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Rhetorical Analysis Essay

 Rhetorical Analysis Essay

Length: approx. 1000 words, excluding lengthy quotations

 

 

The rhetorical analysis essay is meant to build your critical thinking skills by having you closely read and interpret the rhetorical situation of a text. Using concepts from class, you will conduct a rhetorical analysis in which you will assess the effectiveness of the rhetorical strategies an author uses to make an argument.

 

For this assignment, you will select one chapter of Thomas King’s The Truth About Stories: A Native Narrative, and then analyze how the way the chapter is written contributes to King’s theme in the chapter, and to his argument in the text as a whole. Focusing on the rhetorical strategies King uses will require you to read and think carefully about the chapter you select, what it means, how this meaning is conveyed, whether this meaning is convincingly conveyed, etc. You will be required to use very precise evidence in support of your claims and conclusions.

 

Reminder: You are required to make an argument about King’s text; a description or summary of the chapter will not suffice.

 

How to proceed:

 

  1. Choose ONE chapter of Thomas King’s The Truth About Stories.
  2. Ensure you understand both the specific topic/theme of the chapter you have selected and also the ways in which the theme/topic fits into the broader argument King makes in the work as a whole.

2.1. In other words, what, precisely, is King dealing with or arguing in this chapter?

2.2. Think about how the topic of your chapter relates to the other topics King treats in his book.

  1. Write a short essay in which you discuss two or three ways King goes about dealing with his topic. Remember that your essay should not simply provide an overview of the chapter or the text, but that your focus should be on two or three strategies King uses to present the subject matter, as well as on the effectiveness or inadequacies of these strategies. You should support your ideas with specific evidence – i.e. quote the exact words from the text and interpret them. Put your thesis statement in bold font.

 

Be specific in your analysis of your chapter. Point to specific rhetorical features King deploys in the chapter, and suggest how and to what effect these features are being used. Consider the ways in which King’s treatment of his specific topic compares to, or differs from, his treatment of the topic in a different chapter. How does King use these rhetorical strategies alongside strategies from other chapters to build his argument in The Truth About Stories as a whole?

 

If you are unsure about where to start, here are a few things (there are many, many more) to think about in the context of your chapter:

 

  • Why/how does King tell stories (Indigenous, or otherwise) in this chapter?
  • Why does King offer biographical anecdotes (i.e. incidents from his own life)?
  • Why does King rely so heavily on historical information, and what is the relationship of this “history” to the “stories” he tells?
  • How is the chapter organized? In what way is it structured? Is it simply a linear narrative, or are there interruptions or digressions? What purposes do these interruptions have? How does this structure help/hinder King’s discussion of his topic in the chapter or his argument in the work as a whole?
  • What is the tone of the chapter? Is it funny? Serious? Melancholic? Does the tone remain the same throughout the chapter, or does it shift? How does King manipulate his tone to explore his topic, and what effects do these manipulations have?
  • Does King use any striking metaphors to make his point? Are there words or phrases that reappear throughout the chapter/text? What is the effect of repetition in this chapter/text?

 

**You do not need to answer any/all of these questions in your essay itself – they are just to help you get thinking about the rhetorical strategies King uses in the chapter/text**

 

BERG v. ALLIED SECURITY INC. et al.

 

BERG v. ALLIED SECURITY INC. et al.

In Berg v. Allied Security Inc. et al. case, Joan Berg, who was the plaintiff in the case filed a petition against the Allied Security Inc. and Podolsky & Associates Inc. in the Circuit Court of Cook County. The petition was for personal injury act that Berg Inc. et al. had effected on the plaintiff. The Circuit court, on 4th September 1996, gave a ruling judgment that was in favor of the two defendants. After exactly one month, which was on 4th October the same year, the plaintiff moved back to the Circuit court to seek reconsideration and therefore requested the court for a leave to amend. The Circuit court, on the 15th of October, denied the plaintiff the leave to amend. The plaintiff decided to file a notice of appeal which she did after five days, which was on 26th November.

After the filing of the appeal, the defendant, in the Appellate court argued that the notice of appeal by the plaintiff was untimely. In spite of the appeal being filed after only one week after disposal by the Circuit court, the defendants argued that the Appellate court lacked the jurisdiction to hear the appeal by saying that the plaintiff’s motion did not qualify to present the motion as per section 2-1203 of the 735 ILCS 5/2-1203 (West 1998) code of civil procedure (Clinton, 791). The appellate court, however, disregarded the jurisdiction challenge by the defendants and consequently addressed the appeal by the plaintiff. Citing the existence of material facts on the issue, the appellate court held that the summary judgment was improper. The summary judgment granted in favor of the defendants by the Circuit court was put aside by the Appellate court and the case was to proceed in the Circuit court.

After the judgment, the two defendants sought for a leave in the Supreme Court. Just as they had done in the Circuit court, the defendants, in the supreme court the defendants argued that the post-judgment motion by the plaintiff lacked the sufficiency to toll the filing time since the filing was done 30 days after the Circuit court’s ruling and added still that the appellate court lacked jurisdiction to hear the plaintiff’s appeal (Clinton, 791). The Supreme Court of Illinois gave both the defendants leave to appeal. Noting that the plaintiff had presented her case 42 days after the denial of her motion by the circuit court, the Supreme Court of Illinois vacated the court of appeals decision and thus dismissing the appeal. Under rule 303(a) of the Supreme Court, an appeal notice should be filed within the first 30 days of the judgment (Marshall, 497).

The plaintiff, Joan Berg, on the 27th of March 1992, was attacked by a man who held a solid metal bar in his hand in a parking lot as she was getting back to her workplace for the 2 p.m. to 12 a. m. shift. She had gone to pick some pizzas for her fellow workers. The plaintiff was hit in the back of her head as she stepped out of the car. She was repeatedly struck using the metal rod after being pushed into the front seat of the car. The attacker only fled after Joan Berg sounded the horn. According to existing records, this was the first case of violent attack although there were about 20 cases of automobile and property damage and one case of fondling of a woman’s buttock.

On matters security, there was a lease between the plaintiff’s employer and Podolsky, who was the landlord. Some security rights that landlord is reserved to is installation, operation and maintenance of security systems in buildings that monitor, via the use of CCTV cameras or any other means, all the people leaving an entering the building. Incidentally, Podolsky had an already put in place monitoring system and in addition, he had hired Allied to offer a 24 hours security on his premises. There was some mutual agreement between Podolsky and Allied where the contractor (Allied) would be responsible for the furnishing of security personnel. Allied, therefore, issued its guards with the following orders:

  1. Keeping unauthorized persons from the premises so that to lessen risks of assault, theft, and vandalism.
  2. Assisting the employees and the visitors to have access control of the premises environments.
  3. Lessening threats of property damage due to flooding, fire and equipment failure among other causes.

To achieve this, they were charged with the duties of maintaining visibility of very high level, effectively dealing with the arising situations such as equipment failure or unauthorized visitors, relentless alertness and reporting of suspicious cases such as loiterers and also seeking for appropriate assistance in critical situations (George, 15). Having done this, Podolsky made an advertisement to all his tenants, the plaintiff’s employer included, that there will be a 24 hours security including patrols at the parking lot. It was Podolsky’s decision of how many guards will be needed in his premises. On top of having Allied to provide the security, there were 20 installed CCTV cameras all over the premises and connected to four monitors. The Guards were charged with controlling where the cameras viewed at any given time. At the time the plaintiff was attacked, the camera that was to view the parking lot was off and therefore would not scan. Podolsky fired the Allied security nine months after the attack and hired a new security team to offer the security services.

In such a case, the plaintiff had to provide sufficient facts to show that there existed a duty to the plaintiff by the defendant, show a breach of the duty and a proximately resulting injury from the breach. According to White (11), landlords are not required by law to protect a person from criminal activities perpetrated by a third party on their property unless there is an existing special relationship between the parties. A Landowner may, however, voluntarily, decide to provide security in their promises (George, 31). Nevertheless, when the landlord agrees to provide some specified security services to his tenants, a duty arises and he is therefore required by the law to provide the services, of which he should not breach the duty (White, 11). In the case of Berg v Allied et. al., Allied and Podolsky voluntarily decided to get into a contract.

In this case, there was a voluntary agreement for one party to protect the other and therefore it was a legal duty for Podolsky to protect the plaintiff against a criminal act (White, 10). The court also recognized the fact that although the defendant had a duty to protect the plaintiff, it was not construed to absolute protection just like an insurance. In the case, Allied argued that its duties of providing security were limited to the building only and did not include security at the parking lot. Allied added that it did not have authority over the parking lot and in the case of the attack, it would not intervene since it did not have the authority to do so. On his side, Podolsky argued that the attack was unforeseeable since it was the first case of a violent attack on his premises.

Although Podolsky had put up some security measures to curb any unforeseen challenges of security, the protection system was not able to meet its intended purpose. When evaluating and analyzing a Physical Protection System (PPS) design, it is mandatory to first understand and review the protection objectives that the design is meant to accomplish (Valera & Sergio, 200). A PPS integrates procedures, equipment, and people for protection for protection of property and facilities against human attacks, sabotage, and thefts. PPS developers, when installing their IP/CCTV monitors, should ensure that the facilities are in good working conditions ((Valera & Sergio, 200). With this, it is also possible to ensure that the facilities will learn within the specified time. To formulate the objectives of the PPS, the designer should follow three procedural concepts. To begin with, he should characterize the facility conditions and operations. Secondly, he should define all the probable threats and finally, he ought to identify the major targets (Valera & Sergio, 200).

Some guidelines should be observed when designing the PPS systems. The systems work best when detections are far from their targets and delays near to the target (Valera & Sergio, 200). Similarly, there are very close associations between the exterior detections and interior assessment. Without assessment, detection is not detection since it has no use. Additionally, detection devices should be well interlinked with the assessment devices (Valera & Sergio, 200). By the installation of 20 CCTV cameras all around the premises, Podolsky had well designed the detection system to cater for any emerging insecurities in the building. On top of that, he had installed four monitors to cater for the assessment part of the security. In addition, he had put in place some security guards to observe the monitors for any possible detections. It is therefore easy to note that the design and evaluation of the CCTV cameras were effective if they were to be adhered to by the persons responsible for operating them (Seo, 93). However, there are still some limitations that the PPS had. At the time the plaintiff was attacked, the CCTV camera that was installed to detect any unauthorized persons was not in scan mode. The fact that the camera was not in scan mode would suggest different things. First, it would be probable that the system was not functioning properly (Ray & Herting, 19). This would be against the PPS design and assessment criteria. Secondly, it would suggest that there was negligence on the part of the security team who was charged with the mandate of ensuring that there was a 24-hour security on the premises.

According to Cozens, Paul, Greg, and David (340), Crime Prevention Through Environmental Design (CPTED) is a general concept that explains how crimes can be contained in the natural environment. It is influenced by the layout of the environment which includes how buildings are laid out, and the ease or difficulty of accessing a particular premise. The basic strategy of CPTED is natural surveillance, natural access control and territorial enforcement (Cozens et. al., 74). In natural surveillance, facilities are designed in such a way that makes intruders in a particular environment to be observed by the tenants and employees. Natural access control is the design that facilitates the flow of movements which are naturally controlled by building features and sites (Cozens et. al., 341).

Territorial reinforcement involves the design that makes the residents of a place feel secure and a place that discourages intruders (Cozens et. al., 341). In his premises, Podolsky had not well integrated the CPTED concept as he had only concentrated on the employment of security guards and monitoring CCTV cameras to secure the place. The guards were required to patrol the areas all around the premises to ensure that they man the environment and raise alarm in case of any criminal activities. On the contrary, the security persons were negligent on their duties as they disregarded the parking area where the plaintiff was attacked. According to the plaintiff’s petition, she was brutalized and there was not even a single guard in the vicinity who appeared to rescue her. It was not until she sounded the horn when the criminal fled. Still, no guard appeared to see what was happening in the parking lot and therefore the perpetrator of the crime was not identified.

