How has McDonald's change in the last 5 years in UK Essay

How has McDonald's change in the last 5 years in UK - Essay Example The major success of McDonalds is based on this franchisee business model. Approximately 70% of McDonald's worldwide restaurant businesses are owned and operated by independent businessmen and women, our franchisees. McDonald's first restaurant in UK was opened in 1974 in the province of Woolwich. This was owned and managed by the company directly. It was in 1986 that McDonalds started franchise model of business by opening franchise restaurant. Since then number of franchise restaurants in UK has been on steady rise. In this paper, we analyze how the structure of the McDonald's business model and how has it changed in UK. Today Big Business has a strength is the market. McDonald was able to make use this big branding image in UK market. It is natural that large business corporations account for major shares of output, employment, investment and trade. This article reviews five aspects of McDonalds during the last five years from 2001-2006. The major points we are going to discuss are 1. role of the large corporation as a feature of the UK economy 2. role of its business leaders 3. the managerial revolution 4. existing business environment and the size of Britain's large companies relative to other parts of the country. The beginning of this period is marked by a real testing periods for many corporates. Companies need to look for new business models to survive in this context. Understanding the managerial practice of McDonald, it will be meaningful to understand the objectives and concepts of re tailing. In the McDonald's franchise business model they will be supported by the world famous McDonald's system, in the areas of operations, training, advertising, and marketing to name but a few. McDonald's franchises restaurants to individuals only. Never to companies, partnerships, family groups or passive investors. Franchisees run their restaurant(s) as an independent business. They are responsible for driving the business forward and all normal business functions i.e. recruiting, marketing, accounting and administration and managing and representing the brand in the local community. Independent companies supply all raw materials, goods and services to each restaurant. All products used in the restaurant should have approval of the parent group. McDonald's Franchise Agreement is for twenty years. The competition in the food retail sector in UK is growing and the future of foodstuff trade belongs most likely to the retail chains. The retail chains in UK are fairly developed, as they do not differ much from the corresponding developing retail formats. The competition has increased with the entry for retail chains. The share of retail chains of the whole retail trade is at the moment estimated to be around seventy percent, they are taking over the markets at a rapid pace at the expense of unorganised forms of trade. The presence of large retail chains has an impact on the production side also. In the food production sector the competition is fierce, as big UK and foreign producers want to ensure their piece of the huge demand potential. Thus the largest producers are relentlessly utilising their size: they invest in big marketing campaigns and are willing to pay high entry fees to retail chains in order to secure a place on the store shelves and build a strong brand also in UK. Information on

New York University Essay Example for Free

New York University Essay Bill Pope born in Bowling green, Kentucky, USA on 19th June 1952, he is a graduate from New York University with a master degree in fine art. While in university, he did many projects, he shot one of his best documentaries called â€Å"The Sixth Week† which was nominated and won the academy award for the best student documentary. After completing his study in the university, he started working on commercials and music videos for artist as Janet Jackson, Mick Jagger, Metallica Peter Gabriel, Chris Isaak and Motley Crue, among others. His best work won awards in both categories. Since then he had baged many awards which include: 1996-Independent Spirit Awards Best Cinematography, 1999-British Academy of Film and Television and Best Cinematography He developed a passion in cinema and filmmaking. He is an award winning American cinematographer, known for his work on Sam Raimis films and the Matrix trilogy. He had work with film production personalities such as Wachowski Brothers, Robert Zemeck, Editor Zach Staenberg, production designer Owen Paterson, visual-effects supervisor John Gaeta and other. Their collaboration has produced triumph works. Pope was nominated for the best cinematography for his work on Stings â€Å"We `ll be together tonight†. Pope received an MTV award for Best Cinematography. His successive film credits include Clueless (1995) and the feature-length pilot for the ABC television series Maximum Bob (1998), which was directed by former cinematographer Barry Sonnenfeld. Since then he had been one of the most adored film directors of all time directing movies such as Janet Jackson: Design of the decade 1986-1996 which was produced in 1996, Bound (1996), Gridlocked (1997) and many other, many he played the role of the director of photography, these movies includes: Zero Effect (1998),Bedazzled (2000),The Matrix Reloaded (2003),Enter the Matrix (2003),The Matrix Revolutions (2003), Spider-Man 2 (2004),Team America: World Police (2004),Fur: An Imaginary Portrait of Diane Arbus (2006),Spider-Man 3 (2007) and the latest one which is the â€Å"The Spirit† (2008) There are element which influences pope for example, the family, Rights and The Black Power Movements as Social Sculpture, Criminality, Experimental/Popular Music, class and color-caste relations the U. S. and many others. MODE OF PRODUCTION Spider man film series are the most financially successful film. The series include the spider man 3 which was the best film financially. The Spider-Man film series which consisted of three superhero films spider -man in 2002, spider man 2 in 2004 and spider man 3 in 2007, based on the fictional Marvel Comics character of the same name, which are portrayed by Tobey Maguire. Its rights were purchased in 1985 and moved through various production companies and studios, at one point having James Cameron to direct, before being secured by Sony Pictures Entertainment. DIRECTOR OF PHOTOGRAPHY STYLE Bill pope show interest in comic, fictitious and superhero films which he mostly direct. He been in the film industry almost two decade since late 1980`s to now and he seem to be strong as the time goes, he had directed a movie like We `ll be together tonight† by Sting (a bit of Classical Hollywood Studio Era), matrix (Hollywood Renaissance) and spider man-3 (Blockbuster Era). He had been a role model to many young directors would are interested in filmmaking arena. MISE EN SCENE Mise-en scene has evolved as a creative concept through the years in parallel with the evolution of film techniques and procedures. A filmmaker has to be carefully designing the composition and cinematic look of the material setting framed in the images added to their films. In cinematography affects there are mise en scene which means staging, which in French it means ‘having been put into the scene. This covers: Location, sets, props, Costumes, Lighting, and Movement within the frame and Sound. SOUND Sound is one of the main mise en scene which contributes to the quality of a cinema. Sound can be the priority aspect in a film; it goes in hand with the pictures. One cannot enjoy a film if either the sound or picture is not quality in the aspect of picture, the light comes in. The dialogue has to go well with the characters and match the time and place where the film is set. LIGHTING The lighting of a stage or plot is very essential when picture quality is concerned. It draws viewer attention to an object on the screen. Long time ago lighting in holly wood was not mean to draw attention but to eliminate darkness in the picture but today lighting is used to add effects. There are three main aspects to lighting: ? Key lighting which is used to highlight a particular object it is also called the hard light ? Fill light which light up the bordered space overall ? Backlighting it alter and bring out silhouettes and are commonly used in horror films. ? Source light create different effects ? Low-key it gives sharp contrast and deep shadows. LOCATION The fundamental planning of a location, be it anywhere is very it correspond to the characters dress. It gives a lot of information about the persons that fit in it, and even what to take place. PROPS They are parts of the sets or as tools or object used by actors. Props obtain special significance when they are used to communicate characters’ thoughts and feelings, powers and abilities in the primary themes of the film. COSTUME AND MAKE UP Costume and make up serves three fuction in a film ? It supports scenic realism to reproduces as real as possible, while clothing and facial signifies time and place of living. ? They describe parts of character or actor personality. ? They act as narrative make, their change makes someone understand and follow the story line. DIGITAL CINEMATOGRAPHY Digital technology is widely spreading in all sectors. In cinematography, the recent release is the new generation 2/3-inch 3-imager HD acquisition technology. It uses single sensor systems based on variants of the 35mm image format and can also found in market place. The promise of 4K in the NAB Digital Cinema Summit gathered global attention. They addressed issues concerning Hollywood and the global film industry’s transition to digital technology. This panel represents those creating these exciting new technologies. There are many challenge cinematographer encounter, the cinematographer need to develop a system where stereoscopic movie making is enhanced by the use of new set of creative tools in 3D image capture. REFERENCES www. nationmaster. com/encyclopedia/List-of-noted-film-director-and-cinematographer-collaborations 237k Cached Similar pages www. thedailypage. com/isthmus/article. If Spiderman Were Made in the 90s. RetroJunk. Retrieved on 2007-11-07. Leslie Simmons (2008-09-06). Two more Spider-Man films on the way, The Hollywood Reporter. Retrieved on 2008-09-06. http://www. centres. ex. ac. uk/bill. douglas/menu. html Larry Carroll (2008-10-16). Sam Raimi Talks ‘Spider-Man’ Sequel Double-Shoot, Futures of Kirsten Dunst The Lizard, MTV Splash Page. Retrieved on 2008-10-16 http://www. discoveryfilmfestival. org. uk

