Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing School > Patho Exam 2: Evolve Questions > Flashcards

Patho Exam 2: Evolve Questions Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

How soon are ECG changes visible after hypoxia

A

30 to 60 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Who would be at highest risk for developing pulmonary embolism (PE)?

A

72 year old male who is recovering from hip replacement surgery in the hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

This occurs with activity and is often limited and resolves with rest

A
  • Stable angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do aortic blood flow problems occu?

A
  • From the left ventricle to the aorta.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 30 year old male is involved in a motor vehicle accident and sustains trauma to the lungs and chest wall. he experiences respiratory failure. which of the following lab values would the nurse expect

A

elevated PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A group of mountain climbers experience confusion, tachycardia, edema, and decreased renal output after climbing Mount Rainier. A nurse recalls this condition is caused by

A

Decreased inspired oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Expiratory stridor

A

a monophonic wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Arteriosclerosis plaque is caused by

A

collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which is the MOST common complication of an AMI?

A

arrythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical Manifestation of Pulmonary Edema

A
  • dyspnea
  • crackless
  • dullness of percuss at lung bases
  • pink frothy sputum
  • hypercapnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A 60 year old male undergoes surgery for a bone fracture. what nursing measure would be most effective for preventing pulmonary embolism (PE) in this patient?

A

prevent deep vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A 10 year old male is brought to the ER with prolonged bronchospasm and severe hypoxemia. the most likely diagnosis on the chart is

A

Status asthmaticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

a blood clot that remains attached to a vessel wall.

A

Thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

has a rumbling-decrescendo murmur.

A

Mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

a diffuse, inflammatory obstruction of the small airways or bronchioles

A

Bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Airway hyper-responsiveness in asthma is related to

A

exposure to an allergen causing mast cell degranulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis.

A

Emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the most common cause of pulmonary edema?

A
  • left sided heart failure
  • increasing pressure of left chambers of the heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cause a release on renin

A
  1. decrease in the amount of sodium delivered to the kidney.
  2. beta-adrenergic stimuli
  3. low potassium concentration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

An 80 year old female is in the hospital for a bone fracture. while there she develops a large, nonlethal pulmonary embolus. What is the result of the obstruction of pulmonary blood flow>

A

pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

while reviewing lab results, the help confirm a diagnosis of cystic fibrosis in a 1-year old child which substance will be present in the child’s sweat

A

sodium chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define Emphysema

A
  • abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A cough in an infant can be a sign of

A
  • infection
  • foreign body
  • obstruction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A 53 year old male with a 20 year history of smoking is diagnosed with emphysema. Why the patient’s airways are obstructed?

A

Loss of elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which structures are considered part of the acinus?

A
  1. Respiratory bronchioles
  2. Alveolar ducts
  3. Alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define Open Pneumothorax

A
  • air pressure in the pleural space equals barometric pressure
  • b/c air that is drawn into the pleural space during inspiration is forced back out during expiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypoxemia and cyanosis are generally caused by

A
  1. lesions that cause right ventricular outflow tract obstruction
  2. defects involving mixing of saturated and unsaturated blood
  3. transposition of the great arteries
  4. deoxygenated blood flowing into systemic circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

indicates there was trauma to the chest resulting in the collapse of the lung

A

Secondary pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

artery travels in the coronary sulcus between the left atrium and the left ventricle?

A

Circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

caused by cell death and necrosis secondary to trauma or pressure-induced oxygen deficiency

A

Venous Stasis Ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

an inflammatory disease of the peripheral arteries that tends to occur in young men who are heavy smokers

A

Thromboangiitis obliterans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cyanosis definition

A
  • bluish discoloration of the skin & mucous membranes,
  • caused by increasing amounts of desaturated or reduced hemglobin in the blood.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A 42 year old female presents with dyspnea, rapid, shallow breathing, inspiratory crackles, decreased lung compliance, and hypoxemia. tests reveal a fulminate form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.

A

Acute Respiratory Distress Syndrome (ARDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can commonly occur in an infants airway?

A

Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A patient has been diagnosed with a pericardial effusion resulting in the presence of frank blood. Which condition is associated with a bloody effusion?

A
  • Coagulation defect, trauma, and aneurysms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Characteristic associated with hypertension?

A
  1. Family history positive for hypertension
  2. High dietary sodium
  3. Glucose intolerance
  4. Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A yougn patient is admitted to the pediatric unit with cystic fibrosis (CF) exacerbation. the nurse monitors the patient closely because the main cause of death in a child with CF is

A

respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which part of the heart is responsible for electrical impulse stimulation?

A

SA Node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

A patient is diagnosed with an antidiuretic hormone-producing lung tumor. What is the most likely diagnosis?

