The Hunters: Moonsong Chapter Two

Meredith held the tire gauge firmly against the valve of her left back tire while she checked it. The pressure was fine. The pressure on al four tires was fine. The antifreeze, oil, and transmission fluids were al topped off, the car battery was new, and the jack and spare tire were in perfect shape. She should have known. Her parents weren't the kind to stay home from work to see her off to col ege. They knew she didn't need coddling, but they'd show their love by making sure al the preparations were made, that she was safe and perfectly ready for anything that might happen. Of course, they wouldn't tell her that they had checked everything, either; they'd want her to continue protecting herself. There wasn't anything she had to do now except leave. Which was the one thing she didn't want to do. â€Å"Come with me,† she said without looking up, despising the faint quaver she heard in her own voice. â€Å"Just for a couple of weeks.† â€Å"You know I can't,† Alaric said as he brushed his hand lightly over her back. â€Å"I wouldn't want to leave if I came with you. It'l be better this way. You'l get to enjoy the first weeks of col ege like al the other new students, without anyone holding you back. Then I'l come up and visit soon.† Meredith turned to face him and found Alaric gazing back at her. His mouth tensed, just the tiniest tightening, and she could see that parting again, after only a few weeks together, was just as hard for him as it was for her. She leaned in and kissed him softly. â€Å"Better than if I'd gone to Harvard,† she murmured. â€Å"Much closer.† As the summer had ended, she and Matt had realized they couldn't leave their friends and head off to out-of-state col eges as they'd planned. They'd al been through so much together, and they wanted to stay together, to protect one another, more than they wanted to go anywhere else. Their home had been nearly destroyed more than once, and only Elena's blackmail of the Celestial Court had restored it and saved their families. They couldn't leave. Not while they were the only ones standing against the darkness out there, the darkness that would be drawn forever to the Power of the magical ley lines that crossed the area around Fel ‘s Church. Dalcrest was close enough that they'd be able to come back if danger threatened again. They needed to protect their home. So Stefan had gone down to the administrative offices at Dalcrest and used his vampire mojo. Suddenly Matt had the footbal scholarship to Dalcrest he'd turned down in favor of Kent State back in the spring, and Meredith was not only expected as an incoming freshman but was housed in a triple in the best dorm on campus with Bonnie and Elena. The supernatural had worked for them, for a change. Stil , she'd had to give up a couple of dreams to get here. Harvard. Alaric by her side. Meredith shook her head. Those dreams were incompatible, anyway. Alaric couldn't have come to Harvard with her. Alaric was staying here in Fel ‘s Church to research the origins of al the supernatural things that had happened over the town's history. Luckily, Duke was letting him count this toward his dissertation on the paranormal. And he'd be able to monitor the town for danger at the same time. They'd have to be apart for now, no matter where Meredith chose to go, but at least Dalcrest was a manageable drive away. Alaric's skin had a soft tan, and a scattering of golden freckles crossed his cheekbones. Their faces were so close she could feel the warmth of his breath. â€Å"What're you thinking?† His voice was a low murmur. â€Å"Your freckles,† she said. â€Å"They're gorgeous.† Then she took a breath and pul ed away. â€Å"I love you,† Meredith said, and then rushed on before a wave of longing could overwhelm her, â€Å"I have to go.† She picked up one of the suitcases sitting by the car and swung it into the trunk. â€Å"I love you, too,† Alaric said, and caught her hand and held it tightly for a moment, looking into her eyes. Then he let go and put the last suitcase into the trunk and slammed the lid. Meredith kissed him, quick and hard, and hurried herself into the driver's seat. Once she was safely seated, belted in, the engine running, she let herself look at him again. â€Å"Bye,† she said through the open window. â€Å"I'l cal you tonight. Every night.† Alaric nodded. His eyes were sad, but he smiled and held up a hand in fareWell. Meredith backed out of the driveway careful y. Her hands were at ten and two, and she kept her eyes on the road and her breathing steady. Without even looking, she knew Alaric was standing in the driveway, watching her car drive out of sight. She pressed her lips together firmly. She was a Sulez. She was a vampire hunter, a star student, and completely levelheaded in al situations. She didn't need to cry; after al , she would see Alaric again. Soon. In the meantime, she would be a true Sulez: ready for anything. Dalcrest was beautiful, Elena thought. She'd been here before, of course. She, Bonnie, and Meredith had driven al the way up for a frat party junior year, when Meredith had been dating a col ege boy. And she dimly remembered her parents bringing her for an alumni family event, back when she was little. But now that she was part of the school, now that it would be her home for the next four years, everything looked different. â€Å"Pretty swanky,† Damon commented as the car swept between the great gilded gates at the school's entrance and drove on past buildings of faux Georgian brick and neoclassical marble. â€Å"For America, that is.† â€Å"Well, we can't al grow up in Italian palaces,† Elena answered absently, very conscious of the light pressure of his thigh alongside hers. She was sitting in the front of the truck between Stefan and Damon, and there wasn't a lot of room. Having both of them so close was awful y distracting. Damon rol ed his eyes and drawled to Stefan, â€Å"Well, if you have to play human and attend school again, little brother, at least you didn't choose too hideous a spot. And, of course, the company wil make up for every inconvenience,† he added gal antly with a glance at Elena. â€Å"But I stil think that it's a waste of time.† â€Å"And yet, here you are,† Elena said. â€Å"I'm only here to keep you out of trouble,† Damon retorted. â€Å"You'l have to excuse Damon,† Stefan said to Elena lightly. â€Å"He doesn't understand. He was thrown out of university back in the old days.† Damon laughed. â€Å"But I had great fun while I was there,† he said. â€Å"There were al kinds of pleasures a man of means could have at university. I imagine things have changed a bit, though.† They were needling each other, Elena knew, but there wasn't that hard, bitter edge to their sparring that used to be there. Damon was smiling over her head at Stefan with a wry affection, and Stefan's fingers were loose and relaxed on the steering wheel. She put a hand on Stefan's knee and squeezed. Damon tensed next to her, but when she glanced over at him, he was gazing ahead through the windshield, his face neutral. Elena took her hand off Stefan's knee. The last thing she wanted to do was disturb the delicate balance between the three of them. â€Å"Here we are,† Stefan said, pul ing up to an ivy-covered building. â€Å"Pruitt House.† The dorm loomed above them, a tal brick building with a turret on one side, windows glittering in the afternoon sun. â€Å"It's supposed to be the nicest dorm on campus,† Elena said. Damon opened his door and hopped out, then turned to give Stefan a long look. â€Å"The best dorm on campus, is it? Have you been using your powers of persuasion for personal gain, young Stefan?† He shook his head. â€Å"Your morals are disintegrating.† Stefan got out on his own side and turned to give Elena a courteous hand down. â€Å"It's possible you're final y rubbing off on me,† he said to Damon, his lips twitching slightly with amusement. â€Å"I'm in the turret in a single. There's a balcony.† â€Å"How nice for you,† Damon said, his eyes moving quickly between them. â€Å"This is a dormitory for both boys and girls, then? The sins of the modern world.† His face was thoughtful for a moment; then he gave a bril iant smile and began to pul luggage out of the back. He had seemed almost lonely to Elena for that second – which was ridiculous, Damon was never lonely – but that fleeting impression was enough to make her say impetuously, â€Å"You could come to school with us, Damon. It's not too late, not if you used your Power to enrol . You could live on campus with us.† She felt Stefan freeze. Then he took a slow breath and slid up next to Damon, reaching for a stack of boxes. â€Å"You could,† he said casual y. â€Å"It might be more fun than you think to try school again, Damon.† Damon shook his head, scoffing, â€Å"No, thank you. I parted ways with academia several centuries ago. I'l be much happier in my new apartment in town, where I can keep an eye on you without having to slum with students.† He and Stefan smiled at each other with what looked like perfect understanding. Right, Elena thought, with a curious mixture of relief and disappointment. She hadn't seen the new apartment yet, but Stefan had assured her that Damon would be, as usual, living in the lap of luxury, at least so far as the closest town could offer. â€Å"Come along, kiddies,† Damon said, picking up several suitcases effortlessly and heading into the dorm. Stefan hoisted his tower of boxes and fol owed him. Elena grabbed a box of her own and came after them, admiring their natural grace, their elegant strength. As they passed a few open doors, she heard a girl mock wolf-whistle, then giggle breathlessly with her roommate. A box tipped from Stefan's enormous pile as he started up the staircase, and Damon caught it easily despite the suitcases. Stefan gave him a casual nod of thanks. They'd spent centuries as enemies. They'd killed each other, once. Hundreds of years of hating each other, bound together by misery, jealousy, and sorrow. Katherine had done that to them, trying to have them both when they each wanted only her. Everything was different now. They'd come so far. Since Damon had died and come back, since they had battled and defeated the jealousy phantom, they'd come to be partners. There was an unspoken acknowledgment that they would work together to protect a little group of humans. More than that, there was a cautious, but very real, affection between them. They relied on each other; they'd be sorry to lose each other again. They didn't talk about it, but she knew it was true. Elena squeezed her eyes shut for just a second. She knew they both loved her. They both knew that she loved them. Even though, her mind corrected conscientiously, Stefan is my true love. But something else in her, that imaginary panther, stretched and smiled. But Damon, my Damon†¦ She shook her head. She couldn't break them apart, couldn't let them fight over her. She wouldn't do what Katherine had done. If the time came for her to choose, she would choose Stefan. Of course. Would you? the panther purred lazily, and Elena tried to push the thought away. Everything could fal apart so easily. And it was up to her to make sure that never happened again.

