and 5 in the order of when the nurse would implement the intervention; and, in the computerized version, a click-and-drag question that requires the test taker to identify a speci? area of the body as the correct answer. Examples of all types of questions are included in this book. In an attempt to illustrate the click-and-drag question, this book has pictures with lines to delineate choices A, B, C, or D. Refer to the National Council of State Boards of Nursing for additional information on the NCLEX-RN examination (http://www. ncsbn. org). Pen-and-Pencil Exam A test taker taking a pen-and-pencil examination in nursing school who ? nds a question that contains totally unknown information should circle the question and skip it. Another question may help to answer the skipped question.Not moving on and worrying over a question will place success on the next few questions in jeopardy. The mind will not let go of the worry, and this may lead to missing important informatio n in subsequent questions. Computerized Test The computerized NCLEX-RN test is composed of from 75 (the minimum number of questions) to 265 questions. The computer determines with a 95% certainty whether the test taker’s ability is above the passing standard before the examination concludes. During the NCLEX-RN computerized test, take some deep breaths and then select an answer.The computer does not allow the test taker to return to a question. Test takers who become anxious during an examination should stop, put their hands in their lap, close their eyes, and take a minimum of ? ve deep breaths before resuming the examination. Test takers must become aware of personal body signals that indicate increasing stress levels. Some people get gastrointestinal symptoms and others feel a tightening of muscles. Test takers should not be overly concerned if they possess only rudimentary computer skills. Simply use the mouse to select the correct answer.Every question asks for a con? rm ation before being submitted as the correct answer. In addition to typing in pertinent personal information, test takers must be able to type numbers and use the drop-down computer calculator. However, test takers can request an erasable slate to calculate math problems by hand. Practice taking tests on the computer before taking the NCLEX-RN examination. Many textbooks contain computer disks with test questions, and there are many on-line review opportunities. CHAPTER 1 FUNDAMENTALS OF CRITICAL THINKING RELATED TO TEST TAKING 5 Test TakingUNDERSTANDING THE TYPES OF NURSING QUESTIONS Components of a Multiple-Choice Question A multiple-choice question is called an item. Each item has two parts. The stem is the part that contains the information that identi? es the topic and its parameters and then asks a question. The second part consists of one or more possible responses, which are called options. One of the options is the correct answer; the others are the wrong answers and are cal led distracters. The client diagnosed with angina complains of chest pain while ambulating in the hall. Which intervention should the nurse implement ? rst? . Have the client sit down. 2. Monitor the pulse oximeter reading. 3. Administer sublingual nitroglycerin. 4. Apply oxygen via nasal cannula. } STEM } OPTIONS } } CORRECT ANSWER DISTRACTERS Cognitive Levels of Nursing Questions Questions on nursing examinations re? ect a variety of thinking processes that nurses use when caring for clients. These thinking processes are part of the cognitive domain, and they progress from the simple to the complex, from the concrete to the abstract, and from the tangible to the intangible. There are four types of thinking processes represented by nursing questions. . Knowledge Questions—These questions emphasize recalling information that has been learned/studied. 2. Comprehension Questions—These questions emphasize understanding the meaning and intent of remembered information. 3. Application Questions—These questions emphasize the use of remembered and understood information in new situations. 4. Analysis Questions—These questions emphasize comparing and contrasting a variety of elements of information. THE RACE MODEL: THE APPLICATION OF CRITICAL THINKING TO MULTIPLE-CHOICE QUESTIONS Answering a test question is like participating in a race.Of course, each test taker wants to come in ? rst and be the winner. However, the thing to remember about a race is that success is not just based on speed but also on strategy and tactics. The same is true about nursing examinations. Although speed may be a variable that must be considered when taking a timed test so that the amount of time spent on each question is factored into the test strategy, the emphasis on RACE is the use of critical-thinking techniques to answer multiplechoice questions. The RACE Model presented here is a critical-thinking strategy to use when answering multiple-choice questions co ncerning nursing.If the test taker follows the RACE Model every time when looking at and analyzing a test question, its use will become second nature. 