A

small cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A 23-year-old patient presents with severe chest pain that worsens with respiratory movements and with lying down. What is the most appropriate intervention?

A

Administer analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define Paroxysmal Nocturnal Dyspnea

A
  • attacks of SOB & coughing that occur at night.
  • Awakens the person from sleep, and may be quite frightening.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when constrictions and dilations destroy the bronchi.

A

Varicose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Airway Obstruction is most likely to occur in which age group?

A
  • in infants.
  • This is due to their smaller airway and smaller diameter.
  • more cartilage and collapse easily.
  • A cough can be a sign of infection, foreign body, or obstruction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

a 53 year old male with a 20 year history of smoking is diagnosed with emphysema. when the nurse is asked what causes this, what is the nurse’s best response? changes in his lungs are caused by

A

Alpha-1-antitrypsin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which statement regarding cellular injury of the myocardium is correct?

A

Myocardial cells remain viable if blood flow returns within 20 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

definition of cardiac preload?

A

Pressure generated by the end-diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

an increase in parasympathetic nervous stimulation and a decrease in sympathetic nervous stimulation

A

Vasogenic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

a harsh, vibratory sound of variable pitch due to turbulent flow through the partially obstructed airway

A

Stridor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

A patient presents with chest pain that occurs at rest. Abnormal vasospasm of the coronary arteries is detected. What is the most likely cause of the chest pain?

A
  • Prinzmetal angina
    • produces pain at rest and is common in women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the appropriate term for the “thick filaments of myosin that constitute a central dark band”?

A

A Band

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which term describes the occlusion of a blood vessel from a bolus of circulating matter in the bloodstream?

A

Embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

This type of shock is due to infection

A

Septic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

a decrease in blood volume due to hemorrhage

A

Hypovolemic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

a correct cause and effect sequence in the development of acute respiratory distress syndrome (ARDS)?

A
  • alveolocapillary membrane injury causing a massive inflammatory response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which structure is the source of nutrients for the blood vessels?

A

vasa vasorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

This reflex facilitates blood pressure changes and heart rate changes.

A

baroreceptor reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which diagnosis finding is characteristically present when the parietal pleura is infected?

A

Friction Rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Normal Heart Rate for a newborn?

A

100 - 180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the process called where carbon dioxide (CO2) is exchanged for oxygen?

A

Respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

medical condition places a client at a higher risk for developing chronic upper airway obstruction?

A
  • Congenital malformation
  • Subglottic stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

veins have pooled blood.

A

Varicose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

when the bronchi become large and balloon like.

A

saccular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What two factors determine cardiac output?

A

Heart rate and stroke volume

53
Q

a thrombus formation occurring mainly in the lower extremities

A

Deep Vein Thrombosis

53
Q

chest pain, usually substernal chest discomfort

A

Angina Pectoris

53
Q

A geneticist is discussing cystic fibrosis (CF). which information should be included? CF is an ____ disease

A

autosomal recessive

53
Q

inadequate alveolar ventilation in relation to metabolic demands

A

Hypoventilation

55
Q

A patient has rheumatic fever. Which valve is most commonly affected?

A

Mitral

56
Q

A patient has symmetrically dilated airways. Which type of bronchial dilation is this?

A

Cylindrical

57
Q

While planning care for a child with asthma, which of the following is characteristic of asthma

A

Prolonged Expirations

58
Q

the leading cause of death in the first year of life

A

Congenital Heart Disease

59
Q

what is the most common cause of pulmonary edema?

A
  • left sided heart failure
  • increasing pressure of left chambers of the heart
59
Q

This interval is the time when the entire ventricular myocardium is depolarized?

A

The ST interval

60
Q

Which condition can cause of hypercapnia?

A
  • Disease of the medulla
  • Large airway obstruction
  • Thoracic cage abnormalities
  • Depression of Respiratory Center
61
Q

often referred to as the cardioinhibitory center

A

Parasympathetic Excitation

61
Q

Which receptor monitors pH, PaCO2, and PaO2 of arterial blood?

A

Chemoreceptors

61
Q

Define Paroxysmal Nocturnal Dyspnea

A
  • attacks of SOB & coughing that occur at night.
  • Awakens the person from sleep, and may be quite frightening.
62
Q

A 28 year old male reports to his primary care provider that he has had a cold for a week and is coughing up bloody secretions.

A

hemoptysis

63
Q

A patient has impaired blood flow from the left atrium to the left ventricle. Which valvular problems does this describe?

