The physician orders pulse therapy with methylprednisolone (Solu-Medrol) 125 mg IV every 6 hours and plasmapheresis once daily
What major complications associated with immunosuppression therapy will D.W. have to be monitored for?

What is the endocrine system?

K.D. has 20 KS lesions on his neck, upper chest, and both upper arms, all of which are closed and painless. How will you care for the KS lesions?
a. Keep each lesion covered with a clear, transparent dressing
b. Place sterile, saline-soaked gauze over each lesion twice daily
c. Keep the lesions dry, cleaning the affected areas gently as needed
d. Apply topical antibiotic ointment twice daily to the affected areas

J.P., a $56$-year-old man, developed a severe viral infection and suffered fatigue, fever, and myalgia. Although he recovered from the acute episode, J.P. never quite regained his normal activity level. Six months later, J.P. continues to find it difficult to work a $10$-hour day as a brick mason, so he returns to his physician. Diagnostic studies reveal heart failure (HF) related to postviral cardiomyopathy.

Following medical management with metoprolol (Toprol $\mathrm{XL}$ ) and furosemide (Lasix), his condition stabilizes and he returns to work, but his attendance is erratic. J.P.'s condition gradually deteriorates. Sixteen months later he is readmitted to the hospital complaining of dyspnea with minimal exertion, fatigue, orthopnea, chest pain, anorexia, and feelings of abdominal fullness. He has $1+$ peripheral edema and is diaphoretic. Further studies reveal that J.P. has cardiac dilation, moderate to gross ventricular hypertrophy, and a systolic ejection fraction of $17 \%$, consistent with severe congestive cardiomyopathy. Because J.P.'s only other health problem is mild hypertension, a heart transplant evaluation is recommended. J.P. and his wife discuss his prognosis, and he agrees to an evaluation for possible heart transplantation.

J.P.'s surgery and recovery are uncomplicated, and he is sent home and referred to cardiac rehabilitation after adjustment of his immunosuppression therapy and appropriate teaching. J.P. is readmitted for lowgrade fever and dyspnea $6$ weeks after surgery. Cardiac biopsy demonstrates moderate acute rejection.

What is the most important intervention for J.P. at this time, and why?

The nurse is caring for an older woman with cardiac disease. How does the older cardiac patient differ from the younger cardiac patient?

The graph shows Associate's Degrees Earned the number of associate's degrees earned (in thousands) in the United States from 2004 through 2012.

M(x) gives the number of degrees earned by males.

F(x) gives the number earned by females.

T(x) gives the total number for both groups.

Estimate M(2008) and F(2008), and use the results to estimate T(2008).

The table shows the number (in thousands) of earned degrees, by level and gender, conferred in the United States in a recent year.

A person who earned a degree in the year is randomly selected. Find the probability of selecting someone who (a) earned a bachelor's degree. (b) earned a bachelor's degree given that the person is a female. (c) earned a bachelor's degree given that the person is not a female. (d) earned an associate's degree or a bachelor's degree. (e) earned a doctorate given that the person is a male. (f) earned a master's degree or is a female. (g) earned an associate's degree and is a male. (h) is a female given that the person earned a bachelor's degree.

In this exercise, find the probabilities.

During a certain week the mean price of gasoline in the New England region was $\mu$ = $1.535 per gallon. What is the probability that the mean price$ $\bar{x} for a sample of 32 randomly selected gas stations in that area was between$1.530 and $1.545 that week? Assume$\sigma$=$0.045.

Find the indicated probability and interpret the results. If convenient, use technology to find the probability. During a certain week, the mean price of gasoline in the New England region was $\$3.796$ per gallon. A random sample of 32 gas stations is selected from this population. What is the probability that the mean price for the sample was between $\$3.781$ and $\$3.811$ that week? Assume $\sigma = \$ 0.045$.

Find the probabilities and interpret the results. If convenient, use technology to find the probabilities.

During a certain week the mean price of gasoline in the New England region was $2.714 per gallon. A random sample of 32 gas stations is drawn from this population. What is the probability that the mean price for the sample was between$2.695 and $2.725 that week? Assume$\sigma=$0.045$.

Find the probabilities.

During a certain week the mean price of gasoline in the New England region was $\mu$ = $1.689 per gallon. What is the probability that the mean price$ $\bar{x} for a sample of 32 randomly selected gas stations in that area was between$1.684 and $1.699 that week ? Assume$\sigma$=$0.045.

C.Q. returns to the clinic 4 days later to discuss her diagnosis.
C.Q. asks why she has to take so many drugs instead of a "big dose" of one drug. What would you tell her?

W.V. is a $57$-year-old man who lives with his wife and two teenage sons. W.V. developed chronic kidney disease $20$ years ago after he developed acute kidney disease from using a drug for migraine headaches that was later shown to cause severe nephrotoxicity. W.V. underwent hemodialysis for $5$ years before receiving a cadaveric transplant, or cadaver kidney. He recovered without complications, and his serum laboratory values returned to normal. He was placed on triple immunosuppression therapy, including prednisone (Deltasone), cyclosporine (Imuran), and tacrolimus (Prograf), and was discharged to home.

Today, W.V. reports to his physician for a $12$-week follow-up. He returned to work $3$ weeks ago. W.V. has gained $5$ pounds since his last appointment $2$ weeks ago.

$$\begin{aligned} &\text { Vital Signs }\\ &\begin{array}{ll} \text { Blood pressure } & 148 / 82 \mathrm{~mm} \mathrm{Hg} \\ \text { Pulse rate } & 88 \text { beats } / \mathrm{min} \\ \text { Respiratory rate } & 24 \text { breaths } / \mathrm{min} \\ \text { Temperature } & 99.2^{\circ} \mathrm{F}\left(37.3^{\circ} \mathrm{C}\right) \end{array} \end{aligned}$$

$$\begin{aligned} &\text { Laboratory Test Results }\\ &\begin{array}{ll} \text { Creatinine } & 1.2 \mathrm{mg} / \mathrm{dL} \\ \text { BUN } & 22 \mathrm{mg} / \mathrm{dL} \end{array} \end{aligned}$$

How can you best support W.V. and his family?

The physician decides to add mycophenolate ( CellCept) 1 gram orally twice daily to W.V.'s immunosuppressive regimen. How does mycophenolate protect W.V.'s kidney from rejection?