Analysis of the Color Purple essays

Analysis of the Color Purple essays Alice Walkers depiction of a southern black woman in the novel The Color Purple was the most powerful Ive ever read in my life. One reason this was so was because Walker applied a variety of literary devices to the story, giving it more of an impact. She used symbolism, applied her tone as an author, and used a specific dialect for her characters, all in letter form. Its important to the author to use these devices in their novels, especially if they are trying to convey a certain message or issue to their readers. A particularly weighty one at that. If it had not been for the vivid vernacular placed upon her southern-born characters or the use of written letter form as an alternative to the form frequently utilized in novels, this story wouldnt have left such a mark or rather, a stamp, on my soul. The appearance of symbolism in The Color Purple is not as glaring to the readers eye as one may think. Though you dont read the actual words of the title until towards the end of the book, Alice Walker didnt just pluck the name of her award-winning novel out of thin air. On page 291, Celie is showing Shug her completely purple and red room. She even shows her a little purple frog perched on the mantlepiece, carved for her by her husband Albert. I am not sure of the exact significance of the actual color purple in this context, but the use of any color at all at this point in the story symbolizes a character growth in Celie. Through a good chunk of the book she is living a drab and colorless life, exhibiting no emotions of her own. Not until her husbands previous lover, Shug Avery, comes around, do you catch the true Celie and not just a hardworking housewife who gets beatings. And there is, of course, no emergence of any kind of purple coloring until that point. Walker interp rets Celies conversion in color and mood in many ways, but one way in particular was to launch Celie&apos...

Definition and Examples of Conversational Implicature

Definition and Examples of Conversational Implicature In pragmatics, conversational implicature is  an indirect or implicit speech act: what is meant by a speakers utterance that is not part of what is explicitly said. Also known simply as implicature.  Contrast with explicature. What a speaker intends to communicate, says L.R. Horn, is characteristically far richer than what she directly expresses; linguistic meaning radically underdetermines the message conveyed and understood (The Handbook of Pragmatics, 2005). Example Dr. Gregory House: How many friends do you have?Lucas Douglas: Seventeen.Dr. Gregory House: Seriously? Do you keep a list or something?Lucas Douglas: No, I knew this conversation was really about you, so I gave you an answer so you could get back to your train of thought.(Hugh Laurie and Michael Weston, Not Cancer. House, M.D., 2008) Inferences The probabilistic character of conversational implicature is easier to demonstrate than define. If a stranger at the other end of a phone line has a high-pitched voice, you may infer that the speaker is a woman. The inference may be incorrect. Conversational implicatures are a similar kind of inference: they are based on stereotyped expectations of what would, more often than not, be the case. (Keith Allan, Natural Language Semantics. Wiley-Blackwell, 2001) Origin of the Term Conversational Implicature The term [implicature] is taken from the philosopher H.P. Grice (1913-88), who developed the theory of the cooperative principle. On the basis that a speaker and listener are cooperating, and aiming to be relevant, a speaker can imply a meaning implicitly, confident that the listener will understand. Thus a possible conversational implicature of Are you watching this programme? might well be This programme bores me. Can we turn the television off? (Bas Aarts, Sylvia Chalker, and Edmund Weiner, Oxford Dictionary of English Grammar, 2nd ed. Oxford University Press, 2014) Conversational Implicature in Practice Generally speaking, a conversational implicature is an interpretive procedure that operates to figure out what is going on. . . . Assume a husband and wife are getting ready to go out for the evening: 8. Husband: How much longer will you be?9. Wife: Mix yourself a drink. To interpret the utterance in Sentence 9, the husband must go through a series of inferences based on principles that he knows the other speaker is using. . . . The conventional response to the husbands question would be a direct answer where the wife indicated some time frame in which she would be ready. This would be a conventional implicature with a literal answer to a literal question. But the husband assumes that she heard his question, that she believes that he was genuinely asking how long she would be, and that she is capable of indicating when she would be ready. The wife . . . chooses not to extend the topic by ignoring the relevancy maxim. The husband then searches for a plausible interpretation of her utterance and concludes that what she is doing is telling him that she is not going to offer a particular time, or doesnt know, but she will be long enough yet for him to have a drink. She may also be saying, Relax, Ill be ready in plenty of time. (D. G. Ellis, From Language to Communication. Routledge, 1999) The Lighter Side of Conversational Implicature in The Office Jim Halpert: I dont think Ill be here in 10 years.Michael Scott: Thats what I said. Thats what she said.Jim Halpert: Thats what who said?Michael Scott: I never know, I just say it. I say stuff like that, you know- to lighten the tension when things sort of get hard.Jim Halpert: Thats what she said.(John Krasinski and Steve Carell, Survivor Man. The Office, 2007)

