A nurse is cаring fоr а 58-yeаr-оld patient with COPD whо has been taking oral prednisolone 20 mg daily for the past three months. The provider discontinues the medication abruptly. The following morning, the patient reports feeling dizzy and extremely fatigued and has a blood pressure of 88/54. What is the nurse's priority action?
Becаuse оf the chаnges in the pаtient’s cоnditiоn, which of the following actions would be most beneficial? (Select two correct answers)
Which оf the fоllоwing signs аnd symptoms аre consistent with аn anaphylactic reaction? (Select three correct answers)
DIRECTIONS: Chооse the best аnswer fоr eаch question. Spirits in the Sаnd Recent findings shed light on the lives - and mysterious disappearance - of the ancient Nasca. [A] Since their mysterious desert drawings became widely known in the late 1920s, the people known as the Nasca have puzzled archeologists, anthropologists, 1 and anyone else who is fascinated by ancient cultures. Their elaborate lines and figures, called geoglyphs, are found distributed, seemingly at random, across the desert outside Nasca and the nearby town of Palpa. Waves of scientists - and amateurs - have come up with various interpretations for the designs. At one time or another, they have been explained as Inca roads, irrigation plans, even, controversially, landing strips for alien spacecraft. [B] Since 1997, an ongoing Peruvian-German research collaboration called the Nasca-Palpa Project has been putting these theories to the test. The leaders of the project are Johny Isla and Markus Reindel of the German Archaeological Institute. As well as studying where and how the Nasca lived, the researchers have investigated why they disappeared and the meaning of the strange, abstract designs they left behind. If Isla and his colleagues are right, the story of Nasca begins, and ends, with water. Living on the Edge[C] The coastal region of southern Peru and northern Chile is one of the driest places on Earth. In the small, protected basin where the Nasca culture arose, ten rivers descend from the Andes. Most of these rivers are dry at least part of the year. Surrounded by a thousand shades of brown, these ten ribbons of green offered a fertile spot for the emergence of an early civilization. "It was the perfect place for human settlement, because it had water," says geographer Bernhard Eitel, a member of the Nasca-Palpa Project. "But it was a very high-risk environment." [D] According to Eitel and his colleague Bertil Machtle, the micro-climate in the Nasca region has undergone considerable variation over the past 5,000 years. When a high-pressure system over central South America called the Bolivian High moves to the north, more rain falls on the western slopes of the Andes. When the high shifts southward, precipitation decreases. This causes the rivers in the Nasca valleys to run dry. [E] Despite the risky conditions, the Nasca lived in the area for eight centuries following their appearance in about 300 B.C. As the rainfall cycle continued, people moved east or west along the river valleys. In the arid southern valleys, early Nasca engineers devised practical ways of coping with the scarcity of water. An ingenious system of horizontal wells tapped into the inclined water table as it descended from the Andean foothills. These irrigation systems, or puquios, allowed the Nasca to bring subterranean 2 water to the surface. [F] The Nasca people were in fact remarkably "green," perhaps because of the environmental challenges they faced. The creation of the puquios displayed a sophisticated sense of water conservation, since the underground aqueducts 3 minimized evaporation. The farmers planted seeds by making a single hole in the ground rather than plowing, thereby preserving the substructure of the soil. The Nasca also recycled their garbage as building material. "It's a society that managed its resources very well," says Isla. "This is what Nasca is all about." Praying for Water[G] For centuries, Andean people have worshipped the gods of mountains that feed the Nasca drainage system. According to National Geographic explorer Johan Reinhard, the Nasca have traditionally associated these mountains - mythologically, if not geologically - with water. Evidence for Reinhard's thesis came in 1986, when he found the ruins of a ceremonial stone circle at the summit of Illakata, one of the region's tallest mountains. Reinhard believes the Nasca lines were most likely related to worship of mountain gods, because of their connection to water. [H] Further evidence connecting Nasca rituals to water worship was revealed by the Nasca-Palpa Project researchers in 2000. On a plateau 4 near the village of Yunama, Markus Reindel made an important discovery. As he was excavating a mound, he uncovered several broken pots and other relics that clearly represented ritual offerings. Then he came upon pieces of a large seashell. It was of a genus 5 called Spondylus. [I] "The Spondylus