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

Child and young person development Essay

1.2 Describe with example how different aspects of development can affect one another. When it comes to different aspects of development there are many examples that can describe how it effects one another, these are as follows: If a child is less developed in reading, when it comes to children having reading time on the carpet in groups, they may feel uncomfortable and unable to form friendships due to embarrassment and low self esteem. This will then affect their language and social development. This can cause the child to feel lonely and angry at themselves because they are not at the other children’s level of learning. If a child doesn’t like to share toys, this can cause a problem with social interaction as they will find it hard to  form friendships. The other children will try to avoid the child that is unable to share, this can affect the emotional and social development of the child who is unwilling to share as they will feel lonely and neglected and even aba ndoned. If a child is overweight and obese he will struggle to do PE at school as he won’t have the energy and will get tired very quickly. This can cause his classmates to be annoyed with him for delaying the class due to his weight and they will bully him for it. This would leave the child feeling very hurt, embarrassed and he will lose his confidence and self-esteem. This will then effect his physical, social and emotional development. If a child is use to having his way all the time, such as him eating his lunch whilst watching TV, when the child is at nursery and boundaries are in place this will cause the child to have temper tantrums and become angry. This will affect his social, emotional and behaviour development. As he will not understand why at home he can watch TV and eat on the sofa, but at nursery he has to sit with the other children at the table and eat. This will make him feel very upset and frustrated as he is unable to understand the reasons behind it. 2.1 Describe with examples the kinds of influences that affect children and young people’s development including: background, health and environment. Background Children will be part of different ethnic backgrounds, cultures, environments and circumstances; with their families going through different changes school may not be aware of it. Deprivation and poverty can effect pupil’s development, statistics show that children who come from deprived backgrounds are less likely to achieve well in school as parents find it difficult to manage their needs. Some children may come from a home schooling environment so when they start a new school it will be difficult for them to adapt to different teaching methods so they will need additional support. Health Development opportunities can be restricted if a child suffers from poor health or disability. For example, a child who has a disability may be less able to engage in some activates during school. This can affect their physical development but may also restrict their social communication, for  example, on the playground. When a child is aware of their needs it can affect them emotionally. It’s important that children are supported to ensure they are included in as much as possible. Environment The different environment and circumstances that pupils are exposed to at school and during their childhood and teens can affect their development. Many families may go through changes, which will have an impact on the way children respond in different situations. Families may break-up, get divorced or a new partner may be introduced which may effect children emotionally. Families may move house or change country, which can affect individuals socially, there could be a bereavement or illness in the family, which can be traumatic and upsetting for the whole family. If a child is looked after or in care it can effect their development emotionally, socially and physically. 2.2 Describe with examples the importance of recognizing and responding to concerns about children and young people’s development. The following things would cause concern about a child or young person’s development. If the problem was left untreated then things could get worse, and a delay in treatment could mean that the outcome is not as good as it would have been if treatment was started earlier. Speech / Language. If a child or young person does not talk to anyone or even only speaks a few words compared to others, this may cause concern. This would socially affect the child or young person’s because they would find it hard to make friends, work in groups or even interact with adults. It would also affect their communicational development because they would find it hard to speak to people and also may find it hard to listen to instructions etc. Early intervention would be the best way to respond to this concern, the first step would be to have the child or young person’s hearing checked because if they have poor hearing they will find it hard to hear people so will not want to communicate with others in case they get something wrong. Poor reading and writing. If a child or young person has difficulties with their reading and writing it  may cause concern, but this may not be noticeable until the child is around the age of 6 or 7 because by this age they should have learnt how letters are formed and start to string words together. These are the main skills a child needs to help them develop in all areas. Due to poor reading and writing the child or young person will start to fall behind his peers of the same age. They may find it difficult to interact or make friends with others who are more advanced than them, in case they are bullied etc. They would struggle with their intellectual development not only with the reading and writing, but they would struggle with their memory and even their concentration. 