6 Test Taking MED-SURG SUCCESS This methodical approach will improve the ability to critically analyze a test question and improve the chances of selecting the correct answer. The RACE Model has four steps to answering a test question. The best way to remember the four steps is to refer to the acronym RACE. R — Recognize †¢ What information is in the stem. †¢ The key words in the stem. †¢ Who the client is in the stem. What the topic is about. A — Ask †¢ What is the question asking? †¢ What are the key words in the stem that indicate the need for a response? †¢ What is the question asking the nurse to implement? C — Critically analyze †¢ The options in relation to the question asked in the stem. †¢ Each option in relation to the information in the stem. †¢ A rationale f or each option. †¢ By comparing and contrasting the options in relation to the information in the stem and their relationships to one another. E — Eliminate options †¢ One option at a time. †¢ As many options as possible.The text Fundamentals Success: Course Review Applying Critical Thinking to Test Taking by Patricia Nugent and Barbara Vitale includes a discussion exploring the RACE Model in depth and its relation to the thinking processes used in multiple-choice questions in the ? eld of nursing. The ? rst step toward knowledge is to know that we are not ignorant. —Richard Cecil Neurological Disorders Test-taking hints are useful to discriminate information, but they cannot substitute for knowledge. The student should refer to Chapter 1 for assistance in preparing for class, studying, and taking an examination. This hapter focuses on disorders that affect the neurological system. It provides a list of keywords and abbreviations, practice questions focu sed on disease processes, and a comprehensive examination that includes other content areas involving the neurological system and the disease processes addressed in the practice questions. Answers and reasons why the answer options provided are either correct or incorrect are also provided as are some testtaking hints. The following chapters (Chapters 3–12) focus on disorders that affect other body systems and function. 2 KEYWORDS agnosia akinesia aphasia apraxia are? xia ataxia autonomic dysre? exia bradykinesia decarboxylase diplopia dysarthria dysphagia echolalia epilepsy papilledema paralysis paresthesia paroxysms penumbra postictal ABBREVIATIONS Activities of Daily Living (ADLs) Amyotrophic Lateral Sclerosis (ALS) As Soon As Possible (ASAP) Blood Pressure (BP) Cerebrovascular Accident (CVA) Computed Tomography (CT) Electroencephalogram (EEG) Electromyelogram (EMG) Emergency Department (ED) Enzyme-Linked Immunoassay (ELISA) Health-Care Provider (HCP) Intracranial Pressure (ICP) Intensive Care Department (ICD) Intravenous (IV) Magnetic Resonance Imaging (MRI) Nonsteroidal Anti-In? mmatory Drug (NSAID) Nothing By Mouth (NPO) Parkinson’s Disease (PD) Pulse (P) Range of Motion (ROM) Respiration (R) Rule Out (R/O) Spinal Cord Injury (SCI) STAT—immediately (STAT) Temperature (T) Transient Ischemic Attack (TIA) Traumatic Brain Injury (TBI) Unlicensed Assistive Personnel (UAP) Please note: The term health-care provider, as used in this text, refers to a nurse practitioner (NP), physician (MD), osteopath (DO), or physician assistant (PA) who has prescriptive authority. These providers are responsible for directing the care and providing orders for the clients. 7 PRACTICE QUESTIONSCerebrovascular Accident (Stroke) 1. A 78-year-old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech. Which nursing intervention is priority? 1. Prepare to administer recombinant tissue plasminogen activator (r t-PA). 2. Discuss the precipitating factors that caused the symptoms. 3. Schedule for a STAT computed tomography (CT) scan of head. 4. Notify the speech pathologist for an emergency consult. 2. The nurse is assessing a client experiencing motor loss as a result of a left-sided cerebrovascular accident (CVA). Which clinical manifestations would the nurse document? . Hemiparesis of the client’s left arm and apraxia. 2. Paralysis of the right side of the body and ataxia. 3. Homonymous hemianopsia and diplopia. 4. Impulsive behavior and hostility toward family. 3. Which client would the nurse identify as being most at risk for experiencing a CVA? 1. A 55-year-old African American male. 2. An 84-year-old Japanese female. 3. A 67-year-old Caucasian male. 4. A 39-year-old pregnant female. 4. The client diagnosed with a right-sided cerebrovascular accident is admitted to the rehabilitation unit. Which interventions should be included in the nursing care plan? Select all that apply. 1 .Position the client to prevent shoulder adduction. 2. Turn and reposition the client every shift. 3. Encourage the client to move the affected side. 4. Perform quadriceps exercises three (3) times a day. 5. Instruct the client to hold the ? ngers in a ? st. 5. The nurse is planning care for a client experiencing agnosia secondary to a cerebrovascular accident. Which collaborative intervention will be included in the plan of care? 1. Observing the client swallowing for possible aspiration. 2. Positioning the client in a semi-Fowler’s position when sleeping. 3. Placing a suction set-up at the client’s bedside during meals. . Referring the client to an occupational therapist for evaluation. 