ORGANISATION DEVELOPMENT Essay Example | Topics and Well Written Essays - 6750 words

ORGANISATION DEVELOPMENT - Essay Example This requires changing the upgrading the entire organizational functioning through careful diagnosis and analysis such as to attain a different organizational structure and shape such that the work process becomes more efficient and improved. The purpose of OD interventions in organizations is to address the perpetual needs of organizations through a concerted and collaborated effort of both internal and external industrial experts in the particular field to discover such processes which can be used by the organization in order to become more effective towards stakeholders and groups. The assignment seeks to explain the OD intervention process undertaken in IBM in India. For this, it makes an analysis of the need for OD intervention in the organization on the basis of its present situations and conditions. The role of managers as change agents in the intervention process is also brought forth in the study. It explains the need and extent to which managers need to be empowered to bring about the changes and implement them successfully. However, incorporating the process does not come without hurdles. There are a number of strategic and practices which are to be dealt with carefully while managing the process. Reasonable arguments are provided with regards to the ways in which the obstacles can be managed and the process can be made successful. The requirements of OD intervention in IBM can be explained with the help of the contingency theory. This is on account of the ever changing business and technological environment in which it operates. Technology is fast growing and changing at a rapid pace. Thus, it is very easy for organizations and their present technologies to become obsolete and outdated, consequently loosing the competitive edge in the market. It is seen that IBM needs to adapt itself with the changing technologies, systems and practices so as to retain

Questions in Criminal Justice Coursework Example | Topics and Well Written Essays - 2000 words

Questions in Criminal Justice - Coursework Example During the Bram v United States case, the judge gave his verdict in accordance to the rules of the 5th Amendment and stated that if a confession is to be used in the court, it has to be obtained on voluntary basis (Scheb, 2010, 497). During the third quarter of the 20th century, criminal cases in which confession was obtained through coercion were not admitted into the court of law on the basis of the due process. Confession is referred to an individual’s acceptance of being guilty of committing a crime after he has been interrogated and questioned by the law enforcement officers. In contrast to confession, admission refers to an individual’s acceptance of being guilty of committing a crime or being a part of a criminal activity without any interrogating questions or behaviour exercised by the law enforcing officers. During the Brown v Mississippi case, the judge stated that a confession should be examined to identify whether the confession was made voluntarily or invol untarily and whether the confession was reliable enough (Scheb, 2010, 497). The ruling in this case was reversed because the police had brutally interrogated the suspect due to this the suspect had confessed to commit the crime. One way of approaching any confession and/or admission made by a suspect s referred to as due process voluntariness approach. According to this approach if a suspect confesses to be guilty if police officials have used coercion while interrogation, the suspect’s statement of being guilty is not accepted during the proceedings of his case. For example: in Arizona v Fulminante case, it was found that an undercover federal law enforcer coerced Fulminate and then he confessed to being guilty of first degree murder (McCord, 2012, 419). In this case coercion was not physical in nature; rather the coercion was emotional in nature as the undercover federal agent assured to protect Fulminate in prison as there was threat to his life in prison. The undercover a gent made the promise to protect while asking for a confession in return. This case was treated under the 14th amendment clause of due process and the court ruled in Fulminate’s favour, accepting that coercion was applied to obtain a confession. When law enforcing agents apply unlawful method to obtain a confession from a suspect, this act conducted by the police officials is regarded as violation of an individual’s Miranda rights. The process of selection of a jury starts with the compiling of probable jurors, the compilation of to be jurors need to be unbiased and this compilation is of utmost importance. After the creation of the list of to be jurors, the body of jurors for a particular criminal case are selected. Selection of a body of jury out of the compiled potential jury list is recognized as selecting jurors for jury duty. Jury is said to be selected in three different stages. Firstly a list of to be jurors is compiled, next the jurors expected to be on jury d uty in a case are selected and lastly the selection of final jury members is conducted. The numbers of people who fall in the category of probable jury list are recognized as jury pool or list. This list is created through various sources and the best source is the list of registered voters (Neubauer, 2013, p.77). Other sources through which this list can be compiled