3.3.1. Identify the transitions experienced by most children and young people’s. Most children may experience transitions; transitions can be long term or short term. Some transitions that most children may experience are likely to be, starting school or changing from one school to another. Some families may move house several times throughout their lives this can affect a child in that they have to try and make new friends and get use to the area in which they will be living. Children and young people have to make very many of their transitions without prior personal experience, and it can sometimes appear to them as a daunting list of ‘firsts’: first day at school; first exam; first sexual experience. Most of these changes are navigated well by most children and young people, as and when they are ready. The experience they gain and the skills they learn in the process equip them to deal with the challenges of life ahead. The diverse range of transitions faced by children and young people includes: starting or moving school, puberty, bereavement, parents splitting up, illness (their own or a parent’s or sibling’s),changing friendship groups, entry to, or leaving, a pupil referral unit, moving through child health services into adult services, coming out as gay or lesbian this this affects older children, leaving home. Young people and children will need help and support from peers and adults to successfully make the transition to the next stage in their life. The nature and timing and giver of the support will vary depending on the individual’s needs and circumstances. Transition experienced by most children and young people include: Moving away – This could make the child or young person frustrated because they are being torn away from  either their favourite place or friends, this could also make the child become anxious. Friends moving away – This could make the child or young person feel nervous because they will then have to make new friends which may not be easy for the child, this could also make the child become anxious and become shy. Puberty – This could make the child or young person feel confused because they cant control what is happening to them, this could also make the child become dismissive or make the child become argumentative with parents or carers. Starting a new school – This could make the child or young person feel nervous because they have to make new friends and could make the child feel anxious because they don’t know what will happen. This could also make the child become shy or dism issive or even anxious. 3.3.2. Identify transitions that only some children and young people may experience e.g. bereavement. Transitions experienced by only some children and young people include: Diagnosis of a disability – This could make the child or young person feel jealousy because he/she may feel different, this could also make the child act unusual such as being dismissive. Divorce – This could make the child or young person feel frustrated, confused because the child or young person may not be seeing one parent as much as before, this could also make the child act unusual such as becoming withdrawn and being argumentative with parents. New siblings – This could make the child or young person feel jealous because he/she may not be getting as much attention as before, this also make the child act unusual such as becoming dismissive . New step parent – This could make the child or young person feel jealous because he/she may not get as much attention as before. Sometimes this can bring huge positive changes.It can impart the child’s life in a good way. Bereavement-the death of a close friend or relative may be very traumatic for a child, when it comes to times of change and transitions you should give children every opportunity to talk about what. 3.3.3. Describe with examples how transitions may affect children and young people’s behaviour and development. Transitions are an essential part of a  child and young persons development. These changes within a child or young persons life may be progressive or sudden. They present the child/young person with challenges which they must overcome. Transitions are stressful for children and young people, just as they are for adults, and the resulting stress can have far-reaching effects on children’s emotional well being and academic achievements. How a child or young person deals with transitions is greatly affected by the support and response children get from those around them. A child’s early experiences of transitions will have a big impact on how they handle transitions at later stages of life. As some changes of transitions are not anticipated, they can cause distress and feelings of lack of control in the child or young person. This can affect emotional and behavioural development, in turn leading to possible impacts on physiological and intellectual development. The transitions that children and young people face can be: Emotional: affected by personal experiences, for example bereavement or the divorce or separation of parents ,Physical: moving to a new home, class or school, Intellectual: moving from one type of organisation to another, for example from nursery to school, primary school to secondary school, secondary school to college or college to university Physiological: going through puberty or a long-term medical condition. Puberty is a major transition that all children at some point, will have to go through. It can be a difficult time for both sexes emotionally, socially and physically. Behaviour will change and so will their physical appearance, which may cause them to feel insecure, especially if they are female. Peer approval will become increasingly important and may be related to physical development. Males may show more aggressive behaviour as their hormone levels increase and females may become insecure about late development or embarrassed about early development. Both sexes will be very aware of their changes and will compare their own rate of development with that of their friends. Most, reach puberty around the same time, some develop earlier and some later. Boys who develop more quickly are often found to be more popular and independent. Girls, however, if developing earlier than their friends tend to get teased and have a more negative experience. The development of breasts can be very embarrassing for a girl, as it may bring a lot of unwanted comments and attention, not only from boys, but also from other girls who may be jealous of the attention the girl  is getting, or may be teasing and gossiping. This can lower a person’s confidence and make them feel very uncomfortable. Changing for sports in a communal area could become an issue, with other girls staring, and may make the young person stay away from sports, preferring to go sick, rather than endure the unwanted attention. One main transition within a child’s life is changing schools. This can make children feel insecure, nervous and anxious about the unknown. Whilst they may feel some sense of excitement about the new experiences they will be exposed too they will generally be apprehensive. They may be leaving behind good friends, loved teachers, a great support network and may feel a huge sense of loss. Their behaviour may change, they may become withdrawn and emotional. TDA 2.2: Safeguarding the welfare of children and young people. 