6. The nurse and an unlicensed assistive personnel (UAP) are caring for a client with rightsided paralysis. Which action by the UAP requires the nurse to intervene? 1. The assistant places a gait belt around the client’s waist prior to ambulating. 2. The assistant places the cl ient on the back with the client’s head to the side. 3. The assistant places her hand under the client’s right axilla to help him/her move up in bed. 4. The assistant praises the client for attempting to perform ADLs independently. 7. The client diagnosed with atrial ? rillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge? 1. An oral anticoagulant medication. 2. A beta-blocker medication. 3. An anti-hyperuricemic medication. 4. A thrombolytic medication. 8. The client has been diagnosed with a cerebrovascular accident (stroke). The client’s wife is concerned about her husband’s generalized weakness. Which home modi? cation should the nurse suggest to the wife prior to discharge? 1. Obtain a rubber mat to place under the dinner plate. 2. Purchase a long-handled bath sponge for showering. 3.Purchase clothes with Velcro closure devices. 4. Obtain a raised toilet seat for the client’s bathroom. 8 Neurological CHAPTER 2 NEUROLOGICAL DISORDERS 9 9. The client is diagnosed with expressive aphasia. Which psychosocial client problem would the nurse include in the plan of care? 1. Potential for injury. 2. Powerlessness. 3. Disturbed thought processes. 4. Sexual dysfunction. 10. Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke? 1. A blood glucose level of 480 mg/dL. 2. A right-sided carotid bruit. 3. A blood pressure of 220/120 mm Hg. 4. The presence of bronchogenic carcinoma. 1. The 85-year-old client diagnosed with a stroke is complaining of a severe headache. Which intervention should the nurse implement ? rst? 1. Administer a nonnarcotic analgesic. 2. Prepare for STAT magnetic resonance imaging (MRI). 3. Start an intravenous line with D5W at 100 mL/hr. 4. Complete a neurological assessment. 12. A client diagnosed with a subarachnoid hemorrhage has undergone a craniotomy for repair of a ruptured aneurysm. Which intervention will the intensive care nurse implement? 1. Administer a stool softener BID. 2. Encourage the client to cough hourly. 3. Monitor neurological status every shift. . Maintain the dopamine drip to keep BP at 160/90. Neurological Head Injury 13. The client diagnosed with a mild concussion is being discharged from the emergency department. Which discharge instruction should the nurse teach the client’s signi? cant other? 1. Awaken the client every two (2) hours. 2. Monitor for increased intracranial pressure. 3. Observe frequently for hypervigilance. 4. Offer the client food every three (3) to four (4) hours. 14. The resident in a long-term care facility fell during the previous shift and has a laceration in the occipital area that has been closed with Steri-Stripsâ„ ¢.Which signs/symptoms would warrant transferring the resident to the emergency department? 1. A 4-cm area of bright red drainage on the dressing. 2. A weak pulse, shallow r espirations, and cool pale skin. 3. Pupils that are equal, react to light, and accommodate. 4. Complaints of a headache that resolves with medication. 15. The nurse is caring for the following clients. Which client would the nurse assess ? rst after receiving the shift report? 1. The 22-year-old male client diagnosed with a concussion who is complaining someone is waking him up every two (2) hours. 2.The 36-year-old female client admitted with complaints of left-sided weakness who is scheduled for a magnetic resonance imaging (MRI) scan. 3. The 45-year-old client admitted with blunt trauma to the head after a motorcycle accident who has a Glasgow Coma Scale score of 6. 4. The 62-year-old client diagnosed with a cerebrovascular accident (CVA) who has expressive aphasia. 10 MED-SURG SUCCESS 16. The client has sustained a severe closed head injury and the neurosurgeon is determining if the client is â€Å"brain dead. † Which data support that the client is brain dead? 1. When th e client’s head is turned to the right, the eyes turn to the right. . The electroencephalogram (EEG) has identi? able waveforms. 3. There is no eye activity when the cold caloric test is performed. 4. The client assumes decorticate posturing when painful stimuli are applied. 17. The client is admitted to the medical ? oor with a diagnosis of closed head injury. Which nursing intervention has priority? 1. Assess neurological status. 2. Monitor pulse, respiration, and blood pressure. 3. Initiate an intravenous access. 4. Maintain an adequate airway. 18. The client diagnosed with a closed head injury is admitted to the rehabilitation department. Which medication order would the nurse question? . A subcutaneous anticoagulant. 2. An intravenous osmotic diuretic. 3. An oral anticonvulsant. 4. An oral proton pump inhibitor. 19. The client diagnosed with a gunshot wound to the head assumes decorticate posturing when the nurse applies painful stimuli. Which assessment data obtained th ree (3) hours later would indicate the client is improving? 1. Purposeless movement in response to painful stimuli. 2. Flaccid paralysis in all four extremities. 3. Decerebrate posturing when painful stimuli are applied. 4. Pupils that are 6 mm in size and nonreactive on painful stimuli. 