PN 140 FINAL EXAM NCLEX PRACTICE
QUESTIONS WITH COMPLETE
ANSWERS
A eenurse eeis eecaring eefor eea eeclient eewith eesystemic eelupus eeerythematosus ee(SLE).
eeThe eeclient eebegins eeto eecry eeand eetells eethe eenurse eethat eeshe eeis eeafraid eethat
eeher eeskin eewill eebe eedisfigured eewith eelesions. eeWhich eeintervention eedoes eethe
eenurse eeplan eeto eeteach eethis eeclient eeto eeminimize eeskin eeinfections eeassociated
eewith eeSLE? ee
Select eeall eethat eeapply.
A) eeUse eesunscreen eewith eean eeSPF eeof ee15 eeor eegreater.
B) eeRemain eeindoors eeon eesunny eedays.
C) eeAvoid eeswimming eein eea eepool eeor eethe eeocean.
D) eeAvoid eesun eeexposure eebetween ee10:00 eea.m. eeand ee3:00 eep.m.
E) eeDecrease eesun eeexposure eebetween ee3:00 eep.m. eeand ee5:00 eep.m. ee- eeAnswer
eeAnswer: eeA, eeD
The eenurse eeteaches eethe eeclient eeto eelive eea eenormal eelife eewith eea eefew eeextra
eeprecautions. eeThere eeis eea eerelationship eebetween eesun eeexposure eeand eeinfection,
eeso eethe eeclient eeis eetaught eeto eeuse eesunscreen eewith eean eeSPF eeof eeat eeleast ee15
eeand eeto eeavoid eethe eesun eebetween ee10:00 eea.m. eeand ee3:00 eep.m. eeThe eeclient
eemay eeswim eebut eeshould eereapply eesunscreen eeafter eeswimming. eeThe eeclient
eedoes eenot eeneed eeto eestay eeindoors eeon eesunny eedays eeor eeto eedecrease eesun
eeexposure eebetween ee3:00 eep.m. eeand ee5:00 eep.m.
A eepatient eeon eea eemedical eeunit eehas eea eepotassium eelevel eeof ee6.8 eemEq/L. eeWhat
eeis eethe eepriority eeaction eethat eethe eenurse eeshould eetake?
a. eePlace eethe eepatient eeon eea eecardiac eemonitor.
b. eeCheck eethe eepatient's eeBP.
c. eeInstruct eethe eepatient eeto eeavoid eehigh-potassium eefoods. ee
d. eeCall eethe eelab eeand eerequest eea eeredraw eeof eethe eelab eeto eeverify eeresults. ee-
eeAnswer eea. eeDysrhythmias eemay eeoccur eewith eean eeelevated eepotassium eelevel
eeand eeare eepotentially eelethal. eeMonitor eethe eerhythm eewhile eecontacting eephysician
eeor eecalling eethe eerapid eeresponse eeteam.
,A eepatient eeis eeadmitted eeto eethe eehospital eewith eeCKD. eeYou eeunderstand eethat
eethis eecondition eeis eecharacterized eeby
A. eeProgressive eeirreversible eedestruction eeof eethe eekidneys
B. eeA eerapid eedecrease eein eeurinary eeoutput eewith eean eeelevated eeBUN eelevel
C. eeIncreasing eecreatinine eeclearance eewith eea eedecrease eein eeurinary eeoutput
D. eeProstration, eesomnolence, eeand eeconfusion eewith eecoma eeand eeimminent eedeath
ee- eeAnswer eeA. eeProgressive eeirreversible eedestruction eeof eethe eekidneys
CKD eeinvolves eeprogressive, eeirreversible eeloss eeof eekidney eefunction.
Measures eeindicated eein eethe eeconservative eetherapy eeof eeCKD eeinclude
A. eedecreased eefluid eeintake, eecarbohydrate eeintake, eeand eeprotein eeintake.
B. eeincreased eefluid eeintake; eedecreased eecarbohydrate eeintake eeand eeprotein
eeintake.