1.1.1 Identify the current Identify the Current Legislation, Guidelines, Policies and Procedures for Safeguarding the Welfare of Children and Young People including e-safety. The current legislation and guidelines are policies and procedures for safeguarding who is promoting children’s welfare and putting measures in lace to improve children’s safety and preserve abuse. Child protection who are action taken to protect child when there is a reasonable belief that they are at risk of significant harm. All in setting for children and young people in England and Wales are the result of legislation passed in parliament, including England and Wales, the children Act 1989 and children Act 2004. Current Identify the Current Legislation, Guidelines for Safeguarding the Welfare of Children and Young People are Children’s act 1098/2004, Education act 2002,E-safety 2008, Safeguarding, Human rights act, The Vetti ng and Barring Scheme. Children’s act 2004 has five outcomes for well-being in childhood and later life. These are: being healthy; staying safe; enjoying and achieving; making a positive contribution and achieving economic well-being. In 2000, an 8 year old girl called Victoria Climbià ¨ was tortured and murdered by her guardians. Her death resulted in a mass investigation and the demand for stricter child safety laws. The inquest in 2003, lead by Lord Laming, led to the green paper, a preliminary report of government proposals that is published in order to raise discussion on the matter, named Every Child Matters The Act includes: a Children’s Commissioner to champion the views and interests of children and young  people; a duty on Local Authorities to make arrangements to promote co-operation between agencies and other appropriate bodies (such as voluntary and community organisations) in order to improve children’s well-being (where well-being is defined by reference to the five outcomes), and a duty on key partners to take part in the co-operation arrangements; a dut y on key agencies to safeguard and promote the welfare of children; a duty on Local Authorities to set up Local Safeguarding Children Boards and on key partners to take part; provision for indexes or databases containing basic information about children and young people to enable better sharing of information; a requirement for a single Children and Young People’s Plan to be drawn up by each Local Authority; a requirement on Local Authorities to appoint a Director of Children’s Services and designate a Lead Member; the creation of an integrated inspection framework and the conduct of Joint Area Reviews to assess local areas’ progress in improving outcomes; and provisions relating to foster care, private fostering and the education of children in care. Education Act 2002 refers to an Act of the Parliament of the United Kingdom which amended legislation relating to academies, publicly-funded schools operating outside of local government control and with a significant degree of autonomy areas such as wages and digressing from the na tional curriculum. Policies and procedures All settings and pre-schools working with children and young people must have a policy for protection of children under the age of 18 that states responsibilities and is reviewed annually, preparations to work with the Local Safeguarding Children Board, a duty to apprise the Independent Safeguarding Authority of any individual who is threat to children, training on safeguarding for all staff and volunteers, effective rick assessment of the provision to check that the safeguarding policy and plans work, arrangements for DRB checks on all adults who has regular connection with children up to age of 18, contact details of a parent or carer for all children under the age of 18. E-safety The internet and video games are very popular with children and young people and offer a range of opportunities for fun, learning and development. But there are concerns over potentially inappropriate material, which range from  content (eg violence) through to contact and conduct of children in the digital world. Debates and research in this area can be highly polarised and charged with emotion. Dr Tanya Byron, in her landmark report ‘Safer Children in a Digital World’, published in March 2008,set out a challenging agenda for Government, its partners, industry and the third sector, to work together to make children safer when using the internet and video games. Government accepted all of Dr Byron’s recommendations in full, signifying our commitment to children’s safety when using new technology. We cannot make internet completely safety but we can reduse the rick to children and help them to use it properly and safety; blocking access to unsuitable web sites by using a program, reducing the time spend front of the PC, teach the children of dangers and how to recognize them, helping to the children to develop skills to deal with situations, educating parents using internet properly and carer about risks and controls. 1.1.2 Describe the roles of different agencies involved in safeguarding the welfare of children and young people. All children are known by many organisations. That helps to bring effective safeguarding and make the children to feel more secure. Many children know the Childline -0800 1111 Social Services- There to offer support to the child and the setting. Social services have the powers to investigate any suspected improper behaviour from carers, children or the setting. They also have to meet and conduct interviews with the child and the family members involved, liaise with and get relevant information about the child and their circumstances from other agencies involved with the child, they have to take the lead during the Child Protection Conference as well as take action when a child or young person appears or is thought to be in immediate danger. Child Protection Investigation Unit (CPIU)- Unit run by the police who have the powers to investigation, who have the powers to investigate, interview and arrest anyone who is suspected of abusing a child. The CPIU has to make a decision on whether a crime has been committed and if so to begin a criminal investigation. They also have to gather evidence from Social Services and other agencies thought to be involved with the child or young person’s wellbeing. The CPIU must take immediate action if a child or young person is thought to be in any immediate danger which may involve removing the child  from harm or removing the perpetrator and attend any court hearing to give evidence when a crime has been commited. Health Visitors- Health visitors can sometimes be the first person to see signs of abuse, especially physical. They have a duty of care to refer such information to Social Services. Health visitors must carry out a full medical examination or observations of any child or young person who is thought to be at risk of abuse or is/has suffered from abuse. Schools: Schools have the responsibility to develop childrens awareness and their knowledge of what is acceptable and what is not acceptable behaviour, including when using the internet. Support and protect children who are identified as being at greater risk or are on the at risk register and provide professional training of all staff relating to safeguarding. Have policies and securtiy systems for e-learning activities and use software filters. Observe signs of abuse, chages in childrens behaviour or failure to thrive and refer any concerns. Children spend a great amount of time in school with teachers and staff so it is essential staff are able to monitor, keep records, share appropriate information with other agencies and just be aware of any unexplained changes in the child. Any setting such as nursery, childminder, afterschool or holiday scheme. Another agencies are General Practitioners, Local hospital services, child psychology services. 