shell is one of the few items of Andean archeology that has been well studied," Reindel says. "It's a very important religious symbol for water and fertility ... It was brought from far away and is found in specific contexts, such as funerary objects and on these platforms. It was connected in certain activities to praying for water. And it's clear in this area, water was the key issue." [J] In 2004, archeologist Christina Conlee made a much grimmer discovery. Conlee was working at a site near a dry river valley in the southern Nasca region. While excavating a Nasca tomb, she unearthed a skeleton. However, the first part to emerge from the dirt was not the skull, but the neck bones. "We could see the vertebrae 6 sitting on top," Conlee says. "The person was seated, with arms crossed and legs crossed, and no head." Cut marks on the neck bones indicate the head had probably been severed by a sharp knife. A ceramic pot known as a head jar rested against the elbow of the skeleton. An illustration on the jar showed a decapitated 7 "trophy head." Out of the head grew a strange tree trunk with eyes. [K] Everything about the burial - the head jar, the placement and position of the body - suggests the body was disposed of in a careful manner. Conlee suspects the skeleton represents a ritual sacrifice. "Although we find trophy heads spread throughout the Nasca period," she said, "there are some indications that they became more common in the middle and late period, and also at times of great environmental stress, perhaps drought. If this was a sacrifice, it was made to appease 8 the gods, perhaps because of a drought or crop failure." Beginning of the End [L] Despite their offerings, the Nasca's prayers would ultimately go unanswered. Water - or more precisely, its absence - was increasingly critical in the Nasca's final years, between about A.D. 500 and A.D. 600. [M] In the Palpa area, scientists have traced the movement of the eastern margin of the desert about 19 kilometers (12 miles) up the valleys between 200 B.C. and A.D. 600. At one point, the desert reached an altitude of over 1,900 meters (6,500 feet). Similarly, the population centers around Palpa moved farther up the valleys, as if they were trying to outrun the arid conditions. "At the end of the sixth century A.D.," Eitel and Machtle conclude in a recent paper, "the aridity culminated 9 and the Nasca society collapsed." [N] Nevertheless, environmental stresses were not the only vital factor. "It wasn't just climate conditions that caused the collapse of Nasca culture," emphasizes Johny Isla. "A state of crisis was provoked 10 because water was more prevalent in some valleys than in others, and the leaders of different valleys may have been in conflict." By about A.D. 650, the more militaristic Wari (Huari) Empire had emerged from the central highlands and displaced the Nasca as the predominant culture in the southern desert region. [O] Almost 1,500 years later, the legacy of the Nasca lives on. You can see it in the artifacts 11 of their ancient rituals, in the remains of their irrigation systems, and - most famously - in the lines of their mysterious desert designs. The lines surely provided a ritualistic reminder to the Nasca people that their fate was intrinsically tied to their environment. In particular, the lines represent a bond with the Nasca's most precious resource, water. You can still read their reverence for nature, in times of plenty and in times of desperate want, in every line and curve they scratched onto the desert floor. And when your feet inhabit their sacred space, even for a brief and humbling moment, you can feel it. 1 An anthropologist is someone who studies people, society, and culture. 2 If something is said to be subterranean, it is under the ground. 3 An aqueduct is a structure, often a bridge, that carries water. 4 A plateau is a large area of high and fairly flat land. 5 A genus is a class of similar things, especially a group of animals or plants that includes several closely related species. 6 Vertebrae are the small circular bones that form the spine of a human being or animal. 7 If someone is decapitated, their head is cut off. 8 If you try to appease someone, you try to stop them from being angry at you by giving them what they want. 9 If you say that an activity or process culminates in or with a particular event, you mean that the event happens at the end of it. 10 If you provoke someone, you deliberately annoy them and try to make them behave aggressively. If something provokes a reaction, it causes the reaction. 11 An artifact is an ornament, tool, or other object that is made by a human being, especially one that is historically or culturally interesting. Which of the following is closest in meaning to this sentence from paragraph N? By about A.D. 650, the more militaristic Wari (Huari) Empire had emerged from the central highlands and displaced the Nasca as the predominant culture in the southern desert region.
