Unilever Project plan - Free Essay Example

Sample details Pages: 24 Words: 7284 Downloads: 6 Date added: 2017/06/26 Category Statistics Essay Did you like this example? INTRODUCTION: There are many kinds of business everywhere; where there are many issues related to the growth of the company and Different strategies will enable different companies to reach those goals. Unilever is a company started in 1930 formed of Dutch Margarine Company and British based lever brothers. Unilever holds a wide range of products which include food, personal care, beverages, canned foods, ice creams and many more which are worlds best consumer brands. Don’t waste time! Our writers will create an original "Unilever Project plan" essay for you Create order The case study describes a lot of information regarding Unilevers business strategies, key elements of Unilevers path to growth, how they rejuvenated and restructured the companies slow moving performance to wide range of brands across the world. BRIEF CASE STUDY: Unilever was created in 1930 as an outcome of merger with dual chairpersons and headquarters one in Netherlands and other in Unites Kingdom. This is of one the giant and best competitors in the industry which holds wide range of products. The two chairpersons have launched a strategy in early 2000 to recover the companys performance which was said to be lackluster. With the new strategies the company showed a significant progress and has gone through many dealings over the next years, this made the company to open 20 new acquisitions worldwide and increased the sales of the company. Thus the companys business was restructured, renovated and improved through its acquisitions. Then their came companies likes nestle which effecting the growth of Unilever. Unilever then started efforts to attract and motivate young, talented and innovative managers from outside its company. TASK 1: SWOT : A planning technique which is used for summarizing the key issues and evaluates the Strengths (S), Weaknesses (W), Opportunities (O) and Threats (T) in any business is called an SWOT analysis. Analysis is the brief study of any case how they are going to be obtained, who are responsible for causing it and solving it by planning which involves internal and external factors of a business or an organization; internal factors are classified as strengths(S) or weaknesses (W) and external factors are classified as Opportunities (O) or Threats (T). Strengths are those characteristics of a person or a company that are useful to achieve the goals. Weaknesses are the characteristics of a person or a company that is destructive to achieve the objective. Opportunities and threats are the external factors that are helpful in achieving and damaging the business performance respectively. ? Figure1: Illustrative diagram of SWOT Analysis https://en.wikipedia.org/wiki/SWOT_analysis The figure1 show the illustrative diagram of SWOT analysis. The internal factors include personal, finance, manufacturing capabilities, etc and the external factors may include technological changes which may cause changes in products and processes that is inventing a new product or making the product better which include quality of the product and the consumer desire, market influences due to unemployment rates effect the company and price factors is one of the important thing to keep in mind , market place is one more thing which is very important that is the company or a business should be located in a convenient environment to the consumers to attract and the product should be user friendly. Another important factor is that its external appearance the packing and the name of the products should be eye catchy. At last he customer relations should be friendly and consumer satisfaction is ve ry necessary. Other than these there are some more factors which may be changing due to economic and social factors and competitive positions which may create new opportunities or threats. SWOT analysis is useful in decision making when most wanted these include nonprofit organizations, individuals. It is the only method for classification and has its own weaknesses. A SWOT which produces no strategies is of no use whereas which generates important strategies is useful. Unilever had a very tough competition during that time when it was bringing about the changes it was probably at this stage that these companies had moved forward with there various strategies. Skills, assets, finance, facilities are the resources which are used in any business to compete in the industry. In the same way Unilever used their own resources to grow as giant company. They have implemented SWOT analysis and implemented new business strategies and rejuvenated their company from lack lust to significant progress in sales. It has concentrated on marketing and advertising its business and gained increased pricing with supermarket vendors. Unilever was lagging in sales when compared with nestle, Procter Gamble, Kelloggs etc its path of growth strategy which met considerable uncertainty which made Unilever to undertake a series of actions by cutting the companies profile to reach corporate goals and introduced 20 new acquisitions worldwide and restructured the company into two divisions one includes all food products and other household and personal care. Then started other two new businesses across the world. The external market factors such as technological changes, social factors, and other companies growth made a very big impact on the consumer preferences and Unilever had to cut its revenue growth. Later it continued to obtain more products across the world and these products gave managers to make their own decision making to set priorities by introducing new initiatives. Unilever has even motivated and attracted young talented managers from outside the company to join their company. According to Unilevers SWOT analysis the strengths of the company are recognized as it is a global company with strong brand profile with worlds best brands and maintains strong relation with its retailers. But coming to its weaknesses it has insufficient management of brands and doesnt not connect with customers. And inability to maximize acquisitions has reduced spending for R D. Thought it has got many opportunities by introducing many products by changing customer preferences and increase in productio n of quality goods. There are threats equally which cause decrease in revenues with high market competition, increasing the number brands and exchange rates. There are many growth expectations, risks, profit margins in food and house hold industry which is composed of many sectors and sub sectors by challenging the change of customers preferences with challenging rival firms to gain market shares. Then with competitive achievement by creating attractive products through acquisitions and with capability of growing sales of the brands which existed and improve margins. For all this the many key to success was advertising the products. By improving the profits of the company not only included shifting sales of the products but also boosting efficiency and unit costs. There were three factors which worried in 2000, the consolidation pressures in food industry which bothered were slower growth rates in food industries, rapid consolidation among grocery markets that is between branded manufactures and private manufactures for good self space in the grocery stores. In the United States for several years the food industry was miserable and was expected to continue for few more years due to more women working and decreasing house hold sizes, single parents and singles. But the food industry in Europe, Asia, Africa and other less developed countries were attractive. Thought the competition between branded and private manufactures was a never ending issue, private manufactures improved their quality of products by growing market shares. Then there came many giant super markets and gave an opportunity for private brands with attractive prices below branded products and even provided checkout scanners to help the customers know price difference which tempt them to BRIEF SWOT ANALYSIS OF UNILEVERS CASE STUDY STRENGHTS WEAKNESSESS Global company. Reduced spending for R D. Best Brands. Inability to maximize acquisitions. Strong relation with retailers. Insufficient management of brands. Dual Leadership. OPPURTUNITIES THREATS Increasing in need of quality products. Decrease in revenues. Changing customer preferences. Strong competition. Increase in brands. shift to the private brands. Due to the heavy competition among them manufactures had to cut down the costs of the products, number of versions of the products and weed out weak brands and concentrate on those brands which were popular among the customers and those could develop into global brands. Introducing dual headquarters by dividing the food industry which consisted of 6 categories and household industry which consisted of 8 categories there were many benefits such as improving food and household industry by focusing more on them