2.2.1 Identify the sign and symptoms of common childhood illnesses. Most children and young people will experience some episodes of illness in their life. Common illnesses, like coughs and colds, are not usually serious. However, illnesses like meningitis are more serious and will need specialist medical care. Illnesses, like chicken pox, are infectious (easily spread) and others, like asthma, are not infectious at all. It is important for anyone who works with children and young people to be able to recognize the signs of illness and know what action to take. The main signs of illness in a child or young person are poor appetite, no energy, change in behaviour (unusually quiet, not sleeping well, crying more than usual), constipation or diarrhoera, vomiting, skin rash, raised body temperature, a cough, headache, stomach ache, earache or runny nose. Signs and symptoms Young children find it difficult to describe how they feel. They may say that they have ‘tummy ache’ when they actually feel upset, afraid or  worried. Children’s symptoms can worsen very quickly and they should always be taken seriously and not ignored. Frequently the illness are common cold the symptoms are, sneezing, sore throat ,runny nose, headache, temperature. Is important for adult to encourage child to blow nose,the incubation period is 1-3 days. Gastroenteritis the symptoms are vomiting diarrhoea ,dehydration. The treatment,that the child is not dehydrated it is important to give him water often. Scarlet fever,the symptoms are lose appetite,fever sore throat pale around the mouth,strawberry tongue,the treatment it’s important the child rest and adult observe if there is complications. The incubation period 2-4 days. Chicken pox,fever ,very itchy rash with blister-type appearance,the treatment,tepid bath with sodium bicarbonate and calamine applied to skin to stop itching to stop children scratching to avoid scarring. Dysentery – vomiting, diarrhoea with blood and mucus, abdominal pain, fever, headache. Measles- high fever, runny nose and eyes, cough, white spots in mouth, blotchy rash on body and face. Mumps – pain and swelling of jaw, painful swallowing, fever. Rubella (German measles) – slight cold, sore throat, swollen glands behind ears, slight pink rash. Pertussis (whooping cough) – snuffy cold, spasmodic cough with whoop sound, vomiting. Meningitis- fever, headache, irritability, drowsiness, confusion, dislike of light, very stiff neck, maybe small red spots beneath the skin that do not disappear when a glass is pressed against them. 2.2.2 Describe the actions to take when children or young people are ill or injured. Parents or guardians have prime responsibility for their child’s health and should provide the school with information about their child’s medical condition and treatment or special care needed at school. Children should not attend school if they are acutely unwell. The setting or pre-school has a duty of care to look after children with a known medical condition or who become ill or have an accident during school hours. Every setting or pre-school must have First Aid box and at least one individual how is fully trained. In time of accident the key person must be act. If is neseserry can call to emergency. Every setting and pre-school has defferent rules but they must follow the rutenes that will helps to the children. 2.2.3 Identify circumstances when children and young people might require urgent medical attention. Some children may be too young or may not be physically able to tell you when they need medical attention due to a disability. Often children and young people can become seriously ill very suddenly which means that as a member of staff you should be alert to any changes in their behaviour which could indicate pain or nausea. When a child becomes sick or lets you know that they feel unwell, you will need to sufficiently look after them until their parent or a carer arrives to collect them. In life threatening situations the emergency services should always be contacted straight away. An example of this would be if a child had any of the following signs of acute illness: an open wound that won’t stop bleeding or where the blood is pumping out,burns or scalds to the child’s skin, Meningitis symptoms such as a stiff neck, fever, headache and a rash that doesn’t fade when pressed by a glass,confusion, headache, vomiting or blurred vision after a head injury. Being floppy, unresponsive or unconscious. Difficulty breathing and blueness around the lips. Having a high fever, heat exhaustion or severe sunburn. Some children may be too young or may not be physically able to tell you when they need medical attention due to a disability. Often children and young people can become seriously ill very suddenly which means that as a member of staff you should be alert to any changes in their behaviour which could indicate pain or nausea. When a child becomes sick or lets you know that they feel unwell, you will need to sufficiently look after them until their parent or a carer arrives to collect them. In life threatening situations the emergency services should always be contacted straight away.If is necessary call to 999 for an ambulance. 