According to the Berg v. Allied Security Inc. et al. case, it is easy to note that there was no mention of the alarm systems as one of the many security installations that Podolsky had installed. The fact that the culprit of the assault was neither arrested nor identified means that the alarm security system and the display were not well developed (George, 87)). After sounding the horn by the plaintiff, there ought to have been some other workers or security guards who heard the alarm alert and sounded other alarms for an instant reaction to capture the perpetrator of the crime (George, 87). Since nobody else sounded the alarm, it is probable that the alarm display system was not very effective on the premises.

Conclusively, Joan Berg, who was the plaintiff is seen to have lost in a great way since her case did not have the opportunity to be heard since the Supreme Court ruled in the favor of the two defendants. On his side, besides winning the case since it did not proceed—as he pleaded, he is seen to have gone an extra mile of protecting his tenants as he had hired some security agents to provide security services. Additionally, he had also installed 20 CCTV cameras and four monitors. All these shows that he had done a great deal of providing security in his premises although there was a case of violent assault which was unforeseeable.

 

 

 

Works cited

Cozens, Paul Michael, Greg Saville, and David Hillier. “Crime prevention through environmental design (CPTED): a review and modern bibliography.” Property management 23.5 (2005): 328-356.

Clinton, Robert N. “A Mandatory View of Federal Court Jurisdiction: A Guided Quest for the Original Understanding of Article III.” University of Pennsylvania Law Review 132.4 (1984): 741-866.

George, James P., and Anna K. Teller. “Conflict of Laws (2007).” SMU Law Review 60 (2007): 817.

Marshall, Thomas R. “Policymaking and the Modern Court: When Do Supreme Court Rulings Prevail?” Western Political Quarterly 42.4 (1989): 493-507.

Ray, David L., and Christopher A. Hertig. “The future of security.” Security supervision and management: Theory and practice of asset protection (2008): 11-20.

Seo, Tae-Woong “An analysis of vulnerabilities and performance on the CCTV security monitoring and control.” Journal of Korea Multimedia Society 15.1 (2012): 93-100.

White, Jonathan Randall. Defending the homeland: Domestic intelligence, law enforcement, and security. Wadsworth/Thomson Learning, 2004.

Valera, Maria, and Sergio A. Velastin. “Intelligent distributed surveillance systems: A review.” IEE Proceedings-Vision, Image and Signal Processing 152.2 (2005): 192-204.

 

 

 

 

 

Practicum Experience

 

Practicum Experience

Over the course of my study, the practicum experience has been the most challenging one yet. Despite the exposure to real-life work and application of the various school material in the said environment, this experience has had its ups and downs. However, all of these shifts have been learning situations that have facilitated the accumulation of knowledge, experience as well as self-improvement to take place.  Accordingly, during the practicum, I have witnessed the benefits, challenges, and the role of leadership in the changing circumstances of the workplace.

During my everyday observation of the institution, it has become increasingly clear that leadership plays a vital role in the translation of evidence into practice. Accordingly, honing my management skill has morphed into an urgent necessity. It is the only way I will translate anything I have learned into practice. I foresee the importance of understanding the institution’s culture and attitudes towards leadership and change. The only way I can utilize any research there is through carefully navigating these hurdles and cultivating relationships between the general research utilization, beliefs and attitudes and the respective roles (Squires et al., 2011). These are integral components of the culture at the organization. Furthermore, I need to acquire a few extra traits to accomplish my goal. I have to put increased value on research, benchmarking evidence-based care, supporting changes in traditional practice, give out feedback, and to work on my communication skills. Therefore, I foresee that working ion these areas gives me a better chance of successfully translating the evidence into practice.

The practicum environment was running fairly smoothly. However, I noticed one traditional practice in nursing that was still being utilized. Several hospitals still perform the instillation of 5 to 10 ML of normal saline before endotracheal suction is done (Rauen et al., 2008). This practice is a common component of managing artificial airways although there is virtually no evidence to support the benefits of the exercise. Advocates of the procedure argue that it helps in oxygenation, thinning, and removal of secretions (Rauen et al., 2008). All of these claims have been proven to be fallacies by the respective specialists. Furthermore, instillation of has been found to expose patients to bacterial contaminations resulting in cases such as hospital-acquired pneumonia and so forth. Therefore, from my practicum, I can conclude that institution needs to change its saline installation practice.

The practicum setting needs to implement change to avoid outdated practices that are not evidence-based. Such change would entail the AHRQ mode; for knowledge transfer (Titler, 2008). This model is pillared on three key practices; creation and distillation of knowledge, diffusion and dissemination, organizational adaptation and management. Knowledge creation and distillation entails researching while accounting for expected variations in readiness in health care delivery (Titler, 2008). The findings are packaged in a way that they can be translated into evidence-based practice within the organization.  End users should inform the process of distilling the information. The next step involves gathering the professional opinion of leaders and healthcare organizations to work together in the sharing of information that can be the basis of action. Such partnerships make it easy for the horizontal transfer of data that can improve patient safety. Lastly, the organization can transition to end-user adoption and instrumentations (Titler, 2008).

In essence, practitioners from one organization can get research findings from another and utilize them. This phase of the process involves getting the entire organization to implement a particular evidence-based practice. It is during this stage that good leadership proves essential as it is often characterized by transitions within the organization. Therefore, the most appropriate change to propose in the practicum setting is the adoption of a system to translate evidence into practice in the organization.

Leaders have a role in guiding the entire change process. Change, despite how small, can be scary and even disorienting in any institution. Hence, it is important to note the facilitators of the planned change. In this case, it would be a long-term change implementation hence it should be driven by agents of long-term perspective (Ghasemy & Hussin, 2015). The leader should also put into account the four change interventions to enable him to achieve the desired outcome. These are commanding, engineering, planning teaching, and socializing (Ghasemy & Hussin, 2015). On the other hand, resistance to change promises to be the greatest inhibitor to the implementation process. Based on my leadership style, transformational leadership, I see several opportunities and challenges in the practicum. The main opportunity is that this style encourages people to adopt new policies and procedures due to the trust and confidence built (Ghasemy & Hussin, 2015). Such outcomes would be extremely beneficial for the organization. Regarding the anticipated challenges, not every leader in the practicum environment uses transformation to lead. As a result, there might be friction from such leaders during the process.

