Topic: EVIDENCE-BASED RESEARCH

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Question 1

EBR is a research, progress, and analysis company that focus on assisting effective and efficient decision making. The firm uses extensive technical, scientific and astute expertise to come up with relevant, insightful, and effective results to serious issues. Since it was establishing in 1987, EBR has finalized hundreds of prosperous projects for regime, private sector, and international customers, which including better methods to command and governor for coalition missions stretching from warfighting to diplomacy and disaster relief; procurement of actionable economic intelligence; effective and dependable measurement of administrative and institutional performance; exhibiting complex phenomena such as asymmetrical warfare and future statistics technology architectures and systems; designing and achieving experiments that connect emerging ideas to practical novelty; as well as pursuing and forecasting social, political and economic tendencies.

Question 3

A wide diversity of clients from around the sphere call on EBR for strategic check in and for elucidations to both time-sensitive and long-term tests. EBR’s strategy of attack jolts with a firm grasp of current research and awareness (saving both time and money) and the growth of an open approach that recognizes what increased understanding and evidence are desired and how to get them. This design is affected rigorously (and updated as the challenge is irradiated) to create cost-effective goods and services (Natalie, Martland).

Youth Development So Far: In the widest sense, rapid youth progress is a philosophy or tactic that guides societies in the way they start up programs and funds so that modern society can grow to their full potential. B. Community-Based Principles to Lead Youth Development Study over the past years has acknowledged key principles, evidence, and practices that influence healthy youth advance and sustenance successful adolescent changeover to adulthood (Dickson, 2007). The subsequent are the accepted principles that monitor strategies to stimulate youth progress and advance health results for youth:

• A focus on positive outcomes: Kin, schools and societies prepare their young people for maturity by building on the proficiencies and values they requisite to become healthy and fecund adults. Positive youth consequences include capabilities (for instance emotional, social, academic, and vocational), self-assurance, connectedness (affection to community, family, institute) charisma, kindness, and contribution.

 • Youth commitment and youth voice: Young people have significant roles in the family, school, and the community, where their assistances make a difference. These aids can include service, asking with adults in the organization, and collective leadership.

• Inclusiveness: Prospects are accessible to all young individuals in the community. At the matching period, care is taken to convince that young people facing high levels of need for livelihood and care are reached.

 • Long-term assurance: Developmentally special opportunities and provisions are open to youth of all ages. The cares of the community are lasting and reflect the dynamic needs of young individuals.

 • Community involvement: The establishment of youth-friendly surroundings involves all areas of the community, sighted beyond social service and youth platform providers to embrace other community groups and sectors, for instance, religion-based organizations, law implementation/justice system, businesses). Youth growth works best when communities as a complete, including young people, grind together to afford what youth need to realize their strong point and potential.

 • Emphasis on Partnership: Varied allies work together to construct an extensive and synchronized network of prospects and support. This necessitates sharing capitals and accountability for mutual goals, and occasionally this involves partakers to work in new techniques that may take account of the re-examining mission, edifice and policymaking procedures.

Question 4.

A well-written business plan is the one that is written bearing in mind the competition and the challenges that are in the existing market. The business plan may yield a very successful business in that; the person implementing has all the force able risks and shortcomings. This will help the business person to maximize on the existing market so as to make a minimal loss. The entrepreneur works with the plan bearing in mind the risk he has and, therefore, he will have to make risky but creative ideas that will yield profits for the company or the business that he/she is running (Mark, 2014).

The most important aspect of a well-drafted business plan is that it visualizes the risk and brings it to the attention of the entrepreneur. Therefore, he runs the business with the knowledge of risks, and then again due to the competition that might be in existence, the business needs to be creative so as to penetrate through the existing competition.

In summary, evidence-based research is about Insertion the client’s welfares first; evidence-based practitioners embrace a process of all-time learning that includes constantly posing specific problems of direct, concrete importance to clients, examining objectively and competently for the recent best evidence comparative to each query, and taking proper action conducted by evidence.

 

 

 

 

 

 

 

Reference

Dickson, E. (2007). Youth prgress under EBR. 21-28.

Mark, J. (2014). Effective Business plan. Oklohoma: Oxford.

Natalie, G. (Martland). Evidence based reasearch. 36-42.

 

 

                                                                             

 

 

            

Name:

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                              Around the world in eighty days

Introduction

                During the beginning of the 19th century, many literary works brought a great impact on the life of the people through their depiction of what was happening in the society at the time. One such work was the novel, ‘Around the world in eighty days’ by Jules Verne. The book depicts the events that were happening such as technological advancements and European civilization. This paper examines the how the novel portrayed critical events that happening in the 19th century Europe.

                The novel narrates the story of Mr. Phileas Fogg, a rich British man who embarks on a journey to move around the world in eighty days after being promised to get a lot of money from the Reform Club (Verne, 3). Mr. Phileas together with his new butler, Mr. Jean Passepartourt faces a lot of tribulations on their way including being robbed at the bank and also being mistaken as criminals by Mr. Fix, the Scotland Yard detective. The novel, therefore, continues to narrate the critical events that were taking place as Mr. Fogg continued with his journey around the world. The book has extensively tackled the issue of technological advancement that was being witnessed at the time. It was during the industrial revolution.

Mr. Fogg realizes that a new railroad has been opened. Hence, one can be possible travel around the world in eighty days. Europe was experiencing technological advancement due to the discovery of the coal and steam powered locomotives.

                The railroads opened the interior parts of the nation that were previously inaccessible. The advancement in technology also led to the building of manufacturing companies in different regions. The industries, therefore, offered employment opportunities to the people.

                The novel was written when the European civilization was expanding. Mr. Fogg boards a steamboat from New York to France (Verne, 12). The technological expansion that was being experienced had made it possible for the building of steamboats that could cross from New York to the European nations. Fogg being rich and powerful, he is cable of bribing the crew so that they can sail to France in his route to moving around the world in eighty days. This shows how the influence of the European civilization was spreading fast to other nations. Some of the major reasons that enabled Europe to extend its influence were the availability of resources. Europe had skilled manpower that participated in the building of steam engines that could drive locomotives and steam boats.

               According to the book, the places that Mr. Fogg passed on his journey, he could see how industrial revolution was expanding. Finished products that had been manufactured in European nations were being transported to other countries through railroad and steamboats. This also led to the circulation of skilled labor and therefore resulting in the creation of job opportunities in the most European nations.

               This is because diversities such as gender lead to the acquisition of different ideas decisions and expertise that are vital for expansion of civilization. For example, in most media establishments, gender plays a critical role during recruitment. This is because both the male and female gender creates a blend that can deliver the content that the media audience needs. Moreover, communications skills of women are required in the media. Hence, there is a need to consider gender in such companies. Cultural diversity is also important for a company. The presence of people of different cultures will result in the presence of different skilled manpower for the company. The company can, therefore, use the various unique skills to improve its operations thus boost the economic growth of a country.

 

                  However, there are instances where diversity can hinder the economy. For instance, diversity can lead to poor decision making since every individual of different social beliefs or culture will advocate for its ideas to be implemented in the company thus causing confusion and hinder the growth of a county.

                  Diversity has a great impact on economic growth. The presence of diversity in a business organization can boost economic growth due to the availability of different skills and expertise as well as enhance innovation and productivity.