2.2.4. Describe the actions to take in response to emergency situations including fires, security incidents and missing children and young people. You have to know where the fire exit are. Never put anything on the way of a fire way. Close door and windows and try to get out the children from the fire place.Make sure that the children are awalys with an adult. Call to the fire brigade by telephone as soon as you can as follow dear 999, give you phone number, make sure that you spell the address correctly and it received. Any setting must have security. For example at the pre-school where I have a plcemenet the main door alwaiys is locked, the emergency door  is open only from inside.When some one rings is very easy to look how is there.The key person knows the main people who visit the pre-school regulary.In case some stanger get in there is visitor book, check for indentity. Any stranger seen hanging around school or in the school grounds should be reported without delay to the headteacher who WILL call police if necessary. Any stranger found in the building should be challenged by a senior member of staff. If a child cannot be found by their teacher/support worker/lunchtime supervisor, the headteacher must be notified immediately and told when and where the child was last seen. The remaining children will be left safe in the care of suitable staff. All other staff available will conduct a thorough search of the childs classroom, play area,toilets, the school building and the grounds If the child is not found within a very short period of time, the police must be called by the headteacher or a member of staff. 3.3.1. Identify the characteristics of different types of children abuse. Physical Abuse Defined as non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning or otherwise harming a child, physical abuse is the most visible form of child maltreatment. Many times, physical abuse results from inappropriate or excessive physical discipline. A parent or caretaker in anger may be unaware of the magnitude of force with which he or she strikes the child. Other factors that can contribute to child abuse include parents’ immaturity, lack of parenting skills, poor childhood experiences and social isolation, as well as frequent crisis situations, drug or alcohol problems and domestic violence. Physical indicators of abuse include bruises; lacerations; swollen areas; and marks on the child’s face, head, back, chest, genital area, buttocks or thighs. Wounds like human bite marks, cigarette burns, broken bones, puncture marks or missing hair may indicate abuse. A child’s behavior might also signal that something is wrong. Victims of physical abuse may display withdrawn or aggressive behavioral extremes, complain of soreness or uncomfortable movement, wear clothing that is inappropriate for the weather, express discomfort with physical contact or become chronic runaways. Sexual abuse At the extreme end of the spectrum, sexual abuse includes sexual intercourse or its deviations. Yet all offences that involve sexually touching a child, as well as non-touching offenses and sexual exploitation, are just as harmful and devastating to a child’s well-being. Touching sexual offenses include: Fondling; Making a child touch an adult’s sexual organs; and penetrating a child’s vagina or anus no matter how slight with a penis or any object that doesn’t have a valid medical purpose. Non-touching sexual offenses include: Engaging in indecent exposure or exhibitionism; Exposing children to pornographic material; Deliberately exposing a child to the act of sexual intercourse; and Masturbating in front of a child. Sexual exploitation can include:Engaging a child or soliciting a child for the purposes of prostitution; and Using a child to film, photograph or model pornography. These definitions are broad. In most countries, the legal definition of child molestation is an act of a person—adult or child—who forces, coerces or threatens a child to have any form of sexual contact or to engage in any type of sexual activity at the perpetrator’s direction. The effects of sexual abuse extend far beyond childhood. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of self-esteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life. The sexual victimization of children is ethically and morally wrong. Emotional Abuse Emotional abuse of a child is commonly defined as a pattern of behavior by parents or caregivers that can seriously interfere with a child’s cognitive, emotional, psychological or social development. Emotional abuse of a child — also referred to as psychological maltreatment — can include: Ignoring -either physically or psychologically, the parent or caregiver is not present to respond to the child. He or she may not look at the child and may not call the child by name. Rejecting-this is an active refusal to respond to a child’s needs (e.g., refusing to touch a child, denying the needs of a  child, ridiculing a child). Isolating-the parent or caregiver consistently prevents the child from having normal social interactions with peers, family members and adults. This also may include confining the child or limiting the child’s freedom of movement. Exploiting or corrupting. In this kind of abuse, a child is taught, encouraged or forced to develop ina ppropriate or illegal behaviors. It may involve self-destructive or antisocial acts of the parent or caregiver, such as teaching a child how to steal or forcing a child into prostitution. Verbally assaulting.This involves constantly belittling, shaming, ridiculing or verbally threatening the child. Terrorizing here, the parent or caregiver threatens or bullies the child and creates a climate of fear for the child. Terrorizing can include placing the child or the child’s loved one (such as a sibling, pet or toy) in a dangerous or chaotic situation, or placing rigid or unrealistic expectations on the child with threats of harm if they are not met. Neglecting the child. This abuse may include educational neglect, where a parent or caregiver fails or refuses to provide the child with necessary educational services; mental health neglect, where the parent or caregiver denies or ignores a child’s need for treatment for psychological problems; or medical neglect, where a parent or caregiver denies or ignores a child’s need for treatment for medical problems. Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide, difficulty forming relationships. Emotionally abused children often grow up thinking that they are deficient in some way. A continuing tragedy of emotional abuse is that, when these children become parents, they may continue the cycle with their own children. Neglect is usually typified by an ongoing pattern of inadequate care and is easily observed by individuals in close contact with the child. Professionals define four types of neglect physical, educational, emotional and medical. Bulling and harassment Bulling is act show aggressive, unrespect and rude actions. Bullying can take many forms: Physical violence, Intimidation and threats, Name calling and  belittling, Social exclusion (i.e., leaving someone out of social gatherings and activities), Gossiping and spreading rumors about others, Public humiliation, Using slurs, words or phrases that characterize a bullied victim’s identity to suggest that something is unacceptable or worthless (e.g., using the word â€Å"gay† when what is meant is â€Å"un-cool†).