Proctor and Gamble Essay -- Business Marketing Market Essays

Proctor and Gamble This paper will describe the four elements of the marketing mix (product, place, price, promotion). In addition, it will describe how each element is implemented within a specific organization and how the four elements relate to that organizations marketing strategy. The company used in this example is both a product and service driven company and is in business for profit. The company chosen to demonstrate the marketing mix has been a leader in the industry for many years as well as an innovator in product advertising design. Starting out as a soap and candle manufacturer, more than earned their place in the market place. The company is Proctor and Gamble (P&R) and their earliest beginnings are rooted in strong family tradition and humility from the early 1800s. The Proctor and Gamble of today is far different than the founding company operating in a global marketplace, in 140 countries, distributing their products and services to consumers two billion times a day. With such meager beginnings and at the time of inception, their product was needless to say, unpopular. Soap in the early part of the nineteenth century was not on the priority list for consumers to spend their monies on. P&G depended heavily on their candle making but as the light bulb became more popular they quickly realized that candles had become a thing of the past and quickly turned their attentions to the soap business. With a few governmental contracts and some investors, t...

Adrienne Rich’s 21 Love Poems Essay

In â€Å"Twenty-One Love Poems† by Adrienne Rich, each poem helps us understand her life. We as the readers get a â€Å"sneak peak† at the struggles she faces due to an almost ‘doomed’ love affair she has with another woman. The settings of her poems take place in Manhattan which she refers to as the â€Å"island of Manhattan† many times. There is a transitioning from beginning to end of this short collection of poems. Rich begins her collection with a jolly almost exuberant tone of passion and romance she shares with her lover. In poem IV she states â€Å"I open the mail, drinking delicious coffee, delicious music, my body still both light and heavy with you† (10-12). The speaker here is having physical contact with her lover, juxtaposed to the later poems where the lover is only a memory. The solitude she finds herself in is seen in poem XVIII: â€Å"Close between grief and anger, a space opens where I am Adrienne alone. And growing colderà ¢â‚¬  (13-14). This is the exact point where we find out her sadness and loss she has experienced. I will focus on this side of the spectrum, Adrienne Rich’s transition into solitude. Poem XVIII starts off with rain in the city, and the speaker is at a red light at Riverside. It can be interpreted that the rain is in correlation with her sadness and/or tears as to finding herself at a stop in her life, which is in correlation with the red light she is currently waiting on. This assertion can be made by the lines that follow: â€Å"the more I live, the more I think/ two people together is a miracle† (3-4). She is clearly being judgmental about relationships in general based on her experiences in love. Two people together don’t necessarily have to be viewed as a miracle like she puts it. Two women however, in her time, had to have a hidden love, completely unknown to the outside world. The end result would be that their love for each other would have to always stay hidden, as to why she writes: â€Å"The story of our lives becomes our lives† (7). She continues by telling her lover that she knows her response already, and that it most likely will sound like something some Victorian poet would say. â€Å"†¦ salt estranging sea† is what she pulls from Matthew Arnold’s â€Å"To Marguerite† which is mostly stating that we are all alone no matter the millions of people around us. Rich ends the poem by stating that she is in a state of â€Å"estrangement.† Estrangement is separation resulting from hostility, but in this case the estrangement can possibly be synonymous for a fresh start. What can be very  hard to understand about the ending of this poem is that although â€Å"a clef of light† is visible, Adrienne feels more alone than ever. Although the start of something new can be both, good and frightening for someone, th e start of this new day for Adrienne makes her feel colder than she ever has felt. Rich continues in poem XIX to show the darker side of the â€Å"island of Manhattan.† The poem starts off with a question â€Å"Can it be growing colder when I begin to touch myself again, adhesion pull away?† (1-2) The tone here is grief and an uprising anger. It is interesting to observe that although the speaker is engaging in masturbation, she still feels the coldness that overcame her in poem XVIII. It is bizarre because someone wouldn’t normally associate the act of masturbation with coldness, unless, this event brings up a memory, a memory which gives her an unhappy feeling. She continues by stating that a naked face turns from looking backwards and is now looking to the past for comfort, she is ready to take on what is in front of her: † the eye of winter, city, anger, poverty and death† (5). This new present she is currently facing maybe too much for her to digest. This is why she contemplates if her life is worth living in the following line. She shifts the poem to address her lover by asking her a question. She asks her if she is speaking in a cold manner if she says love isn’t miraculous. This is a transitioning in her state of mind, new profound wisdom enters her and she shares it with us and her lover. She realizes that a relationship consisting of two women â€Å"is a work† just like any other relationship. Thos who are able to be in a healthy relationship can view their efforts as â€Å"heroic in its ordinariness.† The poem ends by Rich telling her love to â€Å"look at the faces of those who have chosen to be in love, that although it takes a lot of hard work, they are in the end happy. Poem XX starts off very ambiguously, with the speaker stating that the conversation she and her lover were supposed to have keeps on replaying in her head. The Fact that it never happened haunts her till this day. She continues the poem by stating that she can distinguish a woman she once loved, the very woman who holds many secrets that built an immense amount of fear. She has tried to speak to this woman on many occasions but her â€Å"expressive head† is a â€Å"dragging down deeper† into a place where she is  unable to make contact with her. The woman she is trying to speak to the entire time is herself. She comes into a self realization that she misses the woman she used to be. In twenty- one love poems, Adrienne Rich gives us a peek into her changing thoughts about love and life. She uses contradictions to parallel the thinking process all of us have with love. There is a change of mind happening throughout all of the poems and this makes the poems and poet appear more â€Å"human-like.† What I mean is that in everyday life people have contradictions about many things and this is how Adrienne Rich does a great idea in humanizing thoughts. Her life is hard to live and she realizes that and so do we. I feel safe to say that she knows its tough but this is a life she has chosen. We experience her hardships in her life through her poetry and we see her transition into solitude. Works Cited Rich, Adrienne. 21 Love Poems http://www.sabrinaaiellophotography.com/files/Complete_21_Love_Poems_by_Adrienne_Rich.htm