C. eedecreased eefluid eeintake eeand eeprotein eeintake; eeincreased eecarbohydrate
eeintake.
D. eedecreased eefluid eeintake eeand eecarbohydrate eeintake; eeincreased eeprotein
eeintake. ee- eeAnswer eeC. eedecreased eefluid eeintake eeand eeprotein eeintake; eeincreased
eecarbohydrate eeintake.
Water eeand eeany eeother eefluids eeare eenot eeroutinely eerestricted eein eethe eepre-end-
stage eerenal eedisease ee(ESRD) eestages. eePatients eeon eehemodialysis eehave eea
eemore eerestricted eediet eethan eepatients eereceiving eeperitoneal eedialysis. eeFor eethose
eereceiving eehemodialysis, eeas eetheir eeurinary eeoutput eediminishes, eefluid eerestrictions
eeare eeenhanced. eeIntake eedepends eeon eethe eedaily eeurine eeoutput. eeGenerally, ee600
eemL ee(from eeinsensible eeloss) eeplus eean eeamount eeequal eeto eethe eeprevious eeday's
eeurine eeoutput eeis eeallowed eefor eea eepatient eereceiving eehemodialysis. eePatients eeare
eeadvised eeto eelimit eefluid eeintake eeso eethat eeweight eegains eeare eeno eemore eethan ee1
eeto ee3 eekg eebetween eedialyses ee(interdialytic eeweight eegain). eeFor eethe eepatient
eewho eeis eeundergoing eedialysis, eeprotein eeis eenot eeroutinely eerestricted. eeThe
eebeneficial eerole eeof eeprotein eerestriction eein eeCKD eestages ee1 eethrough ee4 eeas eea
eemeans eeto eereduce eethe eedecline eein eekidney eefunction eeis eebeing eestudied.
eeHistorically, eedietary eecounseling eeoften eeencouraged eerestriction eeof eeprotein eefor
eeCKD eepatients. eeAlthough eethere eeis eesome eeevidence eethat eeprotein eerestriction
eehas eebenefits, eemany eepatients eefind eethese eediets eedifficult eeto eeadhere eeto. eeFor
eeCKD eestages ee1 eethrough ee4, eemany eeclinicians eeencourage eea eediet eewith
eenormal eeprotein eeintake. eeHowever, eeyou eeshould eeteach eepatients eeto eeavoid
eehigh-protein eediets eeand eesupplements eebecause eethey eemay eeoverstress eethe
eediseased eekidneys.
Nurses eeneed eeto eeeducate eepatients eeat eerisk eefor eeCKD. eeWhich eeindividuals eeare
eeconsidered eeto eebe eeat eeincreased eerisk ee(select eeall eethat eeapply)?
,A. eeOlder eeAfrican eeAmericans
B. eeIndividuals eeolder eethan ee60 eeyears
C. eeThose eewith eea eehistory eeof eepancreatitis
D. eeThose eewith eea eehistory eeof eehypertension
E. eeThose eewith eea eehistory eeof eetype ee2 eediabetes ee- eeAnswer eeA. eeOlder eeAfrican
eeAmericans
B. eeIndividuals eeolder eethan ee60 eeyears
D. eeThose eewith eea eehistory eeof eehypertension
E. eeThose eewith eea eehistory eeof eetype ee2 eediabetes
Risk eefactors eefor eeCKD eeinclude eediabetes eemellitus, eehypertension, eeage eeolder
eethan ee60 eeyears, eecardiovascular eedisease, eefamily eehistory eeof eeCKD, eeexposure
eeto eenephrotoxic eedrugs, eeand eeethnic eeminorities ee(e.g., eeAfrican eeAmerican,
eeNative eeAmerican).
Which eestatement eeregarding eecontinuous eeambulatory eeperitoneal eedialysis ee(CAPD)
eeis eeof eehighest eepriority eewhen eeteaching eea eepatient eenew eeto eethis eeprocedure?