A

Mitral Stenosis

64
Q

Describe AutoRegulation

A
  • Blood vessels regulate their own blood flow.
  • In coronary circulation, pressure is between 60 mmHg and 180 mmHg
  • ensures constant coronary blood flow
  • process originates in vascular smooth muscles of the arterioles
65
Q

Define and embolus

A

detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude

66
Q

The inflammation caused by a thrombus

A

Thrombophlebitis

66
Q

A newborn has respiratory distress syndrome, what is a predisposing factor

A

Premature Birth

68
Q

What is the effect of angiotensin II?

A

Vasoconstriction, causes the stimulation of aldosterone

70
Q

A patient with PND is most likely to have

A

left ventricular failure

71
Q

Arteriosclerosis is:

A

thickening and hardening of the vessel wall

72
Q

A condition in which blood has pooled, producing distended and palpable vessels, is referred to as a:

A

Varicose Veins

73
Q

to prevent sudden infant death syndrome, the nurse should instruct parents to

A

always lay infants down on their backs to sleep

73
Q

Surfactant

A
  1. a lipid protein mix produced by type II cells.
  2. is found in the lining of the alveoli
  3. reduces surface tension
74
Q

What complication occurs secondary to hypertension?

A

Congestive heart failure

76
Q

caused by altered hemodynamics

A

Secondary hypertension

77
Q

has a crescendo-decrescendo murmur

A

Aortic stenosis

77
Q

caused by an infection of staphylococcus aureus

A

Infective Endocarditis

78
Q

asthma is thought to be caused by

A

interactions between genetic and environmental factors

79
Q

The respiratory center characteristics

A
  • located in the brain stem.
  • affecting the respiratory muscles’ ability to contract and relax
  • transmitting impulses that bring about the physical act of breathing.
  • influenced by emotions and pain.
80
Q

most commonly caused by radioactive exposure, rheumatoid arthritis, or uremia

A

Chronic pericarditis

82
Q

Define Emphysema

A
  • abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis.
83
Q

Which pathology most commonly results in pulmonary edema?

A

Increasing pressure in the left chambers of the heart

84
Q

often called the cardioexcitation center

A

Sympathetic Stimulation

86
Q

Cigarette smoking produces:

A
  • an increased LDL level
  • thrombotic/inflammatory state
  • decreased HDL
87
Q

Cyanosis definition

A
  • bluish discoloration of the skin & mucous membranes,
  • caused by increasing amounts of desaturated or reduced hemglobin in the blood.
89
Q

When a patient has a massive pulmonary embolism (PE), what complications will the nurse monitor for

A

Shock & Death

91
Q

a nurse recalls respiratory distress and hypoxemia in laryngotracheobronchitis are caused by

A

mucosal edema

92
Q

This reflex causes the heart rate to increase after intravenous infusions of blood or fluid

A

Bainbridge Reflex

93
Q

Complications of hypertension

A
  • ventricular hypertrophy
  • angina pectoris
  • congestive heart failure
  • coronary artery disease
  • myocardial infarction
  • sudden death
96
Q

Pneumonia is caused by

A

viral or bacterial infections

97
Q

characteristic of idiopathic pulmonary arterial hypertension (IPAH)

A
  1. fatigue
  2. dyspnea
  3. Jugular Vein Distention
98
Q

this is the collapse of lung tissue which tend to develop post op

A

Atelectasis

99
Q

HDL

A
  • associated with phospholipids and protein
  • good
100
Q

Oxygen consumption for newborn

A

doubles

102
Q

Define Tension Pneumothorax?

A
  • pleural rupture acts as a one way valve
  • air ents on inspiration but preventing its escape by closing during expiration.
  • air pressure exceeds barometric pressure
  • life threatening
104
Q

A 20 year old male presents to his primary health care provider, difficulty breathing when lying down. What term should the nurse use to document this condition?

A

orthopnea

105
Q

Which of the following would shift the oxyhemoglobin dissociation curve to the left?

A

Hypocapnia

106
Q

A 60 year old female with a history of cirrhosis presents with dyspnea, impaired ventilation, and pleural pain. a diagnosis of pleural effusion is made, and a watery fluid is drained. when giving report, the nurse will refer to this fluid as

A

transudative

107
Q

A 30 year old male prison inmate contracted tuberculosis during an outbreak. while planning interactions, the nurse realizes the patient can transmit this disease through

A

airborne droplets

108
Q

A patient with PND is most likely to have

A

left ventricular failure

109
Q

Clinical Manifestation of Pulmonary Edema

A
  • dyspnea
  • crackless
  • dullness of percuss at lung bases
  • pink frothy sputum
  • hypercapnia
111
Q

Symptoms of acute myocardial infarction (AMI)

A
  • Fever
  • Diaphoresis
  • Substernal Pain
  • Cool, Clammy Skin
112
Q

Functions of the Precardium

A
  • prevents displacement of the heart during gravitational acceleration/deceleration
  • physical barrier, protects the heart against infection
  • contains pain receptors/mechanoreceptors that affect blood pressure.
  • brings about the force required to normalize blood pressure
113
Q