Energy Drinks Market Essay Example for Free

Energy Drinks Market Essay What are energy drinks? Cola and coffee drinks have long been promoted and known as energy drinks meant to give you a little pick me up, mostly in the form of caffeine and sugar. Jolt Cola in the 80s was one of the early entries in the energy drink market, with double the caffeine of normal colas, it was marketed towards teens and college students as a way to get an energy edge and keep you awake and energized. Their slogan, in fact, was twice the caffeine. Jolt has in fact recently been reincarnated given the success of other energy drinks. What are the most popular energy drinks? Red Bull, created by an Austrian company, really defined the category, and was launched in Europe in the late 1980s. Their slogan is Red Bull gives you wings, with images of winged bulls flying in their ads and logos. Red Bull really gained in popularity and fame in the late 90s and into the new millenium, setting off a whole new market segment of beverages energy drinks. They sold more than 1 billion cans of Red Bull in 2000, and their growth continues until this day. Red Bull is estimated to dominate 60-70% of the energy drink market it is popular with teens all the way up through people in their 30s Red Bull and Vodka is a big drink at trendy bars. One of the main ingredients of Red Bull is taurine a chemical substance supposed to increase energy levels. But caffeine is the main component that gives Red Bull its kick. One 8 oz. can contains 80mg of caffeine (about the same as a cup of coffee) and 27g of sugar. Why drink Red Bull? If you visit their website, RedBull. com, youll read that drinking Red Bull increases performance, increases concentration, improves vigilance, improves emotional status, and stimulates metabolism. Is any of this true? Who knows, but there is an entire generation of young people that swear by it. The Energy Drink Market Full Throttle, Monster, Rockstar With the success of Red Bull, a slew of copycat drinks were flooded into the marketplace. The most popular energy drinks are Monster, Full Throttle, and Rockstar. Full Throttle is made and owned by Coca Cola, just like their Coke Blak combination of coffee/cola drink. Full Throttle energy drink is marketed as a rebellious drink, with flames erupting on the can, looking like a handful of Harley Davidson or something. An 8 oz. serving has 110 calories (comes in a 16 oz can) and 29g of sugar. It also packs things like ginseng extract (to keep you sharp) and plenty of caffeine. Full Throttle Fury comes with a citrus flavor and a red can, instead of the standard black can. Coming from Coke, it is almost Fanta Orange like in flavor, vs. the slightly citrussy flavored version of the original. Full Throttle was a late comer to the market, launched in 2005. It is targeted at 20-30 year old men, and contains taurine like Red Bull. Monster Energy Drink Rockstar Monster energy drink is yet another competitor in this crowded field. Unlike Red Bull which comes in the diminuitive 8 oz. cans, Rockstar comes in the larger 16oz. cans, like all the other energy drinks (priced around $1. 89 per can is also pretty standard). It also has a sweet citrussy taste similar to Red Bull. The Monster logo looks like 3 claw marks ripping the can open. They also make a low-carb version and Khaos, the juice monster. Monster Energy Assault is their entry into the soft drink flavored market, but with the same energy kick to set it apart. Finally, there is Rockstar energy drink, from the makers of Hansens Natural Sodas. Their motto is party like a rockstar, targeted clearly at the younger crowd who wants to be wild and crazy and stay up all night. They make several flavors of Rockstar cola, energy drink, and juiced (which is much like Monster Khaos). The energy drink variety has a similar taste to all the others, while the cola version tastes better than most (it has a slight kick to the aftertaste, unlike most traditional colas). The juiced version is our favorite, with a crisp flavor of mango, orange, and passion fruit, leaving you with no aftertaste. It is actually 70% real fruit juice (and 100% energy as they claim! ). They were the first to use the 16oz larger size, and this has caught on and become the standard. Only Red Bull continues to market the smaller cans, which is part of their image. While the UK is certainly not the only market in Europe where energy and sports drinks are big business nor indeed is it the large Bars and clubs remain important outlets for energy drinks across Europe Many people will try an energy drink brand for the first time in a bar, with or without alcohol there is a growing trend towards everyday consumption as a source of energy. This in itself throws up other challenges not least how the brands, and the stores that sell them, distinguish themselves from each other. This has led to a range of new products, which differentiate themselves from Red Bull through packaging, or colour, or taste, or through what they contain, said Hall. Consumers are increasingly knowledgeable, and they understand more and more about the ingredients in these drinks, so if the science is good, it can be a real selling point. Sports drinks are perhaps a case in point. They are generally linked with energy drinks, and indeed have a number of similarities in terms of functionality and target audience. Yet they are generally consumed in different situations they are unlikely to be consumed in a bar, for example and have different effects on the body. I think its true to say that sports drinks marketing is more dependent on science, Hall said. PowerAde and Lucozade are pushing the science of sport into the mainstream. Gatorade has not yet achieved that in Europe, but may be helped by the recent change of ownership [it was bought by PepsiCo from Quaker Oats]. But if we see a three-way marketing push from these leading brands, then the shape of the European market could change dramatically. Though there are differences between sports and energy drinks, they are all about topping up, enabling people to get more out of their lives or their activities. The products have a common target audience young people with lots of spending power and the opportunities are there for excellent growth. But there are potential threats as well. There have been stories of adverse reactions to energy drinks, although the drinks have never been categorically linked to the problems. The companies have always been quick to respond to potential problems such as these, even if they were certain that the problem was not a result of the drink, said Hall. These drinks are constantly pushing the boundaries of science, and there is an argument that says can we ever be totally sure of any products safety. What we need is a balance of judgement, and for the most part that is what we make. KOTLER, Philip. , Marketing management / Philip Kotler, Kevin Keller.? Twelfth ed. , Pearson Prentice Hall. Englewood-Cliffs, New Jersey, KOTLER, Philip. , Principles of Marketing, Second European Ed. , Prentice Hall Europe, London, 1999. PORTER, Michael E. , What is strategy, Harvard business review, Nov-Dec 1996.

