$$\begin{array}{c c} \small\text{A MONEY MANAGER FOR} \underline{\textbf{ Nancy and Joe Thomas}} & \small\text{DATE} \underline{\textbf{ 7/20/--}}\\[10pt] \text{Monthly Living Expenses} & \text{Monthly Fixed Expenses} \hspace{50pt}\\ \end{array}$$

$$\begin{array}{l r |l r} \hline \text{Food/Grocery Bill} & \$210.00 & \text{Rent/Mortgage Payment} & \$715.20\\ \text{Household Expenses} & & \text{Car Payment} & \underline{\$~~~~~~~~~~~}\\ ~~~\text{Electricity} & \$~~55.65 & \text{Other Installments}\\ ~~~\text{Heating Fuel} & \$~~63.75 & ~~~\text{Appliances} & \$~~57.75\\ ~~~\text{Telephone} & \$~~21.47 & ~~~\text{Furniture} & \$110.80\\ ~~~\text{Water} & \$~~31.80 & \text{Regular Savings} & \$~~75.00\\ ~~~\text{Garbage/Sewer Fee} & \$~~17.21 & \text{Emergency Fund} & \$~~50.00\\ ~~~\text{Other} \underline{\text{ Security}} & \$~~25.00 & \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \underline{\text{~~~~~~~~~~~~~~~~~~~~~~~~~~~~~}}& \underline{\$~~~~~~~~~~~} & \\[10pt] \text{Transportation} & & \textbf{ANNUAL EXPENSES} \\ ~~~\text{Gasoline/Oil} & \$~~60.00 & \text{Life Insurance} & \$480.00\\ ~~~\text{Parking} & \$~~35.00 & \text{Home Insurance} & \$180.00\\ ~~~\text{Tolls} & \$~~12.00 & \text{Car Insurance} & \$475.00\\ ~~~\text{Commuting} & \$~~20.00 & \text{Real Estate Taxes} & \$1200.00\\ ~~~\text{Other} \underline{\text{ Misc.}} & \$~~35.00 & \text{Car Registration} & \$~~26.50\\ & & \text{Pledges/Contributions} & \$360.00\\ \text{Personal Spending}& & ~~~\text{Other}\underline{\text{~~~~~~~~~~~~~~~~~}} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Clothing} & \$100.00& \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Credit Payments} & \$~~25.00 & \text{MONTHLY SHARE} & \\ ~~~ \text{Newspapers. Gifts, Etc.} & \$~~16.75 & \text{(Divided by 12)} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Pocket Money} & \$~~32.00 \\[10pt] \text{Entertainment} & & \textbf{MONTHLY BALANCE SHEET}\\ ~~~ \text{Movies/Theater} & \$~~20.00 & \text{Net Income} & \\ ~~~ \text{Sporting Events} & \$~~20.00 & \text{(Total Budget)} & \$1800.00\\ ~~~ \text{Recreation} & \$~~15.00 & ~~~\text{Living Expenses} & \underline{\$~~~~~~~~~~~~~}\\ ~~~ \text{Dining Out} & \$~~32.00 & ~~~\text{Fixed Expenses} & \underline{\$~~~~~~~~~~~~~}\\ \text{TOTAL} & \underline{\$~~~~~~~~~~~} & ~~~\text{Annual Expenses} & \underline{\$~~~~~~~~~~~~~}\\ & & \text{TOTAL MONTHLY} \\ & & ~~~\text{EXPENSES} & \underline{\$~~~~~~~~~~~~~}\\ & & ~~~\text{BALANCE} & \underline{\$~~~~~~~~~~~~~}\\ \end{array}$$

What is the total of their monthly living expenses?

The partner in charge of the Kappeler Corporation audit comes by your desk and leaves a letter he has started to the CEO and a copy of the cash flow statement for the year ended December 31, 2017. Because he must leave on an emergency, he asks you to finish the letter by explaining: (1) the disparity between net income and cash flow, (2) the importance of operating cash flow, (3) the renewable source(s) of cash flow, and (4) possible suggestions to improve the cash position.