Guava Leaves

The purpose of this investigatory project is to prove that herbal plants can cure skin disorders like acne that is irritating and can low our confidence who are going to the stage of puberty like me that’s why I searched on the internet about herbal plants that can treat skin disorders, and I found one guava.Guava has many constituents and high contents which are characterized by their antioxidant functions these nutrients can treat acne that is irritating and boost our confidence down whose going to the stage of puberty like me and 30+ who is still having this type of skin disorder this investigatory project that we can use the extracts of guava to treat acne.Background of the study and introductionGuava plants in the myrtle family which contains about 100 species of tropical shrubs, nowadays people are focusing in herbal plants especially those who are common in the environment. One of the example is the guava plant (Psidium guajava Linn). Based on research this plant is goo d for healing and treating wounds and other skin infections. So in my research I wan't to make a bathing soap out of it, cause I know that it is effective.People, researchers, scientists were focusing to medicinal plants. They want to prove that there are plants that are more effective against diseases especially in skin. This study refers to a plant that can be made into a bathing soap and improves its quality while using this plant (guava leaves). I want people to handle easily in treating their skin disorders. Instead of boiling the leaves, now it’s easy to apply. Boiling takes much time.Statement of the ProblemI stated that Guava leaves extract is good for skin. Based on my research, it has many constituents that are good for skin. It answers the following questions:Is there any constituent of guave leaves that is good for skin? * What are those?It can really treat skin disorders/ Acne?HypothesisCan guava leaves can treat/cure acnes using its extract and making a soap tha t can be used on face for treating acne. Yes, the extract of the guava leaves can be used in making soap and can be used on treating acne my acne has lessen for I applied it on my face for a week.Significance of the StudyYou can make a bathing soap with guave leaves extract as treatment for acne. This plant is very common to our environment, and aside of its avaibility; it is easy to cultivate. It contains many components for healing skin disorders.Scope and LimitationThe study of guava leaves and getting their extract is often useful. It has the ability to treat, cure, disinfect skin disorders and capable of being a herbal plant for acnes.Definition of TermsAstringent- antiseptic propertiesDecoction- infusion of fresh leaves used for wound cleaning and skin to prevent infection and to facilitate healing. Good for skin disorders.Volatile- a substance that changes into a vapor at a relatively low temperature.Eugenol- oily liquid from doves. (C10H12O2)Cloves- aromatic spice from the d ried flower bud of a tropical tree.Tannin- a brownish or yellowish substance found in plants and used in astringents. Saponins- soap from plants; any group of chemical substances extracted from plants that form a soapy lather mixed with water and are used to make soap and detergent.Amydalin- resin used in paints and adhesives.Resin- yellow or brown color and organic substance from plants. Malic Acid- acid from fruit; a colorless crystalline solid found in fruits such as apples. (C4H6O5)Aldehydes- organic compound; a highly reactive organic compound produced by the oxidation of an alcohol and having a CHO group especially the acetaldehyde Ash- the powdery substance that is left when something has been burntGuava:Scientific Name: Psidium GuajavaMethodologyMaterials:Beaker.Molder.NaOH (sodium hydroxide) (60 grams) (150 ml) solution Gas stove.Guava Leaves.The procedurePrepare the stove to be used. Boil it for 10 minutes (Low Heat); Separate the skin from the extract. Put it in a clean c ontainer, let it cool and then set aside. Prepare the Sodium Hydroxide (NaOH) or Lye. Put in a container. (Note: Read first the directions in using Lye. For Example: Don’t put the NaOH on aluminum containers.You must use rubber gloves and Masks in dealing with lye and with other chemical substances. Don’t play with them and Keep out of reach of children.) Put some oil (3 tbsp.) and Water (3 tbsp.). Mix it thoroughly. Put the extract of the fruits to the mixture. (1/2 tbsp.). Stir the mixture continuously in a single direction. (Note: Make sure the mixture is viscous)Let it dry for about 2 days or more.Results, Discussion, Conclusion and RecommendationThe researchers found out that the 4 seasons fruits can help minimize pimples and pores. It can also help clear skin impurities because of the anti-oxidants that the soap contains. This research gave us a hard time because there are a lot of instances that the measurements of the ingredients would not compliment the desire d results. There can also be a downside in this experiment because the soap is not intended to be used in scars because it might irritate it and it stings.The researchers therefore conclude that the guava extract soap can reduce pimples and other skin impurities.This is shown by the experiment that we conducted by putting various kinds of ingredients in different amounts and sizes. The experiment was successful because the researchers came up with their desired result even after several tries.Conclusion and RecommendationThe researchers therefore conclude that the guava extract soap can reduce pimples and other skin impurities.This is shown by the experiment that we conducted by putting various kinds of ingredients in different amounts and sizes. The experiment was successful because the researchers came up with their desired result even after several tries.

