Multiple choice question on water cycle for grade 6

Create a multiple-choice quiz for 5th grade English learners (CEFR A1–A2 level) based on the following reading text. Text: Mari Copeny is a special girl. She helped her city get clean water. Mari lives in a city called Flint in the USA. In 2014, there was a big water problem in Flint. Mari wanted to do something. She decided to send a letter to the president of the USA. His name was Barack Obama. President Obama was angry about the dirty water in Flint. He wanted to help. He visited Flint and learned about the water problem. He helped the city get clean water. Mari is happy her letter helped Flint. She also wants to change other things. One day, Mari wants to be president of the USA. She plans to make life better for many people. Instructions for the quiz: • Create 8–10 multiple-choice questions. • Each question should have 4 answer options (A, B, C, D). • Mark the correct answer. • Use simple language suitable for 5th grade ESL learners. • Focus on comprehension of the text (who, where, why, what happened, sequence of events). • Include at least one question about Mari’s future goal.

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

10 Multiple-Choice Questions About Wudu 1. What is the very first step you must perform before starting Wudu? A) Washing the hands to the wrists B) Having the intention (Niyyah) in the heart and saying "Bismillah" C) Rinsing the mouth D) Wiping the head Correct Answer: B 2. According to the Sunnah, how many times is it recommended to wash the hands, mouth, and nose? A) 1 time B) 2 times C) 3 times D) 4 times Correct Answer: C 3. What are the correct boundaries for washing the face during Wudu? A) From the forehead to the bridge of the nose, and from ear to ear B) From the normal hairline to the bottom of the chin, and from ear to ear C) Only the cheeks and the lips D) From the eyes to the neck, and from ear to ear Correct Answer: B 4. When washing your arms, where should the water start and where must it end? A) From the fingertips up to and including the elbows B) From the wrists to the shoulders C) From the elbows down to the wrists only D) From the palms to the forearms only Correct Answer: A 5. What is the correct way to wipe the head during Wudu? A) Wiping only the neck and back of the head B) Wiping the entire head with wet hands, from the front to the back and returning to the front C) Washing the head thoroughly with running water three times D) Wiping only the hair on the right side of the head Correct Answer: B 6. How should the ears be wiped, and do you need to take fresh water for them? A) They should be washed with running water three times B) They are wiped using the remaining wetness on the fingers after wiping the head, not with fresh water C) They should be wiped with fresh water using a towel D) Wiping the ears is optional and not part of the standard Wudu steps Correct Answer: B 7. Up to which part must the feet be washed completely during Wudu? A) Up to the toes only B) Up to and including the ankles C) Up to the mid-calf D) Only the bottom of the feet needs to be wiped Correct Answer: B 8. What does "Tartib" (Sequence) mean in Wudu? A) Washing the right limb before the left limb B) Performing the steps of Wudu in the specific order commanded by Allah and the Prophet C) Ensuring no parts of the body are left dry D) Repeating each step exactly three times Correct Answer: B 9. What does "Muwalat" (Continuity/Succession) mean during the ablution process? A) Washing each body part immediately after the previous one before it dries B) Using a large amount of water for each step C) Making sure to supplicate between every single step D) Taking a long break between washing the face and the arms Correct Answer: A 10. What is the recommended Supplication (Dua) to say immediately after completing Wudu? A) "Alhamdulillah" three times B) "Ash-hadu alla ilaha illallah wahdahu la sharika lah, wa ash-hadu anna Muhammadan 'abduhu wa Rasuluh" C) "Subhanallah" ten times D) Reading Surah Al-Fatiha Correct Answer: B

Create a multiple choice test (10 questions with answers) from the following text: The Environment The environment is the combination of forces and conditions that surround and influence living and non-living things. Human beings’ environment includes such factors as temperature, food supply and other people that surround them. A plant’s environment may be made up of soil, sunlight, and animals that will eat the plant. A rock’s environment may be made up of seaweed, water and fish. Non-living environmental factors, such as temperature and sunlight, make up the abiotic (non-living) environment. Living organisms such as seaweed and food, make up the biotic environment. Both the abiotic and biotic environments interact to make up the total environment of living and non-living things. Ecology Ecology studies the relationships between living things and their environment. No living thing, plant or animal, lives alone. Every living thing depends in some way upon certain other living and non-living things to survive. The study of ecology increases our understanding of the world and all its creatures. This is crucial because humanity’s survival and well-being depend on relationships that exist on a world-wide basis: changes in distant parts of the world affect us and our environment. One concern of ecologists is the rate at which we are using up natural resources such as coal, gas, and oil. Along with scientists, they are searching for ways to use sunlight and atomic energy for fuel and power as alternative energy sources. Ecology also studies how many living organisms there are on Earth and how they are distributed. It also considers non-living physical factors of the environment, for example the presence of water, as these can influence where organisms decide to live. It is also important to know which organisms share the same environment, as they may need each other to survive. This kind of information helps ecologists to conserve our natural world, protecting the habitat of animals that are in danger of extinction, or trying to reduce pollution and global warming. Ecosystems Ecosystems are biological communities of all living things like plants, animals and organisms in a specific area that interact with each other and with the non-living forms present in their environment. They are the foundations of the biosphere and determine the health of the entire planet’s system. A biosphere is a global ecosystem, containing many different kinds of ecosystems.

You are an elementary school teacher. Create a 20 item multiple choice quiz using the story below. Include the key answers below the questions. "Many years after God made everything, the people of the earth became plenty in number. These people forgot about God and they became very bad. God became very sad. So God said, “I will wipe out all the people on the earth. | will destroy all the animals, birds and fish, and all the trees and plants. | am so hurt by what they do that | feel sorry that | made them.’ Yet, there was a man named Noah. He was a very good man among the people of that time. He obeyed God with all his heart and did not sin against God. Noah found favor in the eyes of the Lord. Noah had a wife and three sons named Ham, Shem, and Japheth. Unlike the people around them, Noah's family lived doing what was right in God's eyes, They loved each other as one family and they never forgot to pray to God. One day, the Lord God called Noah and told him about His plan to punish all His creation and put an end to all the people of the earth. God said, “Noah, make a giant ark with many, many rooms. Put a door on the side of the ark. Make a roof on it and a small window on one side. | am going to bring floodwaters on earth to destroy all living things. Gather all kinds of animals—two of every kind: one male and one female. When the floodwaters would come, you have to bring into the ark all kinds of animals. You are to take every kind of food that is to be eaten for you and for the animals.’ The bad people made fun of Noah’s family who were making a giant ark when in fact the weather was very good. There were no dark clouds and not even a drop of rain was falling down. They continued to do bad things while Noah did everything just as God commanded him. ™ Soon after the ark was finished, the floodgates of heaven were gPened and heavy rain fell on the earth. On that day, Noah and his family entered the ark together with all the different kinds of animals, both big and small. While Noah's family and all the animals were inside the ark, the heavy rain fell non-stop for forty days and forty nights. All the living things outside the ark were destroyed. When the rain stopped, there was a great flood all over the earth. The whole land was covered with water. The waters flooded the earth for 150 days. After 150 days, dry land started to appear so God told Noah to open the door and come out of the ark for the land was already dry. Then Noah sent out all the animals from the ark, too. Then God said to Noah, “I will make a promise to you. Never again will | bring great flood on the earth to destroy all creation. | will set a rainbow in the clouds as a sign of My promise to you and to all the people of the earth.’ So, every time the rainbow appears on the sky, just remember God's promise that He will never again destroy the earth by a flood."

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