Reflection on Non Violence Civil Rights Actions

Martin Luther King preferred to achieve Civil Rights for African Americans through non-violent actions. He believed violence would only lead to more problems and conflicts as whites would want to find a way to get revenge for the problems caused by African Americans. Martin Luther King displays success through his non-violent action with the Montgomery Bus Boycott. The Montgomery Bus Boycott is a prime example of a non-violent boycott. Rosa Parks, a member of the NAACP, decides to not give up her seat to a white man when the bus runs out of seats.After violating the bus rules, Parks was arrested. As a result, the Montgomery Bus Boycott began. African Americans across Montgomery, Alabama, stopped using bus services in order to damage the business financially. According to the Article â€Å"Martin Luther King Jr. , Remembers the Montgomery Boycott,† Martin Luther King believed if the protest was done â€Å"courageously, and yet with dignity,† the â€Å"walls of segregati on [would] finally [be] battered by the forces of justice. By boycotting the bus, the company lost a tremendous amount of money because it lost many of its customers. Eventually, as a result, the bus company had to desegregate the buses and begin seating in a â€Å"first-come, first-served† basis. This economic win by Martin Luther King showed that violence is not always needed to solve problems. Even in the Deep South, the â€Å"Cradle of Confederacy† can be transformed into â€Å"Montgomery, the cradle of freedom and justice† through nonviolent actions.Martin Luther King made an Economic change by sparking a boycott in Montgomery, Alabama. He began a change in the way Civil Rights were going to be achieved for African Americans. Instead of getting their equality through violence and possibly another civil war, African Americans damaged segregated businesses through boycotts making non-violent action more effective.

Keynes essays

Keynes essays Keynesian Economics vs. Supply Side Economics Two controversial economic policies are Keynesian economics and Supply Side economics. They represent opposite sides of the economic policy spectrum and were introduced at opposite ends of the 20th century, yet still are the most famous for their effects on the economy of the United States when they were used. The founder of Keynesian economic theory was John Maynard Keynes. He made many great accomplishments during his time and probably his greatest was what he did for America in its hour of need. During the 1920s, the U.S. experienced a stock market crash of enormous proportions which crippled the economy for years. Keynes knew that to recover as soon as possible, the government had to intervene and put a decrease on taxes along with an increase in spending. By putting more money into the economy and allowing more Americans to keep what they earned, the economy soon recovered and once again became prosperous. Keynes ideas were very radical at the time, and Keynes was called a socialist in disguise. Keynes was not a socialist, he just wanted to make sure that the people had enough money to invest and help the economy along. As far as stressing extremes, Keynesian economics pushed for a happy medium where output and prices are constant, and there is no surplus in supply, but also no deficit. Supply Side economics emphasized the supply of goods and services. Supply Side economics supports higher taxes and less government spending to help economy. Unfortunately, the Supply Side theory was applied in excess during a period in which it was not completely necessary. The Supply Side theory, also known as Reganomics, was initiated during the Regan administration. During the 1970s, the state and local governments increased sales and excise taxes. These taxes were passed from business to business and finally to the customer, resulting in higher p...

Free Essays on Chinese Women

How has the issue of gender superiority evolved in China? The existence of women throughout China’s history was that of total inferiority. As the Chinese society developed women became subordinate to men. Even when death comes, this lesser position was brought out in the discoveries of ancient graves. They showed the wife’s corpse in a bowing position towards her husband. However, the social stature of women in China has grown tremendously compared to 20,000 years ago. In 1949, the Communist government took over China. One of the Communist party’s principles was that of equality for women. This was a big change for the women of China. For the most part, women are given equal rights with men. Especially in large cities. However, this doesn’t apply to 100% of Chinese women. In many areas in China, women are still looked upon as inferior to men. Therefore, the struggle for equality and the end to sex discrimination continues. Since the year 221 BC, the philosophy of China has always been male dominance over women. In the 5th century BC, Chinese philosopher Confucius set three rules for women to follow. The first was â€Å"obedience to the father before marriage, obedience to the husband after marriage, and obedience to the son after the death of the husband.† (Tan p. 11) Chinese history has been traced as far back as 500,000 years ago. However, China has a 4,000 year recorded history. The Chinese lived along the Yellow River 7,000 years ago. They were hunter-gatherers and evidence shows that the society was matriarchal. â€Å"Decent was traced through the women and men lived in the homes of their wives.† (Tan p. 12) Women were respected and all of the children took their mothers’ maiden name. When the Xin dynasty began (2100-1600 BC), attitudes towards women started to change. As society became more stable, the ill treatment of women increased. Men started to take control of the family instead of the women... Free Essays on Chinese Women Free Essays on Chinese Women How has the issue of gender superiority evolved in China? The existence of women throughout China’s history was that of total inferiority. As the Chinese society developed women became subordinate to men. Even when death comes, this lesser position was brought out in the discoveries of ancient graves. They showed the wife’s corpse in a bowing position towards her husband. However, the social stature of women in China has grown tremendously compared to 20,000 years ago. In 1949, the Communist government took over China. One of the Communist party’s principles was that of equality for women. This was a big change for the women of China. For the most part, women are given equal rights with men. Especially in large cities. However, this doesn’t apply to 100% of Chinese women. In many areas in China, women are still looked upon as inferior to men. Therefore, the struggle for equality and the end to sex discrimination continues. Since the year 221 BC, the philosophy of China has always been male dominance over women. In the 5th century BC, Chinese philosopher Confucius set three rules for women to follow. The first was â€Å"obedience to the father before marriage, obedience to the husband after marriage, and obedience to the son after the death of the husband.† (Tan p. 11) Chinese history has been traced as far back as 500,000 years ago. However, China has a 4,000 year recorded history. The Chinese lived along the Yellow River 7,000 years ago. They were hunter-gatherers and evidence shows that the society was matriarchal. â€Å"Decent was traced through the women and men lived in the homes of their wives.† (Tan p. 12) Women were respected and all of the children took their mothers’ maiden name. When the Xin dynasty began (2100-1600 BC), attitudes towards women started to change. As society became more stable, the ill treatment of women increased. Men started to take control of the family instead of the women...