$$\begin{array}{c} \textbf{KAPPELER CORPORATION}\\ \textbf{STATEMENT OF CASH FLOWS}\\ \textbf{FOR THE YEAR ENDED DECEMBER 31, 2017} \end{array}$$

$$\begin{array}{lrr} \text{Cash flows from operating activities}\\ \hspace{5pt}\text{Net income}&&\$\hspace{10pt}\text{100,000}\\ \hspace{5pt}\text{\text{Adjustments to reconcile net income to }}\\ \hspace{15pt}\text{net cash provided by operating activities:}\\ \hspace{25pt}\text{Depreciation expense}&\$\hspace{10pt}\text{10,000}\\ \hspace{25pt}\text{Amortization expense}&\hspace{4pt}\text{1,000}\\ \hspace{25pt}\text{Loss on sale of fixed assets}&\hspace{4pt}\text{5,000}\\ \hspace{25pt}\text{Increase in accounts receivable (net)}&\hspace{4pt}(\text{40,000})\\ \hspace{25pt}\text{Increase in inventory}&\hspace{4pt}(\text{35,000})\\ \hspace{25pt}\text{Decrease in accounts payable}&\underline{\hspace{9pt}(\text{41,000})}&\underline{\hspace{10pt}(\text{100,000})}\\ \text{\hspace{5pt}Net cash provided by operating activities}&&\$\hspace{32pt}\text{-0-}\\ \text{Cash flows from investing activities}\\ \hspace{5pt}\text{Sale of plant assets}&\hspace{4pt}\text{25,000}\\ \hspace{5pt}\text{Purchase of equipment}&\hspace{4pt}\text{(100,000)}\\ \hspace{5pt}\text{Purchase of land}&\underline{\hspace{4pt}(\text{200,000})}\\ \text{\hspace{15pt}Net cash used by investing activities:}&&\hspace{5pt}(\text{275,000})\\ \text{Cash flows from financing activities}\\ \hspace{5pt}\text{Payment of dividends}&\text{(10,000)}\\ \hspace{5pt}\text{Redemption of bonds}&\underline{\hspace{5pt}(\text{100,000})}\\ \text{\hspace{15pt}Net cash provided by financing activities}&&\underline{\hspace{10pt}\text{(110,000)}}\\ \text{Net decrease in cash}&&\$\hspace{5pt}\text{(385,000)}\\ \text{Cash balance, January 1, 2017}&&\underline{\hspace{18pt}\text{400,000}}\\ \text{Cash balance, December 31, 2017}&&\underline{\underline{\text{\$\hspace{18pt}\text{15,000}}}}\\ \end{array}$$

Date

President Kappeler, CEO Kappeler Corporation 125 Wall Street Middleton, Kansas 67458

Dear Mr. Kappeler:

I have good news and bad news about the financial statements for the year ended December 31, 2017. The good news is that net income of $100,000 is close to what we predicted in the strategic plan last year, indicating strong performance this year. The bad news is that the cash balance is seriously low. Enclosed is the Statement of Cash Flows, which best illustrates how both of these situations occurred simultaneously . . .

Complete the letter to the CEO, including the four components requested by your boss.

$$\begin{array}{c c} \small\text{A MONEY MANAGER FOR} \underline{\textbf{ Nancy and Joe Thomas}} & \small\text{DATE} \underline{\textbf{ 7/20/--}}\\[10pt] \text{Monthly Living Expenses} & \text{Monthly Fixed Expenses} \hspace{50pt}\\ \end{array}$$