Academic Success in a K-12 classroom Essay Example | Topics and Well Written Essays - 750 words

Academic Success in a K-12 classroom - Essay Example to continue their education even after they have qualified the â€Å"continuing professional development.† Teachers may acquire a lesson plan to facilitate and help the student learning and prepare them for their future life. In short, it is the teacher who molds the personality of his/her students. (Oxford, Pergamon 1985) A teacher has an important and a significant role in facilitating the students in order to ensure their achievement goals and targets. Helping the students to achieve their long-term and short-term goals is an eloquent and rewarding responsibility. Goal setting is a process that actuates a student to stay focused and to prevent them from spending time on distractions. Once the students develop the manner of setting short-term goals they can more easily follow the path of achieving the life they wish to lead. I, in my class, implemented a few strategies which ensured that all the students achieved the objectives. I did so by making the students understand the term â€Å"critical thinking†, because to achieve different goals and objectives, critical thinking is an important factor to be acquired by the students. I implemented several critical reading strategies which would help the students to learn accordingly. This is to show the students how to implement critical reading str ategies. Similarly I also made the students practice critical thinking techniques in their homework so that they could learn from the lectures that were being delivered. Moreover I also had them to contemplate as to how the process of critical reading would affect their own learning and facilitate them in the future projects. Some students seem eager and ardent about learning, but many require their instructors and teachers to motivate and actuate them. A few strategies that I usually brought into practice to encourage the academically weak students to flourish revolved around increasing their self esteem. I provided these students with positive feedback to animate and

Sherma- Anti- Trust Act (1890) Essay Example | Topics and Well Written Essays - 1000 words

Sherma- Anti- Trust Act (1890) - Essay Example Prior to the enactment of the Sherman Act, large corporations had more powers and were controlling the smaller corporations through price discrimination and price fixing. This led to unbalanced and unfair competition and hence the need to control the activities of the trusts. For instance, one of the reasons why farmers in Missouri farmers agitated for the formulation and enactment of an antitrust law was the fact that most of them were being underpriced by larger and more efficient farms. Sherman Act enabled individuals to start to their own businesses and it provided a perfect environment for business competition as it eliminated monopoly in the market (Koutsoudakis,pg.6). The penalties for violating Sherman Antitrust Act or law entail both criminal and civil penalties. Individuals or corporation that has been found to commit, attempt or conspire to monopolize trade is liable to criminal or civil penalties because they are deemed to have committed felony. If a person has been found to be guilty of violating the Sherman Antitrust Act, a fine of up to $350,000 may be imposed on them or they can liable to face up to three years in prison. On the other hand, corporations that violate the Act can face a fine of up to $10,000,000. Furthermore, the government has been granted the power to seize any property of an individual or corporations that engage in unlawful trade practice that run contrary to the Sherman Act (Koutsoudakis,pg.8). Section seven (7) of the Sherman Act grant every citizen the right to file for a prosecution at any court in the United States and the entitlement for a remedy or compensation. The import of this section is that it gives ordinary citizens the chance of receiving justice without travelling long distances to circuit court of the United States. Question Two William Edward Burghardt Du Bois is one of the prominent African-American intellectual leader who is renowned for the championing of black civil rights. Most of his writings and speech es were aimed at redeeming and uplifting the life of black people in the society. The opinion of W.E.B Du Bois on the Reconstruction Era: â€Å"The slave went free: stood a brief moment in the sun; then moved back again towards slavery† has significant undertones that can be analyzed. The first part of the quote represents the end of slavery that had plagued United States for a long time. Although United States was founded on the precepts and promise of political freedom, individual liberty and freedom and economic prosperity, the same was not realized during the initial stages of its democracy and independence. After independence, slavery was widespread in United States despite the notion that the nation committed to uphold equality of all men and to get powers to rule and govern from the people (Campbell, Fraser and Mancall,pg.80). Slavery was rooted in America and majority of states from the south were composed mainly of slaves. The emergence of civil war that majorly revo lved around slavery brought some changes in United States. The Civil war led to the abolishment of the slavery in United States and this is what W.E.B Du Bois refers to in the first part of his opinion. The Second part of W.E.B Du Bois opinion represents the period after the civil war and the initial stages of the reconstruction era. Most of the Southern States got temporal reprieve when slavery was abolished and this is what

English Language Larners Case Study Essay Example | Topics and Well Written Essays - 1500 words

English Language Larners Case Study - Essay Example For example, we are told that Elsa does not have enough people around her with whom she would practice the speaking of English language when she goes home. Worse of all, there are not as many English language learning materials around her at home as there are Spanish learning materials. Meanwhile, learning through literacy development brings out the idea that practice is one of the best ways to master the learning of English language (Smiley and Salsberry, 2007). This is because as people practice what they have learnt, they get the opportunity to make mistakes and also correct these mistakes. Constant practice also speeds up the process of gaining proficiency as it makes the learner have the luxury of devising personal methodologies of learning the language. Again for Elsa, what is happening is that she is suffering interference in her attempt to learn English as a second language as in school, she gets the opportunity of speaking Spanish with other colleagues who are Hispanic. Inde ed, if English had been the only language she spoke in school, the need for her to take her English lessons seriously would have gone up because that would have been the only way by which she would have had people to communicate with. As far as those happenings that we are not particularly certain about are concerned, mention can be made of the fact that Elsa is not receiving much parental support as far as the learning of English as a second language is concerned. This assumption is made against the background that in the case of Elsa, we read of no drastic attempts being made by the parents or other relations at home to get the little English learner motivated to learn English at the fastest rate possible. It is said that motivation are different and comes in different forms. The two generalized types of motivation that can be applied to a young English language learner like Elsa are intrinsic motivation and extrinsic motivation. Presently, any of these forms of motivation seem to be absent at home for Elsa. If intrinsic motivation was available for Elsa, we would have read of her parents trying to motivate her by trying to speak English with her, getting her as extra class teacher, praising her on her attempts and efforts in learning the English language, and planning special holidays for her for efforts she puts up at school. If extrinsic motivation were also available, we would have read of parents of Elsa buying English language learning materials like wall charts, books and films for Elsa. Indeed, motivation is an important element and reinforcement that speeds up the rate of learning for any new English language learner like Elsa. Four different relevant issues Judging from the readings, there are number of important issues that come up to describe the type of English language learner that Elsa is. Most of these issues also help us in knowing precisely what is wrong with the progress rate of Elsa and how this problem can be corrected or minimized. The first issue that is directly related to the type of English language learner Elsa is has to do with the issue of a learner who lags behind when it comes to English language learning experience. This was made manifest when she was presented with the chapter to read. It is a good sign that Ms Smith also identified this and started thinking of ways of helping Elsa to get more out of the reading experience. The second issue

