A patient on your team is experiencing difficulty breathing. There is no change in the patient's status after you elevate the head of bed, apply oxygen, have the patient use pursed lip breathing, and obtain a breathing treatment for the patient. Auscultation of the lungs demonstrates crackles bilaterally halfway up the lungs. The respiratory rate is 40 breaths/min, with an oxygen saturation level of 90% on 4 liters oxygen per nasal cannula. The patient is restless and having difficulty speaking because of the shortness of breath. After exhausting all nursing interventions, you call the physician by telephone regarding the change in patient's status

1. Describe how you would communicate the following areas using the I-SBAR-R tool.
2. The physician orders Lasix 40 mg IVP and morphine 4 mg IVP and 1 to 2 mg IVP every 1-hour prn. You write down the telephone order and hang up. Your transcription includes the following information:
   • Lasix 40 mp IVP Stat and QD
   • MSO4 4.0 mg IVP Stat and 1.0-2.0 mg IVP q1hr prn

Is this the correct transcription of the order? How would you change it?

3. Did you take the telephone order correctly? What additional steps should be followed?
4. What tips for communicating with physicians on the telephone can you recall from the textbook chapter? Which of these were missing, done incorrectly, or not done during the communication with the physician? Which steps still need to be done?

Sunrise, Inc., has no debt outstanding and a total market value of $356,900. Earnings before interest and taxes, EBIT, are projected to be $50,000 if economic conditions are normal. If there is strong expansion in the economy, then EBIT will be 16 percent higher. If there is a recession, then EBIT will be 25 percent lower. The company is considering a $180,000 debt issue with an interest rate of 5 percent. The proceeds will be used to repurchase shares of stock. There are currently 8,300 shares outstanding. The company has a tax rate of 23 percent, a market-to-book ratio of 1.0, and the stock price remains constant.

a-1. Calculate earnings per share (EPS) under each of the three economic scenarios before any debt is issued. (Do not round intermediate calculations and round your answers to 2 decimal places, e.g., 32.16.)

a-2. Calculate the percentage changes in EPS when the economy expands or enters a recession. (A negative answer should be indicated by a minus sign. Do not round intermediate calculations and enter your answers as a percent rounded to 2 decimal places, e.g., 32.16.)

b-1. Calculate earnings per share (EPS) under each of the three economic scenarios assuming the company goes through with recapitalization. (Do not round intermediate calculations and round your answers to 2 decimal places, e.g., 32.16.)

b-2. Given the recapitalization, calculate the percentage changes in EPS when the economy expands or enters a recession. (A negative answer should be indicated by a minus sign. Do not round intermediate calculations and enter your answers as a percent rounded to 2 decimal places, e.g., 32.16.)

Diabetes

R.M. is a 17-year-old African-American girl with new-onset diabetes, presumed to be type 2 diabetes. She presented to her pediatrician during the winter months with the classic symptoms of polyuria and polydipsia. She reported weight loss over the preceding weeks, but was otherwise well. Her family history was positive for type 2 diabetes in grandparents and some distant relatives and negative for autoimmune diseases.

Physical examination revealed a blood pressure of 103/53 mmHg, pulse of 79, and temperature of 38°C. Her weight was 60 kg (132 lb, 50–75th percentile), height was 155 cm (61 inches, 10th percentile), and body mass index (BMI) was 25 kg/m2 (85th percentile). She had acanthosis nigricans and was at Tanner V stage of sexual development.

Urinalysis revealed a glucose level of >1,000 mg/dl and ketones of 40 mg/dl. Her initial laboratory studies included a blood glucose measurement of 726 mg/dl, bicarbonate of 21 mmol/l (normal range 23–32 mmol/l), venous pH of 7.37, hemoglobin A1c (A1C) of 8.6%, and C-peptide of 1.0 ng/ml (normal range 0.6–3.2 ng/ml).

Discussion Questions: Review the case above and answer these questions.

1.What is the significant differences between type 1 and 2 diabetes.
2. Discuss 4 priority nursing diagnoses?