20.The nurse is caring for a client diagnosed with an epidural hematoma. Which nursing interventions should the nurse implement? Select all that apply. 1. Maintain the head of the bed at 60 degrees of elevation. 2. Administer stool softeners daily. 3. Ensure that pulse oximeter reading is higher than 93%. 4. Perform deep nasal suction every two (2) hours. 5. Administer mild sedatives. 21. The client with a closed head injury has clear ? uid draining from the nose. Which action should the nurse implement ? rst? 1. Notify the health-care provider immediately. 2. Prepare to administer an antihistamine. 3. Test the drainage for presence of glucose. . Place 2 2 gauze under the nose to collect drainage. 2 2. The nurse is enjoying a day out at the lake and witnesses a water skier hit the boat ramp. The water skier is in the water not responding to verbal stimuli. The nurse is the ? rst health-care provider to respond to the accident. Which intervention should be implemented ? rst? 1. Assess the client’s level of consciousness. 2. Organize onlookers to remove the client from the lake. 3. Perform a head-to-toe assessment to determine injuries. 4. Stabilize the client’s cervical spine. 23. The client is diagnosed with a closed head injury and is in a coma.The nurse writes the client problem as â€Å"high risk for immobility complications. † Which intervention would be included in the plan of care? 1. Position the client with the head of the bed elevated at intervals. 2. Perform active range of motion exercises every four (4) hours. 3. Turn the client every shift and massage bony prominences. 4. Explain all procedures to the client before performing them. Neurological CHAPTER 2 NEUROLOGICAL DISORDERS 11 Spinal Cord Injury (SCI) 25. The nurse driving down the highway witnesses a one-car motor vehicle accident and stops to render aid. The driver of the car is unconscious.Which action should the nurse take ? rst? 1. Carefully remove the driver from the car. 2. Assess the client’s pupils for reaction. 3. Stabilize the client’s cervical spine. 4. Attempt to wake the client up by shaking him. 26. In assessing a client with a T-12 SCI, which clinical manifestations would the nurse expect to ? nd to support the diagnosis of spinal shock? 1. No re? ex activity below the waist. 2. Inability to move upper extremities. 3. Complaints of a pounding headache. 4. Hypertension and bradycardia. 27. The rehabilitation nurse caring for the client with an L-1 SCI is developing the nursing care plan.Which intervention should the nurse implement? 1. Keep oxygen on via nasal cannula on at all times. 2. Administer low-dose subcutaneous anticoagulants. 3. P erform active lower-extremity ROM exercises. 4. Refer to a speech therapist for ventilator-assisted speech. 28. The nurse in the neurointensive care unit is caring for a client with a new C-6 SCI who is breathing independently. Which nursing interventions should be implemented? Select all that apply. 1. Monitor the pulse oximetry reading. 2. Provide pureed foods six (6) times a day. 3. Encourage coughing and deep breathing. 4. Assess for autonomic dysre? xia. 5. Administer intravenously corticosteroids. 29. The home health nurse is caring for a 28-year-old client with a T-10 SCI who says, â€Å"I can’t do anything. Why am I so worthless? † Which statement by the nurse would be the most therapeutic? 1. â€Å"This must be very hard for you. You’re feeling worthless? † 2. â€Å"You shouldn’t feel worthless—you are still alive. † 3. â€Å"Why do you feel worthless? You still have the use of your arms. † 4. â€Å"If you attended a work rehab program you wouldn’t feel worthless. † 30. The client is diagnosed with an SCI and is scheduled for a magnetic resonance imaging (MRI) scan.Which question would be most appropriate for the nurse to ask prior to taking the client to the diagnostic test? 1. â€Å"Do you have trouble hearing? † 2. â€Å"Are you allergic to any type of dairy products? † 3. â€Å"Have you had anything to eat in the last eight (8) hours? † 4. â€Å"Are you uncomfortable in closed spaces? † Neurological 24. The 29-year-old client that was employed as a forklift operator sustains a traumatic brain injury secondary to a motor vehicle accident. The client is being discharged from the rehabilitation unit after three (3) months and has cognitive de? cits. Which goal would be most realistic for this client? . The client will return to work within six (6) months. 2. The client is able to focus and stay on task for ten (10) minutes. 3. The client will be able to dress self without assistance. 4. The client will regain bowel and bladder control. 12 MED-SURG SUCCESS 31. The client with a C-6 SCI is admitted to the emergency department complaining of a severe pounding headache and has a BP of 180/110. Which intervention should the emergency department nurse implement? 1. Keep the client ? at in bed. 2. Dim the lights in the room. 3. Assess for bladder distention. 4. Administer a narcotic analgesic. 32.The client with a cervical fracture is being discharged in a halo device. Which teaching instruction should the nurse discuss with the client? 1. Discuss how to remove insertion pins correctly. 2. Instruct the client to report reddened or irritated skin areas. 3. I