                 Through the story of Mr. Fogg, the readers can learn the nature of the European economy and how it was able to influence other nations. The country embraced diversity has the advantage of pooling unique skills from people of different cultural backgrounds, sexual orientations, gender and different language. Through diversity and presence of skilled labor, Europe was able to me a dominant player in the market. The railroads were expanded as well as sea transport. This led to the expansion of areas that was experiencing underdevelopment due to the shortage of natural resources and skilled labor. Europe greatly influenced trading activities in the United States of America through the transpiration of finished products through railway and water.

                 In summary, the novel, ‘Around the world in 80 days’ clearly analyzes critical issues in Europe in the 19th Century.  Various advancements such as technological and industrial advancements had brought a great impact leading to economic growth. The transport and communication networks in Europe had enabled the nations to undertake trade with other world nations such as the United States of America. Through industrial revolution, European nations influenced the activities of other countries.

 

 

 

 

                                                      Work cited

 

Verne, Jules. Around the world in 80 days. France. Pierre-Jules Hertzel. 1873. Print

Nephrotic syndrome (Nephrosis)

DEFINITION: • Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, andsw elling.

• Autoimmune process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins, particulary albumin.

• Nephrotic syndrome is a disorder of the glomeruli (clusters of microscopic blood vessels in the kidneys that have small pores through which blood is filtered) in which excessive amounts of protein are excreted in the urine. This typically leads to accumulation of fluid in the body (edema) and low levels of the protein albumin and high levels of fats in the blood.

• Nephrotic syndrome is not a specific glomerular disease but a cluster of clinical findings, including:Marked increase in protein (particularly albumin) in the urine (proteinuria), Decrease in albumin in the blood (hypoalbuminemia), Edema, High serum cholesterol and low-density lipoproteins (hyperlipidemia).

ANATOMY AND PHYSIOLOGY:

The organs, tubes, muscles, and nerves that work together to create, store, and carry urine are the urinary system. The urinary system includes two kidneys, two ureters, the bladder, two sphincter muscles, and the urethra. Your body takes nutrients from food and uses them to maintain all bodily functions including energy and self-repair. After your body has taken what it needs from the food, waste products are left behind in the blood and in the bowel. The urinary system works with the lungs, skin, and intestines—all of which also excrete wastes—to keep the chemicals and water in your body balanced. Adults eliminate about a quart and a half of urine each day. The amount depends on many factors, especially the amounts of fluid and food a person consumes and how much fluid is lost through sweat and breathing. Certain types of medications can also affect the amount of urine eliminated. The urinary system removes a type of waste called urea from your blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. The kidneys are bean-shaped organs about the size of your fists. They are near the middle of the back, just below the rib cage. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney

From the kidneys, urine travels down two thin tubes called ureters to the bladder. The ureters are about 8 to 10 inches long. Muscles in the ureter walls constantly tighten and relax to force urine downward away from the kidneys. If urine is allowed to stand still, or back up, a kidney infection can develop. Small amounts of urine are emptied into the bladder from the ureters about every 10 to 15 seconds. The bladder is a hollow muscular organ shaped like a balloon. It sits in your pelvis and is held in place by ligaments attached to other organs and the pelvic bones. The bladder stores urine until you are ready to go to the bathroom to empty it. It swells into a round shape when it is full and gets smaller when empty. If the urinary system is healthy, the bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours. Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body. Nerves in the bladder tell you when it is time to urinate, or empty your bladder. As the bladder first fills with urine, you may notice a feeling that you need to urinate. The sensation to urinate becomes stronger as the bladder continues to fill and reaches its limit. At that point, nerves from the bladder send a message to the brain that the bladder is full, and your urge to empty your bladder intensifies. When you urinate, the brain signals the bladder muscles to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax. As these muscles relax, urine exits the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs. Problems in the urinary system can be caused by aging, illness, or injury. As you get older, changes in the kidneys’ structure cause them to lose some of their ability to remove wastes from the blood. Also, the muscles in your ureters, bladder, and urethra tend to lose some of their strength. You may have more urinary infections because the bladder muscles do not tighten enough to empty your bladder completely. A decrease in strength of muscles of the sphincters and the pelvis can also cause incontinence, the unwanted leakage of urine. Illness or injury can also prevent the kidneys from filtering the blood completely or block the passage of urine

PREDISPOSING

FACTOR	RATIONALE
Age Children	ages 11⁄2 and 4 yr are predisposed in having nephrotic syndrome
Sex Males	are more predisposed than males in acquiring nephrotic syndrome
Genetics	People with family history of nephrotic syndrome increases likelihood of developing nephrotic syndrome
Focal segmental glomerulosclerosis > HIV/AIDS > Nephrectomy	Most common cause of idiopathic NS among adults. May be secondary to HIV/AIDS infection or loss of nephrons.
Membranous nephropathy >Hepatitis B infection > SLE > Cancer	Deposition of immune complexes on the glomerular basement membrane causing it to thicken. It can be secondary to certain cancers, Hepatitis B infections and autoimmune disorders such as SLE.
Minimal change	disease Causes 80 to 90% of childhood nephrotic syndrome in children 4 to 8 years of age idiopathic in nature.
Diabetes Mellitus	Prolonged elevated blood glucose levels alters glomerular base membranes thereby causing impaired renal function

 

 

 

SYMPTOMS

LEGEND	SYMPTOM	RATIONALE
S1	Albuminuria	In nephrotic syndrome the podocytes are damaged and very permeable allowing albumin from the blood to escape and be excreted out the body along with urine.
S2	Edema	Edema is the result of fluid shifting from the intravascular space to the interstitial space due to the decrease intravascular pressure.
S3	Hyperlipidemia	Results due to the increased production of lipoproteins by the liver in response to the low levels of albumin in the blood.
S4	HypoalbuminemiaIn	nephrotic syndrome the podocytes are damaged and very permeable allowing albumin from the blood to escape and be excreted out the body along with urine

 

 

 

 

 MEDICAL MANAGEMENT

1.       fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors.

• Fluid and sodium restrictions

Creating a negative sodium balance will help reduce edema, presumably as the underlying illness is treated or as renal inflammation slowly resolves. Patients should limit their sodium intake to 3 g per day, and may need to restrict fluid intake (to less than approximately 1.5 L per day).   Large

doses (e.g., 80 to 120 mg of furosemide) are often required,14 and these drugs typically must be given intravenously because of the poor absorption of oral drugs caused by intestinal edema.3 Low serum albumin levels also limit diuretic effectiveness and necessitate higher doses. Thiazide diuretics, potassium-sparing diuretics, or metolazone (Zaroxolyn) may be useful as adjunctive or synergistic diuretics.

• Diuretics

 “Diuretics are the mainstay of medical management; however, there is no evidence to guide drug selection or dosage,” Dr. Kodner writes. “Based on expert opinion, diuresis should aim for a target weight loss of 1 to 2 lb (0.5 to 1 kg) per day to avoid acute renal failure or electrolyte disorders. Loop diuretics, such as furosemide (Lasix) or bumetanide, are most commonly used.”