ABC company's vice president of marketing proposes a new program to significantly increase product sales by 250,000 units per year throughout the 1998-2004 period. Specifically, it is suggested that the company take the following actions: A. Spend $2.5 million over the period of 1998-2000 as promotional expenditures - for example, spend $1.0 million each in the years 1998, 1999, and $0.5 million in the year 2000. B. Make a one-time investment of $1.4 million in plants and equipment needed at the beginning of 1998 to generate these additional products. No new warehouse capability is needed. This investment is to be depreciated on a straight-line basis over the seven-year period. There will be no salvage values for these plants and equipment in 2005. It is further assumed that the product unit cost is $8.00 in 1998, and it is estimated to increase by 3 percent per year. The product unit price is $20 in 1998, and it is estimated to change as manifested in the following table: Items 1998 1999 2000 2001 2002 2003 2004 Unit Price $20.00 $20.60 $21.00 $21.15 $21.25 $21.25 $21.00 The SG&A expenditure is estimated at $1.25 million in 1998, and it will increase by 3 percent per year during the six-year period. A corporate tax of 40 percent must be paid for any marginal income. There is an interest charge during this period, and the company's weighted average cost of capital (WACC) is 8 percent. If the company's hurdle rate for this type of investment is 25 percent, and the NPV (Net Present Value) for the proposed marketing initiative is negative at that hurdle rate of 0.25, why would you not recommend the marketing initiative be approved? Explain in depth.

Sunrise, Inc., has no debt outstanding and a total market value of $422,400. Earnings before interest and taxes, EBIT, are projected to be $55,000 if economic conditions are normal. If there is strong expansion in the economy, then EBIT will be 14 percent higher. If there is a recession, then EBIT will be 20 percent lower. The company is considering a $205,000 debt issue with an interest rate of 6 percent. The proceeds will be used to repurchase shares of stock. There are currently 8,800 shares outstanding. The company has a tax rate of 23 percent, a market-to-book ratio of 1.0, and the stock price remains constant. a-1. Calculate earnings per share (EPS) under each of the three economic scenarios before any debt is issued. (Do not round intermediate calculations and round your answers to 2 decimal places, e.g., 32.16.) a-2. Calculate the percentage changes in EPS when the economy expands or enters a recession. (A negative answer should be indicated by a minus sign. Do not round intermediate calculations and enter your answers as a percent rounded to 2 decimal places, e.g., 32.16.) b-1. Calculate earnings per share (EPS) under each of the three economic scenarios assuming the company goes through with recapitalization. (Do not round intermediate calculations and round your answers to 2 decimal places, e.g., 32.16.) b-2. Given the recapitalization, calculate the percentage changes in EPS when the economy expands or enters a recession. (A negative answer should be indicated by a minus sign. Do not round intermediate calculations and enter your answers as a percent rounded to 2 decimal places, e.g., 32.16.)

Assume you have just been hired as a business manager of PizzaPalace, a regional pizza restaurant chain. The company’s EBIT was $50 million last year and is not expected to grow. The firm is currently financed with all equity, and it has 10 million shares outstanding. When you took your corporate finance course, your instructor stated that most firms’ owners would be financially better off if the firms used some debt. When you suggested this to your new boss, he encouraged you to pursue the idea. As a first step, assume that you obtained from the firm’s investment banker the following estimated costs of debt for the firm at different capital structures:

If the company were to recapitalize, then debt would be issued and the funds received would be used to repurchase stock. PizzaPalace is in the 40% state-plus-federal corporate tax bracket, its beta is 1.0, the risk-free rate is 6%, and the market risk premium is 6%.

1. Using the free cash flow valuation model, show the only avenues by which capital structure can affect value.

2. 1. What is business risk? What factors influence a firm’s business risk?

   2. What is operating leverage, and how does it affect a firm’s business risk? Show the operating break-even point if a company has fixed costs of $200, a sales price of $15, and variable costs of $10.