Global Trade and Commodities in 15th century Essay

Global Trade and Commodities in 15th century - Essay Example This region acted as a source of slave for the routes in Sahara to Mediterranean. The Portuguese opened this channel to the rest of the world. Portuguese had an economic monopoly over slave trade in Cape Verde of West Africa. Portuguese were particularly well versed with trade route between West Africa, America and Europe. They bought slave from interior of coast of guinea and transported them to the rest of the world especially in America where they could later work in sugar and other plantations. This trade was profitable to Portuguese. This African trade plus the development of Cape Verde islands, expanded tremendously with the emergence of labor-intensive farms that were used to grow, cotton and tobacco in the Caribbean and America as well. Other slave was taken to Brazil, which was a Portuguese colony. By 18th century, Britain had engaged in this trade and majority of ships doing this business belonged to Britain. Jacques Coeur merchant between 1432- 1451, carried out the other type of trade. The great source of trading wealth was the Mediterranean. That used to link Christian market that were more prominent in the west with the far east Muslim markets. He use to take clothes to Levant and could come back with spices from the east. It was a barter form of trade. The Chinese sea trade also took place in the 15th century. It took place when a merchant Zhen, a Muslim eunuch. He traveled as far as Persian Gulf, African coast. Chinese could now export porcelain, silks, silver, gold items and medical concoctions and in return they took herbs, ivory, rhinoceros, jewel, rare varieties of wood, and some ingredients for making dyes. The other trade took place in Europe inlands waterways between 15 to 17th century. This trade occurred across rivers especially after development of manmade canals that ensured there was efficiency in trade as routes became shorter. This developed in Europe only at the late 15th

Contribution of organizational learning to contemporary understandings Essay

Contribution of organizational learning to contemporary understandings of workplace practices - Essay Example Critics such as Sommerlad and Stern believe that the notion of learning within workplace has acquired saliency and visibility.This is primarily because as it connects at the stage of new thinking process. This thinking process is concerned on the process of learning about the modern enterprise, the alteration of nature work and new systems of knowledge. It is understood that the process of workplace practices is moving through the period of social, economic and political change. The prime purpose of the report is to present vivid explanation about the significance of organization learning towards understanding the workplace performs. Furthermore, examples are provided to illustrate the contribution of organization learning. The learning is viewed as interpretative device that cannot be divided amongst different scientific corrections and compartmentalized into different levels to create zones of inter-organization, organizational, group and individual learning processes. According to Gallacher and Reeve, the rapid advancement in technology and increase globalization has helped in the rise of skill and level of organizational workforce. The application of organizational learning process within workplace practices is viewed as flexible system of learning that enables employees working in an organization to engage in continuing professional development and consistent process of updating. In the world of globalization of acceleration of change, organization and approaching strategy are interconnected and execution of practical events is regarded as more effective activities. The idea of implementation of learning process within organization settings has been from the time of Industrial revolution. Since th e time of revolution, the crucial element of organizational operative process is training of employees in practical

Problems At Softy Furnishings Case Study Example | Topics and Well Written Essays - 2000 words

Problems At Softy Furnishings - Case Study Example For that reason, Roz can bring an unfair dismissal to be heard before the tribunal as it subject to appeals on point of law to the Employment Appeal Tribunal (EAT) and then the court of Appeal and the House of Lords. According to, the EAT is the best house to deal with. At common law, Dennis could have provided a straightforward requisite notice to notify on his power. However, ignorance of Roz managerial power attracts questions. Roz needs to be assured that Employment Rights Act UK is a statutory, meaning that the courts are able to use section 3 of the HRA and exercise their interpretive functions to produce indirect horizontal effects which have already been done in different cases (Hockman and Miliband, 2015). As well, Brodie (2010, p. 43) believes that it is common law duty of trust and confidence that is implied into all employment contracts given that the interaction of duties and conventional rights are yet to be explored. Convincingly, Roz should understand that private emp loyment law is primarily contained in the legislation, and these basic statutory provisions are continually interpreted (Carey, 2009, p. 49, and Cabrelli, 2014). The legislation is subject to the interpretative obligation under section 3 of the HRA to ensure its compatibility with convention rights. Moreover, Roz should be assured that employment contracts are governed by some key common law principles that are susceptible to the arguments that the courts should give effects to the convention right when applying them.

St. Patrick's Day Essay Example | Topics and Well Written Essays - 250 words

St. Patrick's Day - Essay Example The first concerning the origins of the â€Å"potato famine† and, the second, the actions of scholarly textbook publishers that have no ethical issues with neglecting large chunks of relevant and important history. The Irish â€Å"Potato Famine† is usually described in textbooks and History classes as a terrible disaster, like an earthquake or a plague; something completely outside of human control. However, that is entirely not the case. The famine had far more to do with the harsh and negligent treatment of English landlords upon Irish farmers. The occurrence was not great â€Å"blight† or â€Å"an act of a God;† it was a physical act of human beings that caused the starvation among the poorer class at the time, which was sadly, the Irish (Bigelow 1). This is new information that is interesting to discover. The second issue, the fact that history books are printing edited or omitted historical events and it is so very common. If textbooks cannot be trusted to teach true and accurate history on any given subject, then how can we trust that information at all? What other topics and subjects might they be presenting a revisionist interpretation of? Ultimately, this discover y and its commonality are rather shocking. In the end, history is history; what happened, happened. There are both shameful and inspiring events in any country or cultures history. However the only way for people, as individuals and societies, can learn from their mistakes and move into a more enlightened future is to have access to our true history, our actions, for better or worse. By presenting a limited or vague interpretation of historical events, specifically such a significant and often misunderstood event, it diminishes the plight of these people and prevents us from looking at our history as a complete whole. The Irish have a rich history both in Europe and here in the United States and it is sad to know that large chunks

