Mrs. Jones recovered from her recent hospitalization for treatment of AKI secondary to pyelonephritis. During her hospitalization, it was discovered that Mrs. Jones has developed early signs of Congestive Heart Failure (CHF) evident by her increasing fatigue and difficulty controlling her high blood pressure over the years. During her hospitalization, an echocardiogram (ECG) was performed which showed that she currently has a 40% ejection fraction as well as mild left ventricular hypertrophy. Upon discharge, her antihypertensive regimen was changed to the following: Discontinue
Lisinopril 10mg PO daily
Start
Metoprolol (Lopressor) 25mg PO BID
Furosemide (Lasix) 20mg PO daily

Continue the following
Ibuprofen 800mg PO q 6 hrs for moderate pain (4-6 verbal scale)
Hydrocodone/acetaminophen 5/325mg PO q 4 hrs for severe pain (7-10)
Aspirin 81mg PO q day
Vitamin D 800IU q HS
Calcium 600mg q HS
Hydroxychloroquine 400mg q day

Required:
a. Which of the listed medications are prescribed to address Mrs. Jones new diagnosis of CHF?
b. Briefly describe how each of these medications help with CHF (ex: inotrope, reduce peripheral vascular resistance, etc.) BE SPECIFIC and use your drug book as a guide.
c. Are there safety concerns the patient needs to be aware of with these medications (Hint: synergistic effects? Self-assessments prior to administration?) If so, what are they?
d. What precautions/assessments need to be taken as the nurse when administering these medications to Mrs. Jones?
e. What important educational points does the nurse need to give Mrs. Jones regarding the newly prescribed medications?

1. true.2. true.3. true.4. false.5. true.the concept of darwin's theory of evolution involves the idea that there are limited resources in a given living environment and that the organisms which live within have variations in their genetic make up due to random mating. the ones with beneficial genetic variations can express certain traits which give them an upper hand in surviving and reproducing in the said environment compared to ones who may have a more disadvantageous variation in traits. over time, the organisms with an upper hand will survive and reproduce more frequently and pass on their beneficial genes while the others die. the result is evolution, where we observe (usually, but not always) eventually, phenotypic distinct changes.

Mantle convection  is the slow  creepingmotion of earth's solid silicate  mantle  caused by  convection  currents carrying  heat from the interior  to the planet's surface.[1][2]  the earth's surface  lithosphere, which rides atop the  asthenosphere  (the two components of the  upper mantle), is divided into a number of  plates  that are continuously being created and consumed at their opposite  plate boundaries. accretion occurs as mantle is added to the growing edges of a plate, associated with  seafloor spreading. this hot added material cools down by  conduction  and  convection  of heat. at the consumption edges of the plate, the material has thermally contracted to become dense, and it sinks under its own weight in the process of  subduction  usually at an  ocean trench.[3]this subducted material sinks through the earth's interior. some subducted material appears to reach the lower mantle,[4]  while in other regions, this material is impeded from sinking further, possibly due to a phase transition from  spinel  to  silicate perovskiteand  magnesiowustite, an  endothermic reaction.[5]the subducted oceanic crust triggers  volcanism, although the basic mechanisms are varied. volcanism may occur due to processes that add buoyancy to partially melted mantle causing an upward flow due to a decrease in density of the partial melt.secondary forms of convection that may result in surface volcanism are postulated to occur as a consequence of intraplate extension[6]  and  mantle plumes.[7]it is because the mantle can convect that the  tectonic plates  are able to move around the earth's surface.[8]mantle convection seems to have been much more active during the  hadean  period, resulting in gravitational sorting of heavier molten  iron, and  nickel  elements and  sulphides  in the core, and lighter  silicate minerals  in the  mantle.