 

• Angiotensin-converting enzyme

In persons with nephrotic syndrome, angiotensin-converting enzyme inhibitors have been shown to decrease proteinuria and lower the risk for progression to renal disease. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce pro-teinuria and reduce the risk of progression to renal disease in persons with nephrotic syndrome.15,16 One study found no improvement in response when corticosteroid treatment was added to treatment with ACE inhibitors.17 The recommended dosage is unclear, and enalapril (Vasotec) dosages from 2.5 to 20 mg per day were used. Most persons with nephrotic syndrome should be started on ACE inhibitor treatment to reduce protein-uria, regardless of blood pressure.

* Although corticosteroid treatment may benefit some adults with nephrotic syndrome, research evidence supporting this therapy is limited. At present, intravenous albumin, prophylactic antibiotics, and prophylactic anticoagulation are not advised.

 

ALBUMIN

Intravenous albumin has been proposed to aid diuresis, because edema may be caused by hypoalbuminemia and resulting oncotic pressures. However, there is no evidence to indicate benefit from treatment with albumin,18 and adverse effects, such as hypertension or pulmonary edema, as well as high cost, limit its use.

 

CORTICOSTEROIDS

Treatment with corticosteroids remains controversial in the management of nephrotic syndrome in adults. It has no proven benefit, but is recommended in some persons who do not respond to conservative treatment.19,20 Treatment of children with nephrotic syndrome is different, and it is more clearly established that children respond well to corticosteroid treatment.21 Classically, minimal change disease responds better to corticosteroids than FSGS; however, this difference isfound primarily in children with nephrotic syndrome. One older study found that corticosteroid treatment improved proteinuria and renal function in persons with minimal change disease, but not membranous nephropathy or proliferative glomerulonephritis.22 Another small older study found that persons with less severe glomerular changes responded well to corticosteroids.23 One case series in black persons with FSGS found no benefit from corti-costeroid treatment.19 Two Cochrane reviews on the treatment of nephrotic syndrome in adults found no benefit for mortality or need for dialysis with corticosteroid therapy for membranous nephropathy or minimal change disease, but found a weak benefit for disease remission and proteinuria in persons with membranous nephropathy.20,24 However, the findings for minimal change disease were based on only one randomized trial, and the role of corticosteroid treatment remains unclear. Many experts recommend the use of corticosteroids, particularly for persons with minimal change disease1; however, adverse effects from corticosteroids often lead to discontinuation.

 

Family physicians should discuss with patients and consulting nephrologists whether treatment with corticosteroids is advisable, weighing the uncertain benefits and possibility of adverse effects. Alkylating agents (e.g., cyclophosphamide [Cytoxan]) also have weak evidence for improving disease remission and reducing proteinuria, but may be considered for persons with severe or resistant disease who do not respond to corticosteroids.

 

 

 

 

LIPID-LOWERING TREATMENT

 

A Cochrane review is underway to investigate the benefits and harms of lipid-lowering agents in nephrotic syndrome.25 Some evidence suggests an increased risk of athero-genesis or myocardial infarction in persons with nephrotic syndrome, possibly related to increased lipid levels.25 However, the role of treatment for increased lipids is unknown and, at present, the decision to start lipid-lowering therapy in persons with nephrotic syndrome should be made on the same basis as in other patients. ANTIBIOTICS There are no data from prospective clinical trials about treatment and prevention of infection in adults with nephrotic syndrome. Given the uncertain risks of infection in adults with nephrotic syndrome in the United States, there are currently no indications for antibiotics or other interventions to prevent infection in this population. Persons who are appropriate candidates should receive pneumococcal vaccination.

 

ANTICOAGULATION THERAPY

 

There are currently no recommendations for prophylactic anticoagulation to prevent thromboembolic events in persons with nephrotic syndrome who have not had previous thrombotic events, and clinical practice varies. A Cochrane review is in process.26 Physicians should remain alert for signs or symptoms suggesting thromboembolism and, if it is diagnosed, these events should be treated as in other patients. Persons who are otherwise at high risk of thromboembolism (e.g., based on previous events, known coag-ulopathy) should be considered for prophy-lactic anticoagulation while they have active nephrotic syndrome

 

LABORATORY EXAM

 

1.Proteinuria (predominately albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome.

2.A needle biopsy of the kidney may be performed for histologic examination of renal tissue to confirm the diagnosis.

3.Recent studies have confirmed the usefulness of serum markers as a means of assessing the disease process. Anti-C1q antibodies are the most reliable markers for assessing disease activity.

 

NURSING DIAGNOSIS

 

• Excess fluid volume related to compromised regulatory mechanism with changes in hydrostatic or oncotic vascular pressure and increased activation of RAAS

 

• Imbalanced nutrition: Less than body requirements related to anorexia, nausea, vomiting, protein catabolism, dietary restrictions and altered oral mucous membranes

 

• Decreased cardiac output related to fluid imbalances affecting circulating volume, myocardial workload and systemic vascular resistance

• Risk for infection depression of immunologic defenses

• Disturbed body image related to changes in physical appearance

• Risk for injury

 

NURSING MANAGEMENT

• Assess and document the location and character of the patient’s edema.

• Weigh the patient each morning after he voids and before he eats, make sure he’s wearing the same amount of clothing each time you weigh him.

• Measure blood pressure with the patient lying down and standing. Immediately report a decrease in systolic or diastolic pressure exceeding 20 mm Hg.

• Monitor intake and output

• Ask the dietitian to plan a low-sodium diet with moderate amounts of protein.

• Frequently check urine for protein

• Provide meticulous skin care to combat the edema that usually occurs with nephrotic syndrome

• Use a reduced-pressure mattress or padding to help prevent pressure ulcers.

• To prevent the occurrence of thrombophlebitis, encourage activity and exercise, and provide antiembolism stockings as ordered

• Give the patient and family reassurance and support, especially during the acute phase, when edema is severe and the patient’s body image changes

 

PROGNOSIS

The prognosis varies depending on the cause of the nephrotic syndrome, the person’s age, and the type and degree of kidney damage. Symptoms may disappear completely if the nephrotic syndrome is caused by a treatable disorder, such as an infection, cancer, or drugs. This situation occurs in about half the cases in children but less often in adults. If the underlying disorder responds to corticosteroids, sometimes progression of the disease is halted, and less often the condition partially or, rarely, completely reverses. When the syndrome is caused by HIV infection, it usually progresses relentlessly, often resulting in complete kidney failure in 3 or 4 months. Children born with the nephrotic syndrome rarely live beyond their first birthday, although a few have survived by means of dialysis treatments or a kidney transplant. When the cause is systemic lupus erythematosus or diabetes mellitus, drug treatment often stabilizes or decreases the amount of protein in the urine. However, some people do not respond to drug treatment and develop progressive kidney failure within a few years. In cases of nephrotic syndrome resulting from conditions such as an infection, allergy, or intravenous heroin use, the prognosis varies, depending on how early and effectively the underlying condition is treated. Nephrotic syndrome may go away once the underlying cause, if known, has been treated. In children, 80 percent of nephrotic syndrome cases are caused by minimal change disease, which can be successfully treated with prednisone. However, in adults most of the time a kidney disease is the underlying cause, and these diseases cannot be cured.