Challenge of Training Global Workers Education_revised final

Challenge of Training Global Workers: Education Recently, globalization has become more and more common in everyday business and world politics. Different countries can contact each other easily allowing foreign trade to flourish, but, with the ease of communication and travel comes some issues that should be accounted for, for example, before hiring workers from different countries, you need to get to know their individual culture, which in turn would be beneficial in training them.There are too many problems with global workers, as we know, training a global employee requires the company to rely on a mass of vigor, manpower, and financial ability, so it is not easy to do business in foreign countries. In my opinion, the key to success of a company is its workers, even though business strategies are made by the leaders, it is the workers who turn these ideas into products and services. And the quality of products and efficiency of labor are the critical factors are indispensable in the company's prosperity. However, training the higher-qualified workers is not as easy as it appears.Diversity, language, educational background, and religion are all important aspects of international workers that quire not only training, but adjustment to the new country and way of business. The business world has witnessed the globalization of different cultures over the decades. It is inevitable for people from different backgrounds having opposite opinions on the same things. Maybe you tell them they should do it in this way, but they think they can't do it in your way, because it's not allowed in their culture. As a transfer student coming from China, Vive been here for about 2 years.So I know the differences between China and America, such as social structure, collectivism vs.. Individualism, business relations, freedom of speech, etc. As I know, China has a very formal and hierarchical social structure that extends to business, institutional and family life. In my homeland, my education and culture teach people that they must follow elders' advice, even if they make the wrong decision, but in America, they could talk equally and exchange ideas without much consideration for identity and to pick up the one decision that suits them best.With collectivism and individualism in China, people always consider others more than themselves. Before Chinese people cake decisions, they always consider what they can do to satisfy others. In America, people consider themselves more than others. American people prefer to consider what they can do to get the most profit for themselves. Considering freedom of speech, as I said, Chinese people always consider others more, so before they speak, they always think about how should they express themselves to avoid to hurt others. In America, people can express themselves freely.They don't need to consider whether this conversation is suitable or not. So diversity would be a challenge for raining international workers. Secon dly, language is another challenge due to the rising trend of globalization, international companies are more likely to hire workers from developing countries. This results in the difficulties of communication. People need to communicate with others that they can express their idea and exchange them. Sometimes they can combine them to think out a better idea. Also when they communicate, they should notice the way to speak, because most conflicts are caused by lack of communication.The world today is not only globalizes in terms of companies and products, but errors as well, and with that, comes difficulty for managers to see eye-to-eye with their workers when training them. With the vast differences of cultures and levels of education, overseas workers could bring new ideas to the table, or, it could adversely slow development and production for companies. Entirely dependent on the type of industry, an international worker might not be able to comprehend the culture of another count ry that can make or break a product's appeal to the consumers.Creativity and Ability are two entirely different attributes that a worker can have, and it's up to their educational background to determine which will take precedence and will be their strength or weakness. The easiest way to show these differentiation in skill assets is the influences of the American and Chinese education systems on their students. Boiled down, Ghana Ruffian, a Chinese student studying in the U. S. Says â€Å"Back in China I learned about gravity from a Powering slide†¦ That's it. † (2013).China's Education system is less about application and firsthand experience, and more about data and memorization of formulas. Tests and exams replace lab experiments, and codebooks replace classroom discussions. In Mining, director of the Shanghai Education Commission's basic education department, stated at an education convening in Shanghai, â€Å"When American high school students are discussing the l atest models of airplanes, satellites and submarines, China's smartest students are buried in homework and examination papers,†¦ † (2012).In explicitly states the stark difference between American and Chinese education, which to the very educators themselves, know is a problem. In the United States, we imagine high school and university science classrooms as avian 2 or 3 person shared desks, with lab equipment scattering the classroom, from beakers, to Bunsen burners, and even having dissecting tables in a stack in the back of the room. In China the same classroom would have individual desks, and the most colorful object in the room might be a AD molecular model made of toothpicks and colored cotton balls.A student's education is not dependent on the school's department's ideas of what should be taught, but what is tested in the infamous GAO college entrance test. If it is not in the entrance exam, it is not needed in the lassoers, and since lab experiments are not tested , schools in China will not spend money on lab equipment. â€Å"On a 2009 standardized test that drew worldwide attention, students in Shanghai finished first in the sciences among peers from more than 70 countries, while the United States came in 23rd†¦ † (Levin, 2013).Chinese censorship and limitations inversely affect the country's ability to be creative and increasing individual freedom of expression seems to be near impossible. Without political and social restraints, China could slip below that 1st place mark, but in the end, is being #1 truly the best? Having not produced any Nobel Prize winners in the past, is being number one truly the best thing? Without having students think outside the box, China will surely plateau in terms of science and innovation. If a Chinese graduate comes to the U.S. And works for a tech company that relies on innovation and engineering, the manager would find that despite the Chinese worker's high test scores, asking him to come up wi th a new idea would simply be too much. China must foster innovation before it can truly call itself a world leader in technology and science. Chinese students can complete the most difficult math equations ever deemed possible a million times over, but if they cannot simply find new ideas and create new things, then China will go nowhere. Most students in the U. S. Therapeutically think of Chinese students as walking, talking calculators†¦ And sadly they are not far from the truth. Ghana Ruffian's mother explains her reasons for sending her son to high school abroad as â€Å"l didn't want my son to become a book-cramming robot,† (2013) But even with the issue of innovation in Chinese education, why then, are Chinese workers sought after in the Job market? If Chinese workers can't innovate, their next best attribute, thanks to the Chinese education system, is their efficiency and dedication to getting the answer as soon as possible and with as few mistakes as possible.To Chinese workers, the answer is the priority, and the question is Just an obstacle. In America, where questions are encouraged, living here can make a lot of workers become overwhelmed by how many flaws their American counterparts make. So who is truly behind? American workers in China are equally sought after, with the rowing western culture in China and other Asian countries, as such, Americans are just as easily wanted as Chinese workers are in America for their ability to be creative and innovative.Another aspect in the training of international workers that could make or break any good manager-worker relationship that is more far-reaching than culture, but more impacting, is the different in religion. To the business world, profit and production take control of business culture, and a company's workers are expected to understand this. For example, all workers in a company are required to show up for ark, wear clothes according to a dress code, or even come to work on specific d ays.This is extremely touchy in the event that a new international worker might be hired. When considering other cultures, it also requires the consideration of the culture's religion, or else there would be drastic deficiency in training the workers, and you could also inadvertently offend his religion. If a manager is not well educated in world cultures, most workers will overlook this and understand their misconceptions, however it seems that in this day and age, if a manager does not understand elisions beliefs, it tends to be more offensive.If a manager has a new international worker come work on Saturdays, when it is expected that he should know his new worker practices his recognized religion on Saturdays, it could cause some cultural or even legal issues with the company policy. † Overall, the incidence of workplace conflicts and discrimination over religion seems to be a fairly significant issue, (Gibson 2013) Thanks to globalization and business culture becoming more international, cultures can mix easily without too much hesitation, but to say that without talking bout education backgrounds is something to be argued.Is it Chinese culture to study the way they do now? Or will the culture change as soon as the demand for innovation becomes more prevalent in the future? With workplace diversity comes intermixing of ideas, but in the case of western development, it seems that the need for Chinese workers is not strictly for exchanging of ideas, but to increase workplace efficiency and accuracy. If China becomes more open to innovation and creativity, would Chinese workers be less sought after? Reference Bennett, R. (n. D). Difference Between American & Chinese Culture. How.

Are We Feeding the Poor People Essay Example | Topics and Well Written Essays - 2000 words

Are We Feeding the Poor People - Essay Example The underlying reason for this has to do with my understanding that the vast majority of this 47% of individuals that Romney indicated were dependent and â€Å"lazy† would ultimately love to have an opportunity to provide for themselves; however, they simply do not have the ability to do so. In such a way, the following analysis will be concentric upon describing this problem from a more nuanced perspective and analyzing this broad and differentiated group in terms of the responsibilities that citizens have towards their fellow citizens and the overall impact of providing services to those that are incapable of providing for themselves. Further, to understand the problem, it is necessary to know who comprises this 47%. According to Mitt Romney, the 47% represents those individuals within the United States that are not required to pay federal income taxes. The majority of these are the low-income households; most of which earn less than $ 30,000 a year. Of these, many are willing to work hard and earn a living; however, they cannot find full time employment as a result of the abysmal state of the economy. As such, they are trapped in minimum wage jobs; oftentimes working as part time employees. Not considering income taxes, these individuals can barely feed the families and provide for the basic necessities of life. As can be seen, expecting these very individuals to pay income tax would dis-incentivize engaging with the workforce and created a situation in which these very individuals would be worse off working several part-time jobs then they would be drawing unemployment checks and other forms of government welfare assistance. As can immediately be seen, simply categorizing these individuals as â€Å"lazy† is a gross exaggeration and misunderstanding of the labor force and how it works. The fact of the matter is that these individuals are not lazy and have instead chosen to work

Reforms Essay Example | Topics and Well Written Essays - 1500 words

