The outside box is fair but the actual book itself is almost new. No staining. There are a few pencil marks here and there but overall it’s good. A CD is included to go over how to pronounce medication and videos on how to solve the calculation problems. However, I have never actually used the CD myself. May be good if English is not your first language or if you really struggled with learning medication names. Recommended for Nursing students or those going into Pharmacy.