Good – Fair – Poor Prognosis

Pathophysiology RAAS – Renin Angiotensin Aldosterone System

ARF – Acute Renal Failure

CRF – Chronic Renal Failure

ESRD – End Stage Renal Disease

CAD – Coronary Artery Disease

CVD – CardioVascular Disease

 

YOU MAY WONDER >>> Q. HOW DOES RAAS LEAD TO ARF??? A. RAAS will eventually be exhausted. Moreover, the RAAS cannot increase vascular volume since there is no albumin to hold the water within the vascular space. Thus the water and sodium reabsorbed will shift into the interstitial space. RAAS will only exacerbate the edema and make the patient more edematous. xD If left untreated then the blood flow to the kidneys(due to decreased intravascular volume) will be compromised causing acute trauma and injury to the nephrons ultimately causing ARF. =) hope this helps

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nephrotic syndrome is a nonspecific disorder in which the , kidneys are damagedcausing them to leak large amounts of ( . . proteinproteinuria at least 35 grams per day per 173 m2 ) . body surface areafrom the blood into the urineOther

 ( symptoms includehypoalbuminemiadecrease in albumin in ), ,

 ( the bloodedemahypercholesterolemiahigh serum ), . cholesterol and normal renal function * . The most common sign is excess fluid in the body This may : take several forms  , o Puffiness around the eyescharacteristically in . the morning  ( . ., o Edema over the legs which is pittingieleaves a , little pit when the fluid is pressed outwhich resolves ). over a few seconds  o Fluid in the pleural cavity causing pleural . effusion More commonly associated with excess fluid is . pulmonary edema  . o Fluid in the peritoneal cavity causing ascites

 

 , The following are baseline essential investigations

 *Urine sample shows proteinuria (> . . ). 35g per 173 m2 per 24 hour 

* () Comprehensive metabolic panelCMP : shows Hypoalbuminemiaalbumin level ≤. / ( =.- / ). 2 5g dLnormal3 5 5g dL 

*High levels of cholesterol ( ), hypercholesterolemia specifically , elevated LDLusually with concomitantly elevated VLDL 

* , Electrolytesurea and creatinine ( ): . EUCsto evaluate renal function

 

 

CAUSES

Nephrotic syndrome has many causes and may either

cell diseasediabetes mellitus and malignancy. such as leukemia  Secondary causes of nephrotic syndrome occurs, after an infectious disease such as infection

– ,with group A betahemolytic streptococci, syphilis malaria tuberculosis orviral infections including varicella hepatitis B HIV. and infectious mononucleosis

 

CASE STUDY FORMAT

 

I.              PATIENT DEMOGRAPHIC DATA

Name: Rose Nina Francisco

Age/Sex: 14/Female

Status: Single Religion: Roman Catholic

Home Address: Cogon, Pardo Nationality:

Filipino Occupation: N/A

 

 

 

 

 

 

 

     II. HEALTH HISTORY PROFILE

A. Past Medical History

1. Pediatric and Adult Illness

Date	Illness	Medication	Remarks
NONE	NONE	NONE	NONE

 

2.       Immunization

 

Immunization	Doses	Immunization Dates	Remarks
BCG	1	Can’t Recall	Complete
DPT	3	Can’t Recall	Complete
OPV	3	Can’t Recall	Complete

 

3.       Hospitalization

Date/Year                   Hospital                                                               Diagnosis                             Duration

2007 2008                    Cebu City Medical Center                             Nephrotic Syndrome      1 week

                                     Cebu  City Medical Center                              Nephrotic Syndrome      1 week

 

4.         Injuries and Accidents

 The patient did not experience any injuries and accidents.

5.      Transfusions- The patient did not undergo any transfusions such as blood transfusion.

6.      Allergies(specify)- The patient has no any allergies

 

B. Family History

 

C. Social and Personal History

•1.Occupation-N/A

 2.Number of Children-N/A

3.Military experiences, foreign travel-N/A

4.Habits (tobacco, alcohol, non-prescription drugs, others)-N/A

5.Diet-fruits, vegetables, pork chop, dried fish

6.Type of Family-Extended Family

7.Cultural and Religious Beliefs-N/A

 

 

8.Brief description of average day:

5:30 am-wake up

6:00 am-breakfast

7:00-9:00 am-class hours

9:15-9:30 am-recess

9:30-12:00 am-class hours

12:00-1:00 pm-lunch

1:00-5:00 pm-class hours

5:30 pm-do homework

6:00 pm-dinner

7:00-8:00 pm-watch T.V

8:00 pm-sleeping time

 

 

D. Review System (for the past 6 months).

Physical Assessment

 General Weight loss      Fatigue                                 Anorexia              Night sweats      Chills Fever         Weakness

 The patient experienced fever due to cough and colds.

The patient experienced fatigue due to illness and lack of sleep.

The patient experienced weakness due to fatigue.

 

Skin	Itch Rash Lesions  Bruising  Bleeding Color change NONE
Eyes	Pain Discharge Itch Vision loss Diplopia  Excessive tearing  Glasses/Contact lens Date of last exam NONE
Ears	Earaches Discharges Tinnitus Hearing loss NONE Nose Obstruction Discharges Epistaxis NONE
Throat and MouthSore	throats Bleeding gums Toothache Dentures NONE Neck and Head Swelling Dysphagia Hoarseness NONE
Chest Cough Sputum	Amount and Character Hemoptysis Wheeze Pain on respiration Dyspnea The patient experienced dyspnea due to obstruction of the airway
Cardiovascular	Precordialpain Palpitation Dyspneaon exertion Orthopnea Dyspnea Paroxysmal nocturnal Edema Heart murmur Claudication Thrombophlebitis NONE
Gastrointestinal	Heartburn Nausea Vomiting Diarrhea Food intolerance Excessive gas or indication Constipation Jaundice Bloating Change in Bowel movement Melena Hemorrhoids Hernia NONE
Genitourinary	Heartburn Nausea Vomiting Diarrhea Food intolerance Excessive gas or indication Constipation Jaundice Bloating Change in Bowel movement Melena Hemorrhoids Hernia NONE
Extremities	Joint pains Varicose veins Claudication Back pain Edema Stiffness Deformities
	The patient experienced edema due to illness which is nephrotic syndrome.
Endocrine	Hot flashes Hair loss Temperature intolerance Polydipsia Goiter NONE
Neurology	Numbness Tingling Tremor Fainting Headaches Muscle weakness Ataxia Seizure Unconsciousness Paralysis/Paresis Memory loss Dizziness
	The patient experienced headaches due to fever.

 

 

 

 

III. CURRENT HEALTH PROFILE

A.Presenting complaints and medical diagnosis to include intervention done prior to

hospitalization.

Rosa Nina Francisco was diagnosed for Nephrotic Syndrome. She Complain of difficulty in breathing.

