What is an Exclamation?

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)

SPANISH STUDENTS 10/22/25 In the sentence 'The author chose to juxtapose the wealthy neighborhood with the impoverished area to highlight social inequality,' what does 'juxtapose' most likely mean based on context clues? * 1 point to separate completely to describe in detail to criticize harshly to place side by side for comparison When reading 'This paradox confused everyone: the more he tried to save time, the less time he seemed to have,' what can you infer about a paradox? * 1 point a mathematical equation a simple solution a type of poem a contradictory statement that reveals truth The passage states: 'The author's use of symbolism was evident when the broken mirror represented the character's shattered dreams.' Based on this context, symbolism involves: * 1 point using objects to represent deeper meanings creating rhyming patterns writing in chronological order using literal descriptions only In the text 'Please elaborate on your answer by providing specific examples and detailed explanations,' the word 'elaborate' suggests the need to: * 1 point use simpler words change the topic add more detail make it shorter The critic wrote: 'The actor's performance captured every nuance of emotion, from subtle sadness to barely contained rage.' What does 'nuance' refer to in this context? * 1 point subtle variations in meaning simple emotions loud expressions obvious differences When the text says 'The implication of her silence was clear to everyone in the room, though she never spoke a word,' what does 'implication' mean? * 1 point a command given a direct statement a question asked a conclusion drawn indirectly The scientist stated: 'Based on our limited observations, our hypothesis suggests that plants grow faster with classical music.' What is a hypothesis? * 1 point a type of experiment a proven fact a final conclusion a possible explanation needing more evidence In 'Three witnesses were able to corroborate the defendant's alibi, strengthening his case significantly,' the word 'corroborate' most likely means: * 1 point to question or doubt to confirm or support to change the story to ignore completely The passage reads: 'The student needed to justify her controversial thesis with solid evidence and logical reasoning.' What does 'justify' mean here? * 1 point to make it longer to make excuses for to avoid explaining to prove something is reasonable When the text states 'The researcher was able to synthesize information from five different studies to create a comprehensive theory,' what does 'synthesize' involve? * 1 point copying one source exactly combining multiple sources to create something new rejecting all previous research focusing on only one idea When a reader encounters 'The symbolism in the novel was complex, with the recurring image of doors representing new opportunities throughout the story,' they should: * 1 point memorize all symbols skip symbolic passages look for deeper representational meanings focus only on the literal meaning If a teacher says 'Your essay needs more elaboration - expand on your main points with examples and analysis,' what critical thinking skill is being requested? * 1 point developing ideas with supporting details summarizing briefly using fewer examples changing the topic entirely In the passage 'The dark clouds gathering on the horizon seemed to foreshadow the troubles that would soon befall the village,' what literary technique is being demonstrated? * 1 point The author is using environmental details to hint at future plot developments The author is focusing on realistic weather descriptions The author is using weather to predict actual meteorological events The author is describing a coincidental weather pattern When analyzing 'Sarah knew the antagonist in her favorite novel wasn't just evil—he represented the fear of change that many people experience,' what deeper understanding about antagonists is revealed? * 1 point Antagonists are always completely evil characters Antagonists can represent abstract concepts or human struggles Antagonists must be human characters Antagonists only exist to create action scenes In the sentence 'The protagonist's journey wasn't just about reaching the destination—it was about discovering who she truly was,' what does this suggest about effective protagonists? * 1 point Protagonists must always succeed in their missions Protagonists should remain unchanged throughout the story Protagonists undergo both external and internal development Protagonists should focus only on external goals When the text states 'The word 'home' carried different connotations for each character—warmth and safety for some, confinement and obligation for others,' what critical reading skill is being highlighted? * 1 point Memorizing dictionary definitions Understanding that words have only one correct meaning Identifying grammatical structures Recognizing that word meanings can vary based on personal experience In 'While the denotation of 'snake' is simply a reptile, the author's use of it to describe the character suggests something far more sinister,' what analytical skill is required? * 1 point Understanding reptile biology Memorizing animal classifications Distinguishing between literal and figurative meanings Identifying sentence structure When examining 'The author's tone shifted from hopeful in the opening chapters to increasingly cynical as the story progressed,' what does this reveal about sophisticated writing? * 1 point Tone is unimportant in storytelling Tone changes reflect the author's developing attitude toward the subject Only the ending tone matters Authors should maintain the same tone throughout In analyzing 'The theme of the novel wasn't stated directly but emerged through the characters' repeated struggles with moral choices,' what does this demonstrate about themes? * 1 point Themes develop through patterns in the narrative Themes are only found in the conclusion Themes should always be explicitly stated Themes must be simple moral lessons When the passage reads 'From the character's nervous glances and hesitant speech, readers can infer that she's hiding something important,' what critical thinking process is being described? * 1 point Following explicit plot statements Memorizing character descriptions Making random guesses about character motivations Using textual evidence to draw logical conclusions In 'The ending was deliberately ambiguous, allowing readers to decide whether the character's actions were heroic or selfish,' what does this suggest about sophisticated literature? * 1 point Good stories always have clear, definitive endings Unclear endings indicate poor writing Ambiguity can enhance reader engagement and interpretation Authors should avoid confusing readers When analyzing 'The controversial decision to ban the book sparked debates about censorship versus protecting young readers,' what critical thinking skill is most important? * 1 point Choosing one side immediately Examining multiple perspectives before forming an opinion Avoiding difficult topics entirely Following popular opinion In 'Each character's perspective on the same event revealed how personal experiences shape our understanding of truth,' what deeper concept is being explored? * 1 point All perspectives are equally valid Perspective is unimportant in understanding events There is only one correct way to view any situation Personal background influences how we interpret events When the text states 'The community proved resilient, rebuilding not just their homes but their hope after the disaster,' what does this reveal about the concept of resilience? * 1 point Resilience encompasses both practical and emotional recovery Resilience is an innate trait that cannot be developed Resilience means avoiding all difficulties Resilience only involves physical recovery In analyzing 'The author's portrayal of the character's empathy—her ability to understand her enemy's pain even while fighting him—added complexity to the conflict,' what does this suggest about empathy? * 1 point Empathy means agreeing with everyone Empathy makes people weak in conflicts Empathy should be avoided in difficult situations Empathy can coexist with opposition and create moral complexity When examining 'The character's integrity was tested when telling the truth would hurt people she loved,' what does this reveal about integrity? * 1 point Integrity means always following rules regardless of consequences Integrity means never causing any harm to others Integrity is only important in public situations Integrity involves making difficult moral choices even when costly In 'The student learned to advocate for her ideas by presenting evidence rather than just stating opinions,' what critical skill is being developed? * 1 point Supporting positions with logical reasoning and evidence Avoiding controversial topics entirely Learning to argue loudly and persistently Always agreeing with authority figures If you rewrote a scene from 'The Birchbark House' from Omakayas's grandmother's first-person perspective instead of Omakayas's, how would this most likely change the reader's understanding? * 1 point Nothing would change since they're both female characters The language would become more formal and difficult The story would become less interesting because adults are boring Readers would gain wisdom from experience but lose the innocence of childhood discovery In a plot diagram, the rising action serves which critical purpose beyond simply building toward the climax? * 1 point To provide background information about the setting To confuse readers so the ending is surprising To develop character relationships and establish stakes that make the climax meaningful To make the story longer and more detailed When analyzing the falling action in 'The Birchbark House,' which element would be most important to consider when writing an alternate version? * 1 point Whether the consequences of the climax align with the new direction you want the story to take Making sure it's shorter than the rising action Including a moral lesson for readers How quickly the conflicts get resolved In the exposition of a story, conflict serves which essential function that many readers don't realize? * 1 point To immediately grab attention with action scenes To provide comic relief before serious events To show off the author's writing skills To establish what the characters characterization/personality, which determines what they' must learn to overcome as they face more problems