Till vs. Until

Till vs. Until Till vs. Until Till vs. Until By Maeve Maddox A reader asks, Isnt the shortened version of until spelled ’til, not til or till? I know that till is a word (I worked as a grocery store cashier as a teenager), so I understand why it doesnt get flagged by spellcheck when some writers incorrectly shorten the word until as till. Many speakers believe that the till in such expressions as â€Å"Till death do us part† and â€Å"Till the end of Time† should be written ’til, as if it were a shortened version of until. In fact, till is not a shortening of until. It is a freestanding word that can be used as a preposition and as a conjunction in the same ways as until. Both words are documented with the sense of â€Å"up to the time of† as early as the 1300s. Till is more common in speech and until in writing, but both have been used interchangeably by generations of writers. Shakespeare uses both in All’s Well That Ends Well (c.1604): Go, tell the Count Rousillon, and my brother, We have caught the woodcock, and will keep him muffled Till we do hear from them. Our rash faults Make trivial price of serious things we have, Not knowing them until we know their grave. Dickens uses both till and until in Great Expectations (1861): I was not expected till to-morrow; but I had my keys, and, if Herbert were gone to bed, could get to bed myself without disturbing him. Until she opened the side entrance, I had fancied, without thinking about it, that it must necessarily be night-time. George Orwell does it in Nineteen Eighty-Four (1949): The new ration did not start till tomorrow and he had only four cigarettes left. Very likely the confessions had been rewritten and rewritten until the original facts and dates no longer had the smallest significance. The form ’til is a fairly recent invention, created by writers in the mistaken belief that spoken till is a shortening of until and should therefore be written with an apostrophe for the missing syllable un-. Bottom line: Till is a perfectly good English word. ’Til is nonstandard. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Spelling category, check our popular posts, or choose a related post below:The Royal Order of Adjectives Rules for Capitalization in TitlesWord Count and Book Length

Kenneth's Waltz Systems of Theory of Int'l Politics Critique and Essay

Kenneth's Waltz Systems of Theory of Int'l Politics Critique and Evaluation - Essay Example Post the Second World War, Neo-Liberalism became a significant feature of International Relations. The concept gained impetus, with the establishment of the European Coal and Steel Community, now known as the European Union. Then came about the Neo-Realistic Approach, put forth by Kenneth Waltz. This approach has been hailed as a more scientific approach. Waltz' 'Theory of International Politics' (1979) laid the basis of the behavioural theory. He does not concern himself exclusively with the ethics of state craft or moral dimensions of foreign policy. In his first work, 'Man, the State and War-A Theoretical Analysis' (1959), he agreed with the classical realist argument that power-seeking state is also a creation of man. However, twenty years later, Waltz acknowledged the bi-polarity and dominance of super-powers in this world. He traces the anarchical state system and highlights the neorealist tenets. Waltz, in his theory, talks about the absence of a world government and states that International Relations is an anarchical system. He also talks about Sovereignty of states and that the International System comprises similar units.

Canadian Cycling Association in 2012 Article Example | Topics and Well Written Essays - 2000 words

Canadian Cycling Association in 2012 - Article Example CCA recommends the following equipment for its cycling teams competing at Olympic level: Bike: The Elementary criteria used, is the basic ABC’s for a good bike (CCA ABC Quick Check, 2006). â€Å"A† means Air in tyres, which entails checking everything in tyres, whether they are inflated or not, the wheel alignment, looseness in axle bearings, condition of tread. â€Å"B† means Brakes, which entails adequate distance between levers and handlebars, the condition of brake pads whether they are worn out or not, brakes tightening fully on the rim, the condition of cables. â€Å"C† means chains or cranks, which entails lubrication on chain, checking whether pedals spin freely, looseness in the bottom bracket, tightness of levers, levers flushing against the forks, tightness of nuts on the axles, loose parts, etc. There are several Canada-based Sports manufacturers catering to bike requirements. Racer Sportif has 6 ranges of sports bikes, priced between $5000-$6000 CAN (Racersportif, 2006). Cyclissmo is another recognized product line, featuring famous brands such as Colnago, Devinci, Look, Shimano, Ridley and SRAM (Cyclissmo, 2006). Parts and accessories: The important parts and accessories, as per Racesportif product manual consist of Road Forks, Tyres (Starting $20 CAN), Computers (Starting $60 CAN). Clothing and Footwear: Several products are available for both. For clothing, air block vests are in demand (Start from $200 CAN). ... measures deliberated in the process of selection, ensure that the most deserving talent is screened for further considerations (CCA, 2003). Equipment: CCA recommends following equipment for its cycling teams competing at Olympic level (Racesportif, 2006): Bike: The elementary criteria used, is the basic ABC's for a good bike (CCA ABC Quick Check, 2006). "A" means Air in tyres, which entails checking everything in tyres, whether they are inflated or not, the wheel alignment, looseness in axle bearings, condition of tread. "B" means Brakes, which entails adequate distance between levers and handlebars, condition of brake pads whether they are worn out or not, brakes tightening fully on the rim, condition of cables. "C" means chains or cranks, which entails lubrication on chain, checking whether pedals spin freely, looseness in the bottom bracket, tightness of levers, levers flushing against the forks, tightness of nuts on the axles, loose parts, etc. There are several Canada-based Sports manufacturers catering to bike requirements. Racersportif has 6 ranges of sports bikes, priced between $5000-$6000 CAN (Racersportif, 2006). Cyclissmo is another recognised product line, featuring famous brands such as Colnago, Devinci, Look, Shimano, Ridley and SRAM (Cyclissmo, 2006). Parts and accessories: The important parts and accessories, as per Racesportif product manual consists of Road Forks (Starting $300 CAN), Tyres (Starting $20 CAN), Computers (Starting $60 CAN), Rims (Starting $60 CAN), Pedals (Starting $165 CAN), Other components such as