 

 

B. Application of the Nursing Process 1. Assessment Finding (Head –to-Toe)

Skin	Uniform skin color, no jaundice, cyanosis Skin intact Skin warm and dry
Hair	Hair is evenly distributed over scalp Hair color black and thin No lesions or pediculosis
Nails	Color pink, well groomed ad convex, smooth and firm
Head	Normocephallic, erect and midline Head symmetrical, no masses, nontende
Face	Facial expression appropriate, no abnormal movements or lesions Facial bones smooth, intact,symmetrical,nontender
Ears	Ears aligned with eyes, symmetrical, no redness, lesions or drainage Eyes Eyes clear and bright, equal parallel alignment Eyelids color consistent with clients complexion Eyelashes evenly distributed, no excessive tearing or dryness
Nose	Nose midline, symmetrical, no deviation, no flaring No deformities or nasal tenderness Sinuses Sinuses clear, nontender
Mouth	Lips pink, moist, no lesions Oral mucosa pink, moist, no lesions, intact Teeth complete Tongue pink, moist,midline
Neck	Neck symmetrical, skin intact, no masses Upper Extremities Skin color uniform; no erythema, edema Abdomen Skin color consistent, no lesions, rashes, scars or discoloration. Hair distribution appropriate for client’s age and gender
Abdomen	flat and symmetrical, no bulges or hernias Umbilicus midline Abdomen soft, nontender, no masses
Lower Extremities	Leg hair evenly distributed; color uniform; no edema or lesion

 

 

Laboratory/Diagnostic Results

Date	Lab Exam	Patient Results	Normal Findings	Interpretation/Significant
09-01-09	Protein to Creatinine ratio	1.55	5-0.9	Suggests the presence of nephrotic range proteinuria.
	Serum albumin	0.9g/dl	0. 3.4-5.4g/dl	Hypoalbuminemia can be caused by Excess excretion by the kidneys.

 

 

 

 

 

·         NORMAL KIDNEY SIZE -The normal kidney size of an adult human is about 10 to -The normal kidney size of an adult human is about 10 to 13 cm (4 to 5 inches) long and about 5 to 7.5 cm (2 to 3 13 cm (4 to 5 inches) long and about 5 to 7.5 cm (2 to 3 inches) wide. It is approximately the size of inches) wide. It is approximately the size of a a conventional computer mouse conventional computer mouse. .

·         NORMAL KIDNEY COLOR NORMAL KIDNEY COLOR -The kidneys are dark-red, bean-shaped organs. One side The kidneys are dark-red, bean-shaped organs. One side of the kidney bulges outward (convex) and the other of the kidney bulges outward (convex) and the other side is indented (concave) side is indented (concave)

 

·         NORMAL KIDNEY LOCATION NORMAL KIDNEY LOCATION - -towards the back of the abdominal cavity, just towards the back of the abdominal cavity, just above the waist. One kidney is normally located just above the waist. One kidney is normally located just below the liver, on the right side of the abdomen and below the liver, on the right side of the abdomen and the other is just below the spleen on the left side. the other is just below the spleen on the left side

 

·         The most basic structures of the kidneys, are nephrons. They are responsible for filtering the blood.

•     The renal artery delivers blood to the kidneys each day. Over 180 liters (50 gallons) of blood pass through the kidneys every day. When this blood enters the kidneys it is filtered and returned to the heart via the renal vein.

  •    The process of separating wastes from the body fluids and eliminating them, is known as excretion. The urinary system is one of the organ systems responsible for excretion. The kidneys are the main organs of the urinary system.

·         The kidney is full of blood vessels.  Every function of the kidney involves blood, therefore, it requires a lot of blood vessels to facilitate these functions.

  •    Together, the two kidneys contain about 160 km of blood vessels

 

Renal capsule

•is a tough fibrous layer surrounding the kidney and covered in a thick layer of adipose tissue. It provides some protection from trauma and damage

•is the outer portion of the kidney between the renal capsule and the renal medulla. In the adult, it forms a continuous smooth outer zone with a number of projections (cortical columns) that extend down between the pyramids.

•ultra filtration occurs

Renal

 •is the innermost part of the kidney

•split up into a number of sections, known as the renal pyramids

•contains the structures of the nephrons responsible for maintaining the salt and water balance of    the blood

•is hypertonic to the filtrate in the nephron and aids in the reabsorption of water.

·         are cone-shaped tissues of the kidney

·         made up of 8 to 18 of these conical subdivisions

·         The broad of each pyramid faces the renal cortex, and its apex, or papilla, points internally

·         The base of each pyramid originates at the corticomedullary border and the apexterminates in a papilla, which lies within a minor calyx, made of parallel bundles of urine collecting tubules.

·         surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into the minor calyx then into the major calyx.

·         Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces propels urine through the pelvis and ureters to the bladder.

 

Phatophysiology

Nephrotic syndrome results from damage to the kidney’s glomeruli, the tiny blood vessels that filter waste and excess water from the blood and send them to the bladder as urine. They consist of capillaries that are fenestrated, that is, have small openings, which allow fluid, salts, and other small solutes to flow through but normally not proteins. Damage to the glomeruli from diabetes, glomerulonephritis, or even prolonged hypertension, causes the membrane to become more porous, so that small proteins, such as albumin, pass through the kidneys into urine. As protein continues to be excreted, serum albumin is decreased, which in turn decreases the serum osmotic pressure. Capillary hydrostatic fluid pressure becomes greater than capillary osmotic pressure, which results in generalized edema. As fluid is lost into the tissues, the plasma volume decreases, stimulating secretion of aldosterone to retain sodium and water, which decreases the glomerular filtration rate to retain water. This additional water also passes out of the capillaries into the tissue, leading to even greater edema. •

SOAPIE

 

S:

O:

A: Knowledge deficit related to chronic illness

P: After 4 hours of nurse-patient and significant others interaction,

the patient and the significant others will be able to:

·         Identify interferences to learning and specific actions to deal with it.

·         Perform necessary procedures correctly and explain reasons for the actions.

·         Initiate necessary lifestyle changes and participate in treatment regimen.

·         Provided an environment that is conducive to learning.

 

I:Assessed readiness to learn.

Provided written information/guidelines and self-learning modules for client to refer to as necessary.

Allowed practice and demonstrations.

 

E:Goal was met. After 4 hours of nurse-patient and significant others interaction, the patient and the significant others will be able to identified the interferences to learning and made specific actions to

deal with it. And they were to performed necessary procedures correctly and they explained the reasons for the actions they made.And they were able to initiated necessary lifestyle changes and

participated in treatment regimen by allowing them to practice and

demonstrate the treatment regimen.

 

 

 

SOAPIE

S-“Wala koy gana mukaon.”, as verbalized by the patient.

O- : protein-creatinine ratio of 1.55 Serum albumin of 0.9g/dl

A-     Imbalanced Nutrition, less than body requirements related to poor appetite, restricted diet, and protein loss.

P- After 8 hours of nurse-patient interaction, the patient will be able to:

·         Identify the appropriate diet for her condition. (Low-sodium diet)

·         Follow the diet prescribed.

·         Verbalize realization of the importance of proper diet.

I- Assessed and monitored food/fluid ingested and calculate caloric intake.

·         Monitored weight daily at same time, same clothing and same scale.

·         Recommended small, frequent meals.

·         Restricted sodium as indicated, and limited fluid intake to 100ml

·         Administered multivitamins, as indicated.

·         Administered medications as appropriate.

·         Monitored laboratory studies.