$$\begin{array}{l r |l r} \hline \text{Food/Grocery Bill} & \$210.00 & \text{Rent/Mortgage Payment} & \$715.20\\ \text{Household Expenses} & & \text{Car Payment} & \underline{\$~~~~~~~~~~~}\\ ~~~\text{Electricity} & \$~~55.65 & \text{Other Installments}\\ ~~~\text{Heating Fuel} & \$~~63.75 & ~~~\text{Appliances} & \$~~57.75\\ ~~~\text{Telephone} & \$~~21.47 & ~~~\text{Furniture} & \$110.80\\ ~~~\text{Water} & \$~~31.80 & \text{Regular Savings} & \$~~75.00\\ ~~~\text{Garbage/Sewer Fee} & \$~~17.21 & \text{Emergency Fund} & \$~~50.00\\ ~~~\text{Other} \underline{\text{ Security}} & \$~~25.00 & \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \underline{\text{~~~~~~~~~~~~~~~~~~~~~~~~~~~~~}}& \underline{\$~~~~~~~~~~~} & \\[10pt] \text{Transportation} & & \textbf{ANNUAL EXPENSES} \\ ~~~\text{Gasoline/Oil} & \$~~60.00 & \text{Life Insurance} & \$480.00\\ ~~~\text{Parking} & \$~~35.00 & \text{Home Insurance} & \$180.00\\ ~~~\text{Tolls} & \$~~12.00 & \text{Car Insurance} & \$475.00\\ ~~~\text{Commuting} & \$~~20.00 & \text{Real Estate Taxes} & \$1200.00\\ ~~~\text{Other} \underline{\text{ Misc.}} & \$~~35.00 & \text{Car Registration} & \$~~26.50\\ & & \text{Pledges/Contributions} & \$360.00\\ \text{Personal Spending}& & ~~~\text{Other}\underline{\text{~~~~~~~~~~~~~~~~~}} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Clothing} & \$100.00& \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Credit Payments} & \$~~25.00 & \text{MONTHLY SHARE} & \\ ~~~ \text{Newspapers. Gifts, Etc.} & \$~~16.75 & \text{(Divided by 12)} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Pocket Money} & \$~~32.00 \\[10pt] \text{Entertainment} & & \textbf{MONTHLY BALANCE SHEET}\\ ~~~ \text{Movies/Theater} & \$~~20.00 & \text{Net Income} & \\ ~~~ \text{Sporting Events} & \$~~20.00 & \text{(Total Budget)} & \$1800.00\\ ~~~ \text{Recreation} & \$~~15.00 & ~~~\text{Living Expenses} & \underline{\$~~~~~~~~~~~~~}\\ ~~~ \text{Dining Out} & \$~~32.00 & ~~~\text{Fixed Expenses} & \underline{\$~~~~~~~~~~~~~}\\ \text{TOTAL} & \underline{\$~~~~~~~~~~~} & ~~~\text{Annual Expenses} & \underline{\$~~~~~~~~~~~~~}\\ & & \text{TOTAL MONTHLY} \\ & & ~~~\text{EXPENSES} & \underline{\$~~~~~~~~~~~~~}\\ & & ~~~\text{BALANCE} & \underline{\$~~~~~~~~~~~~~}\\ \end{array}$$

What is the total of their monthly fixed expenses?

$$\begin{array}{c c} \small\text{A MONEY MANAGER FOR} \underline{\textbf{ Nancy and Joe Thomas}} & \small\text{DATE} \underline{\textbf{ 7/20/--}}\\[10pt] \text{Monthly Living Expenses} & \text{Monthly Fixed Expenses} \hspace{50pt}\\ \end{array}$$

$$\begin{array}{l r |l r} \hline \text{Food/Grocery Bill} & \$210.00 & \text{Rent/Mortgage Payment} & \$715.20\\ \text{Household Expenses} & & \text{Car Payment} & \underline{\$~~~~~~~~~~~}\\ ~~~\text{Electricity} & \$~~55.65 & \text{Other Installments}\\ ~~~\text{Heating Fuel} & \$~~63.75 & ~~~\text{Appliances} & \$~~57.75\\ ~~~\text{Telephone} & \$~~21.47 & ~~~\text{Furniture} & \$110.80\\ ~~~\text{Water} & \$~~31.80 & \text{Regular Savings} & \$~~75.00\\ ~~~\text{Garbage/Sewer Fee} & \$~~17.21 & \text{Emergency Fund} & \$~~50.00\\ ~~~\text{Other} \underline{\text{ Security}} & \$~~25.00 & \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \underline{\text{~~~~~~~~~~~~~~~~~~~~~~~~~~~~~}}& \underline{\$~~~~~~~~~~~} & \\[10pt] \text{Transportation} & & \textbf{ANNUAL EXPENSES} \\ ~~~\text{Gasoline/Oil} & \$~~60.00 & \text{Life Insurance} & \$480.00\\ ~~~\text{Parking} & \$~~35.00 & \text{Home Insurance} & \$180.00\\ ~~~\text{Tolls} & \$~~12.00 & \text{Car Insurance} & \$475.00\\ ~~~\text{Commuting} & \$~~20.00 & \text{Real Estate Taxes} & \$1200.00\\ ~~~\text{Other} \underline{\text{ Misc.}} & \$~~35.00 & \text{Car Registration} & \$~~26.50\\ & & \text{Pledges/Contributions} & \$360.00\\ \text{Personal Spending}& & ~~~\text{Other}\underline{\text{~~~~~~~~~~~~~~~~~}} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Clothing} & \$100.00& \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Credit Payments} & \$~~25.00 & \text{MONTHLY SHARE} & \\ ~~~ \text{Newspapers. Gifts, Etc.} & \$~~16.75 & \text{(Divided by 12)} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Pocket Money} & \$~~32.00 \\[10pt] \text{Entertainment} & & \textbf{MONTHLY BALANCE SHEET}\\ ~~~ \text{Movies/Theater} & \$~~20.00 & \text{Net Income} & \\ ~~~ \text{Sporting Events} & \$~~20.00 & \text{(Total Budget)} & \$1800.00\\ ~~~ \text{Recreation} & \$~~15.00 & ~~~\text{Living Expenses} & \underline{\$~~~~~~~~~~~~~}\\ ~~~ \text{Dining Out} & \$~~32.00 & ~~~\text{Fixed Expenses} & \underline{\$~~~~~~~~~~~~~}\\ \text{TOTAL} & \underline{\$~~~~~~~~~~~} & ~~~\text{Annual Expenses} & \underline{\$~~~~~~~~~~~~~}\\ & & \text{TOTAL MONTHLY} \\ & & ~~~\text{EXPENSES} & \underline{\$~~~~~~~~~~~~~}\\ & & ~~~\text{BALANCE} & \underline{\$~~~~~~~~~~~~~}\\ \end{array}$$

Do the Thomases live within their monthly net income?

T.B. is a $65$-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but "none as bad as this." He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the ED for evaluation.

After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented $\times 3$, and he moves all extremities well. He is restless, is constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm. Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for $1$ week. The patient voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs are BP $164/100$, pulse of $132$ beats $/ \mathrm{min}$, respiration $26$ breaths/min, temperature of $100^{\circ} \mathrm{F}\left(37.8^{\circ} \mathrm{C}\right), \mathrm{Spo}_2 96 \%$ on $2 \mathrm{~L}$ of oxygen by nasal cannula.

What discharge teaching does T.B. need?

S.B. is a $17$-year-old man who lost control of his sport utility vehicle and struck a tree. Witnesses reported he was not restrained, and his face hit the windshield on impact. When paramedics arrived, S.B. was responsive but confused, had significant facial swelling, and complained of pain in his right wrist and left forearm. The paramedics initiated cervical spine precautions, strapped him to a backboard, started oxygen at $15 \mathrm{~L} / \mathrm{min}$ via a nonrebreather mask, and started a 16 -gauge IV with $0.9 \%$ normal saline. His vital signs were $120 / 75,125,36$, and $\mathrm{SaO}_2 94 \%$. On arrival to the local emergency department (ED) 5 minutes later, his VS were $110/62$, $110$ regular, $28$ to $32$ and shallow, and $\mathrm{SaO}_2 99 \%$. An additional 16-gauge IV was inserted and the following labs were drawn: CBC, type and crossmatch, complete metabolic panel, PT/ PTT INR, and alcohol level. The trauma physician completed a head-to-toe assessment and found the following:

Physician Note

Obeys commands, responds to voice but not oriented to time or place. Generalized facial edema with full-thickness $2$-cm cheek laceration and bilateral mandibular depressed fractures. Blood behind left tympanic membrane, edema with slight discoloration over left mastoid process. Clear drainage coming from the left nare. Mid to upper chest contusions without crepitus, breath sounds clear. Abdomen slightly firm but not tender. Catheterized for $500$ mL clear yellow urine; negative for blood, glucose, ketones. Positive deformity of right wrist and diffuse tenderness of left lower forearm.

What are the symptoms of a posterior fossa fracture (fracture of temporal petrous bone), and how does it compare to a BSF?

R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has four siblings who have recently been ill with stomach pains, vomiting, diarrhea, and fever. They were seen by their primary care provider (PCP) and diagnosed wit h viral gastroenteritis. A week later, R.O. woke up at 0200 crying and telling her mother that her stomach "hurts really bad!" She had an elevated temperature of 37.9degree C (100.2degree F). R.O. began to vomit over the next few hours, so her parents took her to the local emergency department (ED). R.O.'s vital signs, complete blood count, and complete metabolic panel were normal, so she was hydrated with IV fluids and discharged to home wit h instructions for her parents to call their PCP or to return to the ED if her condition did not improve or if it worsened. Over the next 2 days, R.O.'s abdominal pain localized to the right lower quadrant. she refused to eat, and she had slight diarrhea. On the third day, she began to have more severe abdominal pain, increased vomiting, and fever that did not respond to acetaminophen. R.O. has returned to the ED. Her VS are 128/78, 130, 28, 39.S degree C (103.1degree F). R.O. is guarding her lower abdomen, prefers to lie on her side with her legs flexed, and is crying. IV access is established, and morphine sulphate 2 mg IV is administered for pain. An abdominal CT scan confirms a diagnosis of appendicitis. R.O.'s white blood count is 12,000 mm3
Which of the following are common clinical manifestations of appendicitis? Select all that apply.
a. Diarrhea
b. Vomiting
c. Left lower quadrant abdominal pain
d. Constipation
e. Arthralgia
f. Diffuse rash
g. Fever.

The partner in charge of the Kappeler Corpora tion audit comes by your desk and leaves a letter he has started to the CEO and a copy of the cash flow statement for the year ended December 31, 2020. Because he must leave on an emergency, he asks you to finish the letter by explaining: (1) the disparity between net income and cash flow, (2) the importance of operating cash flow, (3) the renewable source(s) of cash flow, and (4) possible suggestions to improve the cash position.

$$\begin{array}{c} \hline \hspace{150pt}\textbf{Kappeler Corporation}\hspace{150pt}\\ \textbf{Statement of Cash Flows}\\ \textbf{For the Year Ended December 31, 2020 }\\ \hline \end{array}$$

$$\begin{array}{lrrrrrrrrr} \text{Cash flows from operating activities}\\ \hspace{5pt}\text{Net income}&&\$\text{\hspace{15pt}{100,000}}\\ \hspace{5pt}\text{Adjustments to reconcile net income to net cash provided by}\\ \hspace{10pt}\text{operating activities:}\\ \hspace{20pt}\text{Depreciation expense}&\text{10,000}\\ \hspace{20pt}\text{Amortization expense}&\text{1,000}\\ \hspace{20pt}\text{Loss on sale of fixed assets}&\text{5,000}\\ \hspace{20pt}\text{Increase in accounts receivable (net)}&\text{(40,000)}\\ \hspace{20pt}\text{Increase in inventory}&\text{(35,000)}\\ \hspace{20pt}\text{Decrease in accounts payable}&\text{\underline{\hspace{10pt}{(41,000)}}}&\text{\underline{\hspace{10pt}{(100,000)}}}\\\\ \hspace{5pt}\text{Net cash provided by operating activities}&&\text{\hspace{15pt}{-0-}}\\\\ \text{Cash flows from investing activities}\\ \hspace{5pt}\text{Sale of plant assets}&\text{\hspace{15pt}{25,000}}\\ \hspace{5pt}\text{Purchase of equipment}&\text{(100,000)}\\ \hspace{5pt}\text{Purchase of land }&\text{\underline{\hspace{5pt}{(200,000)}}}&\\\\ \hspace{5pt}\text{Net cash used by investing activities }&&\text{\hspace{15pt}{(275,000)}}\\\\ \text{Cash flows from financing activities}\\ \hspace{5pt}\text{Payment of dividends}&\text{(100,000)}\\ \hspace{5pt}\text{Redemption of bonds }&\text{\underline{\hspace{5pt}{(100,000)}}}&\\\\ \hspace{5pt}\text{Net cash used by financing activities}&&\text{\underline{\hspace{10pt}{(110,000)}}}\\ \text{Net decrease in cash}&&\text{\hspace{15pt}{(385,000)}}\\ \text{Cash balance. January 1, 2020}&&\text{\underline{\hspace{17pt}{400,000}}}\\ \text{Cash balance, December 31, 2020}&&\underline{\underline{\$\hspace{18pt}\text{15,000}}}\\ \end{array}$$

Date

President Kappeler, CEO Kappeler Corporation 125 Wall Street Middleton, Kansas 67458

Dear Mr. Kappeler:

I have good news and bad news about the financial statements for the year ended December 31, 2020. The good news is that net income of $100,000 is close to what we predicted in the strategic plan last year, indi- cating strong performance this year. The bad news is that the cash balance is seriously low. Enclosed is the Statement of Cash Flows, which best illustrates how both of these situations occurred simultaneously...

Instructions

Complete the letter to the CEO, including the four components requested by your boss.

You are the nurse working triage in the emergency department. This afternoon, a woman brings in her father, K.B., who is $72$ years old. The daughter reports that, over the past year, she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. This morning, he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his own coffee, and he seems to be getting more agitated. K.B. reports that he has been having memory problems for the past year and, at times, has difficulty remembering the names of family members and friends. His neighbor found him down the street $2$ days ago, and K.B. did not know where he was.

A review of his past medical history is significant for hypercholesterolemia and coronary artery disease. He had a myocardial infarction $5$ years ago. K.B.'s vital signs today are all within normal limits.

A number of diagnostic tests have been ordered for K.B. From the tests listed, which would be used to diagnose dementia?

$\underline{\phantom{XX}}$ Mental status examinations

$\underline{\phantom{XX}}$ Toxicology screen

$\underline{\phantom{XX}}$ Mini-Mental State Examination

$\underline{\phantom{XX}}$ ECG

$\underline{\phantom{XX}}$ EEG

$\underline{\phantom{XX}}$ CMP

$\underline{\phantom{XX}}$ CBC with differential

$\underline{\phantom{XX}}$ Thyroid function tests

$\underline{\phantom{XX}}$ Colonoscopy

$\underline{\phantom{XX}}$ RPR

$\underline{\phantom{XX}}$ Serum B$_{12}$

$\underline{\phantom{XX}}$ Bleeding time

$\underline{\phantom{XX}}$ HIV screening

$\underline{\phantom{XX}}$ CT

$\underline{\phantom{XX}}$ MRI

S.B. is a $17$-year-old man who lost control of his sport utility vehicle and struck a tree. Witnesses reported he was not restrained, and his face hit the windshield on impact. When paramedics arrived, S.B. was responsive but confused, had significant facial swelling, and complained of pain in his right wrist and left forearm. The paramedics initiated cervical spine precautions, strapped him to a backboard, started oxygen at $15 \mathrm{~L} / \mathrm{min}$ via a nonrebreather mask, and started a 16 -gauge IV with $0.9 \%$ normal saline. His vital signs were $120 / 75,125,36$, and $\mathrm{SaO}_2 94 \%$. On arrival to the local emergency department (ED) 5 minutes later, his VS were $110/62$, $110$ regular, $28$ to $32$ and shallow, and $\mathrm{SaO}_2 99 \%$. An additional 16-gauge IV was inserted and the following labs were drawn: CBC, type and crossmatch, complete metabolic panel, PT/ PTT INR, and alcohol level. The trauma physician completed a head-to-toe assessment and found the following:

Physician Note

Obeys commands, responds to voice but not oriented to time or place. Generalized facial edema with full-thickness $2$-cm cheek laceration and bilateral mandibular depressed fractures. Blood behind left tympanic membrane, edema with slight discoloration over left mastoid process. Clear drainage coming from the left nare. Mid to upper chest contusions without crepitus, breath sounds clear. Abdomen slightly firm but not tender. Catheterized for $500$ mL clear yellow urine; negative for blood, glucose, ketones. Positive deformity of right wrist and diffuse tenderness of left lower forearm.

S.B. remained in the hospital for 48 hours for observation before being discharged. As you are evaluating the discharge teaching for S.B., you would understand that further teaching would be required if he stated:

a. “I will try to avoid blowing my nose for the next two weeks.”

b. “If I start vomiting, I will return to the hospital immediately.”

c. “Since a headache is expected, I can take aspirin for the pain.”

d. “If I do not move my bowels each day, I will take a Dulcolax.”

$$\begin{array}{c c} \small\text{A MONEY MANAGER FOR} \underline{\textbf{ Nancy and Joe Thomas}} & \small\text{DATE} \underline{\textbf{ 7/20/--}}\\[10pt] \text{Monthly Living Expenses} & \text{Monthly Fixed Expenses} \hspace{50pt}\\ \end{array}$$

$$\begin{array}{l r |l r} \hline \text{Food/Grocery Bill} & \$210.00 & \text{Rent/Mortgage Payment} & \$715.20\\ \text{Household Expenses} & & \text{Car Payment} & \underline{\$~~~~~~~~~~~}\\ ~~~\text{Electricity} & \$~~55.65 & \text{Other Installments}\\ ~~~\text{Heating Fuel} & \$~~63.75 & ~~~\text{Appliances} & \$~~57.75\\ ~~~\text{Telephone} & \$~~21.47 & ~~~\text{Furniture} & \$110.80\\ ~~~\text{Water} & \$~~31.80 & \text{Regular Savings} & \$~~75.00\\ ~~~\text{Garbage/Sewer Fee} & \$~~17.21 & \text{Emergency Fund} & \$~~50.00\\ ~~~\text{Other} \underline{\text{ Security}} & \$~~25.00 & \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \underline{\text{~~~~~~~~~~~~~~~~~~~~~~~~~~~~~}}& \underline{\$~~~~~~~~~~~} & \\[10pt] \text{Transportation} & & \textbf{ANNUAL EXPENSES} \\ ~~~\text{Gasoline/Oil} & \$~~60.00 & \text{Life Insurance} & \$480.00\\ ~~~\text{Parking} & \$~~35.00 & \text{Home Insurance} & \$180.00\\ ~~~\text{Tolls} & \$~~12.00 & \text{Car Insurance} & \$475.00\\ ~~~\text{Commuting} & \$~~20.00 & \text{Real Estate Taxes} & \$1200.00\\ ~~~\text{Other} \underline{\text{ Misc.}} & \$~~35.00 & \text{Car Registration} & \$~~26.50\\ & & \text{Pledges/Contributions} & \$360.00\\ \text{Personal Spending}& & ~~~\text{Other}\underline{\text{~~~~~~~~~~~~~~~~~}} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Clothing} & \$100.00& \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Credit Payments} & \$~~25.00 & \text{MONTHLY SHARE} & \\ ~~~ \text{Newspapers. Gifts, Etc.} & \$~~16.75 & \text{(Divided by 12)} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Pocket Money} & \$~~32.00 \\[10pt] \text{Entertainment} & & \textbf{MONTHLY BALANCE SHEET}\\ ~~~ \text{Movies/Theater} & \$~~20.00 & \text{Net Income} & \\ ~~~ \text{Sporting Events} & \$~~20.00 & \text{(Total Budget)} & \$1800.00\\ ~~~ \text{Recreation} & \$~~15.00 & ~~~\text{Living Expenses} & \underline{\$~~~~~~~~~~~~~}\\ ~~~ \text{Dining Out} & \$~~32.00 & ~~~\text{Fixed Expenses} & \underline{\$~~~~~~~~~~~~~}\\ \text{TOTAL} & \underline{\$~~~~~~~~~~~} & ~~~\text{Annual Expenses} & \underline{\$~~~~~~~~~~~~~}\\ & & \text{TOTAL MONTHLY} \\ & & ~~~\text{EXPENSES} & \underline{\$~~~~~~~~~~~~~}\\ & & ~~~\text{BALANCE} & \underline{\$~~~~~~~~~~~~~}\\ \end{array}$$

What individual expenses would be difficult for the Thomases to cut back on?

The Saftir-Simpson scale, used ty the National Weather Service since the I970s to classify hurricane strength, ranks storm strength from Level 1 to 5 , and is used to give an extimate of the possible property damage and flooding expected when the hurricane makes landfall. A Categocy 5 storm maintains winds in excess of 155 mph and is capable of causing widespread damages such as destroying or causing extensive structural damage to homes. It can also trigger a stocm suige moee than $18 \mathrm{ft}$ above normal.

Two of the most fundamental steps people can take are ssembling a disaster sapplies kit and making an emergency plan. They are simple meisures, but can make all the difference when disasters strike. 17. For what parpose is the Saffir-Simpoon scale used? A. estimating property damage and flooding efhen a hurricane makes landfall B. estimating the height of a stoem surge above normal C. determining who should be told to evacuate before a hurricane hits D. measuring the strength of an approashing hurricane 18. What can be inferred from this passage? A. Only Category 5 harricanes will cause major damage. B. Only people living along the shoreline are in danget during burricanes. C. Category 5 hurricanes have the potential to cause major damage, D. People should have a disaster supply kit or an evacuation plan in place before a burricane hits.

What can be inferred from this passage?

A. Only Category 5 harricanes will cause major damage.

B. Only people living along the shoreline are in danget during burricanes.

C. Category 5 hurricanes have the potential to cause major damage,

D. People should have a disaster supply kit or an evacuation plan in place before a burricane hits.

$$\begin{array}{c c} \small\text{A MONEY MANAGER FOR} \underline{\textbf{ Nancy and Joe Thomas}} & \small\text{DATE} \underline{\textbf{ 7/20/--}}\\[10pt] \text{Monthly Living Expenses} & \text{Monthly Fixed Expenses} \hspace{50pt}\\ \end{array}$$

