HESI Exit exam - Evolve questions

A client being treated for hypertension reports having a persistent hacking cough. What class of antihypertensive should the nurse identify as a possible cause of this response when reviewing a list of this client's medications? 1 Thiazide diuretics 2 Calcium channel blockers 3 Angiotensin receptor blockers 4 Angiotensin-converting enzyme (ACE) inhibitors

4 - ACE increases the sensitivity of the cough reflex

Braxton Hicks contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses

The nurse provides discharge medication education to a client who has been switched from a prescription for heparin to a prescription for warfarin sodium. Which client statement indicates to the nurse that teaching was effective? 1 "I will avoid taking aspirin and NSAIDs." 2 "I will avoid exercise and will spend most of the day working at my desk." 3 "I will need to have regular complete blood counts to guide warfarin dosage." 4 "Before going to the dentist, I will ask my healthcare provider for antibiotics."

1 -Acetaminophen should be used when an analgesic is required because it does not interfere with platelet aggregation. Acetylsalicylic acid (aspirin) should be avoided because it interferes with platelet aggregation. A prothrombin time (PT) or international normalized ratio (INR), not a complete blood count, needs to be done periodically.

A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity? 1 Push-ups to strengthen arm muscles 2 Leg lifts to prevent hip contractures 3 Balancing exercises to promote equilibrium 4 Quadriceps-setting exercises to maintain muscle tone

1 -Arm strength is necessary for transfers and activities of daily living and for use of crutches or a wheelchair, so the nurse should teach the client how to do wheelchair push-ups safely. Equilibrium is not a problem. The client does not have neurologic control of the other activities.

Because of the increased discomfort level during the transition phase of labor, nursing care should be directed toward what? 1 Helping the client maintain control 2 Decreasing the rate of intravenous fluid 3 Administering the prescribed medication 4 Having the client breathe in a uniform pattern

1 -The transition phase is the most difficult phase of labor, and the client needs encouragement and support to cope. Fluids should be increased at this time because of the increase in metabolism. Medication is contraindicated at this point because it may depress the newborn at birth. The breathing pattern should be complex, not uniform, at this time because it requires a high level of concentration that helps distract the client.

A nurse administers leucovorin calcium to a client before the prescribed methotrexate. The client asks the reason for this. What effect of leucovorin calcium should the nurse consider when formulating a response? 1 Supplies levels of folic acid required by blood-forming organs 2 Potentiates metabolite required for destruction of cancer cells 3 Acts synergistically with antineoplastic drugs to destroy cancer cells 4 Increases production of phagocytes to help remove debris from destroyed cancer cells

1- Methotrexate is a folic acid antagonist that can depress the bone marrow; this serious toxic effect sometimes is prevented by administration of folic acid. Some healthcare providers advocate its administration after a course of methotrexate therapy to avoid interfering with methotrexate activity.

Which type of immunity will clients acquire through immunizations with live or killed vaccines? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

2 - Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.

Before a male client signs an operative consent for an abdominoperineal resection, the nurse verifies that the client understands that surgery likely will result in which outcome? 1 Permanent ileostomy in the jejunum 2 Permanent colostomy and impotence 3 Temporary ileostomy and diminished libido 4 Temporary colostomy in the descending colon

2 - Permanent colostomy and impotence Large portions of bowel and rectum are removed; during the perineal portion of the surgery, nerves involved in penile erection often are damaged.

A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? 1 To stimulate sodium excretion 2 To help prevent potassium loss 3 To increase urine specific gravity 4 To reduce arterial blood pressure

2 - to help prevent potassium loss spirnolactone is a potassium sparing diuretic used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. Both medications stimulate sodium excretion. Both medications increase urine specific gravity and reduce arterial blood pressure.

A client's arterial blood gas report indicates that pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results? 1 A 54-year-old with vomiting 2 A 17-year-old with panic attacks 3 A 24-year-old with diabetic ketoacidosis 4 A 65-year-old with advanced emphysema

3- The low pH and bicarbonate levels are consistent with metabolic acidosis, which can be caused by excess ketones, a result of diabetic ketoacidosis. A 54-year-old with vomiting most likely will experience metabolic alkalosis from loss of gastric hydrochloric acid. A 17-year-old with panic attacks most likely will experience respiratory alkalosis from hyperventilation. A 65-year-old with advanced emphysema most likely will experience respiratory acidosis.

On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. What should the nurse do first? 1 Reorder the full-fluid diet. 2 Notify the primary healthcare provider. 3 Administer analgesics as prescribed before meals. 4 Provide saline gargles to moisten the mucous membranes.