 

 E- Goals met. After 8 hours of nurse-patient interaction, the patient was able to identify the appropriate diet for her condition. (Low-sodium diet). Follow the diet prescribed. Verbalize realization of the importance of proper diet

 

 

SOAPIE

S- “Murag nanghupong akong anak sa iya bitiis.”, as verbalized by the mother.

 

O- Edema, weight gain, changes in vital signs

 

A-Excess fluid volume related to compromised regulatory mechanism with changes in hydrostatic

vascular pressure and increased activation of rennin angiotensin aldosterone system.

 

P-After 5 hrs of nursing interventions, the patient will be able to: display stable weight

vital signs within patient’s normal range

nearly absence of edema.

 

I-Record accurate intake and output of the patient Monitor urine specific gravity

·         Weight daily at same time of the day, on same scale, with

·         same equipment and clothing

·         Assess skin, face, dependent areas of edema

·         Monitor heart rate and blood pressure

·         Assess level of consciousness: investigate changes in mentation, presence of restlessness.

 

E-Goals were fully met. After 5 hrs of nursing interventions, the patient was able to display stable weight, vital signs within patient’s normal range, and nearly absence of edema.

 

Research Paper help

https://www.homeworkping.com/

 

 

 

Abstract

This article describes the development of the criminal justice system in the United States. Specifically, you will learn how each of the three areas of the criminal justice system (police, courts, and corrections) developed into the institutions they are today. a society without any formalized rules or laws to guide behavior and protect us from criminal activity, that is exactly what it was like for early Americans during the colonial period. It was a time where Americans were figuring out how to coexist in this new land. Over the years, Americans have developed mechanisms that institute and enforce the rules of society as well as assign responsibility and punish offenders. Today, those functions are carried out by the police, the courts and corrections. The early beginnings of the criminal justice system in the United States lacked this structure. . Some of the methods used are fingerprint analysis, DNA databases, ballistics testing, tire tread analysis, tracking of illegal pornographic images.

 

 

 

 

 

 

 

 

 

 

Introduction

Technologies in Criminal Justice

Working in criminal justice today means having the opportunity to utilize robots, GPS systems, advanced cameras and high-powered computer systems. These important technologies have improved investigation, surveillance and analysis procedures – so long as they are backed by the skill set and intelligence to properly use them (Murphy, 2007).Every aspect of law enforcement has a computer program associated with the job, from DNA testing to robotic cameras to automatic license plate recognition systems – just to name a few. The number of electronics now available to make criminal justice jobs more effective is rapidly growing. Of course, criminals also utilize these technologies, so professionals in the industry have to remain one step ahead in technology to combat illicit usage.

Policing

The first contact a defendant has with the criminal justice system is usually with the police (or law enforcement) who investigate the suspected wrongdoing and make an arrest, but if the suspect is dangerous to the whole nation, a national level law enforcement agency is addressed (Ismaili, 2010). When warranted, law enforcement agencies or police officers are empowered to use force and other forms of legal coercion and means to effect public and social order. The term is most commonly associated with police departments of a state that are authorized to exercise the police power of that state within a defined legal or territorial area of responsibility.

In order to assess the impact of criminal identification databases on criminal justice systems, it is first necessary to have some understanding of why biometric criminal identification databases were built in the first place. Contrary to the popular image of fingerprinting as tool for forensic investigation, fingerprint identification was developed for purposes of criminal record keeping, rather than forensics. Specifically, fingerprinting was developed in order to facilitate the storage and retrieval of criminal histories by the state.

Information Technology and the Criminal Justice System suggests that information technology in criminal justice will continue to challenge us to think about how we turn information into knowledge, who can use that knowledge, and for what purposes. Investigators examine what has been learned from past experiences, what the current state of IT is in various components of the criminal justice system and what challenges lie ahead. According to Garside, the purpose of the Criminal Justice System is to deliver justice for all, by convicting and punishing the guilty and helping them to stop offending, while protecting the innocent.

Different models have been devised that attempt to conceptualize the particular features of the justice system that identify principles and characteristics. CrimeControl and Due Process models has been Identified as two of the most enduring models which offer explanations as to how agencies and policies may be shaped and they can usefully be viewed as opposite ends of a continuum since they present contrasting rationale and characteristics.

Due Process

This model incorporates ideas inherent in the rule of law and emphasizes the rights of the defendant through the principles of the presumption of innocence, the defendant’s right to a fair trial, equality before the law and that justice should be seen to be done. Due process can be perceived as an ‘obstacle course’ in that the rights of defendants are emphasized and impediments placed in the way that criminal justice agencies are allowed to operate. The protection given to defendants is to ensure that the innocent are acquitted and only the guilty are convicted and punished.

Crime Control

As the name suggests, this model emphasizes the role of the criminal justice system in reducing and preventing crime by way of prosecuting and punishing those who are guilty of criminal offences. It also accentuates the importance for the justice system of protecting and serving the public through crime reduction. Crime control ‘values’ include the notion that that those thought to be guilty may be pursued regardless of the rules that may be in place for protecting the rights of suspects. In this sense it can be viewed as a ‘conveyer belt’, with the conviction of the innocent tolerated because the ultimate goal of convicting the guilty overrides civil liberties. Fear of crime and demand for swift justice can lead to an increase in ‘crime control’ measures. Recent examples can be seen in the introduction of ‘bad character’ and previous convictions information for the Courts, the removal of the ‘double jeopardy’ rule and the right to hold suspects without charge in the anti-terrorism legislation.

Police are primarily concerned with keeping the peace and enforcing criminal law based on their particular mission and jurisdiction. Formed in 1908, the Federal Bureau of Investigation began as an entity which could investigate and enforce specific federal laws as an investigative and law enforcement agency in the United States; this, however, has constituted only a small portion of overall policing activity.^[11] Policing has included an array of activities in different contexts, but the predominant ones are concerned with order maintenance and the provision of services.^[12] During modern times, such endeavors contribute toward fulfilling a shared mission among law enforcement organizations with respect to the traditional policing mission of deterring crime and maintaining societal order.

 

 

DNA databases

 DNA database ordatabank is a database of DNA profiles. A DNA database can be used in the analysis of genetic diseases, genetic fingerprinting for criminology, or genetic genealogy. DNA databases may be public or private, but the largest ones are national DNA databases. When a match is made from a national DNA database to link a crime scene to an offender who has provided a DNA sample to a database that link is often referred to as a cold hit (Ismaili, 2010). A cold hit is of value in referring the police agency to a specific suspect but is of less evidential value than a DNA match made from outside the DNA database.

Ballistics testing

 Refers to a set of forensic techniques that rely on marks that firearms leave on bullets to match a bullet to the gun it was fired with. It is a subset of forensic ballistics (the application of ballistics to legal questions) and internal ballistics (Burns, 2006). Ballistic fingerprinting techniques are based on the principle that all firearms have inevitable variations due to marks left by the machining process, leaving shallow impressions in the metal which are rarely completely polished out (Neubauer & Fradella, 2013).