$$\begin{array}{l r |l r} \hline \text{Food/Grocery Bill} & \$210.00 & \text{Rent/Mortgage Payment} & \$715.20\\ \text{Household Expenses} & & \text{Car Payment} & \underline{\$~~~~~~~~~~~}\\ ~~~\text{Electricity} & \$~~55.65 & \text{Other Installments}\\ ~~~\text{Heating Fuel} & \$~~63.75 & ~~~\text{Appliances} & \$~~57.75\\ ~~~\text{Telephone} & \$~~21.47 & ~~~\text{Furniture} & \$110.80\\ ~~~\text{Water} & \$~~31.80 & \text{Regular Savings} & \$~~75.00\\ ~~~\text{Garbage/Sewer Fee} & \$~~17.21 & \text{Emergency Fund} & \$~~50.00\\ ~~~\text{Other} \underline{\text{ Security}} & \$~~25.00 & \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \underline{\text{~~~~~~~~~~~~~~~~~~~~~~~~~~~~~}}& \underline{\$~~~~~~~~~~~} & \\[10pt] \text{Transportation} & & \textbf{ANNUAL EXPENSES} \\ ~~~\text{Gasoline/Oil} & \$~~60.00 & \text{Life Insurance} & \$480.00\\ ~~~\text{Parking} & \$~~35.00 & \text{Home Insurance} & \$180.00\\ ~~~\text{Tolls} & \$~~12.00 & \text{Car Insurance} & \$475.00\\ ~~~\text{Commuting} & \$~~20.00 & \text{Real Estate Taxes} & \$1200.00\\ ~~~\text{Other} \underline{\text{ Misc.}} & \$~~35.00 & \text{Car Registration} & \$~~26.50\\ & & \text{Pledges/Contributions} & \$360.00\\ \text{Personal Spending}& & ~~~\text{Other}\underline{\text{~~~~~~~~~~~~~~~~~}} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Clothing} & \$100.00& \text{TOTAL} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Credit Payments} & \$~~25.00 & \text{MONTHLY SHARE} & \\ ~~~ \text{Newspapers. Gifts, Etc.} & \$~~16.75 & \text{(Divided by 12)} & \underline{\$~~~~~~~~~~~}\\ ~~~ \text{Pocket Money} & \$~~32.00 \\[10pt] \text{Entertainment} & & \textbf{MONTHLY BALANCE SHEET}\\ ~~~ \text{Movies/Theater} & \$~~20.00 & \text{Net Income} & \\ ~~~ \text{Sporting Events} & \$~~20.00 & \text{(Total Budget)} & \$1800.00\\ ~~~ \text{Recreation} & \$~~15.00 & ~~~\text{Living Expenses} & \underline{\$~~~~~~~~~~~~~}\\ ~~~ \text{Dining Out} & \$~~32.00 & ~~~\text{Fixed Expenses} & \underline{\$~~~~~~~~~~~~~}\\ \text{TOTAL} & \underline{\$~~~~~~~~~~~} & ~~~\text{Annual Expenses} & \underline{\$~~~~~~~~~~~~~}\\ & & \text{TOTAL MONTHLY} \\ & & ~~~\text{EXPENSES} & \underline{\$~~~~~~~~~~~~~}\\ & & ~~~\text{BALANCE} & \underline{\$~~~~~~~~~~~~~}\\ \end{array}$$

What must be set aside each month for annual expenses?

S.B. is a $17$-year-old man who lost control of his sport utility vehicle and struck a tree. Witnesses reported he was not restrained, and his face hit the windshield on impact. When paramedics arrived, S.B. was responsive but confused, had significant facial swelling, and complained of pain in his right wrist and left forearm. The paramedics initiated cervical spine precautions, strapped him to a backboard, started oxygen at $15 \mathrm{~L} / \mathrm{min}$ via a nonrebreather mask, and started a 16 -gauge IV with $0.9 \%$ normal saline. His vital signs were $120 / 75,125,36$, and $\mathrm{SaO}_2 94 \%$. On arrival to the local emergency department (ED) 5 minutes later, his VS were $110/62$, $110$ regular, $28$ to $32$ and shallow, and $\mathrm{SaO}_2 99 \%$. An additional 16-gauge IV was inserted and the following labs were drawn: CBC, type and crossmatch, complete metabolic panel, PT/ PTT INR, and alcohol level. The trauma physician completed a head-to-toe assessment and found the following:

Physician Note

Obeys commands, responds to voice but not oriented to time or place. Generalized facial edema with full-thickness $2$-cm cheek laceration and bilateral mandibular depressed fractures. Blood behind left tympanic membrane, edema with slight discoloration over left mastoid process. Clear drainage coming from the left nare. Mid to upper chest contusions without crepitus, breath sounds clear. Abdomen slightly firm but not tender. Catheterized for $500$ mL clear yellow urine; negative for blood, glucose, ketones. Positive deformity of right wrist and diffuse tenderness of left lower forearm.

Because S.B. is suspected of having a BSF, why would you avoid placing a nasogastric tube in S.B.?