Consider the product level models of New Product Development Essay

Consider the product level models of New Product Development - Essay Example These factors make the approach to new product development a critical one (Ribbens, 2000, p. 1). The process thus requires management support; it must also benefit from the experience of new product development teams composed of people from all affected activities; it has to follow distinct phases with extremely well defined activities in order to enhance understanding, greater accuracy and reduce risks and failures that are eminent in new product development. Key elements in new product development The process of new product development takes into consideration seven distinct elements, stages or phases. The first element is idea generation. This is the most critical aspect of all the elements in new product development because without idea generation it is difficult to come up with new products. Here ideas are gathered which present possible product options. Many companies conduct idea generation as a continuous process with contributions from within the organization and outside the organization. A number of methods are used and these may include focus group discussions with consumers, comments suggestions and feedback from customers and research from secondary sources. Creative problem solving technique such as brainstorming is used in this case that enables creative minds to come up with new ideas about an existing problem or a gap in the market. In the brainstorming session, first individuals are told about the problem as a creative challenge. This is important in order to come up with ideas that are viable for a new product. After this, people are given a time limit to think and come up with ideas. When the session begins, the people voice out their ideas and the facilitator lists them down with no criticism made. The best ideas are selected by the facilitator and which all group members agree with. The ideas are then evaluated on a scoring criteria and the idea with the highest score becomes the solution to the problem. Another model, the creative problem solving process model advanced by Osborn-Parnes can also be used here if a feasibility analysis has been carried out to identify problems upon which ideas are generated and solutions sought (Blythe, 2006, p. 50). The model is composed of six stages that can be compressed into three with distinct activities at each of these stages. They include: exploring the challenge which involves identifying the goal, gathering relevant data and clarifying the problem at hand; generating ideas involves coming up with options to solve the problem; and preparing for action which involves solution finding and preparing a plan for action. The process is lauded for its involvement of convergent and divergent thinking that can be used at each of these three stages. The second element is screening and this involves the careful and critical evaluations of the options presented by the new product development team to isolate the best idea or attractive options. This could be done in rounds depending on th e number of ideas and may also involve a number of techniques. As the ideas are being evaluated, other considerations are also made in terms of potential sales, the costs of production, profitability, competition. Only the accepted ideas

Atomic Bombing on Japan Essay Example for Free

Atomic Bombing on Japan Essay On the morning of August 6th, 1945 at around 8:16 a. m. , the United States dropped the first bomb on Hiroshima. This bomb was given the nickname â€Å"Little Boy. † Three days after the first atomic bomb was dropped, on August 9th, 1945 at around 11:02 a. m. , the United States dropped a second atomic bomb on Nagasaki. This bomb was given the nickname â€Å"Fat Man. † These two bombs immensely destroyed these cities and took the lives of many people. There was an estimated 200,000 lives taken in the atomic bombing on Japan. The war on the Pacific had been going on for over four years before the atomic bombing occurred. There were two big battles that could have led to the United State’s decision of dropping the atomic bomb, the Iwo Jima and Okinawa. In these two battles there was an astounding amount of deaths taken in these battles from both sides. While both sides of the Japanese and American soldiers fought vigorously taking the many lives of one another, the dropping of the atomic bomb on Hiroshima was a military necessity for the United States. The reason why the dropping of the atomic bomb was a military necessity is because there was nothing else to force Japan to surrender. President Harry S. Truman asked the Japanese to surrender on August 3rd, 1945 or face devastation, but the Japanese failed to meet the deadline. Truman ordered the air force to use the new atomic weapons against Japan. Some argued that if we would had waited a few more weeks, Japan would have surrendered. Others argued that there was no other way to persuade the Japanese to surrender but the atomic bombing. Truman said this was a simple military mission. He said a weapon was available to quickly end the war so he sees no reason not to use it. The alternative to dropping the atomic bomb was a ground invasion in Japan, which would have caused heavy losses to our American troops. From my perspective, I believe that the atomic bombing of Hiroshima was necessary for the preservation and security of our nation. At the time of this incident, the United States was involved in World War II serving as part of the Allied Powers. Therefore, on the morning of December 7th, 1941, the Japanese decided to implement surprised attacks on Pearl Harbor. Pearl Harbor was a US Navy base located in Hawaii. The United States was not expecting these attacks at all. I feel that the attack on Hiroshima was retaliation for the attacks on Pearl Harbor. Although we may have gone a little over board, it had to be done to establish that the US was not a nation to be messed with. The Japanese’s opportunity to fight back was over after the first atomic bomb was discharged because the navy was taken out, the inability to import food and the lack of industrial supplies. In addition the second atomic bomb was dropped to seal the victory over Japan. Although both Japan and the United States suffered great losses from the altercations, Japan was left with much more trauma. The first atomic bomb that was dropped on Hiroshima immediately killed an estimated amount of 66,000 people out of a population of 255,000. The second bomb that was dropped on Nagasaki instantly killed about 35,000 people. However, a numerous amount of soldiers and citizens of Japan did not immediately die. These bombings lead to an awful amount of physical effects that dismembered the country of Japan for many years. Many individuals of Japan either died or suffered from radiation burns, cancer, leukemia, and many other physical disorders. Research shows that radiation increases the long-term risks of cancer. At the time of the bombing, many pregnant women gave birth to children with congenital malformations because of the contact with radiation. After the bombing, there were said to be 6,500 orphans in the city of Hiroshima. Despite the many people that were killed in the bombings, Americans saved many lives on both sides by not invading Japan. The city of Hiroshima and Nagasaki was essentially wiped out by the two atomic bombs. The bombs fiercely took out anything in its path. Not one thing or person within 800 meters of the bomb’s blast survived. Only parts of two buildings were standing after the bomb at the explosion site. The survivors in Japan had to clean up over 11. 5 square kilometers of debris and dead bodies after the bombing. This process took Japan four years to clear up. The bombings also cost Hiroshima $2 billion in damage. There were an estimated 60,000 to 90,000 buildings destroyed by the atomic bombing in Hiroshima. And an additional 14,000 buildings destroyed in Nagasaki. To conclude, the atomic bomb dropped on Japan by the United States was indeed a military necessity. The position of the United States at the time left our country with no other choice but to establish superiority; we needed to end the war. There was little sympathy for an enemy who had stimulated the fight and had behaved the way Japan had. Also, Japan’s surprise attacks on Pearl Harbor had left many Americans pleading for revenge. The atomic bomb did just that, wiping out almost entirely two cities in Japan, Hiroshima and Nagasaki. Although much tragedy and trauma had resulted from the attacks of both countries, the sacrifices were necessary and appropriate.