A 60 year old female with emphysema is having difficulty expiring a given volume of air. when giving report, the nurse will relay that the patient is most likely experiencing ___ pulmonary disease

A

Obstructive Pulmonary Disease

114
Q

A 20 year old male is in acute pain. ABG reveals decreased CO2. What is most likely the cause

A

hyperventilation

116
Q

Expected assessment findings for someone with a pulmonary embolism

A
  • chest pain
  • tachycardia
  • tachypnea
  • fever
  • hemoptysis
117
Q

Reduced oxygenation of arterial blood

A

Hypoxemia

119
Q

dietary fat package

A

Chylomicrons

121
Q

A young woman presents with pallor, numbness, and a sensation of cold temperature of her digits. Which condition is the most likely cause for these symptoms?

A

Raynauds Phenomenon

123
Q

A 20 year old male is in acute pain. ABG reveals decreased CO2. What is most likely the cause

A

hyperventilation

125
Q

LDL

A
  • associated with cholesterol and protein
  • Bad
126
Q

refers to actual blood flow and oxygen delivery

A

circulation

127
Q

lipid-laden cells that contribute to fatty streaks.

A

Foam cells

128
Q

This represents the measure of time from the onset of atrial activation to the onset of ventricular activation?

A

PR interval

129
Q

Asthma affects ____% of children between 5-17 years old

A

10%

130
Q

a disease of the myocardium.

A

Cardiomyopathy

131
Q

A nurse remembers bronchiolitis mainly occurs in children under the age of ______

A

One

132
Q

A patient experiences an elevated systolic pressure accompanied by normal diastolic pressure (below 90 mmHg). Which is the correct term for this condition?

A

Isolated systolic hypertension

133
Q

A patient experiences spinal cord damage following a motorcycle accident. What type of shock would most likely result?

A

Vasogenic

134
Q

Define Alveolar Dead Space

A
  • a series of alveoli in the left lower lobe receive adequate ventilation but do not have adequate perfusion
135
Q

Which are steps in the process of gas exchange?

A
  1. Ventilation
  2. Diffusion
  3. Perfusion
136
Q

occlusion of the coronary arteries without pain

A

Silent ischemia

137
Q

mean pulmonary artery pressure reading will indicate to the nurse that pulmonary hypertension is occurring? Pulmonary artery pressure above _________ mmHg

A

Above 25

138
Q

This interval represents the sum of all ventricular muscle cell depolarizations.

A

QRS complex

139
Q

Define Croup

A
  • an acute laryngotracheobronchitis
  • occurs in children between 6 months and 5 years of age, with a peak incidence at 2 years of age
  • Almost always caused by a virus
140
Q

Which enzymes are released by damaged myocardial muscle tissue

A
  1. Creatnin Kinase
  2. LDH
  3. Troponin
141
Q

a 50 year old male is diagnosed with pulmonary embolism (PE). what symptoms most likely occurred before treatment

A

chest pain and shortness of breath

142
Q

is an accumulation of fluid in the pericardium

A

Pericardial effusion

143
Q

often associated with ectopic hormone production, especially antidiuretic hormone

A

Small Cell Carcinoma

145
Q

Reduced oxygenation of arterial blood

A

Hypoxemia

146
Q

Define Open Pneumothorax

A
  • air pressure in the pleural space equals barometric pressure
  • b/c air that is drawn into the pleural space during inspiration is forced back out during expiration
147
Q

A 60 year old male with a 40 year history of smoking presents with chest pain, cough, sputum production, and pneumonia. tests reveal widespread metastatic cancer, and the primary care provider plans radiation therapy. which of the following is the most likely type of cancer to be documented on the chart

A

Non Small Cell Carcinoma

149
Q

a hypersensitivity usually due to penicillin, latex, and food allergies

A

Anaphalactic Shock

150
Q

A patient has a loud pansystolic murmur that radiates to the back and axilla. Which valvular abnormality is this describing?

A

Mitral regurgitation

151
Q

Which conditions are associated with dyslipidemia?

A

Very low-density lipoproteins (VLDL) - triglycerides and proteins

152
Q

Asthma related to Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by

A

mucus secretion, bronchoconstriction, and airway edema

153
Q

SIDS peaks between ____ and ____ months of age

A

3, 4

154
Q

a result of atherosclerosis

A

peripheral vascular disease

155
Q

A 20 year old male presents to his primary health care provider, difficulty breathing when lying down. What term should the nurse use to document this condition?

A

orthopnea

156
Q

the persistent abnormal dilation of the bronchi

A

Bronchiectasis

Nursing School (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions