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

Greenbold Manufacturing has four divisions named after its locations: Arizona, Colorado, Delaware, and Florida. Corporate headquarters is in Minnesota. Greenbold corporate headquarters incurs $8,400,000 per period, which is an indirect cost of the divisions. Corporate headquarters currently allocates this cost to the divisions based on the revenues of each division. The CEO has asked each division manager to suggest an allocation base for the indirect headquarters costs from among revenues, segment margin, direct costs, and number of employees. The following is relevant information about each division:

$$\begin{array}{lrrrr} &\textbf{Arizona} &\textbf{Colorado} &\textbf{Delaware} &\textbf{Florida}\\\hline \text{Revenues} &\$11,700,000 &\$12,750,000 &\$9,300,000 &\$8,250,000\\ \text{Direct costs} &\underline{~~~~7,950,000}& \underline{~~~~6,150,000}& \underline{~~6,450,000}& \underline{~~6,900,000}\\ \text{Segment margin} &\underline{\underline{\$~~3,750,000}} &\underline{\underline{\$~~6,600,000}}& \underline{\underline{\$2,850,000}}& \underline{\underline{\$1,350,000}}\\ \text{Number of employees} &3,000 &6,000& 2,250& 750\\ \end{array}$$

1. Allocate the indirect headquarters costs of Greenbold Manufacturing to each of the four divisions using revenues, direct costs, segment margin, and number of employees as the allocation bases. Calculate operating margins for each division after allocating headquarters costs.

2. Which allocation base do you think the manager of the Florida division would prefer? Explain.

3. What factors would you consider in deciding which allocation base Greenbold should use?

4. Suppose the Greenbold CEO decides to use direct costs as the allocation base. Should the Florida division be closed? Why or why not?

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.

How can the level or degree of the dementia impairment be determined?

A subtle form of racial discrimination in housing is "racial steering." Racial steering occurs when real estate agents show prospective buyers only homes in neighborhoods already dominated by that family's race. This violates the Fair Housing Act of 1968. According to an article in Chance magazine (Vol. 14, no. 2 [2001]), tenants at a large apartment complex recently filed a lawsuit alleging racial steering. The complex is divided into two parts: Section A and Section B. The plaintiffs claimed that white potential renters were steered to Section A, while African-Americans were steered to Section B. The table displays the data that were presented in court to show the locations of recently rented apartments. Do you think there is evidence of racial steering?

$$\begin{array}{|l|cc|c|}\hline &\text { New Renters } \\ \hline & \text { White } & \text { Black } & \text { Total } \\ \hline \text { Section A } & 87 & 8 & 95 \\ \text { Section B } & 83 & 34 & 117 \\ \hline \text { Total } & 170 & 42 & 212 \\ \hline\end{array}$$

In $1948$, Father Terminiello, a Roman Catholic priest, arrived to make a speech at a Chicago auditorium. Outside the auditorium about $300$ people were picketing his speech. Inside, Terminiello criticized Jews and African Americans, as well as the crowd outside. By the time his speech was finished, $1,500$ people had gathered outside. A police line prevented the protesters from entering the building. However, the "howling mob" outside was throwing stones and bricks at the building, and the police were unable to maintain control. The crowd was also yelling at and harassing people who came to hear Terminiello speak. Terminiello was arrested and charged with disorderly conduct under an ordinance forbidding any breach of the peace. He was convicted, and his conviction was upheld in the Illinois courts. However, in a $5$-to-$4$ decision, the U.S. Supreme Court reversed his conviction, ruling that the breach of the peace ordinance was vague and punished some speech that should have been protected.

Should the police have controlled the crowd instead of arresting Terminiello? Did the police violate his First Amendment rights? Why or why not?

[Related to the Don’t Let This Happen to You on page 392] In his autobiography, T. Boone Pickens, a geologist, entrepreneur, and oil company executive, wrote: It’s unusual to find a large corporation that’s efficient. When you get an inside look, it’s easy to see how inefficient big business really is. Most corporate bureaucracies have more people than they have work. Was Pickens describing diminishing returns or diseconomies of scale? Briefly explain.