Mary Shelleys Frankenstein Essay Example for Free

Mary Shelleys Frankenstein Essay In Mary Shelleys Frankenstein we are presented with more than just a story (which is how it began) but with a novel that raises deep philosophical questions. The tale of Frankenstein is much more than just a story; it is a cautionary tale which pays attention to moral values by presenting the reader with the character of Frankenstein and his toils. Mary Shelley is able to present us with more than just a horrific story but also with the moral ideas which form its fundamental basis. There are a variety of themes which run through the story of Frankenstein with the theme of friendship, nature, and most importantly responsibility. Victor Frankenstein was obsessed with creating life itself out of nonliving parts. This is shown where he refers to himself in third person saying, â€Å"So much has been done, exclaimed the soul of Frankenstein—more, far more, will I achieve; treading in the steps already marked, I will pioneer a new way, explore unknown powers, and unfold to the world the deepest mysteries of creation† (Shelly 49). Victor is so concentrated on the glory of being able to create a being from dead parts that he becomes consumed in his work and never even considers the affect this could have on society. He completely disregards this affect making this the first responsibility that Frankenstein failed to complete. He searched graveyards for material to fashion a new being, which he shocks into life with electricity. Although his creature was extremely big and being made from many different parts quickly combined together into a being was hideous. Once he had created this monster he states, â€Å"now that I had finished, the beauty of the dream vanished, and breathless horror and disgust filled my heart. Unable to endure the aspect of the being I had created, I rushed out of the room and continued a long time traversing my bed-chamber, unable to compose my mind to sleep†(Shelly 58). Frankenstein took no responsibility over his hideous creation here and instead decides to flee from the room in terror and leave the monster. This shows that he wants no part of what he created at this point so he is trying to escape the responsibility of creating the monster. Although inside he kno ws that he created the monster and anything the monster does will be on Frankenstein’s conscious. This leads to new events in the story that he feels responsible for. Frankenstein felt responsible for his younger brothers death when he realized that the monster he created murdered William. Frankenstein started to feel as if he himself had committed the murder because of his role in the monsters existence. Everything the monster did was Frankensteins fault because he was the creator. Rather than blame the monster for his downfall, Frankenstein blamed himself because he created the monsters life. He did not take actual responsibility for his brother’s death however because he did not want anyone to know about the monster. Frankenstein felt as if he murdered Justine as well as William because she was executed for a crime the monster committed of murdering William. If Frankenstein would have taken responsibility for his actions of creating the monster and told people what actually happened to his brother then Justine would not have been killed for a crime she did not commit. The chain of events that the monster set off with Williams murder began not with the monster, but with Frankensteins desire to create life. When the monster came to Frankenstein to plead his case and tell his story, Frankenstein realized that he had some obligation to the monster because he created it, in the same way that he bore responsibility for the monsters actions. Frankenstein was no longer simply responsible to humanity for the monsters actions, but he was also responsible to the monster for his happiness. Being the creator of a life was more responsibility than Frankenstein planned for when he was so eager to create the monster. The monster called upon Frankenstein to fulfill his obligation of providing for his happiness by creating a female companion to keep him company. Out of his sense of obligation to his creation and out of fear for his family (which the monster threatened to harm if Victor did not make a companion), Frankenstein agreed to make the female monster. His responsibility to his creation carried greater weight than the idea of his responsibility to humanity for the actions of the original monster and the new one he agreed to create. He hadnt yet realized the full weight of responsibility he would bear for the actions of both monsters. Before Frankenstein could marry Elizabeth, he had to complete his obligation to the monster so that he could be completely rid of him and the responsibility for his actions. As a result, Frankenstein postponed the wedding and took a trip to England to work without the danger of being discovered by his family because he had still not told anyone about the monster that he created and actually to responsibility for its actions. His obligation to the monster was not only to ensure the monsters happiness, which Frankenstein felt obliged to do as the monsters creator, but also as a way to protect his family from the monsters vengeance. Before he completed the female monster, Frankenstein realized the weight of responsibility he would bear if together the two monsters destroyed any other human life or reproduced, and the thought was just too much to bear. Rather than deal with the responsibility for two hideous, superhuman creatures, Frankenstein would rather deal with the wrath of one, so he destroyed his work on the female monster. This kept him free from the enormous feeling of responsibility of any actions of the two monsters. Frankenstein was responsible for Henrys death at the hands of the monster, and this grief rendered him ill for a long time. Frankenstein is once again in the position he found himself with William and Justines deaths. He didnt murder Henry, but his friendship with Frankenstein made Henry susceptible to the monsters wrath because he used Henry to get back at Frankenstein. Although the Irish magistrate acquitted him, Frankenstein knew that he was responsible for Henrys death because he had d efied the monsters wishes and the monster repaid him by killing his friend. The monster then did exactly as it said it would if Frankenstein did not create a companion for it and went to kill his fiancà ©e Elizabeth. Frankenstein, feeling responsible for Elizabeths death as well, vowed vengeance on the monster. The only way to absolve his responsibility for the monsters actions was to kill him, so thats what Frankenstein set out to do. He was responsible for the monsters creation and its actions, and he planned to be responsible for the monsters destruction as well which would free his mind from any new struggles. Frankenstein has already lost all of the friends that he was close with and really lost everything he has dreamed of at the hands of the monster. He believes without his friendships he has nothing to live for except the destruction of the monster. Friendship is important throughout the novel because it is the goal of Walton, the narrator, as well as the monster Frankenstein created. Loneliness and isolation are major conflicts throughout â€Å"Fr ankenstein†, and in this novel they motivate the monster to turn to destruction. The first sight of the theme of friendship we see is how Walton longs for a friend to share his excitement over the voyage to the North Pole. He is separated from his sister, whom he may never see again, and he has no one to buoy his courage or steady his heady excitement. Walton writes, â€Å"I have no friend, Margaret: when I am glowing with the enthusiasm of success, there will be none to participate my joy; if I am assailed by disappointment, no one will endeavor to sustain me in dejection†(Shelly 19). Friendless in the cold, white blankness of Archangel, and preparing to sail into the vast and unknown frozen arctic, seems a desolate situation for Walton. He feels the need of someone of his same intelligence that he can share his thoughts with so that the friend could keep Walton positive when he feels as though failure on his journey is near. Without a friend Walton is just a lonely being among others that cannot sustain his need for a friend to help him find a bit of lig ht in the dark days of his voyage to sooth his soul. â€Å"Frankenstein† also uses Natural beauty as well as friendship for a soothing influence on the characters of the novel and it is an important part of the Romantic influence. This appreciation of beauty in a novel so filled with brutality seems an odd contrast, but it is part of what makes this story a Romantic piece. On Frankenstein’s trip back home he was anxious about the changes in his homeland since he had been away for six years, so he spent a few days resting in a small town and letting the landscape of his country ease his worry. â€Å"I remained two days at Lausanne, in this painful state of mind. I contemplated the lake: the waters were placid: all around was calm; and the snowy mountains, ‘the palaces of nature’, were not changed. By degrees the calm and heavenly scene restored me, and I continued my journey toward Geneva† (Shelly 76). The familiar landscapes, which seemed timeless when compared to the span of human life, calmed his worries. Nature makes us feel small and unimportant because we last such a short time in comparison to the mountains, rivers, and trees around us, so whatever we are experiencing must be miniscule as well. Gazing at the calm and relaxing place is helpful to ease the mind of struggles and to calm the mind. In conclusion, the theme of responsibility proves to be the most important in the novel â€Å"Frankenstein†. Although Frankenstein himself does not take responsibility over his action of creating the monster until it has destroyed almost everything he loved. If he had taken this responsibility from the beginning he could have avoided the tragedies that brought him into a depression. The only things that could help him through this terrible time would be friendships or nature. The fact that he lost all of his friendships through the destruction of the monster that he had not taken responsibility for led Frankenstein to have to find peace within nature. Works Cited Shelly, Mary W. Frankenstein. London: Penguin Group, 1992. Print.