Indeed, the practicum experience has been a challenging as well as a learning platform. I learned that leadership plays a central role in the translation of evidence into practice in the organization. Accordingly, I worked on honing my skills as a leader for the very same purpose. Based on my observations the practicum environment appeared relatively okay. However, practices such as the instillation of normal saline during endotracheal suction could use a change per evidence-based practice. For the institution to ensure that it is constantly translating evidence into practice, they could adopt the AHRQ mode. This adoption will require transformational leadership to be successful.

References

Ghasemy, M., & Hussin, S. (2015). Change, leadership and change- oriented leadership theories in   higher education: A review.

Rauen, C. A., Chulay, M., Bridges, E., Vollman, K. & Arbour, R. (2008). Seven evidence-based practice habits: putting some sacred cows out to pasture. Critical Care Nurse, 28(2), 98-123.

Squires, J. E., Estabrooks, C. A., Gustavsson, P., & Wallin, L. (2011). Individual determinants of research utilization by nurses: a systematic review update. Implement Sci, 6(1). .

Titler, M. G. (2008). Chapter 7 the evidence for evidence-based practice implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses, (7).

Christian Ethics

Topic: Christian Ethics

Thread: 350–400 words Provide an examination of at least 1 biblical text that can be used as an argument for a Christian’s responsibility to conduct research in an ethical manner. Cite and summarize the biblical text and provide specific application to common research practices and IRB training module material.

Replies150–200 words: Respond to and interact with at least 2 of your peers.

 

C’s Response

I have always relied upon the book of Proverbs to provide insight on my daily walk and immediately two verses came to mind.   Proverbs 19:2 offers “Desire without knowledge is not good, and whoever makes haste with his feet misses the way” (Proverbs 19:2, The New King James Version).  As a “type A” personality and a “list maker”, I often have to remind myself to slow down.  In fact, when writing one sentence this past week, it took me forty five minutes to make sure all the citations were correct, and moreover, the authors were addressing what I thought they were addressing.  Coming from a sports background where human performance in a game is often measured against a play clock and one is expected to make decisions very quickly to impact a game, this type of slow, intentional and methodical work has been interesting and a challenge.  However, it is necessary to slow down and make very sure you are approaching your research in the correct way.

Subsequently, Proverbs 14:15 provides “The simple believes everything, but the prudent gives though to his steps”( Proverbs 14:15, The New King James Version).  This type of research is not one to be conducted quickly nor should one accept in one’s research that everything you have come across is accurate.  From an ethical standpoint, Creswell offers that researchers should “refrain from presenting information that potentially harms participants”(Creswell, 2013, p. 66).  Research should be done methodically and intentionally, however, it should be conducted in a way that one has an intentional plan to address ethical concerns, and subsequently, how one should deal with those concerns if they arise.  As I work with my own students, they will remark “They say…..” and I always inquire “Who are the “They”?”.  Subsequently, they hear a monologue from me about the perils of their internet searches and warning them about the intent of their sources.

Finally, Proverbs is peppered with advice on how to live one’s life.  And I could extrapolate verses that could apply to all scenarios approached in research, but it can simply be boiled down to the “Golden Rule” provided in the book of Matthew “Do unto others as you would have them do unto you”(Matthew 7:12, The New King James Version).  As one of my prior professors indicated, we stand on the shoulders of the ones that came before us as we conduct our research.  As those researchers either made mistakes, intentional or not, we learn what to do and what not to do.  And subsequently, we should be deliberate enough in our efforts to get our research right always knowing we should treat others as we want to be treated.

 

References

Creswell, J. W. (2013). Research design: qualitative, quantitative, and mixed methods approaches. 3rd ed. Thousand Oaks, California: SAGE Publications.

 

 

Respiratory Alterations

Discussion: Respiratory Alterations

In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.

Consider the following three scenarios:

 

Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.

 

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

 

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

 

To Prepare

  • Review the three scenarios, as well as Chapter 27 and Chapter 28 in the Huether and McCance text.
  • Select one of the scenarios and consider the respiratory disorder and underlying alteration associated with the type of cough described.
  • Identify the pathophysiology of the alteration that you associated with the cough.
  • Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the disorder.

 

By Day 3

Post a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how the factors you selected might impact the disorder.

 

Use the below reference as one of the references

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Loius: Mosby.

 

 

case study

Read the following case study:

Motivated by his ambitions and previous work in coffee shops, Angelo is moving to Barrow, Alaska, to open a shop he has named Alaska Coffee. Angelo intends to sell coffee, espresso, and a couple of food items. He has signed a lease for a shop on one of the main streets and is moving in. His parents fronted him the cost or actual items of furniture and utensils, and he acquired some donated items, so he will not have to count these items in his cash accounting. Angelo is nearly ready to start selling coffee!

Angelo notes that he has the following fixed costs that he does have to count:

  • $1200/month for employees, totaled up, and
  • $1500/month lease, insurance, state, and borough fees.

Angelo figured he would allocate these  fixed costs to his products in the same proportion that they provided revenue as shown in this table:

ITEMPRICE SOLD / UNITVARIABLE COST / UNIT% REVENUE
Coffee$2.00 / cup$ 0.25 / cup75%
Espresso3.00 / small cup0.50 / small cup15%
Scones4.00 / ea.2.00 / ea.5%
Bear Claws1.50 / ea.1.00 / ea.5%

 

As you can see, local demand and the cost of acquiring supplies and ingredients from a store in the Arctic drives Angelo’s accounting. The coffee is the thing for him! However, the other items are selling as well.

Angelo asks a visiting family member to prepare a report for him that answers the questions below.

  • With the way Angelo has the fixed cost proportioned out by 75%, 15%, 5%, and 5% for each of the four items for sale, what is the break-even point of sales of each item for him in a month?
  • What would the total sales figure for the shop be at the break-even point?
  • What, if anything, should Angelo do to improve his business?

Prepare the report as instructed in a response of at least three pages. Be sure to research at least two sources to support your ideas and integrate the sources in APA-formatted citations and matching reference lists. Additionally, use Times New Roman 12pt. double-spaced font.

Information about accessing the grading rubric for this assignment is provided below.

 

Ranking Investment Alternatives

 

Ranking Investment Alternatives

(Problem 10-41) Grosvenor Industries has designated $1.2 million for capital investment expenditures during the upcoming year.  Its cost of capital is 14 percent.  Any unused funds will earn the cost of capital rate.  The following investment opportunities along with their required investment and estimated net present values have been identified:

 

ProjectNet InvestmentNPVProjectNet InvestmentNPV
A$200,000$22,000F$250,000.00$30,000.00
B$275,000$21,000G$100,000.00$7,000.00
C$150,000$6,000H$200,000.00$18,000.00
D$190,000-$19,000I$210,000.00$4,000.00
E$500,000$40,000J$250,000.00$35,000.00

In your response, complete the following:

  • Rank the projects using the profitability index.  Considering the limit on funds available, which projects should be accepted?
  • Using the NPV, which projects should be accepted, considering the limit on funds available?
  • If the available investment funds are reduced to only $1,000,000:
    • Does the list of accepted projects change from Part 2?
    • What is the opportunity cost of the eliminated $200,000?

 

Racism in America

 

Racism in America

Racism is one the most pressing social issues in America, among many others. From the beginning of the country, up until the present day, racism has been a part of American society, and it has negatively impacted the lives of many minority groups throughout its history. While the situation has gotten better over the years, it is still a major problem, and, because of this, many scholars and academics have studied the issue trying to explain its root causes. In particular, psychologists have determined three explanations for racism in America. Therefore, what follows below is a brief discussion of racism in America, along with a look at three psychological theories that help explain it: socialization, prejudice, and stereotypes.

Racism can be commonly defined as the idea that all members of a race have the same defining characteristics, either positive or negative. This comes in many forms, some obvious and easy to label as racist and others more subtle, requiring detailed analysis. For example, subtle forms of racism include members of a race not being hired at the rates as others, communities that are predominantly one race being designed so that they have less access to services, schools of predominantly one race being less funded, and countless other examples. These types of examples can be found throughout American society, where the victims are often African Americans and Hispanics and the perpetrators are often white, although it can happen between any two ethnic groups. Because of how widespread it is, it is important that the causes and the effects of racism be studied so that maybe that can be combated.

Racism in America is revealed in the data. For example, African Americans make up 12.7% of the population, yet they are arrested for 37% of violent crimes such as murder and assault and 29% of robberies. This shows that the law enforcement and judicial system is biased towards African Americans, in that they are more likely to be arrest and convict African Americans. Furthermore, according to the Harvard Business Review, African Americans are hired at less rates than other demographics. The study in question looked at hiring rates over many years, involving almost 43,000 applications for almost 21,000 positions. The researchers determined that there was little change in the rates that African Americans were hired, suggesting that this form of racism has not changed since 1990, the earliest the data was collected (Quillian, 2017). Statistics like this show that racism is sown into the fabric of American society, forcing some to have less opportunity, even today. Therefore, it is hard to argue against the fact that racism is still prevalent in American and a continually negative force in the lives of many Americans.

To explain why racism like this happens, not just in America, but all over the world and throughout history, the field of human psychology needs to be employed. First of all, the concept of socialization needs to be addressed. This can be defined as a person adopting the values and beliefs of the society in which they raised. Regarding racism, if a society is predominantly one race and this race is racist then these negative ideas get perpetuated as children grow up witnessing it and learning it. This happens in many ways, including many that are imperceptible, such as how races are depicted in advertising or in movies. According to one paper the way a child watches their parents has an effect later in life. They claim, “an adolescent’s perception of their parent’s racial socialization practices is a dynamic influence on the relationship between racism and racial identity expressions of African American school-aged youth” (Stevenson, 2009). This demonstrates that the environment that children grow up in effects how they perceive race and racial identity. Therefore, one of the major causes of racism is the socialization of children in America, in that other races are negatively portrayed in everything from how their parents talk to how they seen elsewhere.

Furthermore, prejudice is, of course, an important factor in racism in America. This can be defined as the incorrect perception of an individual based on their inclusion in a certain group. Psychologically speaking, prejudice comes from the need for people to fit in with a group and the social norms defined by a society. That is, people naturally gravitate towards groups and for the sake of social cohesion, people adopt the values and beliefs of that group. Moreover, a society dictates what is acceptable and what is not by the social norms. These are what people have collectively decided are the values and beliefs of the larger group. Furthermore, Brown suggests that prejudice is a necessary part of survival, as people need to make quick judgements about everything, as an in depth analysis is just not feasible (Brown, 1995). Therefore, people apply these psychological principles to other people, which helps explain the origin of racism.

Lastly, stereotypes are another major factor. These can be defined as the solidification of prejudice built up over time. That is, prejudices that have existed for a long become part of the collective belief system regarding another group of people. Stereotypes can be positive or negative, but they form the basis for the prejudice against another group of people. Regarding racism, people use negative stereotypes to judge other races of people based on an incorrect assumption about the group they belong to (“Race, Ethnicity”, 2007). Therefore, stereotypes help perpetuate racism as it makes it easier to be prejudice.

 

 

 

 

 

 

Reference

Brown, R. (1995). Prejudice: Its Social Psychology. Blackwell Publishing.

Quillian, L. (2017, October). Hiring Discrimination Against Black Americans Hasn’t Declined in 25 Years.

Race, Ethnicity, and the Criminal Justice System. (2007). AMERICAN SOCIOLOGICAL ASSOCIATION.

Stevenson, H. C. (2009). Racial/Ethnic Socialization Mediates Perceived Racism and the Racial Identity of African American Adolescents. Cultural Diversity and Ethnic Minority Psychology,15(2), 125-136.

 

 

 

 

 

 

 

Therapy

  1. Therapy is created to be a safe place for the patient and a place to work out there issues. Each person will have their own unique issues to work through in the session.  In the beginning the patient will need to open up to the therapist to get to the issues they have. One issue that may arise is transference which is when the patient makes similarities from a significant figure in their life to the therapist. Female therapist resembles the patients mother, which can be an easy way to get the patient to talk or a roadblock that has to be overcame before the session can begin

Thoughts on this?

 

  1. Please explain the four major theoretical models and perspectives.
  2. Interviewing is a part of a clinical psychologist’s assessment and there are various types. One of the first interviews conducted with an individual needing care is the Initial Intake or Admissions Interview. This interview not only gives the individual a general idea of the facility and the treatment but seeks to understand the problems and symptoms that they are experiencing to recommend the proper care for them.

 

The Mental Status Interview is used to see a person’s mental functioning and ability, their thought processes and judgment. This is to give an initial look into any psychiatric concerns the individual may have to provide them with the right treatment.

 

A crisis interview is when there is an immediate emergency and the individual is experiencing a crisis. The individual is quickly assessed if they are a risk to themselves or others and the nature of the crisis. The psychologist must be quick, calm and able to make swift decisions during this time.

 

The diagnostic interview uses the individuals self-reported symptoms and the DSMIV-TR to diagnose the individual’s mental health issues.

 

Structured interviews have very specific questions and were designed to improve the validity and reliability of interviews. The questions are normally yes or no, with follow up questions for specific details. This interview provides information for diagnosing and treatment options. Computer-Assisted Interviews are part of the structured interviews and allow individuals more privacy as they feel less pressure when responding to a computer rather than to an individual. These forms of interviews can also offer convenience as they can be time savers.

 

An exit or termination interview is done when the individual has completed treatment. The results are used to evaluate the effectiveness of their program and to assess if and what continual treatment needs that the individual may need. (Plante, 2011)

 

When does one use each of the above?

 

 

 

 

 

 

  1. Here is a list of just some of the testing that we do in our field, who would benefit from this and why?

 

1)     Cognitive testing

  1. a)     Intelligence testing

(1)   Defining intelligence

(2)   Wechsler scales

(3)   Stanford-Binet scales

  1. b)    Other cognitive ability testing
  2. c)     Neuropsychological testing
  3. d)    Controversies

 

2)     Personality tests

  1. a)     Personality and psychological functioning
  2. b)    Objective approaches

(1)   MMPI-2

(2)   MCMI-III

(3)   16PF

(4)   NEO-PI-R

  1. c)     Projective approaches

(1)   Rorschach

(2)   Thematic apperception test

(3)   Projective drawings

(4)   Sentence completion test

 

  1. Personality is how we think and behave with the world around us. Personality testing is used to assess the ways that people think feel and behave, to diagnose, create treatment plans, identify patterns and dynamics.  Personality tests can be beneficial for employers as they are designed to reflect traits and behaviors that the individual has that remain part of them throughout their life. It allows the employer to have an idea of who the individual is and the characteristics, strengths or weaknesses they may have. This gives the employer the ability to assess if the individual is a good fit for the company or a position prior to hiring the person. (Plante, 2011)

 

For example, seeing that an individual is outgoing, positive, fair and friendly, the employer would be able to judge if a customer service position fit their unique characteristics. Someone that was shy, negative and argumentative would not be a good fit in customer service but may do well in a position that had less interaction with the public.

Thoughts on whether this s a good thing or not, some people may look like one thing on paper vs real life???

 

 

References:

Plante, T. G. (2011). Contemporary Clinical Psychology. Hoboken, New Jersey: John Wiley & Sons, INC.

 

 

 

nursing

Questions 1-60 of 60 | Page 1 of 1

 

Question 1

A patient receiving a seventh cycle of paclitaxel and carboplatin is assessed for:

aanorexia.
bflank pain.
cweakness.
dshortness of breath.

Question 2

To prevent hemorrhagic cystitis in a patient receiving ifosfamide, the nurse:

aadministers mesna at 60%–100% of the ifosfamide dose.
badministers amifostine at 60%–100% of the ifosfamide dose.
chas the patient drink 8 ounces of fluids every hour.
dchecks the creatinine level prior to each dose.

Question 3

A patient with CD20 positive, non-Hodgkin lymphoma is scheduled to begin rituximab. The nurse knows:

athe risk of infusion reactions is decreased since the patient is chemotherapy-naive.
binfusion-related side effects are reduced with subsequent infusions.
canother therapy is ordered if the patient has an infusion reaction.
dmost infusion-related reactions occur 24-48 hours after the infusion.

Question 4

A patient scheduled for a fifth cycle of oxaliplatin reports difficulty buttoning his shirts. What is the nurse’s next action?

aInstruct the patient to wear gloves.
bAdminister the agent as ordered.
cNotify the physician
dApply ice to the fingertips.

Question 5

A patient scheduled to receive a fourth cycle of paclitaxel and cisplatin reports burning and numbness in his feet. The nurse’s priority is to assess for:

acerebellar neurotoxicity.
bchemical arachnoiditis.
cmotor neuropathy.
dautonomic neuropathy.

Question 6

A patient receiving cycle four of doxorubicin, bleomycin, vincristine, and dacarbazine reports dyspnea, tachypnea, and exercise intolerance. The patient is prepared for a:

acomputed tomography scan
bmagnetic resonance imaging.
cchest tube insertion.
dpositron-emission tomography.

Question 7

Specialized white blood cells called lymphocytes mature from:

amyeloid precursors.
blymphoid precursors.
cagranulocytes.
dgranulocytes.

Question 8

High-dose cytarabine administration places a patient at risk for:

acerebellar toxicity.
bhand-foot syndrome.
cpulmonary fibrosis.
danaphylaxis reaction.

Question 9

Which of the following increases a patient’s risk for acute nausea and vomiting?

aAge greater than 60
bHistory of alcohol abuse
cHistory of tonsillectomy
dFemale gender

Question 10

Which of the following is a dose-limiting toxicity for vinorelbine?

aMyelosuppression
bNeurotoxicity
cHepatotoxicity
dNausea

Question 11

When spiking an IV bag containing a hazardous drug, the nurse should wear:

aa surgical mask.
ban isolation gown.
ca respirator.
da face shield.

Question 12

The nurse administering cetuximab to a patient who is receiving concurrent radiation therapy is vigilant in monitoring for:

athyroid storm.
benterocolitis.
ccardiopulmonary arrest.
dhemorrhage.

Question 13

Which of the following stages of the cell life cycle gives cells some protection from exposure to cell cycle-specific chemotherapy agents?

aGap 1
bSynthesis
cGap 0
dPremitotic

Question 14

How do malignant transformed cells differ from normal cells?

aThey are different in structure from others of the same type.
bThey are fully differentiated and encapsulated.
cThey are unable to sustain an adequate blood supply.
dThey are unable to move away from their usual location.

Question 15

Which of the following best describes the effect of biologic therapy in the treatment of cancer? Biologic therapy:

ainhibits hematopoietic cell growth.
binduces the apoptosis of cancer cells.
cenhances the host’s immune system.
dpotentiates the effects of chemotherapy.

Question 16

How are vesicants administered peripherally?

aIV push
bSyringe pump
cContinuous infusion
dIV pump

Question 17

A patient reports that there is leaking at the chemotherapy infusion site. After assessing and warning others, the nurse:

aconsults the pharmacist for instructions.
bcontacts the physician for additional orders.
cretrieves the hazardous drug spill kit.
drelocates the patient to another room.

Question 18

The risk of developing palmar-plantar erythrodysesthesia increases with combination therapy with:

acapecitabine and radiation therapy.
bfluorouracil and leucovorin.
cdocetaxel and capecitabine.
dfluorouracil and pegfilgrastim.

Question 19

A patient receiving decitabine must have treatment delayed for which of the following?

aANC 1,200 neutrophils/mcL
bAspartate aminotransferase 6 U/L
cSerum creatinine 2.5 mg/dL
dDirect bilirubin 0.3 mg/dL

Question 20

Immune-related diarrhea for a patient being treated with pembrolizumab typically presents how many weeks after initiating therapy?

a6-18 weeks
b4-5 weeks
cMore than 19 weeks
dLess than 3 weeks

Question 21

Using the Calvert formula, calculate the carboplatin dose for a 65-year-old male patient who weighs 80.2 kg. The patient’s serum creatinine is 0.8 mg/dL with a target AUC of 4.

a517.6 mg
b519 mg
c455.1 mg
d397 mg

Question 22

Which of the following is primarily involved in acute nausea and vomiting?

aInhibition of the vagus nerve
bInhibition of the vestibular system
cSerotonin released from enterochromaffin cells
dSubstance P binding to neurokinin-1 receptors

Question 23

Which of the following agents is an irritant?

aEpirubicin
bDaunorubicin
cBleomycin
dDactinomycin

Question 24

A patient receiving nivolumab has a follow-up CT scan 12 weeks into therapy which shows a very slight increase in the size of his lung tumors. In the absence of any other significant changes in his condition, what is the expected treatment for the patient?

aContinue the current therapy with nivolumab.
bDiscontinue the drug.
cChange the treatment drug.
dIncrease the dosage of nivolumab.

Question 25

An example of an immune checkpoint inhibitor is:

acarfilzomib
bpembrolizumab.
crituximab.
dbortezomib.

Question 26

When assessing a patient who received treatment with high-dose busulfan one year ago, the nurse is most concerned about which of the following signs and symptoms?

aCough, dyspnea, and low-grade fever
bPapulopustular rash and urticaria
cWeakness, numbness, and tingling
dHeadache and decreased vision

Question 27

Which of the following personal protection equipment is worn for handling hazardous drugs?

aTwo pairs of sterile powder-free gloves
bDisposable gown made of a high permeability fabric
cStandard surgical face mask with a face shield
dTwo pairs of chemotherapy-tested gloves

Question 28

The nurse notes a loss of blood return while administering IV vinblastine. After stopping the infusion and aspirating any remaining drug from the catheter, the nurse’s priority is to:

ainfuse dexrazoxane as soon as possible.
binject sodium thiosulfate into the site.
capply a warm pack for 15-20 minutes.
dapply ice for 6-12 hours.

Question 29

The possible etiologies of venous irritation from chemotherapy administration include:

adiluted drugs.
ban agent pH equal to 9.1.
ca small-bore peripheral IV.
dhypotonic solutions.

Question 30

Which type of immune response includes skin and mucous membranes?

aAdaptive
bCell-mediated
cHumoral
dInnate

Question 31

A patient who is two months pregnant and diagnosed with an aggressive type of breast cancer refuses treatment. The nurse requests a consult with the:

amedication safety committee.
bethics committee.
ctumor board.
doncology department.

Question 32

The final step in developing a biosimilar is to:

atransfer the gene into a virus or an Escherichia coli vector
bremove the growth medium once the quantity is sufficient.
cpurify and stabilize the protein and place in the drug format.
didentify and clone the protein at the core of the biologic.

Question 33

A short-term outcome of patient education is:

adecreasing healthcare costs.
bimproving health-related quality of life.
cempowering active participation in health care.
dincreasing customer satisfaction.

Question 34

A hypersensitivity reaction to bleomycin is most likely to develop in a patient receiving treatment for which of the following diagnoses?

aTesticular cancer
bMalignant melanoma
cFollicular lymphoma
dCervical cancer

Question 35

A patient reports worsening of an extravasation site. The nurse will find which initial document most helpful?

aOsmolarity of the solution infused
bPhotographs of the site with date and time
cInitial dose of the chemotherapyation
dQuality of blood return before the infusion

Question 36

Which of the following small molecule inhibitors is indicated for the treatment of pancreatic cancer?

aErlotinib
bCarfilzomib
cBortezomib
dCabozantinib

Question 37

Which of the following drugs has the highest predicted risk of a hypersensitivity reaction?

aFluorouracil
bDactinomycin
cDacarbazine
dOxaliplatin

Question 38

Which of the following drugs is a nonanthracycline antitumor antibiotic?

aBleomycin
bIdarubicin
cEpirubicin
dDoxorubicin

Question 39

What is the mechanism of action of monoclonal antibodies?

aRemove immune cells from the body, and retrain them to identify and kill specific antigens
bTarget tumor-specific antigens on the surface of some cancer cells
cAccelerate and fully engage immune cells to create a robust immune response
dIntroduce the immune system to fragments of weakened or dead bacteria

Question 40

Hazardous drugs can be released into the environment when:

apriming tubing with a neutral solution.
bcompounding parenteral Schedule 1 agents.
cdiscarding syringes used to administer chemotherapy.
dadministering premedications in the infusion suite.

Question 41

Which of the following dose-limiting toxicities is attributed to cyclophosphamide?

aHemorrhagic cystitis
bHepatotoxicity
cPeripheral neuropathy
dNephrotoxicity

Question 42

Using a medication cup to administer an oral tablet form of chemotherapy:

aprevents aerosolization.
bassures an accurate dose is administered.
cavoids a hazardous drug spill.
dprotects the surfaces from contamination.

Question 43

A patient receiving a checkpoint inhibitor experiences a dose-limiting toxicity. What does the nurse anticipate the physician will order?

aDecrease the next dose.
bSlow the rate of infusion.
cAdminister the next dose.
dHold the next dose.

Question 44

Which is a nursing action for a patient with chronic lymphocytic leukemia who is scheduled to receive bendamustine?

aAdminister seizure prophylaxis.
bEncourage frequent voiding.
cInfuse the agent over 240 minutes.
dEvaluate serum calcium and potassium.

Question 45

The goal of adjuvant therapy is to:

adecrease the immune response prior to transplantation.
bshrink the primary tumor to improve the effectiveness of surgery.
ctarget minimal disease for a patient at high risk of recurrence.
deliminate residual disease prior to receiving a stem cell transplant.

Question 46

Which of the following drugs when given in its pegylated liposomal form reduces the risk of cardiotoxicity and allows for a significantly higher cumulative dose?

aDaunorubicin
bEpirubicin
cIdarubicin
dDoxorubicin

Question 47

The nurse is exposed to a hazardous drug through ingestion by:

apushing chemotherapy through an implanted port.
bsplashing chemotherapy into the eyes.
cdrinking in an area that chemotherapy is administered.
dbreathing in aerosolized particles from a chemotherapy spill.

Question 48

A patient with a VAD which has a good blood return reports pain and burning close to the access site shortly after idarubicin is started. The nurse expects to:

aelevate the affected extremity until the pain subsides.
badminister hyaluronidase in multiple SQ injections.
capply warm packs for 15 minutes four times daily.
dadminister the dexrazoxane infusion through an alternate site.

Question 49

During an initial infusion of trastuzumab, a patient begins to shake and reports chills, nausea, and a headache. The nurse should:

astop the infusion, manage the reaction, and then restart the infusion.
bpermanently discontinue the infusion after managing the reaction.
cstop the infusion, administer epinephrine, and then restart the infusion.
dslow the infusion and administer diphenhydramine and methylprednisolone.

Question 50

Which of the following is the final level of protection in the hierarchy of hazard controls?

aPersonal protective equipment
bHazard elimination
cAdministrative controls
dEngineering controls

Question 51

Which of the following interventions is an example of utilizing evidence-based practice?

aUsing honey as an oral rinse for mucositis
bApplying emollients to manage skin toxicities
cUsing reverse isolation routinely for patients with neutropenia
dEncouraging individual aerobic exercise activities for fatigue

Question 52

Biotherapeutic agents work by:

adestroying rapidly dividing cells.
benhancing the immune response.
ckilling slowly dividing cells.
dweakening cell transformation.

Question 53

Which of the following toxicities is associated with rituximab?

aRenal
bOphthalmologic
cPulmonary
dGonadal

Question 54

The nurse caring for a patient with colon cancer that has metastasized to the liver is concerned that stricture can be caused by:

acisplatin.
bcarboplatin.
cfluorouracil
dfloxuridine.

Question 55

Calculate the ANC for a patient with the following laboratory values: WBC 1.7 x 109/L, neutrophils 14%, bands 20%, and hemoglobin 10 g/dL.

a3400 neutrophils/mcL
b238 neutrophils/mcL
c578 neutrophils/mcL
d5780 neutrophils/mcL

Question 56

The signs and symptoms of a peripheral extravasation include:

apain and swelling along the IV site
bulceration and blistering along the IV site.
cblotches and streaking at the IV site.
dtightness and aching at the IV site.

Question 57

A patient with relapsed non-Hodgkin lymphoma is receiving ibritumomab tiuxetan. The nurse understands that:

athe patient will be placed on isolation and radiation precautions for three days after the drug is given.
bthe drug is bound to a diphtheria toxin which targets the lymphoma cells and kills them.
cthe patient’s platelet count should be greater than 100,000/mm3 before starting the therapy.
dthe medication should be given in combination with an antiplatelet therapy.

Question 58

A patient receiving chemotherapy is unable to retain liquids and has vomited nine times over the past day. What is the grade of these adverse events according to the NCI’s Common Terminology Criteria for Adverse Events?

a1
b2
c4
d3

Question 59

The physician calls to give the nurse verbal chemotherapy orders. Which of the following nursing actions is appropriate?

aRequest that the physician provide the order to the pharmacist.
bHave a second nurse listen to the physician’s order to verify the dosage.
cNotify the physician that telephone orders are unacceptable.
dObtain the chemotherapy name and dosage and read the order back to the physician.

Question 60

Infusion-related hypotension is associated with which of the following drugs?

aVinblastine
bEtoposide
cVinorelbine
dPaclitaxel