Conclusion

Lie detectors are referred to as deception detection, uses questioning techniques along with technology that record physiological functions to ascertain truth and falsehood in response. It is commonly used by law enforcement and has historically been an inexact science. There is a wide variety of technologies available for this purpose. A gun control law is defined by a number of federal statutes in the United States of America. These laws regulate the manufacture, trade, possession, transfer, record keeping, transport, and destruction of firearms, ammunition, and firearms accessories (Bean, 2002). They are enforced by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF). Over the years, Americans have developed mechanisms that institute and enforce the rules of society as well as assign responsibility and punish offenders. Today, those functions are carried out by the police, the courts and corrections. The early beginnings of the criminal justice system in the United States lacked this structure. . Some of the methods used are fingerprint analysis, DNA databases, ballistics testing, tire tread analysis, tracking of illegal pornographic images. The main purpose of the Criminal Justice System is to deliver justice for all, by convicting and punishing the guilty and helping them to stop offending, while protecting the innocent.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Bean, P. (2002). Technology and criminal justice. International Review of Law, Computers & Technology, 13(3), 365-371.

Burns, R, G. (2006).The Criminal Justice system. Florida: Pearson Prentice Hall.

Ismaili, K. (2010)U.S.Criminal Justice Policy: A Contemporary Reader. United States. US. Jones & Bartlett Learning

Murphy, E. (2007). The new forensics: Criminal justice, false certainty, and the second generation of scientific evidence. California Law Review, 721-797.

Neubauer, D and Fradella, H. (2013). America’s Courts and the Criminal Justice System. United States. US. Cengage learning.

 

 

Managerial Finance – Problem Review Set – Time Value of Money

 

1.)

 

Suppose an investor plans to invest a given sum of money.  She can earn an effective annual rate of 5% on Security A, while Security B will provide an effective annual rate of 12%.  Within 11 years’ time, the compounded value of Security B will be more than twice the compounded value of Security A.  (Ignore risk, and assume that compounding occurs annually.)
a.	True
b.	False

 

2.)

 

The present value of a future sum decreases as either the discount rate or the number of periods per year increases.
a.	True
b.	False

 

3.)

 

When a loan is amortized, a relatively high percentage of the payment goes to reduce the outstanding principal in the early years, and the principal repayment’s percentage declines in the loan’s later years.
a.	True
b.	False

 

4.)

 

Midway through the life of an amortized loan, the percentage of the payment that represents interest is equal to the percentage that represents principal repayment.  This is true regardless of the original life of the loan.
a.	True
b.	False

 

5.)

 

You are analyzing the value of a potential investment by calculating the sum of the present values of its expected cash flows.  Which of the following would lower the calculated value of the investment?
a.	The cash flows are in the form of a deferred annuity, and they total to $100,000.  You learn that the annuity lasts for only 5 rather than 10 years, hence that each payment is for $20,000 rather than for $10,000.
b.	The discount rate increases.
c.	The riskiness of the investment’s cash flows decreases.
d.	The total amount of cash flows remains the same, but more of the cash flows are received in the earlier years and less are received in the later years.
e.	The discount rate decreases.

6.)

 

Which of the following statements is CORRECT?
a.	If you have a series of cash flows, all of which are positive, you can solve for I, where the solution value of I causes the PV of the cash flows to equal the cash flow at Time 0.
b.	If you have a series of cash flows, and CF0 is negative but all of the other CFs are positive, you can solve for I, but only if the sum of the undiscounted cash flows exceeds the cost.
c.	To solve for I, one must identify the value of I that causes the PV of the positive CFs to equal the absolute value of the PV of the negative CFs.  This is, essentially, a trial-and-error procedure that is easy with a computer or financial calculator but quite difficult otherwise.
d.	If you solve for I and get a negative number, then you must have made a mistake.
e.	If CF0 is positive and all the other CFs are negative, then you cannot solve for I.

 

7.)

 

Which of the following bank accounts has the highest effective annual return?
a.	An account that pays 8% nominal interest with monthly compounding.
b.	An account that pays 8% nominal interest with annual compounding.
c.	An account that pays 7% nominal interest with daily (365-day) compounding.
d.	An account that pays 7% nominal interest with monthly compounding.
e.	An account that pays 8% nominal interest with daily (365-day) compounding.

 

8.)

 

A $50,000 loan is to be amortized over 7 years, with annual end-of-year payments.  Which of these statements is CORRECT?
a.	The annual payments would be larger if the interest rate were lower.
b.	If the loan were amortized over 10 years rather than 7 years, and if the interest rate were the same in either case, the first payment would include more dollars of interest under the 7-year amortization plan.
c.	The proportion of each payment that represents interest as opposed to repayment of principal would be lower if the interest rate were lower.
d.	The last payment would have a higher proportion of interest than the first payment.
e.	The proportion of interest versus principal repayment would be the same for each of the 7 payments.

 

 

 

 

 

 

 

 

9.)

 

Which of the following statements regarding a 30-year monthly payment amortized mortgage with a nominal interest rate of 10% is CORRECT?
a.	The monthly payments will decline over time.
b.	A smaller proportion of the last monthly payment will be interest, and a larger proportion will be principal, than for the first monthly payment.
c.	The total dollar amount of principal being paid off each month gets smaller as the loan approaches maturity.
d.	The amount representing interest in the first payment would be higher if the nominal interest rate were 7% rather than 10%.
e.	Exactly 10% of the first monthly payment represents interest.

 

10.)

 

Which of the following statements is CORRECT, assuming positive interest rates and other things held constant?
a.	A 5-year, $250 annuity due will have a lower present value than a similar ordinary annuity.
b.	A 30-year, $150,000 amortized mortgage will have larger monthly payments than an otherwise similar 20-year mortgage.
c.	A typical investment’s nominal interest rate will always be equal to or less than its effective annual rate.
d.	If an investment pays 10% interest, compounded annually, its effective annual rate will be less than 10%.
e.	Banks A and B offer the same nominal annual rate of interest, but A pays interest quarterly and B pays semiannually.  Deposits in Bank B will have the higher future value if you leave the funds on deposit.

 

11.)

 

You are considering two equally risky annuities, each of which pays $5,000 per year for 10 years.  Investment ORD is an ordinary (or deferred) annuity, while Investment DUE is an annuity due.  Which of the following statements is CORRECT?
a.	The present value of ORD must exceed the present value of DUE, but the future value of ORD may be less than the future value of DUE.
b.	The present value of DUE exceeds the present value of ORD, while the future value of DUE is less than the future value of ORD.
c.	The present value of ORD exceeds the present value of DUE, and the future value of ORD also exceeds the future value of DUE.
d.	The present value of DUE exceeds the present value of ORD, and the future value of DUE also exceeds the future value of ORD.
e.	If the going rate of interest decreases, say from 10% to 0%, the difference between the present value of ORD and the present value of DUE would remain constant.

 

 

 

 

 

 

12.)

 

You plan to invest some money in a bank account.  Which of the following banks provides you with the highest effective rate of interest?
a.	Bank 1; 6.1% with annual compounding.
b.	Bank 2; 6.0% with monthly compounding.
c.	Bank 3; 6.0% with annual compounding.
d.	Bank 4; 6.0% with quarterly compounding.
e.	Bank 5; 6.0% with daily (365-day) compounding.

 

13.)

 

Last year Toto Corporation’s sales were $225 million.  If sales grow at 6% per year, how large (in millions) will they be 5 years later?
a.	$271.74
b.	$286.05
c.	$301.10
d.	$316.16
e.	$331.96

 

14.)