2008 Financial Collapse Summary

2008 Financial Collapse Summary Dave Levengood â€Å"Too Big to Fail† vs. â€Å"How an Economy Grows and Why it Crashes† The Great Recession of 2008 was not only the largest economic crash of this decade, it was the largest economic crash since the Great Depression. The Great Recession has been studied extensively since it happened, and there are finite conclusions as to why it occurred that can be drawn from the facts. First, ineffective government regulations of the banking system allowed the Wall Street banks to carelessly loan out money to essentially anyone who asked for it. Second, many of those loans, which originally stimulated the housing bubble, were defaulted on when the nearly 8 trillion dollar housing bubble burst, leaving behind billions of dollars of debt. Third, this debt destroyed consumer confidence in the large banks, causing a drop in the stock market as people withdrew their money. The lack of â€Å"credit† as Ben Bernanke describes it, almost threw the American Economy into an abyss much deeper than that of the Great Depression. Two works that both outline the causes and re sults of the Great Recession are Peter Schiff’s â€Å"How an Economy Grows and Why it Crashes,† and the HBO film, â€Å"Too Big to Fail.† Schiff’s book uses a comical portrayal of the U.S. economy in the form of islanders of the nation Usonia, with â€Å"fish† as dollars. HBO’s documentary focuses more on the day-to-day actions by the government and banks trying to prevent this recession forming into a depression. In all however, both works draw on and allude to the known problems in the U.S. economy that led to the Great Recession. â€Å"Too Big to Fail† implies that the start of the entire economic fall was when President Reagan deregulated the banks, giving them much more freedom to give out loans. This freedom was then abused by overconfident banks and thus the recession occurred. Schiff does not share the same view outright in his book, however his comments on the frequency and careless loans by the banks cannot be overlooked. That being said, Schiff focuses extensively on the changing value of currency over the course of the recession. After being taken off the gold standard, Schiff describes how the U.S. economists were free to change their currency as needed to sustain growth. The ONLY reason why this worked was because the U.S. had become such a large economic player that the Reserve Note was backed up by the â€Å"trustworthy† reputation of previous years. Had other nations not accepted our dollars as a reserve note, we would have a much more difficult time borrowing and spending money to day. Furthermore, Schiff describes the acts of the Federal Reserve inflating currency as the â€Å"re-officialization† of the dollar bill into  ¾, then  ½ of its original value. This crack of instability in our currency was heavily leaned upon during the great recession when the value of our currency was questioned. After the large investment banks lost money, consumers seriously questioned the value of the dollar. As true with all expectations, when confidence and expectations are low, they tend to be self-fulfilling prophecies in that they come true because people think they will. Therefore, â€Å"Too Big to Fail† describes the original cause of the recession as the deregulation of the banks by Reagan, while Schiff might argue that the underlying cause was because of the insecurity in the value of the United States dollar. The second cause of the Great Recession was the housing bubble. While there may have been some disagreement in the underlying causes of the recession between the two works, both Schiff and â€Å"Too Big† are in agreement over the catastrophic consequences of the bursting of the housing bubble. â€Å"Too Big to Fail† details how the banks were truly sunk by the defaulting of housing loans. In forcing mergers and subsidies, the problem was constantly the â€Å"toxic assets† which were the housing stocks. After the burst of the bubble, all of the large Wall Street banks were left with billions of dollars owed to them in the form of housing debts. Nobody knew if those debts would be repaid, however given the look of the housing markets at the time, the banks assumed the worst. Schiff also details the housing bubble as the â€Å"hut rut.† After political and fiscal dancing by the leaders of Usonia to re-stabilize their fish note, things in the Usonian economy b egan to look up. Schiff describes the hut rut as a gradual idea at first, with large dependable borrowers striving for the â€Å"American Dream† of owning a hut. Then, the government stepped in to help subsidize the buying of homes and restricts interest rates from being too high for risky buyers. This was most likely a large political move to gain re-election by making it appear as though homes were provided to all of the country. The result of these subsidies and restrictions was an upward spiral in the hut-market. The spiral increased speed until it was completely out of control of the government that originally regulated it. All semblance of legitimate value was lost, as consumers just demanded to get a hut to attain social status. As this towering house of cards grew and grew, so did the doubts and fragility within the market. Finally, the peak was reached and instead of all buyers of huts and small sellers, there were only sellers of huts. The prices deflated exponentia lly, and thus the hut bubble burst in a spectacular fashion. Therefore, Schiff describes how the subsidies and interest rate restrictions promoted excessive buying of houses by people who could not afford them, and â€Å"Too Big† demonstrates the effect of those defaulted loans on the banks that made them. The final act of the recession was the actual bailing out of the major companies, subsidies given, and eventually cash injections forced onto Wall Street banks. This part of the recession is the part most focused on by â€Å"Too Big to Fail.† The first domino to fall was the bailing out of Bear Stearns by the U.S. government as it was bought JP Morgan. This fall then caused the next smallest bank, Lehman Brothers, to get hit hard by shaky consumers. The combination of Richard Fuld’s ignorance in the Korean negotiations, and poor loan choices by the bank itself led to Lehman Brothers’ declaration of bankruptcy. While this causes an appreciation in the U.S. dollar for a short span, the lack of confidence originally in Lehman Brothers spreads like a disease to all the other banks in the system. One aspect of the recession that the film covers that Schiff does not is AIG. AIG took on an unbelievable amount of housing risks, expecting all of the assets to go up, howev er when the housing bubble crashed hard, so did AIG. The effect of AIG’s faltering was extrapolated throughout the economy due to the massive size of the company. Providing insurance to essentially all areas of the economy, AIG was â€Å"too big to fail† however, when it did, it threatened to take down the entire system with it. In an attempt to re-stabilize the system, Timothy Geithner, a policy-maker during the recession, attempts to merge the investment banks to boost confidence, however that fails miserably. The eventual plan that is decided upon is a 700 billion dollar bailout that would be used to purchase the â€Å"toxic assets† that were such a problem to the investment banks. However, after discovering the toxic asset plan too slow, Henry Paulson, secretary of the treasury during the recession, decides to give direct cash injections to the bank, with the hope of them lending it out. The only problem with the TARP bailout, is that the banks did not lend out the money. The economy continued to slope downward until 2009 when the market finally stabilized. While the collapse of AIG and the investment banks were truly scary notions, the true threat that faced the economy was the lack of credit. As described by Ben Bernanke, the ability to borrow money and pay it back plus interest is the heart and soul of an economy. Without credit, an economy will grind to a halt. This lack of credit is addressed by Schiff as well, who describes the government’s policies towards the lack of credit as simply throwing fish at it until the economy corrected itself. The only real policies that Schiff addresses by the government during the recession is the bailing out of Freddie Mac and Fannie Mae by George Bush to stop them from hurting the economy any more than they already had. Schiff believes that the savior of the U.S. recession was China, in the form of lending the U.S. the money necessary for the cash injections and stimuli. The problem that Schiff describes with this plan is necessity to repay China all of the debts that we owe it. Therefore, Schiff details how China supplied our government with the â€Å"real† money necessary to stop the bleeding of the housing market, while â€Å"Too Big to Fail† shows the steps taken to stop the bleeding itself. In conclusion, the Great recession of 2008 was an event long in the making, starting with the deregulation of the banking industry by Reagan and formation of the Fed by FDR. This caused weakness in the economy that was exploited by the crash of the housing bubble, and the resultant scramble for cash by out government has left us trillions of dollars in debt. The largest problem coming out of this recession is the probability of another bubble in the form of treasury bonds. If this bubble develops and the government does not kill it before it has time to grow, we could be facing a much larger and more permanent crash. Luckily, this recession did not turn into a depression. This is outlined in an article by Chris Isidore, a senior economics editor at CNN who attributes the survival of our economy to the trillions of dollars poured into the econmy by Ben Bernanke. While Schiff may not have agreed with the extensive borrowing to finance this, there is no doubt that Bernanke saved our eco nomy from total collapse, even if he did use any mean necessary. Schiff’s epilogue sums up the current position of U.S. political leaders, in that they do not have the courage to do what is necessary to fix the economy, instead worrying about their jobs and money. Hopefully we can learn from the mistakes shown in both of these works and ensure a stable and steadily growing economic future.