regionally and globally. Accelerating decision making and successful integration of R D though there were some critics that Unilever has been paying more for some of its acquisitions such as acquire Amora Maille. Unilever as of then in 2003 had been seen as a growing organization which probably had all the necessary requirements to make it a force to recon with, during the Path to Growth strategy many aspects of the company had come out some of them included the strengths, weaknesses, opportunities and threats. Strengths, probably the biggest strength that the company had at that time was the correct selection of the brands and the products it had in store unilever had done many researches and had to make many decisions to get the right combinations products that where to be sold it also had the right ideas to increase the sales and all the leading brands to help its cause. Unilever was very good at that time even if the financial aspect was taken into consideration it could experiment with various aspects of its store cause had the financial backup which was required at that time to help it implement various ideas and deal with the market pressures, for any company to improve its sales marke ting always plays a very important role this was probably there biggest strength as the marketing strategy applied by them managed to grab peoples attention as they easy to be connected to and much more simplistic and realistic. Unilever did manage all its clients very well considering that during a phase when they where cutting on the brands it would have been a risk to out anything at that time but it was very well managed by the company. Mainly the fact that unilever was now looking to make the higher range or the brands which where more famous as there core brands which made it much easier for them to advertise considering that it is much easier to promote a very well known and a trusted brand rather than a normal or new brand to increase the sales. Weaknesses, though unilever had a very good policy and all the right objectives to make a difference in the industry it couldnt happen basically due to the lack of proper organization, it was actually much like a bureaucratic organization where things where divided between too many people and it had become difficult to get the ideas moving due to the lack of proper organization, it probably all started with the fact that the company had to deal with too many brands in the first place it would obviously have the impact when the Path to Growth strategy came up cause of the then 1600 brands only 400 brands where retained and rest all where either removed or replaced, that shows that due the lack of proper organization and too many brands being part of it didnt help it in making the changes it wanted to in a better and quickest way. The organization was probably one field in which the company was lacking because it was felt that at the top of the company as there were too many people mak ing decisions and these decisions had to be put forward and this delayed the process of improvement for the company. Opportunities, during this phase of development and renewing it content and upgrading of the stock it turned out to be very fruitful as it provided many working opportunities for people it was at that time that many people where starting to get full time work, during this phase a lot of acquisition also took place with the major brands which resulted in some alterations in plans to that which were planned. SlimFast which is a private company is another acquisition of Unilever after implementing path to growth strategy in 2000 the company bargained an agreement to purchase slimfast diet foods. It had strong sales and network and has a special space in every super market and drugstores these products were made from natural ingredients and added vitamins and minerals to provide good nutritional profile. It also maintained a very good relationship with Food and Drug Administration (FDA) and other agencies. Unilever has concentrated more on this Slimfast since the company was growing fast and attracted the customers to buy more of it for healthier and long living life .Management of Unilever utilized the opportunity to globalize the product in other countries like Europe, Australia due to increase in the percent of obese. According to the world health organization percent of the obese was increasing gradually. UNILEVERS TOP COMPETITORS ? Figure: Competitors Performance Comparison https://finance.aol.com/company/unilever-plc-amer/ul/nys/top-competitors Ben Jerrys acquisitions which produces one of the finest ice creams anywhere in pint cartons and wholesale at groceries. Their sales slogan was Vermont finest All Natural Ice cream. They never use any artificial flavors thought the cost is little more it is worth the price. According to the time magazine Vermont makes the best ice cream in the world with 29 flavors in pint cartons and 45 flavors in bulk cartons. There products were distributed throughout the world. On demand Ben jerry operated three manufacturing plants where Vermont plant produces super premier ice cream and frozen yogurts where as spring field produces ice cream, lot fat ice creams in bulk, pint cartons and half gallons. Dreyers and Haagen-Dazs were the two major competitors of Ben jerry and other competitors were Colombo frozen yogurts, Kemps ice cream and star bucks. Ben Jerry produces a wide range of ice creams products like sticks, bars, frozen yogurt pops etc. Though Haagen- Dazs was the global market leader followed by Ben jerry it had an insignificant market share in United States where as Haagen- Dazs was more significantly sold in foreign markets. Both Ben jerry and Haagen-Dazs produced ice creams with cookies and candies in it. Bestfoods was a global company across the world almost in 60 countries which was busy in manufacturing and marketing the food products. Bestfoods profits are almost from outside of the United States that is almost 60 percent of its profits. It is one of the best managed food companies among United States who has much number of employees working with in their company in which half of them were at non US locations. The company increased payments for 14 successive years has its revenues grow by7.8 percent annual rate and suddenly slow downed during the period of 1997 and 1999. Then the company introduced a strategy with four core elements. Globalization of the companys core consumers: Products which are new in the market are needed to be globalized that is the products which are less popular among the consumers, are needed to be advertised and market those products to increase its sales and profits of those products. Few such products are knorr product line, salad dressing and food service operations. The advertising of such kind of products was done very well in order to get those products globally recognized and be accepted among many big brands and soon they became household names. Improvement in cost effectiveness: With changing customer preference the quality of the products must be improved and therefore there should also be improvement in cost effectiveness as the quality improves cost increases. Cost effectiveness is nothing but it is a way by which you show to a customer that a certain is product is worth using or is better than other product or the money u spend on it is worth it. Cost effectiveness in simple would be defined as showing the worth of the product. Looking for new market opportunities: Extending the product sales all over the world via new product introductions and extending sales of the products which are existed in the market. It is very important for any company to be always alert and look for opportunities to extend the business to a large scale and see it in a bigger picture based on the opportunities it gets. Using free cash to make new acquisition: With expanding the products and brands company has created 60 acquisitions in the global market. After struggling a lot in June 2000 best foods agreed to be acquired by Unilever. Best foods were the largest acquisition undertaken by Unilever by as far as concerned and which makes a largest combination of food companies in 12 years. Management of Unilever believed that combining and assimilating bestfoods would result in pre tax cost saving, better efficiencies in business process, synergy in distribution marketing, reformation of general and administrative functions and improved economies of scale. By creating robust business in United States market, increasing strengths of Unilever and best foods in Europe, building of best foods in Latin America to speed up the growth of Unilever brands, by distributing strengths in Asia- pacific to grow and sped up Bestfoods brands and increasing the sales of Unilever products by food service channel of Bestfoods. The work culture was so casual to make the atmosphere fun and lively with communication between the management and employees. The company respected the employees suggestions and respected them even paid the employees a reasonable salary Finally Unilever