The Use of Isolation in Two Fairy Tales Essay -- Literature Writing Li

The Use of Isolation in Two Fairy Tales The social evolution from the Enlightenment to the Romantic Age altered the usage of reason in literature by instituting elements of imagination and mysticism. Likewise, the usages of certain concepts in literature can reflect social attitudes of the author’s environment. One such concept that is common to both Ludwig Tieck’s â€Å"Fair-Haired Eckbert† and Wilhelm Wackenroder’s â€Å"A Wondrous Oriental Fairy Tale of a Naked Saint† is the isolation of characters. Isolation, as the cause, or simply as an indicator, of suffering in these two literary fairy tales is a notion that is successfully used to dictate the spiritual fates of the characters in each story. There are several manifestations of isolation as the cause of suffering in â€Å"Fair-Haired Eckbert†. The first manifestation is literally separation anxiety. Despite the fact that character interactions in this story only lead to trouble, the characters yearn for solidarity with one another. Subsequently, their isolation inevitably leads to misery. After running away from home, Bertha’s lonely voyage is filled with tears and is self-described as â€Å"utterly comfortless,† and she longs â€Å"but to see one [other] human creature† (33). Upon discovering the green valleys that imply potential cohabitants, Bertha claims, â€Å"my loneliness and helplessness no longer frightened me† and she is â€Å"joyfully surprised† (34) to see the old woman. Bertha overcomes the pains of isolation by living with the old woman; however, this relationship soon falls apart and Bertha once again runs away. Bertha voyages â€Å"amid tears and sobs† (39) and stumbles back upon her home town. After finding out her parents had passed away, Bertha â€Å"drew back quickly and left the village ... ... strong religious overtones present in both texts. Isolation is utilized as a cause of suffering for the characters in Tieck’s â€Å"Fair-Haired Eckbert.† It serves as punishment for these characters as a result of bearing the burden of original sin, and thus conveys the pessimistic view of human spirituality as a downward spiral from the Garden of Eden. Conversely, in Wackenroder’s â€Å"A Wondrous Oriental Fairy Tale of a Naked Saint,† the concept of redemption from isolation (the indicator of suffering) represents the optimistic stance of human spirituality as ascension to Heaven. It follows that the dichotomy between isolation as an indicator or the cause of suffering in these two stories reflects the larger dichotomy between optimistic and pessimistic tones taken in Romantic literature, specifically those taken by Tieck and Wackenroder in these two literary fairy tales.

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

Defining Social Problems

A distinction is made between the definition of a social problem and sociological problem by Peter Worsley (1972). The latter refers to the problem of explaining social behaviour in terms of a sociological theory, whilst the former is some piece of social behaviour that causes public friction and or private misery and calls for collective action to solve it. The study of social problems is a complex and very controversial undertaking. Broadly speaking, this is not understandable to the average layman whose concepts of what constitutes a social problem is firmly established by the rhetoric of his/hers everyday social discourse and indeed the classification of acts or situations as social problems seem to be a relatively simple exercise. It is becoming more and more evident by present day sociologists and social scientists alike the complexities involved in defining, identifying and classifying a social situation as a social problem. This process has far-reaching implications on the focus, scope and projected recommendations of studies conducted of a particular social situation. There are two major conceptualizations of defining a social situation as a social problem. The first is centered around the self-explanatory phase â€Å"public opinion approach†. This approach contends that a â€Å"social problem cannot exist for a society unless it is recognized by that society to exist† (Blumer, 1971) the inference here is that it is the members of the society that define and construct their social reality and that via socialization these interpretations of societal phenomena and value consensus is conveyed to the offspring. Individuals and social situations that do not conform to the norms and values of society are often viewed as social problems. In Blumer's definition of social problem he uses a broad concept of society but fails to further refine his definition. Merton writing in Contemporary Social Problems also utilizes in his definition of what is a social problem the broad and in my opinion ambiguous term â€Å"people†. His definition of social problems is as follows â€Å"a social definition exists when there is a sizeable discrepancy between what is and what people think ought to be†. One discovers that each society has their own conceptualizations and interpretations of their social world and furthermore as contemporary sociologists, namely M. G. Smith and his pluralist model of society (adapted from the research of J. Furnival of Burma), have suggested different fractions of society have competing and contrasting ideologies. The use of such terms suggests social union and cohesion of meanings and oversimplifies the above mentioned complexities of societies. A branching school of thought emerging from the public-opinion approach in the defining of social problems is in my opinion the quantitative approach. Perhaps realizing the aforementioned pitfalls of the definition proposed by Blumer and Merton some sociologist have attempted to further refine their definitions by assigning a seemingly quantitative value to them. Sheppard and Voss's definition is critiqued by Manis [Contemporary Social Problems] They define a social problem as â€Å"a social condition which a large proportion of society †¦ see as undesirable or in need of attention† Here the quantitative term â€Å"large proportion of society† refines the initial term â€Å"society† and â€Å"people† utilized in the definition of Blumer and Merton respectively. Julian writing in Social Problems, 10th edition, too in his definition utilizes the term † significant proportion of people†, Kornblum includes the term â€Å"most people† and likewise Fuller and Myers in their book The Natural History of a social problem, â€Å"American Sociological Review' quantifies his definition by added the term † a considerable number of people†. Though the inclusion of some additional factor concentrates the overall definition of what is a social problem it still does not give a full representation of the other forces at work that lead to a social condition being classified as a social problem. We have moved from the ambiguity of the term â€Å"society† to saying that it's the majority who decide or define social problems. The supporters of the public opinion approach contend that this approach limits the subjectivity of the researcher. Turner and Beeghley believe that by relying on the public's conceptualization of what constitutes a social problem that the sociologist remain neutral and value-free thereby playing a passive rather than active role in the process of defining social problems, since he/she is unable to impose his values, morals and ethnics. Gross dismisses the proposed objective rational proposed by the supporters of the public-opinon approach. He believes that for the sociologist even to interpret a public response to a social situation as negative or positive, good or bad is in itself a value judgment! This method of defining social problems is not as value free and objective as Beeghley and Tuner insinuate. If one is to speak of the majority, then what of the minority. In all fairness some public-opinion supporters have attempted to address this aspect of the debate around the definition of social problems. Sheppard and Voss have included in their definition the point that not only is a social problem defined by the â€Å"large proportion of society† but by â€Å"powerful elements of it† who see a social condition as undesirable and in need of attention. Julian makes an intuitive juxtaposition of the words to further develop this point. In his definition he contends that a social problem is so defined when â€Å"a significant number of people or a number of significant people† †¦ agree that the condition violates an accepted value or standard†¦. It confuses the definition somewhat since one is unable to determine whether the values of the majority are the ones violated by the social condition and it is thus defined as a social problem or if a social problem is so defined because the accepted values of the powerful (assumption here is that individuals who share the same social status or class have the same values) have been threatened. In the book, Defining Social Problems, there is considerable evidence to suggest that power groups play a significant role in the defining of social problems. Here the writer contends, and correctly so, that a social problem can exist for a number of years and still not be classified or acknowledged as a social problem! A social problem is said to ‘exist when an influential group asserts that a certain social condition affecting a large group of people is a problem that may be remedied by collective action. ‘ This introduces the concept that social problems are ‘subjective, value-laden and culturally informed' a point contested by Manis. Furthermore it's the influence of the power groups derived from their ‘strength, status or sheer number of people' that have significantly impacted on social policy at the national level. The example given was centered around the hysteria of the milk cartoon kids. There arose in the 1950's in the USA an outcry against the seemingly stark increase in the number of kidnappings. This caused a mass hysteria and this ‘social problem' was deemed acute and severe enough to warrant an increase in police surveillance at schools. The situation was not a real social condition but it was considered as such. This is one of the primary concerns of Manis whereby subjectivity in the definition of a social problem may lead to falsehoods. He suggests rather an objective approach which he labels the ‘knowledge values of science'. He links social facts to values and devises an approach to defining social problems based on: intrinsic values, contextual values and social responsibility values. By utilizing his method, he contends, ensures objective results by the sociologist. Though not part of the Marx theory, the labeling theory in this case exists alongside and supports the theory that power groups play a significant role in defining social problems. Howard Becker was instrumental in the development of the labeling theory. Pierre Bordeaux, a Marxist, studied the education system extensively and acknowledges the ability of the powerful to impose their definition of reality on others. The controversy surrounding the definition of social problems is still going strong. Some may ask why is it important to understand how a social situation is classified as a social problem. The implementation of social policies affects everyone and some policies may not always be to our benefit. For example the Mass Marriage Movement in Jamaica looked to encourage couples to marry because some British sociologists thought that single-parent families were having adverse effects on their children and this was considered a problem. Through the research of dedicated Caribbean sociologist we know differently. In conclusion, I adapt the view points of Merton and Roberts, Contempory Social Problems, that social problems ‘vary among societies and it varies in the same society among social groups and from time to time, since both the social realities and the social norms differ and change. Fuller and Myers to develop a rather accommodating definition of a social problem. They wrote ‘Every social problem thus consists of an objective and a subjective definition. The objective condition is a verifiable condition which can be checked as to the existence and magnitude by impartial and trained observers†¦. The subjective definition is the awareness of certain individuals that the condition is a threat to cherished values. ‘