A. ee"It eeis eeessential eethat eeyou eemaintain eeaseptic eetechnique eeto eeprevent
eeperitonitis."
B. ee"You eewill eebe eeallowed eea eemore eeliberal eeprotein eediet eeafter eeyou eecomplete
eeCAPD."
C. ee"It eeis eeimportant eefor eeyou eeto eemaintain eea eedaily eewritten eerecord eeof eeblood
eepressure eeand eeweight."
D. ee"You eemust eecontinue eeregular eemedical eeand eenursing eefollow-up eevisits eewhile
eeperforming eeCAPD." ee- eeAnswer eeA. ee"It eeis eeessential eethat eeyou eemaintain
eeaseptic eetechnique eeto eeprevent eeperitonitis."
Peritonitis eeis eea eepotentially eefatal eecomplication eeof eeperitoneal eedialysis, eeand eeit
eeis eeimperative eeto eeteach eethe eepatient eemethods eeto eeprevent eeit eefrom eeoccurring.
eeAlthough eethe eeother eeteaching eestatements eeare eeaccurate, eethey eedo eenot
eeaddress eethe eepotential eefor eemortality eeby eeperitonitis, eemaking eethat eenursing
eeaction eethe eehighest eepriority.
How eeshould eeyou eeassess eethe eepatency eeof eea eenewly eeplaced eearteriovenous
eegraft eefor eedialysis?
A. eeIrrigate eethe eegraft eedaily eewith eelow-dose eeheparin.
B. eeMonitor eefor eeany eeincrease eein eeblood eepressure eein eethe eeaffected eearm.
C. eeListen eewith eea eestethoscope eeover eethe eegraft eefor eepresence eeof eea eebruit.
D. eeFrequently eemonitor eethe eepulses eeand eeneurovascular eestatus eedistal eeto eethe
eegraft. ee- eeAnswer eeC. eeListen eewith eea eestethoscope eeover eethe eegraft eefor
eepresence eeof eea eebruit.
, A eethrill eecan eebe eefelt eeby eepalpating eethe eearea eeof eeanastomosis eeof eethe
eearteriovenous eegraft, eeand eea eebruit eecan eebe eeheard eewith eea eestethoscope. eeThe
eebruit eeand eethrill eeare eecreated eeby eearterial eeblood eerushing eeinto eethe eevein.
What eeare eethe eemain eeadvantages eeof eeperitoneal eedialysis eecompared eeto
eehemodialysis?
A. eeNo eemedications eeare eerequired eebecause eeof eethe eeenhanced eeefficiency eeof
eethe eeperitoneal eemembrane eein eeremoving eetoxins.
B. eeThe eediet eeis eeless eerestricted eeand eedialysis eecan eebe eeperformed eeat eehome.
C. eeThe eedialysate eeis eebiocompatible eeand eecauses eeno eelong-term eeconsequences.
D. eeHigh eeglucose eeconcentrations eeof eethe eedialysate eecause eea eereduction eein
eeappetite, eepromoting eeweight eeloss. ee- eeAnswer eeB. eeThe eediet eeis eeless eerestricted
eeand eedialysis eecan eebe eeperformed eeat eehome.
Advantages eeof eeperitoneal eedialysis eeinclude eefewer eedietary eerestrictions eeand
eehome eedialysis eeis eepossible.
The eenurse eeteaches eea eeclient eewho eeis eerecovering eefrom eeacute eekidney eedisease
eeto eeavoid eewhich eetype eeof eemedication?