Question 1 Category: Current Events Question: What was the primary demand of the Kenyan Gen Z protesters featured in the BBC documentary Unmasked: The Truth Behind the Gen Z Protests? Options: A) Free education B) Repeal of the Finance Bill 2024 C) Climate change action D) New elections Correct Answer: B) Repeal of the Finance Bill 2024 Explanation: The BBC documentary highlights that Kenyan youth protested to demand the repeal of the Finance Bill 2024, which proposed tax hikes raising $2.7 billion. Question 2 Category: Science Question: Which gas, discovered on the sun before Earth, is the second most abundant element in the universe? Options: A) Hydrogen B) Oxygen C) Helium D) Nitrogen Correct Answer: C) Helium Explanation: Helium was first detected in the sun’s spectrum in 1868 and is the second most abundant element after hydrogen in the universe. Question 3 Category: Current Events Question: Which Kenyan city was the epicenter of the Gen Z protests covered in the BBC documentary Unmasked: The Truth Behind the Gen Z Protests? Options: A) Mombasa B) Nairobi C) Kisumu D) Eldoret Correct Answer: B) Nairobi Explanation: Nairobi, Kenya’s capital, was the main hub for the #OccupyParliament protests, with significant events like the Parliament breach occurring there, as shown in the documentary. Question 4 Category: History Question: Which empire, known for its vast trade networks, was centered in modern-day Turkey and lasted until the early 20th century? Options: A) Roman Empire B) Ottoman Empire C) Mongol Empire D) Byzantine Empire Correct Answer: B) Ottoman Empire Explanation: The Ottoman Empire, spanning over 600 years until 1922, was a major trade and cultural power centered in modern-day Turkey. Question 5 Category: Current Events Question: According to the BBC documentary, what technology helped document evidence of police brutality during the Kenyan Gen Z protests? Options: A) Drones B) Smartphone videos C) Facial recognition software D) Satellite tracking Correct Answer: B) Smartphone videos Explanation: The documentary used smartphone videos from protesters and bystanders, analyzed via open-source data, to document police brutality during the 2024 protests. Question 6 Category: Geography Question: What is the smallest country in the world by land area? Options: A) Monaco B) Vatican City C) San Marino D) Liechtenstein Correct Answer: B) Vatican City Explanation: Vatican City, with an area of about 44 hectares, is the smallest sovereign state in the world by land area. Question 7 Category: Current Events Question: What hashtag became synonymous with the Kenyan Gen Z protests, as featured in the BBC documentary Unmasked: The Truth Behind the Gen Z Protests? Options: A) #KenyaRising B) #OccupyParliament C) #TaxRevolt D) #GenZFight Correct Answer: B) #OccupyParliament Explanation: The #OccupyParliament hashtag was widely used by protesters to rally against the Finance Bill 2024, as documented by the BBC. Question 8 Category: Entertainment Question: Which actor starred as the lead in the 2023 film Barbie and also played a role in La La Land? Options: A) Emma Stone B) Margot Robbie C) Zendaya D) Saoirse Ronan Correct Answer: B) Margot Robbie Explanation: Margot Robbie starred as Barbie in the 2023 film and played a supporting role in La La Land (2016). Question 9 Category: Sports Question: Which sport is played at the Wimbledon Championships? Options: A) Cricket B) Rugby C) Tennis D) Golf Correct Answer: C) Tennis Explanation: Wimbledon, held annually in London, is the oldest and one of the most prestigious tennis tournaments in the world. Question 10 Category: Technology Question: In web development, what does the acronym “CSS” stand for? Options: A) Computer Style System B) Cascading Style Sheets C) Creative Script Syntax D) Centralized Style Standard Correct Answer: B) Cascading Style Sheets Explanation: CSS (Cascading Style Sheets) is used to style and format the appearance of web pages written in HTML.