Health Promotion Essay Example | Topics and Well Written Essays - 2000 words - 2

Health Promotion - Essay Example This, therefore, meansthathealthpromotion has positiveeffects on practicesandpolicies that supporttheorganization’s profitability andindividual’s employability (Zenzano et al. 2011). Healtheducationbuildstheskills, knowledgeandpositiveattitudes of students about health. Healtheducationteaches about social, mental, emotionalandphysicalhealth. In addition to that, itmotivatesstudents to maintainandimprove their health, reduceriskbehaviorsandpreventdiseases. Healtheducationstudents are helped to learnskillsthatthey will apply in makinghealthychoices in their entirelife (Davidson 2010). Effectivehealtheducationresults in positivechanges in thestudent’s behavior which in thelongrunlower their risk around tobacco, alcoholandotherdrugs, prevention of injuries, sexualityandfamilylife, physicalactivity, mental, nutritionandemotionalhealthandprevention of diseases.Learning in othersubjects is promoted through healtheducation. One studyindicatedthat math andreadingscores of thirdand fourth gradestudentswerehighforthosewhounderwent a comprehensivehealtheducationandlowerforthosewhodid not. Anumber of studieshaveshownthattheperformance of healthierstudents is high. Their attendance is high, performbetter on testsandhavebettergrades. Thismeansthathealthystudentslearnbetter (Zenzano et al. 2011). Nurses have an importantrole ofimprovingthe adherence of thepatient to themedicine. Theydothis by checkingtheknowledge of thepatients, their understandingandproviding them with personalized supportandinformation. In addition to thateachnurse is supposed to ensurethat their patient’s adherence to medicinesis improved. A follow-up to find out if there are mattersaffectingthemedicinetakingbehavior of thepatient should also be carried out by thenurse. Nurses are supposed to checkthetreatmentmanagement of thepatientandtakethenecessaryactionifthepatientfails to

Thank you letter Essay Example | Topics and Well Written Essays - 500 words - 1

Thank you letter - Essay Example y important that leadership should be constantly updated with the issues and problems related to communication across various departments and geographical units. The technically written mails help to provide accurate, concise and grammatically free information so that it not only makes sense but also facilitates the seniors to diagnose and resolve the issue efficiently and timely. The interview has also helped to emphasize that the technical writing is an art, especially in Communication Focal Point. The communication widely differs from person to person. It is full of technicalities with military but straight forward when dealing with civilian side. Indeed, while regular Airmen need to be informed in simple ways, the technical officials require more comprehensive details of the problems. As such, the communication officer needs to highlight technical details which are accurate and clearly written with no ambiguity and grammatical errors. We have also come to understand the interesting difference in the types of awards that a person can be submitted for. Any acronyms can be used for POM or performer of the month provided they are spelled out five spaces below the last sentences as against list of acronyms for base awards! The interview is also explicit in details about the wide-ranging duties of NCOIC and how technical knowledge also involves understanding of the legal documentation and the process of forwarding it. The personal information file and legal documentation etc. become vital aspects of the job profile. Most importantly, our interview has shown that defense personals must be prepared to accept different job profiles as you have done; crossing from missile maintenance to communication. Moreover, the technical writing of the present job profile is quite different to communication in other branches which is straightforward and simpler. Your interview has been very inspiring and shows that individuals should constantly make efforts to learn from their

NYC HOMELESS POLICY Research Paper Example | Topics and Well Written Essays - 750 words

NYC HOMELESS POLICY - Research Paper Example Main reasons and causes for homelessness as written by many reports and studies include; poverty (that is caused by many factors like unemployment), war, abuse by the government or people with power, lack of affordable housing among others. This paper will focus on the temporary shelter policy for New York Homeless people. There has been a lot of criticism and debate on the temporary shelters policy for some time now. The coalition for the homeless says that the mayor’s tact relies on short-term emergency interventions, at the expense of long term federally funded options like housing programs that have had promising results in the past. During an interview with WCBS 880’s reporter Paul Murnane, the coalition’s executive director, Mary Brosnahan said, â€Å"sadly this year, the state for the homeless in New York City has never been worse, today for the first time in New York history, we have 50,000 sleeping each night in our shelter system and that includes over 21,000 homeless kids†. The Homeless Service Commissioner Seth Diamond said the numbers of the homeless entering the system are falling. On the same issue, the mayor, Bloomberg on his part said â€Å"that the coalition is not a reputable organization. He blamed the increase in the number of homeless in the shelters on Albany and Washington. ... The temporary shelters are better than nothing at. This is because they keep the homeless people off the street as the shelters are located in designated areas. Because of this reason, they need to be maintained until a more permanent solution can be found. This can be done in a number of ways one being identifying the fakes from the genuine homeless people. According to a report in the New York Times, more than one out of four families in shelters, 28 percent, include at least one employed adult, city figures show, and 16 percent of single adults in shelters hold jobs. This means that the City of New York is paying to run shelters for people who are employed. If this continues, there will be an overflow of people in the shelters leading to disease outbreak, congestion and worse living conditions. The mayor’s administration should stop this exploitation by the people able to rent cheap housing for themselves; so that they can have an accurate number of the city’s homele ss for effective planning and maintenance. It would also be difficult to maintain the shelters because of the increasing number of the homeless population. This refers to the homeless families that have been living in shelters for years and have increased the number of children in their families. This means that they will require more tents to fit the number of people in the family for privacy and a little bit of comfort. The maintenance money will also have to increase because there are more mouths to feed than the original number. The children of the homeless are more often than not faced with the same fate as their parents and part from growing up in shelters, they end up living in them when they grow up thus the shelter dilemma becomes a vicious cycle. Poverty is another

