Questions 19-30 are based on the following passage Toxic Agents in the Environment           1 Determining what types and levels of risk a potential toxicant might pose requires diligent scientific work, both in the laboratory and in the field. Shortly we will look at how scientists study the effects of toxicants in the lab, but first let’s quickly survey what kinds of toxic agents exist around us and how they behave and move through the environment. Toxicants come in many different types            2 Toxicants can be classified into different types based on their health effects. The best-known arecarcinogens, chemicals or types of radiation that cause cancer. In cancer, certain malignant cells growuncontrollably, creating tumors, damaging the body’s functioning, and often leading to death. In our society today, the greatest number of cancer cases is thought to result from carcinogens contained in cigarette smoke. Carcinogens can be difficult to identify because there may be a long lag time between exposure to the agent and the detectable onset of cancer. Historically, much toxicological work focused on carcinogens. Now, however, we know that toxicants can produce many different types of effects, so scientists have many more endpoints, or health impacts, to look for.             3 Mutagens are chemicals that cause mutations in the DNA of organisms (Chapter 4). Although mostmutations have little or no effect, some can lead to severe problems, including cancer and many otherdisorders. Mutations can harm the individual exposed to the mutagen, or if the mutations occur in sperm or egg cells, then the individual’s offspring may suffer the effects.            4 Chemicals that cause harm to the unborn are called teratogens. Teratogens that affect the development of human embryos in the womb can cause birth defects. One example involves the drug thalidomide, developed in the 1950s as a sleeping pill and to prevent nausea during pregnancy. Tragically, the drug turned out to be a powerful teratogen, and its use caused birth defects in thousands of babies. Even a single dose during pregnancy could result in limb deformities and organ defects. Thalidomide was banned in the early 1960s once the connection with birth defects was recognized. Ironically, today the drug shows some promise in treating a wide range of diseases, including Alzheimer’s disease, AIDS, and various types of cancer.               5 Some toxicants cause harm by affecting the immune system, which protects our bodies from disease. Allergens over-activate the immune system, causing an immune response when one is not necessary. One hypothesis for the increase in asthma in recent years is an increase in allergenic synthetic chemicals in our environment. Other toxicants may weaken the immune system, making the body less able to defend itself against bacteria, viruses, allergy-causing agents, and other attackers.           6 Neurotoxins are also harmful to the body. Neurotoxins, however, assault the nervous system.Neurotoxins include various heavy metals such as lead, mercury, and cadmium, as well as pesticides and some chemical weapons developed for use in war. A famous case of neurotoxin poisoning occurred in Japan, where a chemical factory dumped mercury waste into Minamata Bay between the 1930s and 1960s. Thousands of people in and around the town on the bay were poisoned by eating fish contaminated with the mercury. First the town’s cats began convulsing and dying, and then people began to show odd symptoms including slurred speech, loss of muscle control, sudden fits of laughter, and in some cases death. The company and the government eventually paid out millions of dollars in compensation to affected residents.         7 Most recently, scientists have recognized the importance of endocrine disrupters, toxicants thatinterfere with the endocrine system. The endocrine system consists of a series of chemical messengers(hormones) that travel through the body. Sent through the body at extremely low concentrations, thesemessenger molecules have many vital functions. They stimulate growth development and sexual maturity, and they regulate brain function, appetite, sexual drive, and many other aspects of our physiology and behavior. Hormone-disrupting toxicants can affect an animal’s endocrine system in various ways, including blocking the action of hormones or accelerating their breakdown. Many endocrine disrupters possess molecular structures that happen to be very similar to certain hormones in their structure and chemistry. If a molecule is similar enough, it may mimic a hormone and interact with the receptor molecules for that hormone, just as the hormone would. –Brennan, Withgott, Environment, Pearson, 2005, pp. 299-300 Based upon its use in Paragraph 7, the best definition of the word disruptor is 

At the initial stage of acquaintanceship, the characteristics of effective interpersonal communication are usually present to only a small degree. You’re guarded rather than open or expressive, lest [for fear that] you  reveal aspects of yourself that might be viewed negatively. Your ability to empathize with or to orient yourself significantly to the other is limited because you don’t yet know the other person. The relationship — at this stage, at least — is probably viewed as too temporary to be worth the effort. Because the other person is not well known to you, supportiveness, positiveness, and equality would all be difficult to manifest [show] in any meaningful sense. The characteristics demonstrated are probably more the result of politeness than any genuine expression of positive regard. At this stage, there is little genuine immediacy; the people see themselves as separate and distinct rather than as a unit. Because the relationship is so new and because the people don’t know each other very well, the interaction is often characterized by awkwardness — for example, overlong pauses, uncertainty over the topics to be discussed, and ineffective exchanges of speaker and listener roles. Casual friendship is the second stage. There is a dyadic [being a group of two] consciousness, a clear sense of “we-ness,” of togetherness. At this stage, you participate in activities as a unit rather than as separate individuals. A casual friend is one we would go with to the movies, sit with in the cafeteria or in class, or ride home with from school. The qualities of effective interpersonal interaction begin to be seen more clearly at this stage. You start to express yourself openly and become interested in the other person’s disclosures. You begin to own your feelings and thoughts and respond openly to his or her communications. Because you’re beginning to understand this person, you empathize and demonstrate significant other-orientation. You also demonstrate supportiveness and develop a genuinely positive attitude toward both the other person and mutual communication situations. Close and intimate friendships have an intensification of the casual friendship. This is the third stage, and you and your friend see yourselves more as an exclusive unit. Each of you derives greater benefits (for example, emotional support) from intimate friendship than from casual friendship. Because you know each other well (for example, you know one another’s values, opinions, attitudes), your uncertainty about each other has been significantly reduced — you’re able to predict each other’s behaviors with considerable accuracy. [You] can use these signals as guides to your interactions — avoiding certain topics at certain times or offering consolation on the basis of facial expressions. Similarly, you can read the other’s nonverbal signals moreaccurately. (Adapted from DeVito, The Interpersonal Communication Book. 12th ed., 2004, p. 284) What is the relationship between the parts of the following sentence? “Your ability to empathize with or to orient yourself significantly to the other is limited because you don’t yet know the other person.” (third sentence in the first paragraph)

Exemplify hormones secreted by the anterior pituitary gland.