Assume you have just been hired as a business manager of PizzaPalace, a regional pizza restaurant chain. The company’s EBIT was $50 million last year and is not expected to grow. The firm is currently financed with all equity, and it has 10 million shares outstanding. When you took your corporate finance course, your instructor stated that most firms’ owners would be financially better off if the firms used some debt. When you suggested this to your new boss, he encouraged you to pursue the idea. As a first step, assume that you obtained from the firm’s investment banker the following estimated costs of debt for the firm at different capital structures:

If the company were to recapitalize, then debt would be issued and the funds received would be used to repurchase stock. PizzaPalace is in the 40% state-plus-federal corporate tax bracket, its beta is 1.0, the risk-free rate is 6%, and the market risk premium is 6%.

• Using the free cash flow valuation model, show the only avenues by which capital structure can affect value.

• 1. What is business risk? What factors influence a firm’s business risk?

  2. What is operating leverage, and how does it affect a firm’s business risk? Show the operating break-even point if a company has fixed costs of $200, a sales price of $15, and variable costs of $10.

a)The yields of four zero-coupon bonds of varying maturities are as follows: Maturity YTM 1 6.1% 2 6.2% 3 6.3% 4 6.4% If you expect the implied term structure to be the same next year as it is this year, what is the expected return on the 2-year zero coupon bond over the coming year? Please express your answer in percent, rounded to the nearest basis point.

b)The maturities and yields of three zero-coupon bonds are as follows:

Next year, you expect the yields on zero-coupon bonds to be as follows:

c)What is your expectation of the rate of return on a 3-year zero-coupon bond over the coming year? Please express your answer in percent rounded to the nearest basis point.

d)The 1-year rate is currently 2%, and the expected 1-year rate a year from now is 1%. If the liquidity preference theory holds and the liquidity premium for the 2-year rate is 1.0%, what should the 2-year rate be? (Assume that the liquidity premium for the 1-year rate is 0.0%) Please express your answer in percent rounded to the nearest basis point.

If the 1-year rate is currently 3%, and the 2-year rate is 4.5%, what is the expected 1-year rate a year from now if the expectations hypothesis holds? Please express your answer in percent rounded to the nearest basis point.

You are being consulted as a young forensic investigator. Here are the facts:

Your client, Mr. Clean, comes to you with the following true story.

• Mr. Clean owned with a partner, Mr. Dirty, a coin-operated laundry. Mr. Dirty recently passed away and his family discovered over $1,000,000 worth of coins in Mr.Dirty's two-bedroom apartment. Mr. Clean is astounded to hear this and immediately goes back to the business to check some business statistics that he heretofore never bothered checking and discovered that indeed for the past 20 years of their partnership a material amount of income was missing each week.
• Mr. Clean assumes that Mr. Dirty's $1.0 million plus of coins and the statistics of missing money at the business is no coincidence...Mr. Dirty's coins were stolen from the business by Mr. Dirty.
• The problem - how to prove this to be the truth? How to prove that Mr. Dirty did it? In order for Mr. Clean to have a claim on his insurance policy and on Mr. Dirty's estate, some amount of proof is needed.

Try to propose answers to the following questions:

1. What sort of statistics at the business did Mr. Clean look at to see that money was missing every week?
2. What steps could you undertake to prove that Mr. Dirty stole the money? In other words, what types of evidence could you develop that points the finger at Mr. Dirty in a way that would convince most people that Mr. Dirty did steal the money from the business.  REMEMBER: CIRCUMSTANTIAL EVIDENCE IS OFTEN HOW FRAUD IS PROVEN.

The Dunley Corp. plans to issue 5-year bonds. It believes the bonds will have a BBB rating. Suppose AAA bonds with the same maturity have a 5% yield. If the market risk premium is 4% using the data in the tables:

a. Estimate the yield Dunley will have to pay, assuming an expected 55% loss rate in the event of default during average economic times. What spread over AAA bonds will it have to pay?

b. Estimate the yield Dunley would have to pay if it were a recession, assuming the expected loss rate is 80% at that time but the beta of debt and market risk premium are the same as in average economic times. What is Dunley's spread over AAA now?

c. In fact, one might expect risk premia and betas to increase in recessions. Redo part (b ) assuming that the market risk premium and the beta of debt both increase by 20% , that is they equal 1.20 times their value in recessions.