DIRECTION: Chооse the best аnswer fоr eаch question. Secrets of the Mаya The study of caves and wells in Mexico's Yucatan Peninsula is shining new light on the beliefs of the ancient and modern Maya. [A] From deep in a well near the ruins of the Maya city of Chichen Itza, archeoastronomer 1 Arturo Montero shouts to his colleague on the surface, "I saw it, I saw it! Yes, it's true!" Leaning over the mouth of the well, archeologist Guillermo de Anda hopes to hear what he has suspected for many months. "What is true, Arturo?" he shouts. And Montero yells up again, "The zenith 2 light, it really works! Get down here!" [B] The two archeologists are anxious to confirm whether this cenote could have acted as a sacred sundial 3 and timekeeper for the ancient Maya. On two days every year - May 23 and July 19 - the sun reaches its zenith over this part of Mexico. At those moments, the sun is vertically overhead and there is no shadow. On the morning of their descent, on May 24, Montero and de Anda see that the sun's rays come very close to vertical. The day before, they realized, a beam of light would have plunged straight down into the water. [C] Beneath its narrow mouth, the walls of the cenote open up to become a giant dome. It looks like a cathedral, except for the roots of trees that penetrate the rock as they reach for the water. The beam of sunlight dances like fire on the surrounding stalactites, 4 and it turns the water a beautiful transparent blue. The archeologists were probably the first people in centuries to watch the sun move slowly across the cenote's water. [D] Did Maya priests wait in this well - known as the Holtun cenote - to observe and correct their measurements of the sun's angle when it reached the zenith? Did they come here during times of drought to make offerings to their water god, and at other times to give thanks for a good harvest? These and other questions involving the Maya religion and its extraordinarily accurate calendar are what the two explorers were investigating. [E] In recent years, archeologists have been paying more attention to the meaning of caves, the zenith sun, and cenotes in the beliefs of the ancient and modern Maya. Archeologists already knew that the ancient Maya believed cenotes to be doors to a world inhabited by Chaak, the god of life-giving rain, but the significance of this fact has only recently started to become clear. [F] De Anda began exploring Holtun in 2010. One day, inspecting the walls of the cenote a few meters below the surface, he felt something above his head. He was astonished to find a natural rock shelf holding human and animal bones, pottery, and a knife - probably used for sacrifices - all neatly placed there centuries earlier. Below the water, he saw a number of columns and Maya stone carvings - the well was clearly a sacred site. Key to Survival[G] Three years later, in the cornfield on the surface above the cenote, a crew of Maya farmers is working hard in the grueling Yucatan heat to pull the explorers out of the well. "There was a good rain the other day," said the crew's leader, Louis Un Ken, as he wipes the sweat off his face. "The Chaak moved." [H] For men like Un Ken, the old gods are still very much alive, and Chaak is among the most important. For the benefit of living things, he pours from the skies the water he keeps in jars. Thunder is the sound of Chaak breaking a jar open and letting the rain fall. The Chaak had moved, Un Ken said, and that meant the planting season would soon arrive. [I] Chaak's absence can cause disasters for the Yucatan Maya, possibly the demise of the ancient Maya civilization itself. Their land is an endless limestone shelf. Rain sinks through the porous 5 limestone down to groundwater levels, and consequently no river or stream runs through the land. From the air, one sees a green sea of dense jungle, but at ground level, however, the tropical forest appears very thin. Wherever there is enough soil, the Maya plant corn or a milpa, a crop-growing system including the corn, beans, and squash that constitutes their basic source of protein. But corn is a hungry crop; it sucks lots of nutrients from the soil. For thousands of years, milpa farmers have kept their small fields productive by burning a different area of trees every year and planting in the corn-friendly ashes. [J] As for water for the fields, that's where Chaak comes in. Only seasonal rains can make the corn grow, and they must arrive in an exact pattern: no rain in winter so that the fields and forest will be dry enough to burn by March; some rain in early May to soften up the soil for planting; then very gentle rain to allow the planted seeds to begin to grow; and finally, plenty of rain so the corn can flourish. Pleasing the Rain God [K] In the village of Yaxuna, many people still depend on milpa, and an annual ceremony is held there to please the rain god. They walk a long way through the forest to a sacred cave and climb down to its center to bring up the water the ceremony requires. They raise the altar, dig a large cooking pit, and provide 13 fat chickens for the ritual meal. They cook them in the pit so the steam can rise directly to the rain god as an offering. [L] One recent such ceremony in Yaxuna was guided by Hipolito Puuc Tamay, a Maya holy man called a hmem. He stood in front of an altar praying for the holy blessing of rain. On instructions from the hmem, one of the villagers sat on a rock near the altar, blowing from time to time into one of the gourds 6 in which Chaak stores the wind. He was just one of the neighbors, but he was also the rain god, and he sat with his eyes closed so as not to harm the ceremony with his terrible glance. Two other participants brought him to the altar, facing backward, to receive a blessing from the hmem. [M] Out of nowhere, a wind came up, and thunder could be heard in the distance. As the ceremonial meal was being distributed, the rain started - a sign, the hmem said, that Chaak had received his offering and was pleased with his people's prayer. Soon, perhaps, the earth would be ready for planting. 1 An archeoastronomer is someone who studies archeological artifacts to determine what ancient people believed and understood about astronomy. 2 The zenith is a point directly above a particular location. 3 A sundial is a device used for telling the time when the sun is shining. The shadow of a pointer falls onto a surface marked with the hours. 4 Stalactites are rock formations hanging from cave ceilings, slowly formed by dripping water. 5 Something that is porous has many small holes in it, which water and air can pass through. 6 A gourd is a container made from the hard, dry skin of a gourd fruit. Gourds are often used for carrying water or for decoration. Which would be the best alternative title for this passage?