Identify the endocrine gland that is located atop the kidneys.

Which of the following is not a function of hormones?

At the initial stage of acquaintanceship, the characteristics of effective interpersonal communication are usually present to only a small degree. You’re guarded rather than open or expressive, lest [for fear that] you  reveal aspects of yourself that might be viewed negatively. Your ability to empathize with or to orient yourself significantly to the other is limited because you don’t yet know the other person. The relationship — at this stage, at least — is probably viewed as too temporary to be worth the effort. Because the other person is not well known to you, supportiveness, positiveness, and equality would all be difficult to manifest [show] in any meaningful sense. The characteristics demonstrated are probably more the result of politeness than any genuine expression of positive regard. At this stage, there is little genuine immediacy; the people see themselves as separate and distinct rather than as a unit. Because the relationship is so new and because the people don’t know each other very well, the interaction is often characterized by awkwardness — for example, overlong pauses, uncertainty over the topics to be discussed, and ineffective exchanges of speaker and listener roles. Casual friendship is the second stage. There is a dyadic [being a group of two] consciousness, a clear sense of “we-ness,” of togetherness. At this stage, you participate in activities as a unit rather than as separate individuals. A casual friend is one we would go with to the movies, sit with in the cafeteria or in class, or ride home with from school. The qualities of effective interpersonal interaction begin to be seen more clearly at this stage. You start to express yourself openly and become interested in the other person’s disclosures. You begin to own your feelings and thoughts and respond openly to his or her communications. Because you’re beginning to understand this person, you empathize and demonstrate significant other-orientation. You also demonstrate supportiveness and develop a genuinely positive attitude toward both the other person and mutual communication situations. Close and intimate friendships have an intensification of the casual friendship. This is the third stage, and you and your friend see yourselves more as an exclusive unit. Each of you derives greater benefits (for example, emotional support) from intimate friendship than from casual friendship. Because you know each other well (for example, you know one another’s values, opinions, attitudes), your uncertainty about each other has been significantly reduced — you’re able to predict each other’s behaviors with considerable accuracy. [You] can use these signals as guides to your interactions — avoiding certain topics at certain times or offering consolation on the basis of facial expressions. Similarly, you can read the other’s nonverbal signals moreaccurately. (Adapted from DeVito, The Interpersonal Communication Book. 12th ed., 2004, p. 284) Based on the passage, responses between acquaintances

Chemical signals that affect the behavior of other glands and tissues are called ____________.

At the initial stage of acquaintanceship, the characteristics of effective interpersonal communication are usually present to only a small degree. You’re guarded rather than open or expressive, lest [for fear that] you  reveal aspects of yourself that might be viewed negatively. Your ability to empathize with or to orient yourself significantly to the other is limited because you don’t yet know the other person. The relationship — at this stage, at least — is probably viewed as too temporary to be worth the effort. Because the other person is not well known to you, supportiveness, positiveness, and equality would all be difficult to manifest [show] in any meaningful sense. The characteristics demonstrated are probably more the result of politeness than any genuine expression of positive regard. At this stage, there is little genuine immediacy; the people see themselves as separate and distinct rather than as a unit. Because the relationship is so new and because the people don’t know each other very well, the interaction is often characterized by awkwardness — for example, overlong pauses, uncertainty over the topics to be discussed, and ineffective exchanges of speaker and listener roles. Casual friendship is the second stage. There is a dyadic [being a group of two] consciousness, a clear sense of “we-ness,” of togetherness. At this stage, you participate in activities as a unit rather than as separate individuals. A casual friend is one we would go with to the movies, sit with in the cafeteria or in class, or ride home with from school. The qualities of effective interpersonal interaction begin to be seen more clearly at this stage. You start to express yourself openly and become interested in the other person’s disclosures. You begin to own your feelings and thoughts and respond openly to his or her communications. Because you’re beginning to understand this person, you empathize and demonstrate significant other-orientation. You also demonstrate supportiveness and develop a genuinely positive attitude toward both the other person and mutual communication situations. Close and intimate friendships have an intensification of the casual friendship. This is the third stage, and you and your friend see yourselves more as an exclusive unit. Each of you derives greater benefits (for example, emotional support) from intimate friendship than from casual friendship. Because you know each other well (for example, you know one another’s values, opinions, attitudes), your uncertainty about each other has been significantly reduced — you’re able to predict each other’s behaviors with considerable accuracy. [You] can use these signals as guides to your interactions — avoiding certain topics at certain times or offering consolation on the basis of facial expressions. Similarly, you can read the other’s nonverbal signals moreaccurately. (Adapted from DeVito, The Interpersonal Communication Book. 12th ed., 2004, p. 284) The main idea of the fourth paragraph is

Your patient has just come back to your unit after receiving a dual chamber pacemaker.  While reviewing the telemetry strip to assess that the pacemaker is functioning properly you notice that there are pacer spikes at appropriate intervals but they are not followed by a QRS complex.  This would indicate which of the following?

A patient with extensive electrical burn injuries is admitted to the emergency department. Which prescribed intervention would the nurse implement first?