1. Which sentence correctly uses the present continuous tense to express a temporary action? A. She works at a bank. B. She is working at a bank for the summer. ✅ C. She worked at a bank last year. D. She has worked at a bank for years. ⸻ 2. Which of the following uses the past continuous tense to describe an interrupted action? A. I was eating dinner when the phone rang. ✅ B. I eat dinner when the phone rings. C. I had eaten dinner before the phone rang. D. I was eat dinner when the phone ringed. ⸻ 3. What is the function of “is/am/are + V.ing” in a sentence? A. To show routine habits B. To describe completed past actions C. To indicate actions in progress at the moment of speaking ✅ D. To express future intentions with certainty ⸻ 4. Which sentence shows incorrect use of the past continuous tense? A. She was singing while I played the piano. ✅ B. They were talking when I arrived. C. I was reading while he was cooking. D. It was raining all night yesterday. (Explanation: A uses mixed tenses incorrectly. It should be: “She was singing while I was playing the piano.”) ⸻ 5. Choose the sentence that uses the present simple tense in a conditional structure. A. If it is raining, we will cancel the trip. ✅ B. If it was raining, we would cancel the trip. C. If it rained, we canceled the trip. D. If it rains, we are canceling the trip. ⸻ 6. Identify the sentence in which the auxiliary verb is incorrectly used. A. He is doing his homework now. B. She was watched a movie last night. ✅ C. They were playing football all afternoon. D. I am going to the store. ⸻ 7. Which sentence best demonstrates the habitual use of the present simple? A. I am jogging every morning. B. I jog every morning. ✅ C. I was jogging every morning. D. I have jogged every morning. ⸻ 8. Choose the best explanation for using “was/were + V.ing”: A. To talk about a permanent state B. To describe future arrangements C. To express a continuous action in the past ✅ D. To indicate hypothetical situations