The lamb to the slaughter and The speckled band :: English Literature

Wide Reading: The lamb to the slaughter and The speckled band For me, a good murder mystery needs to contain a mixture of aspects. Like in mid-summer murders and Morse it needs to include the following things, a good setting, there needs to be a good setting so that it sets up the whole of the story, it needs to be somewhere quiet and peaceful. The characters need to be strong characters that all relate to each other, there also needs to be a twist in the characters to add depth an mystery, perhaps the last clue to the murderer. The murderer has to be someone unexpected, someone who perhaps wasn't the strongest character. The victim has to be someone who has mystery but perhaps gave the killer reason to, so you might feel that they deserved it but you might have sympathy for, it also needs to be someone you least expect to be killed, perhaps the stronger character. And the detective has to be someone who everyone can sort of relate to, who has a slight mystery behind him or her so that even when you think you know them there is a skeleton in their closet. The murder weapon has to be something of power and something that represents some element in the play. It also has to be something unexpected like an exotic animal or as in lamb to the slaughter, a leg of lamb! Also the plot has to be thick and unexpected, with plenty of twists and red herrings. It also needs to make the reader feel included in the story so you feel as if you were there. Finally the ending of the story has to be meaningful and it needs to draw a conclusion. The killer has to be found, the reasons to be explained and the murder it self be told and what happened prior to the event. This finishes off what happened and lets us draw our own conclusions, although for a good murder mystery something's need to be left a mystery. I am going to compare the different areas in each story. I shall be comparing the following  · Settings  · Characters The settings for Lamb To The Slaughter and The Speckled Band a very different. The setting for the speckled band is in Victorian England, in the earlier 1900's. it is set in a country town, in a big mansion. A wealthy family lives in it. It is torn apart by deceit, greed and the death of the lady of the household. The back ground to the story goes a little something like this. The lady of the Stoke morans first

Consequences in Nathaniel Hawthornes The Scarlet Letter :: Scarlet Letter essays

Consequences in The Scarlet Letter      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are two sides of consequences for almost everything that happens in life, directly or indirectly.   In life, we could learn mostly from the consequences, rather than from the punishments of our actions.   If the consequences are good, we know that the action should be repeated, sometimes.   If bad consequences outweigh the good, we know repeating would not be wise.   Hester Prynne of Nataniel Hawthorne's The Scarlet Letter, learns from punishment and the consequences of adultery, but from which does she learn more from?      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Punishment from the magistrates was usually strict and severe. Hester's punishment was to stand on the wooden platform, in the town square, for three hours.   She could not speak to any to the numerous eyes that stared at, through her until dark. Hester also had to wear an embroidered A of scarlet cloth upon her chest.   The A symbolized that she was an adulteress, and should not be associated with.   Hester had also been banished from town, and branded an outcast.   Even though she did not name her lover, so that he could be punished, he did not go unpunished. Reverend Dimmesdale had taken it upon him to stand on the same platform that Hester had, and he also whipped himself.   The whipping did not serve its purpose, he was laughing all the while that he lashed himself.   Neither means of punishment had taught him anything, as well as Hester.      Ã‚  Ã‚  Ã‚   To fill in for what punishment had not taught, consequence brought forth the lessons of life.   The consequences that Hester found were bad and good.   There is usually two sides of consequences.   The scarlet letter showed everyone she was a sinner, an adulteress, making the people sick of her, and did not acknowledge her.   Yet as time went on, people noticed that Hester had embroidered the scarlet letter so beautifully, that she had offers to have embroidery done for others.  Ã‚  Ã‚   As the course of the story the A had changed its meaning.   People saw how strong Hester was and refused to interpret the A as it was meant, the A became to mean both ABLE, and ANGEL.   For her good deeds done unto the community.   She gave clothing to the poor and helped out wherever possible.

ICT and You :: ICT Essays

For this work, I am going to write about how I use ICT in my everyday life. I will be looking at how I use ICT at Home and at School. I will also identify how I use ICT for: - > My own personal use (this is when I use it just for me) > Social use (this is when I use the ICT with other people) PC Technology ------------- I use Microsoft Excel a lot, which helps me to do graphs in science for coursework and I also use it at home for sorting my pocket money and spending so I am organized with my money and don’t overspend. It is very easy to use and your work is always very neat and presentable which is important for my coursework. I also use Microsoft Word for many things in school, these include: writing out coursework, completing homework and English essays. Microsoft word offers a great easy program, which is easy to use and also you can put text, pictures and photographs onto a word document. I like using MS FrontPage to design and make web pages and websites this can be done personally for me or socially for a group of people. Designing website can be relaxing and stress free or can be frustrating and stressing, all depending on what type of web site it is. Internet The internet is very helpful to me in school because I can search up useful and useless information an instant using search engines like â€Å"google† the downsides to sites like these is, you have to be specific otherwise you could end up having thousands of pages of junk for example if your searching for the official Manchester United site and only type in â€Å"Manchester United† you will get any pages appearing containing the words â€Å"Manchester† and â€Å"United† you can get around about 3,460,000 results, when the words â€Å"Official Manchester United Football Club Website† only pages containing them words are found, there are around about 69,400 results just by being a bit more specific. I use this at home, personally to keep up-to-date with breaking news of my favorite football club and in school personally for my business coursework. At home I enjoy being on MSN messenger to talk to friends and Family worldwide, msn is good because it’s faster than email and cheaper than phone calls, the disadvantage is that my internet connection depending where I am and what time of the day it is could be slow I have a 576k ADSL modem so there’s no worries for me but slower internet connections like a 23.3k modem could have a delay or even a bad

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