The Review Essay Example | Topics and Well Written Essays - 2000 words

The Review - Essay Example In 1970, it accounted for 6.4% of the US capital stock and in 1988, this figure stood at 19.8% (Roach, 1988). The increase has been more pronounced in the manufacturing sector. In this sector, it grew from 1.6% in 1970 to 10.6% in 1988 (Roach, 1988). Extensive computerization and use of information technologies initiates an interest in knoing why many organizations or institutions have adopted these technologies. Most organizations are profit oriented and this means they not only focus positive returns but also how to obtain good financial rewards. Having this focus, many organizations always seek ways of limiting their costs of production while increasing production at the same time. This paper gives a literature review on how computerization and the use of IT increase worker productivity and reduces costs of production for many organizations, the focus being the manufacturing sector. Computerization and the use of IT in the workplace The term information technology can be defined a s the acquisition, processing, storage and distribution of numerical, textual, vocal and pictorial information through a combination of computing and telecommunications (Allen and Morton 1994). It therefore encompasses computer software, computer hardware, information systems, processes, data constructs, programming languages. Machines under IT domain render any data or information in visual format via multimedia distribution. Computerisation or computing refers to the action of utilising and improving or advancing computer software and computer hardware according to Agrawal and Symes (1994). In simple terms, computerisation is any goal-oriented activity benefiting from computer hardware and software. In the case of manufacturing industry, machines are run by computers that manipulate data according to a set of programs or instructions. General examples of utilisation of computerisation and IT manufacturing industries include networking, data management, information databases, and m ost importantly automation of machines. Like in many organisations, labour productivity in manufacturing industries is calculated by dividing the level of output by the specific level of labour input. Worker productivity is one of the important elements in determining the efficiency of an industry. Impact of computers and ITs on worker productivity and costs of production For many manufacturing industries, information technologies have continuously influenced work and changed the way it is done. One of the main impact of computerization and the use of technologies is the automation of machines. This has allowed manufacturing industries to assign repetitive and non-core tasks to machines while allowing employees to specialize in performing non-repetitive, complex and core duties of the organization. In this case, employees are able to fully utilize their skills and talents in the tasks assigned to them. This means that they offer their best and can handle more work in the area assign ed to them. Before the introduction of computers and IT in the workplace, employees would carry out every type of production activity including the most tedious and repetitive tasks. Due to the distances between the physical places of production assigned to these tasks, workers wasted a lot of time moving from one part of the industry to the other. As stated above, automated machines have taken over some of the repetitive and tedious tasks and

NYC HOMELESS POLICY Research Paper Example | Topics and Well Written Essays - 750 words

NYC HOMELESS POLICY - Research Paper Example Main reasons and causes for homelessness as written by many reports and studies include; poverty (that is caused by many factors like unemployment), war, abuse by the government or people with power, lack of affordable housing among others. This paper will focus on the temporary shelter policy for New York Homeless people. There has been a lot of criticism and debate on the temporary shelters policy for some time now. The coalition for the homeless says that the mayor’s tact relies on short-term emergency interventions, at the expense of long term federally funded options like housing programs that have had promising results in the past. During an interview with WCBS 880’s reporter Paul Murnane, the coalition’s executive director, Mary Brosnahan said, â€Å"sadly this year, the state for the homeless in New York City has never been worse, today for the first time in New York history, we have 50,000 sleeping each night in our shelter system and that includes over 21,000 homeless kids†. The Homeless Service Commissioner Seth Diamond said the numbers of the homeless entering the system are falling. On the same issue, the mayor, Bloomberg on his part said â€Å"that the coalition is not a reputable organization. He blamed the increase in the number of homeless in the shelters on Albany and Washington. ... The temporary shelters are better than nothing at. This is because they keep the homeless people off the street as the shelters are located in designated areas. Because of this reason, they need to be maintained until a more permanent solution can be found. This can be done in a number of ways one being identifying the fakes from the genuine homeless people. According to a report in the New York Times, more than one out of four families in shelters, 28 percent, include at least one employed adult, city figures show, and 16 percent of single adults in shelters hold jobs. This means that the City of New York is paying to run shelters for people who are employed. If this continues, there will be an overflow of people in the shelters leading to disease outbreak, congestion and worse living conditions. The mayor’s administration should stop this exploitation by the people able to rent cheap housing for themselves; so that they can have an accurate number of the city’s homele ss for effective planning and maintenance. It would also be difficult to maintain the shelters because of the increasing number of the homeless population. This refers to the homeless families that have been living in shelters for years and have increased the number of children in their families. This means that they will require more tents to fit the number of people in the family for privacy and a little bit of comfort. The maintenance money will also have to increase because there are more mouths to feed than the original number. The children of the homeless are more often than not faced with the same fate as their parents and part from growing up in shelters, they end up living in them when they grow up thus the shelter dilemma becomes a vicious cycle. Poverty is another

I want to do the topic on service learning and how it can increase Assignment

I want to do the topic on service learning and how it can increase admission retention - Assignment Example Sincerely, [Student signature] Student typed name Student title Encl, Contents Recommendation Report: Service Learning at Angelo State University 5 Discussion of Problem 6 Partnerships 9 Outreach 10 Curricular Engagement 11 Recommended Solution 12 Table of Figures Figure 1: Kellogg Logic Model (2004) 9 Figure 2: Google search results for keywords service learning and outreach 10 Figure 3: Service Learning and associated skills 12 Executive Summary Hook the reader with a clear explanation of what you want to do Briefly summarize each of the major segments of the report University description Problem Your solution Why now? Recommendation Report: Service Learning at Angelo State University It is no secret that many colleges and universities across the country are struggling to stay afloat. Earlier this year, Moody's Investors Service put out a negative outlook for the industry as a whole and predictions are bleak. According to the New York Times, only about 500 out of more than 4,000 Am erican colleges and universities are considered to have stable enough finances to survive (Selingo, 2013). In order to stay viable, many colleges and universities are putting strong effort into retaining freshmen students whose tuitions contribute a significant proportion of overall revenue (Pullaro, 2010). Retaining these students not only contributes to an educated, productive citizenry, but increases the likelihood of retaining them throughout the remainder of their degree plan. Unfortunately, freshmen students face a wide variety of issues that can affect their ability to maintain pursuit of a college degree, only some of which can be addressed by the university. Tinto (1993) provides some common barriers that affect a student's ability to stay in school. While factors such as intention and commitment are inherent to each individual, the university can provide programs that facilitate positive outcomes. Types of services that could assist in these areas would include programs su ch as Angelo State University's (ASU) First-Year Experience program to help with the challenges of adjustment, changes in educational expectations, unfamiliarity with the new culture/environment/lived experience, and, very commonly, feelings of isolation. External barriers to staying in school include students' obligations to family and community and students' ability to finance their college attendance, including tuition, fees, books, and living expenses. Helping students address these needs would also theoretically help increase student retention. While the university cannot reduce tuition rates and still remain viable, it is possible for ASU to address some of these internal and external barriers by incorporating a service learning approach throughout the campus community. The concept of integrating instruction with meaningful community service as a means of engaging students has been around for a long time, but it wasn't until 2001 that the first International Conference on Serv ice Learning took place (Historical Timeline, 2013). As it is now defined, service learning refers to programs in which students are encouraged to use what they are learning about in the classroom and apply it to real-world issues that ultimately benefit their communities. Through the service learning process, the students benefit in a variety of ways. They become invested in the community and connect with other students or