refreshment (n): (small amounts of food and drink ( Refreshments will be available during the interval.) stimulant (n): a substance which temporarily arouses physiological or organic activity ( Caffeine is a natural stimulant .) reinforcement (n): the act of making sth stronger / (plural) soldiers sent to join an army to make it stronger ( Constructors have been hired to add reinforcement to the foundations of the old bridge.) initiative (n): the ability to make decisions without waiting to be told what to do (Being a successful entrepreneur requires one to have great initiative.) inhibition (n): a shy or nervous feeling that stops you from expressing your real feelings (She drinks alcohol at parties to get over her inhibitions.) initiation (n): a ceremony, ritual, test, or period of instruction with which a new member is admitted to an organization or office (The initiation period for new employees lasts approximately six weeks.) initial (n): the first letter of a name, esp. when used to represent a name (Do you know what Ms Rowling's initials, J and K, stand for?) concise (adj): short and clear, expressing what needs to be said without unnecessary words (She gave a concise overview of the points she was about to make in her speech. ) direct (adj): happening or done without involving other people, actions, etc. in between ( You will only be hired if you have direct experience in this field.) devious (adj): not straightforward, sincere and honest about your intentions or motives; shifty (They came up with a devious plan to overthrow the chairman of the company.) circuitous (adj): not straight or direct (The professor gave a circuitous explanation confusing his students.) diluted (adj): (of a liquid) made weaker or less pure by being mixed with sth else( Orange squash should be diluted with water before it is served.) delicate (adj): easily hurt or destroyed.( This silk shirt is too delicate to put in the washing machine.) desolate (adj): extremely sad and feeling lonely. (After the death of his wife he led a desolate life.) diffused (adj): widely spread or scattered; not concentrated/ wordy ( He spoke in such a diffused manner that it was impossible to take notes on his lecture.) might (n): the power, force, or influence held by a person or group (The captive struggled with all of his might and managed to free himself of the chains.) plot (n): a secret plan made by several people to do sth that is wrong, harmful or not legal, esp. to do damage to a person or a government / a storyline ( The plot of the forthcoming Harry Potter book has yet to be revealed.) glaze (n): a thin clear liquid put on objects before they are finished, to give them a shiny surface ( She mixed sugar and lemon to make the glaze of the cake.) plight (n): an unpleasant condition, esp. serious, sad or difficult one ( Last night's documentary dealt with the plight of political asylum seekers.) comprise (v): to consist of be composed of( The final exam is comprised of three parts.)

Create a comprehension quiz for the following vocabulary; To be getting on in age: Growing older; advancing in years. Pet peeve: Something that annoys or bothers someone significantly. Pinhead: A small-minded or foolish person. Nit-pick: To find fault with small or trivial details. Whilst/while: During the time that; at the same time as. On a dig: Engaged in archaeological excavation. Mad vs crazy: "Mad" typically refers to anger or insanity, while "crazy" can denote insanity or extreme enthusiasm. Twitch: A sudden, quick movement or spasm. Dreamt/dreamed: Past tense forms of the verb "to dream." Eaves: The part of a roof that overhangs the walls. Burly man: A strong, muscular man. She’s a looker: A woman who is attractive or visually appealing. Breech birth: A birth in which the baby is delivered feet first instead of head first. Being too forward: Acting too boldly or presumptuously. Gooey: Soft and sticky, often used to describe certain textures or emotional situations. Spare tire: Excess fat around the waistline; a protruding belly. Twists and turns of fate: Unexpected changes or developments in life. Pompous: Self-important or arrogant. Play a prank on someone: To carry out a mischievous trick or joke on someone. Scamps: Mischievous or playful individuals, often used affectionately. To tend one's resignation: To formally submit one's resignation from a job. A sound judgment: A wise or rational decision. To set someone up with someone else: To arrange a meeting or date between two people. Loon: A colloquial term for a crazy or eccentric person. Duvet: A type of blanket filled with feathers, down, or synthetic fibers, used as a bed covering. Don't Meddle: Do not interfere or intervene. Croquet mallet: A hammer-like instrument used to strike croquet balls. Cut it out: Stop doing something annoying or inappropriate. Pop over: Visit briefly or unexpectedly. It was a riot: It was extremely funny or enjoyable. Spit Tspat spat: Sounds indicating a quick, spat-out expulsion of saliva. A hoot: Something that is amusing or enjoyable. Overhear: To unintentionally hear what others are saying without their knowledge. You're quite a package: You possess many appealing qualities or attributes. I'm quite a catch: I am an attractive or desirable partner. Limper: A person who walks with a limp. A hanky: A handkerchief, a small piece of cloth carried for personal hygiene or used as a fashion accessory.

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