Myths About Domestic Violence

Myths About Domestic Violence Lawanna Lynn Campbell endured a marriage full of domestic violence, infidelity, crack cocaine addiction, and alcohol abuse. When she was told to keep silent about being abused by her husband, she took matters into her own hands. After 23 years, she eventually escaped and made a new life for herself. Below, Campbell discusses the myths surrounding domestic abuse and their impact as she struggled to break free from a life of pain, shame, and guilt. MYTH Boyfriends and girlfriends sometimes push each other around when they get angry, but it rarely results in anyone getting seriously hurt. When I was 17, my boyfriend went for my throat and choked me in a fit of jealous rage upon learning that I had dated others before we became exclusive. I thought this was an involuntary reflex he could not control. I believed that his outburst showed just how much he really loved me and wanted me for himself. I quickly forgave him after he apologized, and in some morbid way, felt flattered to be loved so much. I later found out that he was very much in control of his actions. He knew exactly what he was doing. People who abuse often use a series of tactics besides violence including threats, intimidation, psychological abuse and isolation to control their partners. And if it happened once it would happen again. And sure enough, that incident was only the beginning of more acts of violence that led to serious injuries throughout our years together. FACT As many as one-third of all high school and college-age young people experience violence in an intimate or dating relationship. Physical abuse  is as common among high school and college-age couples as married couples. Domestic violence is the number one cause of injury to women between the ages of 15-44 in the U.S. – more than car accidents, muggings and rapes combined. And, of the women murdered each year in the U.S., 30% are killed by their current or former husband or boyfriend. MYTH Most people will end a relationship if their boyfriend or girlfriend hits them. After that first incident of abuse, I believed that my boyfriend was truly sorry and that he wouldn’t ever hit me again. I rationalized that it was only this one time. After all, couples often have arguments and fights that are forgiven and forgotten. My parents fought all the time, and I believed that behavior was normal and unavoidable in marriage. My boyfriend would buy me things, take me out, and show me attention and affection in an effort to prove his sincerity, and he promised that he would never hit me again. This is called â€Å"the honeymoon† phase. I believed the lie and within months I married him. FACT Nearly 80% of girls who have been physically abused in their intimate relationships continue to date their abuser after the onset of violence. MYTH If a person is really being abused, it’s easy to just leave. It was extremely complicated and difficult for me to leave my abuser, and there were several factors that delayed and hindered my decision to get away from him. I had a strong religious background and believed it was my obligation to forgive him and to submit to his authority as my husband. This belief kept me living in an abusive marriage. I also believed that even though we weren’t fighting all the time, it really wasn’t that bad. He owned a business, and at one point, was the pastor of a church. We were prosperous, had a beautiful home, drove nice cars, and I enjoyed the status of being the perfect middle-class family. And so, for the sake of money and status, I stayed. Another reason why I stayed was for the sake of the children. I didn’t want my children to be psychologically damaged coming from a broken home. I had been psychologically and emotionally abused for so long that I developed low self-esteem and had a low self-image. He consistently reminded me that no one else would ever love me like he did and that I should’ve been glad that he married me in the first place. He would belittle my physical characteristics and remind me of my shortcomings and faults. I often went along with whatever my husband wanted to do just to avoid a fight and to avoid being left alone. I had my own guilt issues and believed that I was being punished and deserved the misfortune that happened to me. I believed that I could not survive without my husband and was afraid of being homeless and destitute. And even after I left the marriage, I was stalked and almost killed by him. This type of psychological abuse is often ignored by the victims of domestic violence. Since there are no visible scars we think we’re okay, but in fact, the psychological and emotional torments are the ones that have the most lasting impact on our lives even long after the abuser is out of our lives. FACT There are many complicated reasons why it’s difficult for a person to leave an abusive partner. One common reason is fear. Women who leave abusers are at a 75% greater chance of being killed by the abuser than those who stay. Most people who are abused often blame themselves for causing the violence. No one is ever to blame for another person’s violence. Violence is always a choice, and the responsibility is 100% with the person who is violent. It is my desire that we become educated about the warning signs of domestic abuse and encourage women to break the cycle of abuse by breaking the silence. Sources: Barnett, Martinex, Keyson, â€Å"The relationship between violence, social support, and self-blame in battered women,† Journal of Interpersonal Violence, 1996.Jezel, Molidor, and Wright and the National Coalition Against Domestic Violence, ​Teen Dating Violence Resources Manual, NCADV, Denver, CO, 1996.Levy, B., Dating Violence: Young Women in Danger, The Seal Press, Seattle, WA, 1990. Straus, M.A., Gelles R.J. Steinmetz, S., Behind Closed Doors, Anchor Books, NY, 1980.U.S. Department of Justice, Bureau of Justice Statistics’ National Crime Victimization Survey, 1995. Uniform Crime Reports, Federal Bureau of Investigation, 1991.Violence Against Women: Estimates from the Redesigned Survey, U.S. Department of Justice, Bureau of Justice Statistics, August 1995.