3-Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity. Analgesics as prescribed will reduce soreness during meals.

Which type of hepatitis spreads through contaminated food and water? A. hep a b. hep b c. hep c d. hep d

a - b, c, d - spread through blood

Which symptoms are common during the fulminant stage of inhalation of anthrax? Select all that apply. 1 Dyspnea 2 Dry cough 3 Diaphoresis 4 Mild chest pain 5 High temperature

dyspnea diaphoresis high temp (prodromal phase will have dry cough and mild chest pain)

pheochromocytoma

(d.t benign tumor on adrenal medulla ) hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor)

Which diseased condition associated with the client's heart is an example of an autoimmune disease? 1 Uveitis 2 Rheumatic fever 3 Myasthenia gravis 4 Graves' disease

2

A child with a congenital heart defect has a cardiac catheterization. What is an essential element of nursing care after this procedure? 1 Encouraging early ambulation 2 Monitoring the extremity distal to the insertion site 3 Restricting fluids until blood pressure and heart rate have stabilized 4 Comparing blood pressure in the affected and unaffected extremities

2 -Monitoring the extremity distal to the insertion site for changes in temperature and color should indicate the presence or absence of a clot; comparing pedal pulses of both extremities may reveal clot formation that disrupts circulation. The child is kept in bed at least 6 hours after the procedure.

A 24-year-old client complains to the nurse in the women's health clinic that her breasts become tender before her menstrual period. What should the nurse recommend that the client do 1 week before an expected menses? 1 Take salt tablets daily. 2 Increase protein intake. 3 Eliminate daily exercise. 4 Decrease caffeine intake.

2 -The client is exhibiting one symptom of premenstrual syndrome (PMS); eliminating food and beverages containing caffeine can limit breast swelling. Salt intake should be reduced premenstrually to limit the development of edema.

What are examples of a client's flat bones? Select all that apply. 1 Sacrum 2 Scapula 3 Sternum 4 Humerus 5 Mandible

2, 3 Bones such as the sacrum and mandible are irregular bones

The nurse is conducting a nutrition class for a group of clients with heart failure (HF). Which information is most important for the nurse to share with the class? 1 Restricting fluid intake 2 Eating a low caloric diet to reduce weight 3 Recognizing which products are high in cholesterol 4 Choosing fresh or frozen vegetables instead of canned ones

4 -The key principle to teach HF clients is the importance of decreasing sodium in their diet and which foods contain sodium. If sodium is decreased, water retention will decrease also. Fresh or frozen vegetables have less sodium than canned ones.

What are the sx of tuberculosis ? A. fatigue B. nausea C. weight gain d. low grade fever e. increased apetite

A, B, D. fatigue nausea low grade fever weight loss

What does grade 3 indicate according to the muscle-strength scale? 1 Active movement against gravity and some resistance 2 Active movement of body part with elimination of gravity 3 Active movement against full resistance without evident fatigue 4 Active movement against gravity only and not against resistance

According to the muscle-strength scale, a score of 3 indicates active movement against gravity only and not against resistance. A score of 4 indicates active movement against gravity and some resistance. A score of 2 indicates active movement of a body part with elimination of gravity. A score of 5 indicates active movement against full resistance without evident fatigue.

A client had a laparoscopic cholecystectomy. Postoperatively the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What should the nurse include in the teaching plan when preparing this client for discharge? Select all that apply. 1 Wash the puncture sites with strong soap and hot water daily. 2 Call the healthcare provider if you have a fever of 100o F (37.8oC) or more for two days. 3 Remove the tape-strips over the puncture sites one week after surgery. 4 Check the puncture sites daily for redness, tenderness, swelling, heat, or drainage. 5 Ease the discomfort from the gas used to insufflate the abdomen during surgery by applying a heating pad to the left shoulder.

2, 4 The puncture sites should be washed gently with mild soap and warm water. Tape-strips should be allowed to fall off; they should not be pulled off because they reinforce closure of the incision. A heating pad 20 minutes hourly is recommended to relieve discomfort in the right, not left, shoulder as a result of phrenic nerve irritation because of retention of carbon dioxide gas insufflated into the abdomen during surgery.

A nurse witnesses a person fall. The person becomes unresponsive and pulseless. The nurse plans to use an automated external defibrillator (AED) that is available on site. What should the nurse do first? 1 Remove all jewelry. 2 Wash the chest area. 3 Use a grounded electrical source. 4 Remove medication patches on the chest.