has announced sale of Bestfoods Backing Company to Canadian food and super market group known as George Weston for $ 1.76billion though Unilever declared to divest Bestfoods Baking Company and Unilever other products and bakery products does not exit any more at Unilever. Bestfoods has 19plans across the United States with a strong management team and was entirely US based. It was one of the best distributing for delivering the baked products which are really baked fresh and sent directly to the retail stores. With its dedication and hard work Bestfoods sales has increased its profit margins by 8 percent. Later again Unilever announced to sell 19 Bestfood brands across North America to ACH food companies which is a supplementary of Associated British Food. By successfully combining the operations of bestfoods with Unilever by the year end of 2003 the two companies had been merged in 63countries across the world TASK 2: Path to Growth: Path to growth strategy was initiated in 2000 and was restructured for several years for better and significant results. The key elements of this Unilevers path to growth strategy were cutting down its brands from 1600 brands to 400core brands to achieve top line sales and increase profits by advertising the brands which are more popular and leading brands across the world and concentrating on R D. Another important key element was divesting underperforming brands and theirs companies and introducing more innovated things to enhance the internal development of the organization and making new acquisitions. Unilevers years of slow performance and its lack of corporate strategy in the competition industry with low number of brands and ordinary performance in growing markets with a little global presence made to create a path to growth strategy which was a 5 year growth plan which made them to concentrate on more brands and product innovations for internal and external growth of the company. And made the company to grow with acquisitions. According to FitzGerald and Bergmans path to growth strategy they predicted to manufacture double digit wages per share growth and superior positions. Focusing on the key brands by advertising and marketing made business grow higher and build brand value and increased brands prices. The case study shows Unilever as a global company according to SOWT analysis after introducing the path to growth strategy the company had really increased its sales and with introducing more number of acquisitions and cutting down the cost of revenues. As the acquisitions like Slimfast, Ben jerry and best foods were rapidly growing their market across the world building a very strong profile and providing customers attractive products and offers. Slim fast has 20%anual growth rate with strong sales and distribution all over the world and also maintained good customer relation. Where Ben jerry was worlds giant ice cream products and yogurt maker with strong brand equity. Bestfoods was USs 10 largest foo d products company with a strong global position. The two key elements of the Unilevers new business strategy was to cut down on the number of brands that were being sold or being marketed by the company, at that time Unilever was operating with as many as 1600 brands and much more products due to this the cut down on the number of products and brands was considered, the 1600 brands that where part of the company were cut down to as many as 400 core brands, the core brands mostly included all the famous and popular brands which are generally very popular among people, this idea came up as to make sure that the products where sold and by doing this it would not be much of a problem for the marketi8ng of these products as most of these brands where already day to day and very famous brands which people would generally prefer buying, which would mean that it would take much less an effort to connect to the people and more over the marketing was also done in such a way that people where able to connect to it very easily, the other key e lement of the unilevers strategy was to remove all the underperforming companies or brands and introduce some other new brands or companies in order to enhance the internal development of the organization and make new acquisitions which would enhance the sales of the company and make it more likable for the people this strategy was designed to increase the sales of the company and get rid of the companies which where not much in demand . Weaknesses according to SWOT analysis showed the company has dual leadership, insufficient management of brands and reduced R D after all this slow performance and small global presence the management has introduced path to growth strategy, which increased the company sales with cutting down it costs and introducing more acquisitions resulted in globalizing the company. As a result there were few expectations to achieve a double digit growth and securing a better position in global market for food and household products by increasing the quality of the product to gain pricing power and attract more customers. But according to the strategy plan the targets which were set was really high that is top line sales growth of 5-6 percent annually, increasing profits, and plan to complete by the end of 2004. If we look and analyze the path to growth strategy we can tell whether the strategy is working or not, we can say that it is working by its success rates and increase in profits and increase in brands and acquisitions that is the consumer preferences have changed due to which the products quality has changed and prices have changed the leading brands sales have increased from 75 percent to 93 percent. Food and personal care industry have increased its profits consistently. Operating assets have also improved by 9 percent. Acquisitions like slim fast, Ben jerry and best foods have gradually improved its growth and established its acquisitions all over the world. But the other side it is completely not yes, Unilever was gaining profits significantly after introducing new strategies but it was losing too yes it reported a net loss of $318M as the competitions was increasing and new brands were coming in to the market and rivals were introducing new strategies to compete Unilever. In th e year 2004 sales grew only by .4 percent leading brands by .9 percent so this proves that Unilever was lagging behind competitors in terms of innovation and advertising. Unilevers lack of advertising and marketing failed to improve sales. The company was small and not globalized. In this case Unilever attracted the new young talented manages to join their company with innovated ideas to increase its company profits by new methods of advertising and marketing. To justify Unilever strategies it maintained dual headquarters and dual chairpersons which reduced effective thinking and slow downed the decision making. Unilever is divided into Unilever Plc and Unilever NV. This made Unilever to focus on the needs of the customers and increase its sales profits in various industries like food, personal case, and household industries all over the world. As customers demand the products which are of the best quality and branded but at the same time convenient, cheap and attractive. The market for household products have been decreased its profits as the numbers of single parents have been increased and the rate of females working out have been increased and the demand for the healthy and high quality food has been increased. The consumers preference of the products such as its look, quality of the product and nutritional values has been increased by providing a strong competition against its giant competitors and private manufactures. This allows Unilever to focus on the need of its customers by increasing its sales. In 2003 Unilever executing its path to growth strategy by increasing its operating margins to over 15percent, but the sales of the leading brands growth as slowdown and raised questions among the investors and retailers that whether company brands could deliver some 5-6 percent of growth in revenues in the next coming years. TASK 3: Unilevers current business Strategies: Ever since the Path to Growth strategy ended in 2005 there has been a 15% increase in the sales and development in the overall progress of Unilever. After the Path to Growth came to an end a new process was developed by Unilever called as the Brand Imprint which helped the marketing teams in understanding how the business could face risks as well as opportunities from the social, economic and environmental issues. In this process each brand was scrutinized by a team looking into various aspects of it such as the direct as well the indirect impacts of the product, it also checked how the brand would go ahead in the future looking at the products possibilities of growth both from a customer and a stakeholders point of view. The outcome of the Brand Imprint is that the process has helped in making important decisions for the company keeping the future in perspective it also developed in addressing social missions, social and environmental issues. The Brand Imprint provided a perfect experience to find some systematic and measurable ways to explore different brands and improve the brands by addressing social issues, helping people the product well and reducing the environmental issues. When the S.W.O.T analysis was done on the Path to Growth strategy many different aspects of the strategy where scrutinized using the SWOT analysis in which it dealt with many aspects such as the strength, weakness, opportunities and the threats that are being faced. After the analysis it came out that it had been very useful to determine the various aspects attached to it. Unilever for years had been a slow developing company, though the company had the right infrastructure and the capital but it couldnt utilize it properly that was basically the reason why the path to growth and various other strategies where starting to come up to help the company to increase the sales of the products and improve the business. Path to growth played a major part in the development of the company. The Path to Growth strategy did prove to be quite a useful thing considering the fact that during this period almost all of the unsuccessful brands where removed or replaced and the brands which where trusted and kept managed to increase the sales by 75% to 93%. Unilevers growth was considerably slow during this phase because the company was at that stage making very drastic changes and for these changes to come up and make a difference was something unexpected but the companys growth was obvious in certain fields thanks to the new strategies that had come in to improve the sales of the company so as to improve the business of the company. It was due to the fact that the company probably took way too much time u started and implement its plans that it caused the success to be not as higher as expected. Many business analysts and commentators felt that most of the strategies of the path to growth where working fine but there was always a speculation that what ever progress was talking place was happening too slow considering the competition the market was in with at that time, it was also felt that as the basic functionality of the business was spread among way too many people made the management way to complex and it would have been better off if it was simpler. It did work out fine when it came to the advertising of the product and getting it known to the people as it was more public oriented and it used the sources to the full extent to connect to the people. It did experience a drastic growth during that period as the analysis had proved that the company had the highest growth percentage as compared to any other company during that period it did bring in high profits to the company but looking at the whole picture it did prove to be a huge loss for the company considering the fa ct that they faced a countable loss in the revenue margin and that proved to be the difference, though it did have the right amount of sales and customers due to the slowness of there analysis to sort out and remove or replace the stuff did make a difference to analysis in the larger picture. But the company did grow during that time which might as well have effected the revenue cause many new store where started and large number of employees where starting to be employed on a full time basis. It did do quite well on the international market as well. By looking at the way the company had grown during this stage is quite remarkable many business analysts and commentators had felt that they probably had the right scheme of action because during that time they where handling 1600 brands and which was way too much and among those were quit few brands which hardly made any diff to the company so then the whole idea of brands cut based on the market outlook and sales reports was looked into to classify as to which of the products or brands where fast selling and which had the scope to sell more. It was that idea to cut down on the number of brands and start promoting only few brands which where much easier to be marketed and which where more likable by the people by which it would increase the sales and also make the marketing of these products easier cause when you are promoting bigger brands which are often very well known to public would mean that u don have to spend much on the marketing. Did the company experience growth during this period? Yes, would be the right thing to say voiding the minor things which might effect the outcome but it did see the light of success though slowly and there process and ideas where starting to get implemented in a better way and in a more successful way to deal with the growth of the company, the process of cutting down on the under selling companies was probably the decision that started to turn the tide for the company as it was when the losses where starting to be covered and it was more like a store where the fast selling stuff was found. Unilevers Path to Growth had probably the right ideas to take the company to the highest position with its aims and objectives on the right part but probably it was at the implementation of the whole strategy that could have probably caused the difference in this strategy from just a successful strategy to a very successful state The strategy had the right plans to study the whole products and the brands which where being sold and come up with whole list of brands that where actually more likely to be sold quickly and frequently and those which where not that much preferred, it does take in a lot of effort to recognize what is selling and what people like the most as you have to be cautious that u don get any of the products that is more frequently sold off the shelf. By early 2005 there was a need for a new business strategy and a new strategy which was more active and a top down approach to managing a companys brand profile was introduced for Unilever to support this growth strategy. But the growth to strategy at the starting point was precise, tough compared to the companys profile. On the whole Unilever did manage to grow very well in the market during this period and it was for its strategies and policies and the work put into it that the whole thing was done successfully. TASK 4: Academic theories: The word diversification means a strategy for a company for its market growth. To look forward to increase its profits by increasing the sales of the products. There are four main strategic alternatives emphasizing how each strategy might change companies competitive capabilities they are Market penetration, product development, market development and diversification. ? https://en.wikipedia.org/wiki/Diversification_(marketing_strategy) Basically the four main strategic alternatives deal with the markets and the products which are based on the present position of demand and supply of the market and the position of the products. Market penetration, it is nothing but the way by which a products sales can be determined, consider there is a particular product which is generally used by everyone and is almost the same for everyone then in that case the penetration of that particular product will be deeper as its demand is much higher than other products, it can simply be told that the deeper the penetration the greater the product sales, by using the market penetration technique we can determine as to which product is currently more sort after and which one has the highest demand by doing this it will effect the business cause the demand for that product will be much higher. By using the market penetration we can come up with new marketing techniques as to increase sales of a product which is not much in demand or gain more profit on products which are in higher demand, for example lets consider a product which has not been off the shelf due to competition from other products in this case if we do the market pen etration we would know the reasons as to why the product has not been sold. Based on this if the reason for that is if the product is expensive then we can look into the market penetration and decide to cut down the price so as to match that of its competitors. There are many growth expectations, risks, profit margins in food and house hold industry which is composed of many sectors and sub sectors by challenging the change of customers preferences with challenging rival firms to gain market shares. Then with competitive achievement by creating attractive products through acquisitions and with capability of growing sales of the brands which existed and improve margins. For all this the many key to success was advertising the products. By improving the profits of the company not only included shifting sales of the products but also boosting efficiency and unit costs. Market position can also help you determine as to which products need to be stocked up the most and how these are to be managed and depending on the demand we can decide as to what can be done to increase the publicity or marketing of that particular product. Product development, it is nothing but the way at which any particular product has improved its sales or how a product has worked out is called as the product development, the product development is generally used to determine as to which product id leading at the moment so as to utilize more of it to increase the sales , in the product development if any particular product is higher in demand due to its development it can be helpful in increasing the sales of that product but where as simultaneously if there is any product which is least popular we can make efforts using this to know as to what would be the reason behind the product not being to the sales expectations. Market development, the market development strategy is nothing but a way by which we can develop our business and increase the sale of the products, it is the process of getting new customers, new products and new business to the company by making new promotions so as to increase the sales of the products and to increase new customers, market development in simple terms can be called as the process by which we wish to develop the business by getting in new customers and getting some new products to our already existing customers is the market development. The market development strategy generally deals with the non-customers who dont often come in to shop, with this market development we manage to attract the people to now come into the store and improve our business. Diversification, it is nothing but the spreading of the investments among the company in order to increase the business, diversification is a means of way by which the market penetration can be improved, in the diversification looking at the market conditions the company invests in various fields so as to make the product develop by which the product will get more penetration, if the product gets more penetration that means it will increase the business to the company. On the whole diversification is a corporate technology by using which they generally tend to woo the customers to make the decision and increase the market penetration. All the four strategies have there own importance in improving the business the market penetration is the basic thing which helps the company in building up a product which would become a money spinner for companies, the market penetration process helps in finding the right product that is in demand and the right ways by which a normal product can be in creased is called market penetration. Similarly, product development is a way by which we can determine as to what is the actual position of a particular product in the market and so as to what needs to be done for the development of that product is called as the product development. Market development is similar to product development in which we check as to what needs to be done so as to improve the sales and customers in the company. While diversification is probably the main source that holds all of these together, by using the diversification a product can be made to increase its market penetration, diversification involves the spreading of investments among the various other aspects in business so as to improve and let other products grow so as to improve the market penetration. Diversification is something which holds all the four alternative strategies together and diversification is more like an influencing factor on these for the products to be judged in the market and vi ce versa. Unilever in order to improve the sales has few strategies which are influenced by the strategic alternatives, in the unilevers method to increase the growth the number of brands that where being promoted or sold had to be cut down from 1600 to just 400 core brands which could be done with the help of the market penetration, by using the market penetration and looking at the market penetration of the various brands in the company it would help out in which brands had the highest penetration in the market and which had the least penetration in the market, so that the brands with the least penetration where removed from the company. Market penetration makes the whole task of choosing the brands which had to stay and the brands which where to be removed by having a look at the brands penetration. Similarly in the aspect of divesting the underperforming companies the strategic alternative comes into play where the product development is taken into consideration, in this a if a particular product or brand is not having a high market penetration then it is said that it is looked after to see the product development of the product so as to check if the product would help in the internal development of the company. The overall picture was of business strengths and weaknesses too much wastage of money and many better opportunities to align resources behind building the brand profile for the future. However the food products were also globalized with slower growing market. Unilevers expectations were to achieve double digit growth and secure a better position in the global market by building a brand value with increase in sales by diversifying that is creating more number of acquisitions across the world and making the products which are local in a market globally according to the change of customer preference. And making the company with dual chairperson and dual headquarters this made Unilever a more successful in the competitive industry while it is easy to manage the company and make decisions very quickly and effectively. Changing customer preferences that is according to the four business strategies product development need to be modified or a new product need to invented it is better to ch ange and improve the quality of a product which is already existing rather than inventing a new product. As the number of women working out has increased gradually and single parents have increased and heir became a decrease in household products and rapid consolidation among retailers has made food industry miserable. Whether the theory is supported by practice: Yes the theory of these strategic alternatives is very much accepted and supported by practice, all the four strategic alternatives that ate used for the companys capabilities are generally accepted and supported by practice, it is very well known that the four strategic alternatives are market penetration, product development, market development and diversification. These are the four strategic alternatives which are generally supported by practice because when implementing the actual strategies of unilever these alternative strategies do come into being used and help in the successful implementation of those ideas. The, market penetration, product development, market development and diversification are the generally used ways of judging a product and its current performance and in requirements in the market, these help in judging and making various promotions to these products. Probably among all the four strategic alternatives the market penetration is the one which is more frequently come across as it basically deals with finding the products which currently have the highest sales and vice versa it is very well known that for any product deeper the penetration higher the demand for the product so this strategy is almost applied regularly. References https://en.wikipedia.org/wiki/Unilever https://www.planware.org/strategicplan.htm https://finance.aol.com/company/unilever-plc-amer/ul/nys/top-competitors https://en.wikipedia.org/wiki/SWOT_analysis https://extension.psu.edu/NWRegion/comm/marketfactors.htm Crafting and Executing Strategy By Jr. Thompson, Arthur A, A. J. Strickland, III, A. J. Strickland III, John E Gamble https://books.google.com/books?id=D35W13gPIpACpg=PP1dq=Crafting+and+Executing+Strategyei=oddsSpuSK5iwMteE-IACclient=firefox-a

My First Day At Work - 868 Words

Nursing Home My first day at work was stressful and I was very saddened that I couldn t do much to help. I was placed to work on the long term care side of the nursing home and was told everyone down this hall is a two-person care. I didn t expect to see most of them in really bad health and the other C.N.A workers just went about and worked like nothing was wrong, but it was so hard to see people who couldn t move much and you could tell they were trying so hard to talk and try moving. This eventful day changed my life I thought I wasn t going to be able to work here until I was washing an old man’s back and he started crying as I stopped, I took a step back and asked if I had hurt him he said â€Å"no I’m sorry it’s just no one has every touched my back since my wife had passed† as I realized how important I can make these people I felt it as a privilege to be able to help at them a their most vulnerable point in life. My family, my two jobs, and career goals are the factors that have shaped me into the caring person I am today and has gotten me to where I am today. My family has always been so supportive and I am lucky to have all my loved ones near me. I always want to please my family in any way possible so as soon as my grandma asked what I wanted to do with my life I explained â€Å"I really don’t know† this is when she said she wanted me to be a nurse and take care of her. Since I am already taking care of her by feeding her at certain times and checking her sugar andShow MoreRelatedMy First Day Of Work1424 Words   |  6 PagesCorp and I am honored to write this memo to you on my first day of work. I am excited and looking forward to working with all the talented and dedicated people, who are comitted to achieving our organization’s ultimate goal of promoting transparency and accountability in government entities across the nation. I will actively seek your input as we take our organization forward. As your new leader, I would like to take this moment to share my first thoughts and views on our organization. Three pointsRead MoreMy First Day Of Work Essay2132 Words   |  9 Pagesjust a couple of days after applying. Before going into my first day of work, I memorized the company’s website, trying to gather as much information as I could from it. I was excited to learn that the development department was female lead and, according to the website, composed of mostly women. In fact, the majority of the leadership positions at the company were occupied by women. Both my family and I were happy and pleasantly surprised that I would be getting the opportunity to work in such a rareRead MoreMy First Day Of Work At The Twin Towers1139 Words   |  5 PagesKaty, my best friend, as we walked along the industrialized streets of New York. â€Å"We can’t be late for our first day of work!† I continued to yammer. I might have been a bit annoying, but I had a reason to rush her. It was our first day of work at the Twin Towers. I was so excited! Plus, my dear husband worked in th e same building. Well not quite, he worked on the seventy-seventh floor, while I worked on the first floor. Everything was as I imagined it would be. I was a waitress in 2001, but my goalRead MoreMy First Day at Work - Personal Narrative Essay946 Words   |  4 Pages12 February 2013 My First Day at Work When I was a kid, I couldn’t wait until I was old enough to get a job. Sure, it would be a good way to make friends and learn how to prepare myself for the real world, but for me, it was mostly about making my own money. Having to ask my parents for cash every time I needed some annoyed me, mostly because they’d always say no. Every time they did, I would always whine and complain about how different things would be when I had money of my own, how I would neverRead MoreIt’S Been About Four Years Since My First Day Of Work At1249 Words   |  5 PagesIt’s been about four years since my first day of work at the white house. Well technically, my work for the white house started just out of college, when I got my first job as a desk jockey at the Federal Bureau of Investigation. I was working in the cyber security branch wasting my days trying to follow the money trails of billionaires who’d move their money back and forth from offshore accounts. You w ould think the FBI would be some sort of billion-dollar operation filled with machine guns, drugRead MoreMy First Day732 Words   |  3 PagesSunday, June 25, 2017, was a special day for me when I stepped into a different world, or I would say the real world. I started first of my job at Ross. I had never felt very different before. I felt like a grown teenager, not the one who used to act like a kid and be rude to others. I had significant changes from that day on as if I was in a different world and I became a whole new person. I would really like to share how it’s a special day for me and how I felt a different world. I woke thatRead MoreThe Process Of Improving Time Management1198 Words   |  5 PagesImproving Time Management The goal of my personal development project was to better my time management and to see if I could implement a good schedule before the end of term. I chose this goal because of the hectic lifestyle I have. At the beginning of this project, I was playing soccer at a competitive level for which I have to train five times a week. I was also working part time. During the beginning of term, I was not satisfied with the quality of work I was producing for homework and oftenRead MoreWork Experience Essay1120 Words   |  5 PagesWork Experience Between June 30th to July 14th, I had the most nervous and prominent moment of my life, I went to work for the first time of my 15 years life. I felt exciting fervent and passionate, after a scrutinisingRead MoreGet This Job Essay730 Words   |  3 Pagesworked in my life and now I am at that point in life whereby I have bills to settle meaning it is time to get a job and act like the adult that I am supposed to be. Applying for a job is not the easiest thing to do and the process can be demotivating especially in the beginning. The first thing to do is type out a basic CV and it should not be untruthful. I typed out my CV and I mentioned that I have never had a job, and I am looking to acquire skills from this job. I listed my skills and my ability

A First Person Narrative of Major Depression Disorder

First Person Narrative Major Depression Disorder (MDD) My name is (student name) and I am 29 years old, living with my spouse in a rented place and working in a Bank as a relationship executive. We knew each other very well before getting married and used to see each other in college. We got married about two years back and my wife immediately wanted kids but we have not yet conceived although the doctor says everything is normal. I think it all started when I was a little boy, when my dad deserted us for a younger woman leaving us vulnerable and financially weakened. I started to hate my dad and looked up to my working mother who was raising us as well as doing two day jobs. I am the eldest son with three siblings, a brother and two sisters. My Mother did a lot for us but the stress of work and raising us got to her and with time she became ultra self righteous, controlling and demanding (Becker et al., 2008). I started working from the age of 18 in a restaurant as a waiter and used to help my mom in running finances of the house and well being of siblings. I met my spouse in college and brought her home to meet my mother; Mother disliked her without many reasons and wanted me to leave her or leave her house immediately. I stayed with my mother for the next six months but later on I got married to the same girl and moved out. This action enraged my mother saying that she didnt want to see my face and that I should not be present at her funeral. To make sureShow MoreRelatedAnalysis Of Aaron Beck s Cognitive Behavioral Therapy Essay1348 Words   |  6 Pagesself talk. According to Seligman and Reichenburg (2014), â€Å"cognitive-behavioral therapy is not one approach, but a term applied to a coherent model that is open to and integrates new empirical findings about a pathological disorder into a new model of treatment for that disorder (344)†. Cognitive behavioral therapy (CBT) is structured and directive, relying heavily on the cognitive tools of psychoeducation, Socratic questioning, and inductive method. CBT interprets personality development as a processRead MoreTherapy Had Stronger Effects Than Ipt And Miscellaneous Interventions1587 Words   |  7 Pagescomorbidity and the type of control group† (Pinquart, Duberstein, Lyness 2007 p. 654). Another fact I found in the study was that, the patients with lower level depression are likely beneficiaries of therapy induced increase in abilities to manage the pressures in which contribute or exacerbate the severances of the mood disorders. With this said, â€Å"Nonetheless, the avail able data suggest that cognitive and or behavioral treatments are more effective than physical exercise, IPT and miscellaneousRead MoreThe Displacement Of Persons1330 Words   |  6 PagesThe displacement of persons, better known as refugees, is an inescapable and persistent issue in our global world. Current reports estimate that there are 19.5 million refugees worldwide (â€Å"UNHCR† 2014). Among this estimation 2.59 million, or a little over 13% of the refugees in the world are from Afghanistan (â€Å"UNHCR† 2014). Afghanistan is entering into its fourth decade of war, beginning with the 1979 Afghan-Soviet war to recent violence involving Al-Qaida and U.S. military forces. During thisRead MoreThe Issue Of Bipolar Disorder755 Words   |  4 Pagesarticles in which my reaction will be based upon are: Definitional Issues in Bipolar Disorder Across the Life Cycle (Youngstrom 2009) and Advancing Research in Early-Onset Bipolar-Barriers and Suggestions (Carlson 200 9). These two articles both had in common a specific implication of a particular issue. The main issue that caught my attention is the controversy of a doctors ability to diagnose a child with bipolar disorder. Many years ago diagnosing a child as bipolar was a rare and almost an unseen eventRead MoreComparison of 4 Major Psychological Disorders3058 Words   |  13 PagesCOMPARISON OF MAJOR PSYCHOLOGICAL DISORDERS The Oxford dictionary defines psychology as Science of the nature, function and phenomena of human soul or mind: mental characteristics. (1980). The normal mental characteristics of the human mind are very difficult to categorize; so when looking at the disorders of the mind a number of factors have been identified that attempt to define (Meteyard, 2007, p. 49) what is abnormal or psychopathological. For this assignment I will be looking at fourRead MoreTrauma Case Study : Trauma Case839 Words   |  4 Pageshowever, ongoing and periodical developmental, physical, and psychological assessment is recommended by the multi-disciplinary team. Grandmother (caregiver) Diagnosis and treatment plan include a DSM-IV Axis I 296.32 Major Depressive Disorder, moderate, to address major depression, Axis 1 V61.20 Parent-Child Relational Problem, Axis I 305.1 Nicotine Dependence, Axis IV relational issues to address problems in male partner relationship. At the request of the client, a Native Healer from her TribeRead MoreIndigenous Australian s Impact On Mental Health And Social And Emotional Wellbeing1407 Words   |  6 Pages2008). It is known that their life expectancy is seventeen years less than other Australians. The aim of this assignment is to do a biography of an Indigenous person as a representative of a specific Indigenous health topic. It is about putting the face to facts and telling a story that comes with the statistics. This biographical narrative will share the journey of a Stolen Generation survivor embarked on, tracing their family members. It will highlight the traumatic effects associated with the separationRead MoreNarrative And Cognitive Behavioral Therapies ( Cbt )2433 Words   |  10 Pagessessions I have had this year revolved around Narrative and Cognitive Behavioral Therapies (CBT). When I am meeting with a client my first approach is to always listen to the clients and then from what they tell me, decide which direction I want to precede. At my field placement at Belmont Behavioral Hospital this year, most of the clients I have come into contact with have either had deaths in their family, or been diagnosed with bipolar disorder, depression, or other diagnoses that inv olve some kindRead MoreBenefits Of Social Support For Stress952 Words   |  4 Pages Introduction During the university/college years, students face stress in many aspects of their life. Students feel an immense stress in first year where the settling process occurs and a high need for good, and quick adjustment. Therefore, coping with stress is vital in this period and as Çivitci (2015) suggested, social support is an important coping strategy to utilise. Social support, whether perceived or actual, has a vital role in coping with stress, physical and psychological well-beingRead MoreNarrative Therpay2610 Words   |  11 PagesRunning Head: Narrative Therapy Narrative Therapy Research Paper Israel Escobar Theories in Counseling Families and Individuals Narrative Therapy Since the field of modern psychology is extremely broad, there are literally dozens if not hundreds

Med-Surg Success a Course Review Applying Critical Thinking Free Essays

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. We will write a custom essay sample on Med-Surg Success a Course Review Applying Critical Thinking or any similar topic only for you Order Now 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 Development 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 administering 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 gradua ted 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 us 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 System iframe class="wp-embedded-content" sandbox="allow-scripts" security="restricted" style="position: absolute; clip: rect(1px, 1px, 1px, 1px);" src="https://phdessay.com/the-cardiovascular-system-intrinsic-conduction-system/embed/#?secret=3SbVOjJ1mj" data-secret="3SbVOjJ1mj" width="500" height="282" title="#8220;The Cardiovascular System#8221; #8212; Free Essays - PhDessay.com" frameborder="0" marginwidth="0" marginheight="0" scrolling="no"/iframe They 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 friends, 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 Reviewers Freda 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 Assistant 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, APR N, 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 Nurse 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 UNDERSTANDING 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 COMPREHENSIVE 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 Atheros clerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 COMPREHENSIVE 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 Hepati tis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 42 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 C OMPREHENSIVE 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 contains the usual prac tice 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 divide d 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 the 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 Interventions: (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-information 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 highlighting 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 material 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 t hat 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 information 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? rmation 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 Taking UNDERSTANDING 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 called 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 cognit ive 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 concerning 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 for each option. â € ¢ 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 focused 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 QUESTIONS Cerebrovascular 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 (rt-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 fema le. 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 clie nt 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 diagno sed 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 respirations, 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 the 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 pri ority? 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 three (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. 22. 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. Perform 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 w orthless—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 de partment 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 How to cite Med-Surg Success a Course Review Applying Critical Thinking, Papers

Entrepreneurship and Marketing Microsoft

Question: Describe aboyt Microsoft. Analyse their entrepreneurial journey, from the conception of the initial idea through to start-up growth. Discuss, with examples, whether or not your analysis supports Burns assertion? Answer: Introduction The assignment focus on the effective leadership skills followed by Bill Gates the founder of the Microsoft. Through this work his character traits and his journey has been presented in this work. Qualified leader are ones who work hard and willingly help the followers in the company. The personal traits are required for launching the business successfully without increasing the cost for the production. But the question arises of what are the characteristics? The role of the entrepreneur plays a key role in the business expansion and development. The character of the leaders is exclusive and distinct, which makes them exclusive. Bill Gates was a dedicated leader with foresighted vision and objectives. It is often said that both the managers and entrepreneurs are born and made. They do have the personal traits and they do bear with it and they are also defined by their history and the experiences that they have. Bill Gates believed in rendering the best possible services to the client s and thus worked on the team efforts. Character traits of an individual to the success of a business Bill Gates was interested in developing different software which could be used for the business development. The leader through the leadership skill encouraged the members to do the right thing at the right manner. Through communication skills the leader interacted with the members of the team. This helped in analyzing the challenges and handling the problem that existed at the workplace. The issue of the character traits of an individual with the success of the business and picking of the winners are the need to be approached with the caution. It is possible, to identify the personal traits of an entrepreneur, is not possible for them to make the link with the sort of the business that they need for. There are three types of traits possessed by Bill Gates Firstly, Bill Gates is known well as risk bearer which enabled him to improve the performance of the team members. Gates