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 living expenses?

The following items and amounts were taken from Motte Inc.’s 2014 income statement and balance sheet.

______ Cash                        $ 84,700
______ Retained earnings            123,192 
______ Cost of goods sold           438,458 
______ Salaries and wages expense   115,131 
______ Prepaid insurance              7,818 
______ Inventory                     64,618 
______ Accounts receivable           88,419
______ Sales revenue                584,951
______ Notes payable                  6,499
______ Accounts payable              49,384
______ Service revenue                4,806
______ Interest expense               1,882

Instructions (a) In each, case, identify on the blank line whether the item is an asset (A), liability (L), stockholder’s equity (SE), revenue (R), or expense (E) item.

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.

What are some cognitive changes seen in a number of elderly patients?

Tris (hydroxymethyl)aminomethane, commonly called TRIS or Trizma, is often used as a buffer in biochemical studies. Its buffering range is from pH 7 to $9 ,$ and $K _ { b }$ is $1.19 \times 10 ^ { - 6 }$ for the reaction

$$\begin{array} {l}{{\left( \mathrm { HOCH } _ { 2 } \right) _ { 3 } \mathrm { CNH } _ { 2 } ( a q ) + \mathrm { H } _ { 2 } \mathrm { O } ( l ) \rightleftharpoons \left( \mathrm { HOCH } _ { 2 } \right) _ { 3 } \mathrm { CNH } _ { 3 } ^ { + } ( a q ) + \mathrm { OH } ^ { - } ( a q )} \\\quad {\text{TRIS}\quad \quad \quad \quad \quad \quad \quad \quad \quad \quad \quad \quad \quad \text{TRISH}^+}} \end{array}$$

A buffer is prepared by diluting 50.0 g of TRIS base and 65.0 g of TRIS hydrochloride (written as TRISHCl to a total volume of 2.0 L. What is the pH of this buffer? What is the pH after 0.50 mL of 12 M HCl is added to a 200.0-mL portion of the buffer?

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.

K.B. is discharged and sees his primary care physician $2$ days later. K.B. receives a prescription for donepezil (Aricept) $5$mg PO/day at night. As you review the prescription with K.B.'s daughter, she tells you that she is “excited” because she did not know there were medications that could cure Alzheimer's disease.

How do you respond?

Reidland Manufacturing has four divisions: Acme, Dune, Stark, and Brothers. Corporate headquarters is in Minnesota. Reidland corporate headquarters incurs costs of $16,800,000 per period, which is an indirect cost of the divisions. Corporate headquarters currently allocates this cost to the divisions based on the revenues of each division. The CEO has asked each division manager to suggest an allocation base for the indirect headquarters costs from among revenues, segment margin, direct costs, and number of employees. The following is relevant information about each division:$

$$\begin{matrix} & \text{Acme} & \text{Dune} & \text{Stark} & \text{Brothers}\\ \text{Revenues} & \text{\$23,400,000} & \text{\$25,400,000} & \text{\$18,600,000} & \text{\$16,500,000}\\ \text{Direct costs} & \text{15,900,000} & \text{12,300,000} & \text{12,900,000} & \text{13,800,000}\\ \text{Segment margin} & \text{\$7,500,000} & \text{\$13,200,000} & \text{\$5,700,000} & \text{\$2,700,000}\\ \text{Number of employees} & \text{6,000} & \text{12,000} & \text{4,500} & \text{1,500}\\ \end{matrix}$$

$ 1. Allocate the indirect headquarters costs of Reidland Manufacturing to each of the four divisions using revenues, direct costs, segment margin, and number of employees as the allocation bases. Calculate operating margins for each division after allocating headquarters costs. 2. Which allocation base do you think the manager of the Brothers division would prefer? Explain. 3. What factors would you consider in deciding which allocation base Reidland should use? 4. Suppose the Reidland CEO decides to use direct costs as the allocation base. Should the Brothers division be closed? Why or why not?

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.”