4 - Medication patches that interfere with electrode placement must be removed before application of electrodes because of possible burn caused by electrical conduction in the area of the patch. Jewelry usually is not a problem with the function of an automated external defibrillator. Skin preparation is unnecessary. The AED is battery-operated and does not need a grounded electrical source.

Which cytokine increases growth and maturation of myeloid stem cells?1.Interleukin-2 2. Thrombopoietin 3. Granulocyte colony-stimulating factor 4. Granulocyte-macrophage colony-stimulating factor

4. Granulocyte-macrophage colony-stimulating factor is a cytokine that increases growth and maturation of myeloid stem cells. Interleukin-2 is a cytokine that increases growth and differentiation of T-lymphocytes. Thrombopoietin is a cytokine that increases growth and differentiation of platelets. Granulocyte colony-stimulating factor is a cytokine that increases numbers and maturity of neutrophils.

Which urinary diagnostic test does not require any dietary or activity restrictions for the client before or after the test? 1 Renal scan 2 Renal biopsy 3 Renal arteriogram 4 Concentration test

A renal scan does not require any dietary or activity restrictions. A renal biopsy requires bed rest for 24 hours after the procedure. A renal arteriogram requires the client to maintain bed rest with affected leg straight. A concentration test requires the client to fast after a given time in the evening.

After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits undigested antacids and reports having severe epigastric pain. The nursing assessment reveals an absence of bowel sounds, a pulse rate of 134, and shallow respirations of 32 per minute. In addition to calling the healthcare provider, what is the priority nursing action? 1 Prepare the client for surgery. 2 Administer oxygen per nasal catheter. 3 Place in the supine position, with legs elevated. 4 Ask the client if there have been any black stools.

1 - These symptoms are classic indicators of a perforated ulcer, for which immediate surgery is indicated; this should be anticipated. Although oxygen may be helpful, it is not the priority. The symptoms are more indicative of perforation than of shock, so placing the client in the supine position with legs elevated is not appropriate at this time.

client who sustained serious burns now has a stress ulcer. Which clinical indicators of shock should the nurse immediately report to the primary healthcare provider? Select all that apply. 1 Weakness 2 Diaphoresis 3 Tachycardia 4 Cold extremities 5 Flushed skin tone

1, 2, 3, 4 The stress ulcer can bleed, leading to shock. Weakness is related to the decrease in the oxygen-carrying capacity of the blood associated with shock. Diaphoresis and tachycardia are sympathetic nervous system responses associated with shock. Peripheral vasoconstriction is associated with the sympathetic nervous system response associated with shock and leads to cold extremities. The skin will be pale, rather than flushed, because of peripheral vasoconstriction.

Which structures are included in the external genitalia in males? Select all that apply. 1 Penis 2 Testes 3 Scrotum 4 Urethra 5 Seminal vesicles

1, 3 penis and scrotum (testes are primary reproductive organs not external genitalia)

Which sleep disorders are examples of dyssomnias? Select all that apply. 1 Insomnia 2 Nightmares 3 Sleep terrors 4 Restless leg syndrome 5 Obstructive sleep apnea

1, 4, 5 Insomnia, restless leg syndrome, and obstructive sleep apnea are examples of dyssomnias. Nightmares and sleep terrors are examples of parasomnias.

A client is scheduled for a sigmoidoscopy. What instruction should the nurse provide the client in preparation for this diagnostic procedure? 1 Have an enema the morning of the test. 2 A chalklike substance will have to be swallowed. 3 Withhold food for 24 hours before the test. 4 A sterile container will be provided for the collection of a stool specimen

1-

What should a nurse teach a nonbreastfeeding mother to help relieve the discomfort of engorgement? 1 Empty the breasts manually once a day. 2 Apply cold packs to the breasts frequently. 3 Ask the practitioner to prescribe a medication for pain. 4 Loosen the brassiere until the breast swelling has subsided.

2

A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client? 1 Acidosis 2 Calcium depletion 3 Potassium retention 4 Sodium chloride depletion

2 -In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms.

What are the symptoms of tuberculosis? Select all that apply. 1 Diarrhea 2 Anorexia 3 Weight gain 4 Hemoptysis 5 Night sweats

2, 4, 5 Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. Signs include a persistent cough, anorexia, hemoptysis, night sweats, shortness of breath, and a high body temperature

A nurse is caring for a client with a diagnosis of varicose veins. Which clinical findings can the nurse expect to identify when assessing this client? Select all that apply. 1 Discolored toenails 2 Reports of leg fatigue 3 Localized heat in a calf 4 Reddened areas on a leg 5 Tortuous veins in the legs 6 Pain in lower extremities when standing

2, 5, 6, Leg fatigue is a common clinical manifestation caused by venous stasis and inadequate tissue oxygenation. Vein walls weaken and dilate resulting in distended, protruding veins that appear tortuous and darkened. As vein walls weaken and dilate, venous pressure increases and the valves become incompetent; venous stasis and inadequate oxygenation result in leg pain.

A recently hospitalized client with multiple sclerosis is concerned about generalized weakness and fluctuating physical status. What is the priority nursing intervention for this client? 1 Encourage bed rest. 2 Space activities throughout the day. 3 Teach the limitations imposed by the disease. 4 Have one of the client's relatives stay at the bedside.

2-Spacing activities will encourage maximum functioning within the limits of strength and fatigue. Bed rest and limited activity may lead to muscle atrophy and calcium depletion. Strengths, rather than limitations, should be stressed.

During a routine clinic visit of a client who has myasthenia gravis, the nurse reinforces previous teaching about the disease and self-care. The nurse evaluates that the teaching is effective when the client states which information? 1 Plan activities for later in the day. 2 Eat meals in a semirecumbent position. 3 Avoid people with respiratory infections. 4 Take muscle relaxants when under stress.

3 -Respiratory infections place people with myasthenia gravis at high risk because they do not cough effectively and may develop pneumonia or airway obstruction. Activity should be conducted earlier in the day before the energy reserve is depleted; periods of activity should be alternated with periods of rest. The client should eat sitting in a chair to prevent aspiration

The nurse shares with a client that, "I got depressed too when I was diagnosed with cancer several years ago." What does the nurse hope to achieve when engaging in a brief self-disclosure of personal information during a therapeutic conversation with a depressed client? 1 To assure the client that the nurse also is willing to share information 2 To help establish a trusting bond between the nurse and the client 3 To show the client that such feelings are experienced by others 4 To establish that one can recover from depression

3 -To show the client that such feelings are experienced by others

The nurse is caring for a client with hypothyroidism. Which instruction is most important to provide to the client to help in managing their condition? 1 "Take medication on time" 2 "Perform regular exercises" 3 "Dress warmly in cold weather" 4 "Take more proteins in your diet"

3- Thyroxin levels decrease during cold temperatures, thus hypothyroidism causes the client to become very sensitive to cold. Clients are advised to dress warmly in cold weather to prevent worsening the situation

A 5-month-old child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. Prevention of what behavior is a priority for the nurse after the surgery? 1 Crying 2 Coughing 3 Straining at stool

3- Forceful evacuation involves taking a deep breath, holding it, and straining (Valsalva maneuver). This increases intrathoracic pressure, which puts excessive strain on the heart sutures.

Which sexually transmitted disease is caused by a virus? 1 Syphilis 2 Gonorrhea 3 Genital warts 4 Chlamydial infection

3- Genital warts are caused by a sexually transmitted virus. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

A client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN). What would be appropriate for the nurse to include in the client's discharge teaching? 1 Learning how to change the percutaneous catheter 2 Determining which days to self-administer the PPN solution 3 Arranging for professional help to monitor the alternative nutrition 4 Scheduling administration of the PPN solution around mealtimes

3- Professional assistance will ensure correct administration, which may limit complications such as intravascular overload and sepsis; eventually, the client may self-administer the PPN with supervision. Learning how to change the percutaneous catheter usually is done by an appropriate health care provider. PPN usually is administered every day. The PPN solution usually is administered as an intermittent infusion while the client is sleeping at night, not at mealtimes; this allows for independent movement during the day.

A psychiatric nurse understands that a situational crisis usually resolves within what timeframe? 1 1 to 4 days 2 2 to 3 weeks 3 1 to 2 months 4 2 to 6 months

A situational crisis is a sudden, unexpected event with which the individual is unable to cope using past coping behaviors; 1 to 2 months provides an opportunity for the individual to learn new coping behaviors.

What is an example of a type I hypersensitivity reaction? A. Anaphylaxis B. Serum Sickness C. Contact Dermatitis D. Blood transfusion reaction

C. Contact Dermatitis An example of a type I hypersensitivity reaction is anaphylaxis. Serum sickness is a type III immune complex reaction. Contact dermatitis is a type IV delayed hypersensitivity reaction. A blood transfusion reaction is a type II cytotoxic reaction.