DIRECTION: Chооse the best аnswer fоr eаch question. The Collаpse of Angkor After rising to sublime 1 heights, the sacred city may have engineered its own downfall .An Empire's Fall [A] Almost hidden amid the forests of northern Cambodia is the scene of one of the greatest vanishing acts of all time. This was once the heart of the Khmer kingdom. At its height, the Khmer Empire dominated much of Southeast Asia, from Myanmar (Burma) in the west to Vietnam in the east. As many as 750,000 people lived in Angkor, its magnificent capital. The most extensive urban complex of the preindustrial world, Angkor stretched across an area the size of New York City. Its greatest temple, Angkor Wat, is the world's largest religious monument even today. [B] Yet when the first European missionaries arrived in Angkor in the late 16th century, they found a city that was already dying. Scholars have come up with a list of suspected causes for Angkor's decline, including foreign invaders, a religious change of heart, and a shift to maritime trade. But it's mostly guesswork: Roughly 1,300 inscriptions survive on temple doors and monuments, but the people of Angkor left not a single word explaining their kingdom's collapse. [C] Some scholars assume that Angkor died the way it lived: by the sword. The historical records of Ayutthaya, a neighboring state, claim that warriors from that kingdom "took" Angkor in 1431. If so, their motive is not difficult to guess. No doubt Angkor would have been a rich prize - inscriptions boast that its temple towers were covered with gold. After its rediscovery by Western travelers just over a century ago, historians deduced from Angkor's ruins that the city had been looted 2 by invaders from Ayutthaya. [D] Roland Fletcher, co-director of a research effort called the Greater Angkor Project, is not convinced. Some early scholars, he says, viewed Angkor according to the sieges 3 and conquests of European history. "The ruler of Ayutthaya, indeed, says he took Angkor, and he may have taken some formal regalia 4 back to Ayutthaya with him," says Fletcher. But after Angkor was captured, Ayutthaya's ruler placed his son on the throne. "He's not likely to have smashed the place up before giving it to his son." [E] A religious shift may also have contributed to the city's decline. Angkor's kings claimed to be the world emperors of Hindu mythology and erected temples to themselves. But in the 13th and 14th centuries, Theravada Buddhism gradually took over from Hinduism, and its principles of social equality may have threatened Angkor's elite. "It was very subversive, just like Christianity was subversive to the Roman Empire," says Fletcher. [F] A new religion that promoted ideas of social equality might have led to a worker rebellion. The city operated on a moneyless economy, relying on tribute 5 and taxation, and the kingdom's main currency was rice, the staple food of the laborers who built the temples and the thousands who ran them. For one temple complex, Ta Prohm, more than 66,000 farmers produced nearly 3,000 tons of rice a year, which was then used to feed the temple's priests, dancers, and workers. Scholars estimate that farm laborers comprised nearly half of Greater Angkor's population. [G] Or maybe the royal court simply turned its back on Angkor. Angkor's rulers often erected new temple complexes and let older ones decay. This may have doomed the city when sea trade began to develop between Southeast Asia and China. Maybe it was simple economic opportunism that had caused the Khmer center of power to shift: The move to a location closer to the Mekong River, near Cambodia's present-day capital, Phnom Penh, allowed it easier access to the sea. [H] Economic and religious changes may have contributed to Angkor's downfall, but its rulers faced another foe. Angkor was powerful largely thanks to an advanced system of canals and reservoirs, which enabled the city to keep scarce water in dry months and disperse excess water during the rainy season. But forces beyond Angkor's control would eventually bring an end to this carefully constructed system. [I] Few ancient sites in southern Asia could compare to Angkor in its ability to guarantee a steady water supply. The first scholar to appreciate the scale of Angkor's waterworks was French archeologist Bernard-Philippe Groslier. In 1979, he argued that the great reservoirs served two purposes: to symbolize the Hindu cosmos 6 and to irrigate the rice fields. Unfortunately, Groslier could not pursue his ideas further. Cambodia's civil war, 7 the brutal regime of the Khmer