Reforms - Essay Example The changes have bought positive impacts from the view point of parliamentary democracy, parliamentary sovereignty and the rule of law. Two such reforms, introduced under the Labour Party reform agenda, are the House of Lords act, 1999 and Freedom of Information, 2000. The former reform was introduced with the goal to make the House of Lord more representative as well as democratic whereas the later was created to make the government operations more open and increase the democracy and sovereignty of the nation1. UK is a nation that follows parliamentary democracy i.e. the members who form the government body are also members of either of the two Houses of the Parliament (though there are a very few exceptions to this) and, the government of Britain is answerable to the Parliament as it owes its very existence to the Parliament. The Parliament of UK is also a sovereign parliament i.e. the legislative body is superior to any other government body inclusive of executive or judicial bodi es. In the United Kingdom, it is the Parliament which decides the laws and the work of the judges is to interpret it. They cannot themselves make a law2. Under the House of Lords reform, the right to sit and vote held by the hereditary peers was to be ended but the legislative powers of the House of Lords was to remain the same. No particular political party would then have majority in the House of Lords and its composition will be a reflection of the percentage of votes cast in the last General Election. When the first phase of this reform came, all but 92 of the then present hereditary peers were removed from the House of Lords. 3 This law positively affects the British democracy, as proposed by many scholars. According to the result of a poll, the British MPs too have favored a fully elected House of Lords in comparison to the traditional composition citing that a step like that will have a major impact on the British constitutional reform. The government of Britain was previousl y divided into commons and the lords i.e. the there existed a â€Å"lower house† or popularly the â€Å"House of Common† which comprised of elected members and on the other hand there existed the â€Å"upper house† or the â€Å"House of Lords† who were unelected. The Lords believed themselves to be privileged who had either been put to the coveted seat by their fathers who sat on those chairs in the past or by the ruling party of their time. This arrangement was totally in contrast with the idea of democracy. The ultimate decision making power used to rest with the Lords and only when their decisions differed considerably with those of the Commons, the attempt to rule out those decisions used to be made. This highlights the existence of a large section of society with no important voice in the legislative process of the nation. This shows a democratic split. In a truly democratic country, problems like this would have never emerged. Therefore, it can be s aid that the House of Lords Act, 1999 was a step towards enhancing the democracy of the nation. (Britain’s Deficient Democracy) The reformed House of Lords is more confident, authoritative and it is broadly a representation of the society it seeks to serve. It contains people from different parts of the United Kingdom, from varied professions, from all ethnic and religious communities, both men and women and hence it will be

Hospitality Group Developing your Managerial Skills Essay

Hospitality Group Developing your Managerial Skills - Essay Example 10 Relate Management Skill 10 Compare and Contrast 10 Conclusion 11 References 12 Bibliography 15 Introduction This reflective essay aims to present a brief of my professional development with respect to international and cultural employability skills along with my team development and planning and organising skills which I believe to be quite helpful in deriving better career prospects in hospitality industry. The essay will cover a theoretical explanation of the employability skills I could develop from my previous academic experiences and draw towards a critical review of my learning in these particular areas. In the current phenomenon, diversity is often regarded as one of the vital aspects within the hospitality industry which creates a direct influence on the tastes and preferences of the customers along with the level of commitment and expectations of the employees. The presence of cultural diversity both the internal and the external market of hospitality industry is quite ap parent as compared to the other industry structures. Today, it has widely been argued that managing diversity within the workforce is important as well as a difficult task for managers in the hospitality industry by which organizations can generate greater cultural awareness while operating within international marketplaces. Contextually, the significance of generating cultural awareness and other intertwined employability skills such as team development and planning and organising have often been argued as a crucial facet of hospitality industry. Review of 3 Employability Skills Employability Skill 1: International & Cultural Awareness Literature Review According to Quappe & Cantatore (2005), cultural awareness imposes a direct impact on the communication system of an organisation which comprises the capability of creating consciousness towards the cultural values, beliefs and perceptions in different contexts. In this regard, it has been observed that different cultural groups eva luate and interpret situational components applying different perspectives, which further essentialists the obtainment of cultural awareness among modern day professionals (Quappe & Cantatore, 2005). As explained by Whitelaw & et. al. (2009) cultural diversity is quite apparent in the modern day hospitality sector in the both the dimensions of internal organisational culture (employees/workforce) and external organisational environment (customers/marketplaces). It is in this context that professionals need to continuously enhance and develop their efficiencies in this particular dimension so as to satisfy the contemporary needs of the hospitality industry (Whitelaw & et. al., 2009). According to Hall (2003), cultural awareness is often professed as an attitude which can be obtained from his/her learning experiences by an individual when interacting with various cultural groups. It has further been implied in this context that culture can be distinguished as the big ‘C’ of material culture and smaller ‘c’ of shared culture within an organisation (Hall, 2003). Based on a similar context, Moss (2002) revealed that when students and other academic professionals are engaged with the learning of cultural aspects, they will able to comprehend the