Financial accounting standards Essay Example for Free

Financial accounting standards Essay The income statement, which portrays the financial performance of the company, is also described in the financial statements elements. Income and expenses from ordinary activities are recognized as the main elements of such statement, which when matched result in a profit or loss for the period. Capital maintenance adjustments are also pointed out, which may effect the income statement. This arises from the restatement of assets and liabilities that may eventually influence the equity of the firm (International Accounting Standards 2000, p 61-64). The measurement bases utilized in order to compute the monetary amounts of the assets, liabilities, equity, revenue and expenditure noted above are also outlined in the framework. There are five main measurement bases recognized in the accounting framework, which are explained below: †¢ Historical Cost – such measurement bases states that assets are recorded at the historical, which is normally the date of purchase. This implies that the value of the asset at the date of acquisition is the one portrayed in the Balance Sheet. For example, if a motor vehicle costing $8,000 is bought. The $8,000 historical cost value will be adopted as its measurement bases. As regards liabilities, the amount of cash obligation arising at the inception of the transaction will also be utilized as the measurement means. Any payments that are eventually undertaken to cover such liability are diminished from that amount. This is most common method adopted in practice by business organizations. However, when the need arises, such measurement bases are promulgated with other methods in order to portray a more true and fair financial picture (International Accounting Standards 2000, p 70-71). †¢ Current Cost – as its name implies, assets are recorded at the current amount of cash and cash equivalents that would be required if a similar was going to be purchased. Under such measurement bases, liabilities are determined according to the undiscounted cash obligation necessary to settle such commitment (International Accounting Standards 2000, p 70). †¢ Realizable value – this method is similar to the current cost one, with the exception that assets value is computed in line with the equivalent price that the present asset can attain if disposed in the market. The value of liabilities under such measurement bases is the same to the historical cost one. That is liabilities are determined in line with their settlement value (International Accounting Standards 2000, p 70). †¢ Present value – this encompasses that assets are recording according to the present discounted value of the envisaged cash inflows that such asset will provide to the organization in its day-to-day business activities. Liabilities are also valued at the present discounted value of the expected cash outflows entailed in the foreseeable future (International Accounting Standards 2000, p 70). The concept of capital and capital maintenance is the last basic principle covered by the accounting framework. The principle of capital under a financial side comprises the invested assets by the owner, which are identical to the equity or net assets value. Under the physical concept of capital, it entails the operating ability. That is the productive power of the organization (International Accounting Standards 2000, p 72). The concept of capital mentioned in the previous paragraph leads to the proceeding concepts of capital maintenance:†¢ Financial Capital Maintenance – profit/loss is computed under such concept as the difference between the financial value of the net assets at the end of the year and the financial value of the net assets at the commencement of the financial year (International Accounting Standards 2000, p 72). The fair value measurement bases, which is a new valuation method abides with such concept. †¢ Physical Capital Maintenance profit in this case focuses on the productive ability of the corporation. That is the excess of physical production at the end of the year when compared with that of the beginning forms up the profit figure (International Accounting Standards 2000, p 73). 2. The principles outlined in the framework do not exercise a direct influence on the intended parties. It holds an indirect affect by affecting the accounting standards issued by the recognized accountancy board. Such accounting standard will then have a direct influence on the accounting treatment of specific items and on the presentation of accounting information. Indeed the framework acts as a yardstick that guides the development of accounting standards. It is a generic document that narrows the range of alternatives that can be adopted during the standard setting process (Foster M. J. et al 2001, p 1,2). Further more, the framework aids the communication process in the Financial Accounting Standards Board, both internally and externally. Through the adoption of a generally accepted accounting framework, the message of the Financial Accounting Standards Board would be more easy to be communicated to accountants in the respective industries (Foster M. J. et al 2001, p 2).