Rouge, 8 and the subsequent arrival of Vietnamese forces in 1979 turned Angkor into a no-go zone for two decades. [J] In the 1990s, Christophe Pottier followed up on Groslier's ideas and discovered that the south part of Angkor was a vast landscape of housing, water tanks, shrines, roads, and canals. Then, in 2000, Roland Fletcher and his colleague Damian Evans - as part of a collaborative study with Pottier - viewed some NASA radar images of Angkor. The researchers marveled at the sophistication of Angkor's infrastructure. "We realized that the entire landscape of Greater Angkor is artificial," Fletcher says. Teams of laborers constructed hundreds of kilometers of canals and dikes 9 that diverted water from the rivers to the reservoirs. Overflow channels bled off excess water that accumulated during the summer monsoon months, and after the monsoon, irrigation channels dispensed the stored water. "It was an incredibly clever system," says Fletcher. [K] Fletcher was therefore baffled when his team made a surprising discovery. An extraordinary piece of Angkorian workmanship - a vast structure in the waterworks - had been destroyed, apparently by Angkor's own engineers. "The most logical explanation is that the dam failed," Fletcher says. The river may have begun to erode the dam, or perhaps it was washed away by a flood. The Khmer broke apart the remaining stonework and modified the blocks for other purposes. [L] Any weakening of the waterworks would have left the city vulnerable to a natural phenomenon that none of Angkor's engineers could have predicted. Starting in the 1300s, it appears that Southeast Asia experienced a period of extreme climate change, which also affected other parts of the world. In Europe, which endured centuries of harsh winters and cool summers, it was known as the Little Ice Age. [M] To an already weakened kingdom, extreme weather would have been the final blow. "We don't know why the water system was operating below capacity," says Daniel Penny, co-director of the Greater Angkor Project. "But what it means is that Angkor ... was more exposed to the threat of drought than at any other time in its history." If inhabitants of parts of Angkor were starving while other parts of the city were hoarding a finite quantity of rice, the most likely result was social instability. "When populations in tropical countries exceed the carrying capacity of the land, real trouble begins," says Yale University anthropologist Michael Coe, "and this inevitably leads to cultural collapse." A hungry army weakened by internal problems would have exposed the city to attack. Indeed, Ayutthaya's invasion happened near the end of a long period of drought. [N] Add to the climate chaos the political and religious changes already affecting the kingdom, and Angkor's prospects were bleak, says Fletcher. "The world around Angkor was changing; society was moving on. It would have been a surprise if Angkor persisted." [O] The Khmer Empire was not the first civilization brought down by climate catastrophe. Centuries earlier, loss of environmental stability likewise brought down another powerful kingdom halfway around the world. Many scholars now believe that the fall of the Maya followed a series of droughts in the ninth century. "Essentially, the same thing happened to Angkor," says Coe. [P] In the end, the tale of Angkor is a sobering lesson in the limits of human ingenuity. "Angkor's hydraulic 10 system was an amazing machine, a wonderful mechanism for regulating the world," Fletcher says. Its engineers managed to keep the civilization's achievement running for six centuries - until a greater force overwhelmed them. 1 If you say something is sublime, you mean it has a wonderful quality. 2 If a store or house is looted, people have stolen things from it, for example, during a war or riot. 3 A siege is a military or police operation in which soldiers or police surround a place in order to force the people there to come out. 4 Regalia is the ceremonial jewelry, objects, or clothes that symbolize royalty or high office. 5 A tribute is something you give, say, do, or make to show your admiration and respect for someone. 6 The cosmos is the universe. 7 A civil war is a war fought between different groups of people who live in the same country. 8 The Khmer Rouge was a radical communist movement that ruled Cambodia from 1975 to 1979 after winning power through a guerrilla war. 9 A dike is a wall built to prevent flooding. 10 Something that is hydraulic involves the movement or the control of water. What is the main idea of paragraph J?