Clients with which tag are referred to as "walking wounded" clients while managing a disaster? 1 Red 2 Black 3 Green 4 Yellow

Clients who sustained minor injuries during a disaster and can evacuate themselves are referred to as walking wounded clients and they are green-tagged. Red tags are given to clients who have immediate threats to the life and should be treated immediately. Black tags are given the clients who are not expected to live or are dead. Yellow tags are given to clients who sustained major injuries and need treatment within 30 minutes to 2 hours.

Inhalation Anthrax Clinical Manifestations A. Fever B. Fatigue C. Rhinitis D. Dry Cough E. Sore throat

Fever Fatigue Dry Cough Mild chest pain

nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? Select all that apply. 1 Mosquito bites 2 Sharing syringe needles 3 Breastfeeding a newborn 4 Dry kissing the infected partner 5 Anal intercourse

Fluids such as blood and semen are highly concentrated with human immunodeficiency virus (HIV). HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or dry kissing.

Which autoimmune disease is directly related to the client's central nervous system? A. Rheumatic Fever B. MS C. Myasthenia Gravis D. Good pasture syndrome

Multiple Sclerosis

Two days after a myocardial infarction, a client has a temperature of 100.2° F (37.9° C). What should the nurse do first? Incorrect1 Auscultate the chest for diminished breath sounds. 2 Encourage coughing and deep breathing every hour. Correct3 Record the temperature reading and continue to monitor it. 4 Suspect an infection and notify the healthcare provider immediately.

Myocardial necrosis causes a rise in body temperature within the first 24 hours after a myocardial infarction. This increase in temperature gradually returns to the usual range for an adult after several days. A temperature of 100.2° F (37.9° C) is an expected response to myocardial necrosis, not a respiratory infection

Which type of immunity is acquired through the transfer of colostrum from the mother to the child? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.

A client receives a prescription for morphine via patient-controlled analgesia (PCA). Before beginning administration of this medication, what should the nurse assess first? 1 Temperature 2 Blood pressure 3 Respirations 4 Urinary output

Respirations

The nurse is providing discharge teaching to the parents of a 3-day-old infant. The mother expresses concern regarding sudden infant death syndrome (SIDS). To reduce the risk of SIDS during sleep, how does the nurse instruct the parents to position the infant? 1 Prone 2 Supine 3 Side-lying 4 Next to an adult in bed for closer monitoring

Supine - 2 - provides for maximal air movement

What type of hypersensitivity reaction is the cause of systemic lupus erythematosus? 1 Type I 2 Type II 3 Type III 4 Type IV

Systemic lupus erythematosus is an example of an immune complex-mediated, or type III, hypersensitive reaction. Anaphylaxis is an example of a type I or immediate hypersensitive reaction. Cytotoxic or type II hypersensitive reactions can result in conditions such as myasthenia gravis and Goodpasture syndrome. Graft rejection and sarcoidosis are conditions that are caused by delayed or type IV hypersensitivity reactions.

A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my child hurts himself or herself, I'll give 2 children's ibuprofen. Is that right?" How will the nurse respond? 1 "That's right. Ibuprofen will ease the pain." 2 "Give your child acetaminophen. Ibuprofen may cause bleeding." 3 "No. I'll explain why your child isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."

The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

the nurse is caring for a client with a respiratory tract infection that started with a common cold but has progressed to whooping cough. The client also has coughing fits that last for several minutes. Which organism is responsible for the client's condition? 1 Bacillus anthracis 2 Bordetella pertussis 3 Streptococcus pneumoniae 4 Mycobacterium tuberculosis

This disease is caused by Bordetella pertusis. Pertussis is a respiratory tract infection that begins with the common cold and progresses to whooping cough. The client also develops coughing fits that last for several minutes.

A client is admitted with a sudden onset of dyspnea and chest pain. What are the interventions in the order in which the nurse will perform them to provide comfort to the client? 1. Elevating the head of the bed 2. Monitoring and assessing for other changes 3. Notifying the Rapid Response Team 4. Reassuring the client and family members 5. Preparing for oxygen therapy and blood gas analysis

the nurse should immediately notify the Rapid Response Team on a priority basis. Reassuring the client and the family members helps to stabilize the client. Then the nurse should elevate the head of the bed to help the client breathe easier. To prevent the severity of dyspnea, the client should be prepared for oxygen therapy and blood gas analysis. This should be followed by monitoring and assessing for other changes in the client.