 

Suppose a U.S. government bond promises to pay $1,000 five years from now.  If the going interest rate on 5-year government bonds is 5.5%, how much is the bond worth today?
a.	$765.13
b.	$803.39
c.	$843.56
d.	$885.74
e.	$930.03

 

15.)

 

Suppose the U.S. Treasury offers to sell you a bond for $747.25.  No payments will be made until the bond matures 5 years from now, at which time it will be redeemed for $1,000.  What interest rate would you earn if you bought this bond at the offer price?
a.	4.37%
b.	4.86%
c.	5.40%
d.	6.00%
e.	6.60%

 

 

 

 

 

 

 

 

16.)

 

Ten years ago, Levin Inc. earned $0.50 per share.  Its earnings this year were $2.20.  What was the growth rate in Levin’s earnings per share (EPS) over the 10-year period?
a.	15.17%
b.	15.97%
c.	16.77%
d.	17.61%
e.	18.49%

 

17.)

 

You have a chance to buy an annuity that pays $1,200 at the end of each year for 3 years.  You could earn 5.5% on your money in other investments with equal risk.  What is the most you should pay for the annuity?
a.	$2,636.98
b.	$2,775.77
c.	$2,921.86
d.	$3,075.64
e.	$3,237.52

 

18.)

 

You own an oil well that will pay you $30,000 per year for 10 years, with the first payment being made today.  If you think a fair return on the well is 8.5%, how much should you ask for if you decide to sell it?
a.	$202,893
b.	$213,572
c.	$224,250
d.	$235,463
e.	$247,236

 

19.)

 

What’s the present value of a 4-year ordinary annuity of $2,250 per year plus an additional $3,000 at the end of Year 4 if the interest rate is 5%?
a.	$8,508.74
b.	$8,956.56
c.	$9,427.96
d.	$9,924.17
e.	$10,446.50

 

 

 

 

 

 

 

 

20.)

 

An investment promises the following cash flow stream:  $750 at Time 0; $2,450 at the end of Year 1 (or at t = 1); $3,175 at the end of Year 2; and $4,400 at the end of Year 3.  At a discount rate of 8.0%, what is the present value of the cash flow stream?
a.	$7,916.51
b.	$8,333.17
c.	$8,771.76
d.	$9,233.43
e.	$9,695.10

 

21.)

 

What’s the future value of $1,500 after 5 years if the appropriate interest rate is 6%, compounded semiannually?
a.	$1,819.33
b.	$1,915.08
c.	$2,015.87
d.	$2,116.67
e.	$2,222.50

 

22.)

 

Your uncle has $300,000 invested at 7.5%, and he now wants to retire.  He wants to withdraw $35,000 at the end of each year, beginning at the end of this year.  He also wants to have $25,000 left to give you when he ceases to withdraw funds from the account.  For how many years can he make the $35,000 withdrawals and still have $25,000 left in the end?
a.	14.21
b.	14.96
c.	15.71
d.	16.49
e.	17.32

 

23.)

 

You agree to make 24 deposits of $500 at the beginning of each month into a bank account.  At the end of the 24th month, you will have $13,000 in your account.  If the bank compounds interest monthly, what nominal annual interest rate will you be earning?
a.	7.62%
b.	8.00%
c.	8.40%
d.	8.82%
e.	9.26%

 

 

 

 

24.)

 

An investment costs $1,000 (CF at t = 0) and is expected to produce cash flows of $75 at the end of each of the next 5 years, then an additional lump sum payment of $1,000 at the end of the 5th year.  What is the expected rate of return on this investment?
a.	6.77%
b.	7.13%
c.	7.50%
d.	7.88%
e.	8.27%

 

25.)

 

What’s the future value of $1,500 after 5 years if the appropriate interest rate is 6%, compounded monthly?
a.	$1,922.11
b.	$2,023.28
c.	$2,124.44
d.	$2,230.66
e.	$2,342.19

 

26.)

 

East Coast Bank offers to lend you $25,000 at a nominal rate of 7.5%, compounded monthly.  The loan (principal plus interest) must be repaid at the end of the year.  Midwest Bank also offers to lend you the $25,000, but it will charge an annual rate of 8.3%, with no interest due until the end of the year.  What is the difference in the effective annual rates charged by the two banks?
a.	0.93%
b.	0.77%
c.	0.64%
d.	0.54%
e.	0.43%

 

27.)

 

You plan to make annual deposits into a bank account that pays a 5.00% nominal annual rate.  You think inflation will amount to 2.50% per year.  What is the expected annual real rate at which your money will grow?
a.	1.98%
b.	2.20%
c.	2.44%
d.	2.68%
e.	2.95%

 

 

 

 

28.)

 

You are considering investing in a bank account that pays a nominal annual rate of 6%, compounded monthly.  If you invest $5,000 at the end of each month, how many months will it take for your account to grow to $200,000? Round fractional years up.
a.	33
b.	37
c.	41
d.	45
e.	49

 

29.)

 

Your child’s orthodontist offers you two alternative payment plans.  The first plan requires a $4,000 immediate up-front payment.  The second plan requires you to make monthly payments of $137.41, payable at the end of each month for 3 years.  What nominal annual interest rate is built into the monthly payment plan?
a.	12.31%
b.	12.96%
c.	13.64%
d.	14.36%
e.	15.08%

 

30.)

 

Merchants Bank offers to lend you $30,000 at a nominal rate of 6.0%, simple interest, with interest paid quarterly.  Gold Coast Bank offers to lend you the $30,000, but it will charge 7.0%, simple interest, with interest paid at the end of the year.  What’s the difference in the effective annual rates charged by the two banks?
a.	1.49%
b.	1.24%
c.	1.04%
d.	0.86%
e.	0.69%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31.)

 

Your sister turned 35 today, and she is planning to save $5,000 per year for retirement, with the first deposit to be made one year from today.  She will invest in a mutual fund that will provide a return of 8% per year.  She plans to retire 30 years from today, when she turns 65, and she expects to live for 25 years after retirement, to age 90.  Under these assumptions, how much can she spend in each year after she retires? Her first withdrawal will be made at the end of her first retirement year.
a.	$47,888
b.	$50,408
c.	$53,061
d.	$55,714
e.	$58,500

 

32.)

 

Your father now has $1,000,000 invested in an account that pays 9.00%.  He expects inflation to average 3%, and he wants to make annual constant dollar (real) end-of-year withdrawals over each of the next 20 years and end up with a zero balance after the 20th year.  How large will his initial withdrawal (and thus constant dollar (real) withdrawals) be?
a.	$68,139.22
b.	$71,725.49
c.	$75,500.52
d.	$79,474.23
e.	$83,657.08
33.)
You anticipate that you will need $1,500,000 when you retire 30 years from now.  You plan to make 30 deposits, beginning today, in a bank account that will pay 6% interest, compounded annually.  You expect to receive annual raises of 4%, so you will increase the amount you deposit each year by 4%.  (That is, your 2nd deposit will be 4% greater than your first, the 3rd will be 4% greater than the 2nd, etc.)  How much must your 1st deposit be if you are to meet your goal?
a.	$10,216.60
b.	$10,754.31
c.	$11,320.33
d.	$11,886.35
e.	$12,480.66