Health Three Levels Of Promotion Health And Social Care Essay

Health Three Levels Of Promotion Health And Social Care Essay The three levels of health promotion include primary, secondary, and tertiary. All levels are equally important and key in preventing disease and providing starting points for health care providers to offer patients positive, effective change. All levels are important in nursing because nurses are able to take part in almost every step of the promotion. Within the three levels of promotion, there are five steps. These steps include health promotion and specific protection (primary prevention); early diagnosis, prompt treatment, and disability limitation (secondary prevention); and restoration and rehabilitation (tertiary prevention) (Edelman Mandel, pg. 18). Primary prevention includes health promotion and specific protection (Edelman et al, pg. 18). In primary prevention, the main focus is to avoid the development of the disease and to focus on interventions to maintain a healthy life. Its purpose is to [also] decrease the vulnerability of the individual or population to disease or dysfunction (Edelman et al, p. 14). Nurses must do their part in encouraging preventative and appropriate interventions to improve patient health. Primary prevention also involves two further subdivisions that include health promotion and health protection. An example of health promotion would be educating a patient on their health or on nutrition. This type of promotion includes any type of education that would promote a healthy lifestyle. Health protection would be anything that would protect the patient from a disease. For example, health protection can include administering immunizations to reduce exposure the influenza virus this winter. Secondary prevention refers to activities like screening and early diagnosis that aid in treatment of the existing health problem, disease, or harmful situation. Secondary prevention ranges from providing screening activities and treating early stages of disease to limiting disability by averting or delaying the consequences of advanced disease (Edelman et al, p. 18). It is during secondary prevention when early detection occurs in the window of time just before symptoms are apparent, which fosters early treatment and delays onset of more serious symptoms (Murray, R., Zentner, J., Yakimo, p. 42). The difference between primary prevention and secondary prevention is simple. In primary prevention, the focus is more on how to prevent or decrease the probability of the disease or problem before it precedes and allots different suggestions to promote a healthy lifestyle. In secondary prevention however, the preventative methods are more focused on the actually screening and encourages ear ly detection and treatment before a serious disease occurs. Tertiary Tertiary prevention is the last level of promotion that promotes health. Tertiary prevention refers the person to optimum function or maintenance of life skills through long-term treatment and rehabilitation (Murray et al, p. 42). This form of prevention involves treatment, rehabilitation, prompt treatment, and patient education. Usually, tertiary prevention is used when the disability or disease cannot be reversed or is permanent. This level of prevention is easier to look at more as treatment rather than prevention. At this point, the disease has already been established, and the main focus is to minimize the detrimental effects of the disease process and maintain optimal health. It is important that the nurse ensure[s] that persons with disabilities receive services that enable them to live and work according to the resources that are still available to them (Edelman et al, p 19). In primary and secondary prevention, the treatment is geared more towards preventing the actual disea se and early diagnosis and detection. In tertiary treatment, the focus turns toward the reduction of any further complications once the disease process has already progressed. All three levels are equally important to prevent disease, but also have a key impact in health promotion in nursing. Health promotion and purpose for nursing Health promotion is behavior motivated by the persons desire to increase well-being and health potential (Murray et al pg. 42). Individually, patients must find that motivation to ensure and attain optimal health. Nurses, as well as many other health care providers play an important role in motivating and encouraging patients to maintain and strive towards better health. Here is where nurses can use all skills learned to use primary, secondary, and tertiary prevention to encourage healthy lifestyles. Nursing roles and responsibilities The role of the nurse in health care promotion can be demanding, and tiresome, but in the end is simply gratifying. Nurses must take on many different roles to ensure that the patients are promoting and maximizing they health. These roles may include: educator, advocate, provider of care, researcher, care manager, and consultant. By incorporating all these different roles, nurses teach people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large (Murray et al, pg.42). The goal is for people to become more aware of lifestyle changes that can consequently worsen their health status and make the lifestyle changes to maintain a healthier lifestyle. Nurses can assist in promoting health in many different ways. Nurses are the educators in providing patients and their families with the proper resources to maintain a healthy life. Whether it means teaching on nutrition, immunizations, or diseases, nurses provide most of the teaching. Nurses can also be advocators by making sure the patient is receiving what they are entitled to in the health care system and from their provider. The nurse is to go to person when the provider is not available. Nurses also aid in providing the delivery of care, consulting the patient when any problem exists, and researching and relaying message to the provider when a problem or question exists. For example, in Healthy People 2010, nurses must take on the role in all of these situations to promote a healthier, better lifestyle. Implementation methods for health promotion In order to implement health promotion, nurses are taught to properly find alternative methods that personalize every patient in contact with their delivery of care. Not all forms of health promotion are done by the bedside nurse, but can also be encompassed by the clinic nurse and the community nurses. These levels of promotion can be brought on by the clinic and community nurse by offering different presentations regarding what is directly affecting the specific community. By involving the community in different methods of health care promotion and prevention, the nurse is doing his/her part to assist in primary and secondary promotion. Then, if the assistance is needed, tertiary prevention can be used. The nurse must learn to encompass and become familiar with every aspect of prevention and promotion in order to do his/her part in preventing and promoting healthier lifestyles. In order to facilitate and accommodate to patients needs, evidence based practice is key. There are many articles that can justify and help solidify the need for prevention and promoting in patient lifestyles. Compares the three levels of health promotion prevention First article The article that I found from the Grand Canyon University Library discussing primary prevention is called Opportunities for the Primary Prevention of Obesity during Infancy. This article discusses the opportunities that physicians have to decrease and prevent obesity during infancy. The article proved that through early intervention and prevention, great promise [holds] for interrupting the vicious cycle of obese children becoming obese adults who subsequently have obese offspring themselves (Paul, Bartok, Downs, Stifter, Ventura, and Birch). Evidenced proved that if providers instructed parents on different strategies to promote healthy behaviors, that the infants will have long lasting obesity preventive effects. By using primary prevention, obesity during infancy and possibly throughout the lifetime may be decreased by primary intervention. This article would be beneficial to nursing practice because throughout pregnancy, nurses would be able to show how vital it is to continue to maintain and continue to show healthy eating habits to pregnant mothers and their children to potentially avoid obesity and other health problems for the child. Second article The second article that I found from the Grand Canyon University Library discussing secondary prevention was called Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals perspective. This article was based on a nurse led trial that used secondary prevention to improve coronary heart disease and lower all-cause mortality during a four year follow up. This article emphasized on how this clinic was run by nurses and whether or not it was effective. Studies showed how it was viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point (Campbell Murcia). It also proved that although it might have been effective, many of variables interrupted in proving the study effective. Issues like lack of space and staff shortages, funding training, and communication arose within the practice and eventually en ded the study. The study still showed how effective the nurses ran the clinic and seemed to be able to do their part in preventing and lowering the occurrence of coronary heart diseases. Third article The third article I found in the Grand Canyon University Library on tertiary prevention is called Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma. This article emphasized the importance in prevention in asthma. It stated that the primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease, (Joseph, Williams, Own by, Saltzgaber, and Johnson). This article is good because it is able to illustrate all of the effects of proper primary, secondary, and tertiary prevention. The article showed how by managing, and understanding the disease, changes that could reduce asthma morbidity in US minorities and ultimately mitigate disparities (Joseph, et al). Conclusion This purpose of this paper was to inform the reader of the different levels of health promotion and the role that nurses must play in encouraging this care. Nurses can do their part in promoting a healthier lifestyle for their patients by using alternative methods of prevention. Primary prevention involves health promotion and protection, secondary prevention involves screening and early diagnosis, and tertiary prevention focuses on treating the actual disease and preventing any further complications. It is important for nurses to understand that the role they play on patient health care is vital. Patients rely on nurses to help alleviate and advocate for them when any sort of ailment or sickness occurs. In order for nurses to promote health they must become familiar with the different ways of helping to prevent and promote healthier lifestyles. The articles that were chosen in this article illustrated the different positive effects of prevention and the different ways nurses and hea lth care providers can promote a healthier lifestyle.

Behaviorism, Constructivism, and Cognitivism: Multiple Approaches To Le

A. Behaviorism, constructivism and cognitivism are relatively common theories used in the classroom as ways to approach student learning. Behaviorism focuses on observable behavior, such as students answering questions correctly, or being able to follow directions to complete a task as instructed. Characteristics of a classroom that uses behaviorism might be memorization of facts, writing vocabulary words, or a token reward system to inspire the desired behavior and decrease undesired behaviors. Constructivism, as indicated by the root word â€Å"construct,† focuses on the construction of new ideas, or expanding on what is already known. Students in a classroom using constructivism as a means for learning might seem more actively engaged in the learning process; they often learn something new through applying what they already know about the content area, and exploring new matter to further their understanding. This type of classroom often uses hands on manipulatives to allow students to actually build, create, or experiment with what they are learning. A cognitivism approach to learning might be explained by the minds capacity to process information – such as how a learner might remember something, retrieve information, or store new concepts. Learning through this method often depends on how the student processes what the teacher is presenting. Classrooms using this approach might incorporate learning strategies that help students categorize and sequence information to assist with processing. Like constructivism, it can be an active style of learning. A1. Support Personal examples of a behaviorist style of instruction are based on the widely renowned theory by B.F. Skinner, which in the classroom can be summarized by reinf... ...speaker and the listener. The student can store often used responses, and prepare anticipated answers prior to situations where he will be meeting with those less familiar with his speech capabilities. By implementing this type of device, the student has become more confident and can communicate appropriately for a student his age. In this instance, the integration of technology into the learning environment may make a difference as to whether the student is employable or overlooked due to the inability to communicate well on the job. Works Cited Brewer, E.W., Campbell, A.C., Petty, G.C. (2000). Foundations of Workforce Education. Dubuque, Iowa: Kendall/Hunt Publishing Company. Standridge, M.. (2002). Behaviorism. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved May 9, 2012 from http://projects.coe.uga.edu/epltt/

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