had signed the contract to write software in basic and other languages for IBM personal computers. Through effective strategies the program was developed and informed to the staffs. Secondly, he believed that vision is important and he was a great convincer. He easily convinced that internet phenomenon is unbelievable and the most amazing thing that happened in the computing scenario. Through vision the leader encouraged the team members to work towards the goal that has been decided by the company. The objectives of the company have been to render the best possible services to the clients. For this, the challenges involved at the workplace were analyzed. Through this process, an attempt was made to solve the issue and introduce better strategies for improving the productivity. Thirdly, Bill Gates was innovative in nature along with his philanthropy style where he drives interest and passion in the largest private foundation to improve the global learning and health. Gates introduced different types of innovative products through which the needs and preferences of the customers were handled in an effective manner. For this, the opportunities with the operational activities were analyzed. Through this method, an attempt was made to develop and introduced with the company. When the entrepreneur might manage the business belonging to someone else, then he has to look over the mater as the respect of for at least a time. Similar, in the case of the owner manager, how will find the growth business and it is quite by the accident. Success and failure of the business comes in the mix of the different things where the character traits are one of the equations that are considered here. It takes a time for the managers and entrepreneurs to show that there is managed the business with the growth rate. There has been made much of the researches in the owner manager and entrepreneurs and they would not have been more successful. Picking winners-needs to be approached with caution To pick the winners, there are number of the methodological problems that deal with the attempt to measure the personality characteristics and it includes that they are not at all stable and they require the subjective type of the judgments. Bill Gates worked towards promoting the better working staffs, through which the challenging tasks at the workplace could be easily handled. It is also believe that the managers have certain typical character traits and the emphasis is made on these characteristics. Picking winners requires being more innovative that is to say, that they must have the ability it spot opportunities and to innovate the things. Innovation is the prime tool that is sued by the entrepreneur to create or exploit the opportunity and it is the most important characteristics traits that will set apart the entrepreneurs from the owner managers. They need to be more kind of the self-confident and one need to be more confident in the judgment of their own and they most have the ability to startup their own business. It is to be approached with the caution because even the slightest lack will make these characteristics of no use. Some of the researchers also believe that entrepreneurs have to look down the delusional one. The decision making process of 124 entrepreneurs was researched where it was found that entrepreneurs were more prone to the delusi on and opportunism and such like. Entrepreneur and their long journey Bill gates, as an entrepreneur never invented any new kind of the technology and Microsoft earliest beginnings was that he always known as the master of the technology and adapting to the specific market and also he made the dominating of the nature market with the innovative programs it was he who also astute the business skills. He also has said that success comes to him with partnership. In December, 1974, Gates fried and also the tech enthusiast showed him the magazine where it was about the worlds first microcomputer and sensing the opportunity there was also they have told the president for the company that they have the popular language basic for the Altair. In gates garage in Arizona, both started working on it. When Gates learned that IBM was looking for the new personal computer s and then he bought the existing operating system and developed the MS-DOS and licensed it to the IBM. It was also the fact that IBM created the mass market. This way the Microsoft came in existenc e and from startup business to till now, it has been emerging a lot with all the way. Analysis supports Burns association According to Burn, what is more expected of the character traits is that they have the difference between that of the owner manager, manger and the entrepreneur and in the above mentioned case where Bill Gates had made start up business and prior to this he had made the various attempts of the successful manager, shows his insight view on how to develop the good quality of the computers. Gates possess very little master of the universe and focus on the scale of the wealth. His social ambitions are modest. Gates believed in improving the team work, and the challenges involved were analyzed in the right manner. Creating a new venture and successful entrepreneurship To create the new venture, there is a need of innovation, self-confidence, reliability, character traits and motivation factors that are very important because with these factors, the managers or the entrepreneurs will be able to decide the good and bad for their company, it is always advised to the entrepreneurs that while running different kind of the sources and companies, they are always in the need required to have faith and self-confidence that plays an essential role. Conclusion In conclusion, it is said that the personal attributes and the character traits are the most important parameters where the operating skills are needed. To run the successful business, what is most required are these two. When you do not have the skills of the carpenter, then you cant be the carpenter and without skills you cannot make it. The smaller is the business, and then one needs to be all-rounder. References Acs, Zoltan J.Entrepreneurship (what's the big deal) and the Macroeconomy in the 21st Century, Understanding Entrepreneurship: Issues and Numbers(130KB, 14 pages). Paris:OECD, 2005. Acs, Zoltan J. "How is Entrepreneurship Good for Economic Growth?"Innovations, 1.1. 2006. pp. 97107. Ahmad, Nadim and Anders Hoffman.A Framework for Addressing and Measuring Entrepreneurship(546KB, 31 pages). Paris:OECD, 2007. Australian Bureau of Statistics.Characteristics of Australian Exporters, 200708. Canberra: Australian Bureau of Statistics, 2009. Baumol, William. "Entrepreneurship: Productive, Unproductive and Destructive."Journal of Political Economy, 98.5. 1990. pp. 893921. Bruce, Doug.SMESuccession: Update. Toronto: Canadian Federation of Independent Business. 2006. Competition Policy Review Panel.Compete to Win: Final Report June 2008. Ottawa: Industry Canada, 2008. Council of Canadian Academies,Innovation and Business Strategy: Why Canada Falls Short? The Expert Panel on Business Innovation. April 2009. Drucker, Peter.Entrepreneurship and Innovation: Practice and Principles. Collins, 1993. Dunn, Thomas and Douglas Holtz-Eakin. "Financial Capital, Human Capital, and the Transition to Self- Employment: Evidence from Intergenerational Links."Journal of Labor Economics, 18.2. 2000. pp. 287305. Fraser, Stuart.Finance for Small and Medium-Sized Enterprises: A Report on the 2004 UK Survey ofSMEFinances. University of Warwick, 2005. Gartner, William, B. " à ¢Ã¢â€š ¬Ã¢â‚¬ ºWho is an entrepreneur?' is the wrong question."American Journal of Small Business, 12.4. 1988. pp. 1132. Gimeno, Javier, Timothy, B. Folta, Arnold, C. Cooper, and Carolyn Y. Woo. "Survival of the Fittest? Entrepreneurial Human Capital and the Persistence of Under-Performing Firms."Administrative Science Quarterly, 42.4. 1997. pp. 750783. Halabisky, David.Exporting Matters: Job Creation Performance of Exporters, 19932002,Further Results from the Growth Firms Project. Ottawa: Industry Canada. 2005. Industry Canada.Key Small Business Statistics. Ottawa: Industry Canada, 2009. National Agency for Enterprise and Construction.Entrepreneurship Index 2006: Entrepreneurship Conditions in Denmark. Copenhagen: Danish Enterprise and Construction Authority, 2006. OECD.Measuring Entrepreneurship: A digest of indicators. Paris:OECD-Eurostat Entrepreneurship Indicators Programme. 2008. Parsley, Chris, and David Halabisky.Profile of Growth Firms: A Summary of Industry Canada Research. Ottawa: Industry Canada. 2008. Statistics Canada.Labour Force Survey. Ottawa: Statistics Canada, 2008. [Extracted on July 10, 2009] Statistics Canada.Survey on Financing of Small and Medium Enterprises, 2004. Ottawa: Statistics Canada, 2005. Statistics Canada.Survey on Financing of Small and Medium Enterprises, 2007. Ottawa: Statistics Canada, 2009. Stinchcombe, Arthur. "Social Structure and Organizations," in James G. March, ed.,Handbook of Organizations. Chicago: Rand McNally, 1965. pp. 142193.