A eeNonsteroidal eeanti-inflammatory eedrugs ee(NSAIDs) ee
B eeAngiotensin-converting eeenzyme ee(ACE) eeinhibitors
C eeOpiates
D eeCalcium eechannel eeblockers eefiltration eerate eeand eeblood eeflow eewithin eethe
eekidney. ee- eeAnswer eeA eeNonsteroidal eeanti-inflammatory eedrugs ee(NSAIDs) ee
NSAIDs eemay eebe eenephrotoxic eeto eea eeclient eewith eeacute eekidney eedisease, eeand
eeshould eebe eeavoided. eeACE eeinhibitors eeare eeused eefor eetreatment eeof
eehypertension eeand eeto eeprotect eethe eekidneys, eeespecially eein eethe eediabetic
eeclient, eefrom eeprogression eeof eekidney eedisease. eeOpiates eemay eebe eeused eeby
eeclients eewith eekidney eedisease eeif eesevere eepain eeis eepresent; eehowever, eeexcretion
eemay eebe eedelayed. eeCalcium eechannel eeblockers eecan eeimprove eethe eeglomerular
A eeclient eewith eeend-stage eekidney eedisease eehas eebeen eeput eeon eefluid
eerestrictions. eeWhich eeassessment eefinding eeindicates eethat eethe eeclient eehas eenot
eeadhered eeto eethis eerestriction?
A eeBlood eepressure eeof ee118/78 eemm eeHg
B eeWeight eeloss eeof ee3 eepounds eeduring eehospitalization
C eeDyspnea eeand eeanxiety eeat eerest ee
QUESTIONS WITH COMPLETE
ANSWERS
A eenurse eeis eecaring eefor eea eeclient eewith eesystemic eelupus eeerythematosus ee(SLE).
eeThe eeclient eebegins eeto eecry eeand eetells eethe eenurse eethat eeshe eeis eeafraid eethat
eeher eeskin eewill eebe eedisfigured eewith eelesions. eeWhich eeintervention eedoes eethe
eenurse eeplan eeto eeteach eethis eeclient eeto eeminimize eeskin eeinfections eeassociated
eewith eeSLE? ee
Select eeall eethat eeapply.
A) eeUse eesunscreen eewith eean eeSPF eeof ee15 eeor eegreater.
B) eeRemain eeindoors eeon eesunny eedays.
C) eeAvoid eeswimming eein eea eepool eeor eethe eeocean.
D) eeAvoid eesun eeexposure eebetween ee10:00 eea.m. eeand ee3:00 eep.m.
E) eeDecrease eesun eeexposure eebetween ee3:00 eep.m. eeand ee5:00 eep.m. ee- eeAnswer
eeAnswer: eeA, eeD
The eenurse eeteaches eethe eeclient eeto eelive eea eenormal eelife eewith eea eefew eeextra
eeprecautions. eeThere eeis eea eerelationship eebetween eesun eeexposure eeand eeinfection,
eeso eethe eeclient eeis eetaught eeto eeuse eesunscreen eewith eean eeSPF eeof eeat eeleast ee15
eeand eeto eeavoid eethe eesun eebetween ee10:00 eea.m. eeand ee3:00 eep.m. eeThe eeclient
eemay eeswim eebut eeshould eereapply eesunscreen eeafter eeswimming. eeThe eeclient
eedoes eenot eeneed eeto eestay eeindoors eeon eesunny eedays eeor eeto eedecrease eesun
eeexposure eebetween ee3:00 eep.m. eeand ee5:00 eep.m.
A eepatient eeon eea eemedical eeunit eehas eea eepotassium eelevel eeof ee6.8 eemEq/L. eeWhat
eeis eethe eepriority eeaction eethat eethe eenurse eeshould eetake?
a. eePlace eethe eepatient eeon eea eecardiac eemonitor.
b. eeCheck eethe eepatient's eeBP.
c. eeInstruct eethe eepatient eeto eeavoid eehigh-potassium eefoods. ee
d. eeCall eethe eelab eeand eerequest eea eeredraw eeof eethe eelab eeto eeverify eeresults. ee-
eeAnswer eea. eeDysrhythmias eemay eeoccur eewith eean eeelevated eepotassium eelevel
eeand eeare eepotentially eelethal. eeMonitor eethe eerhythm eewhile eecontacting eephysician
eeor eecalling eethe eerapid eeresponse eeteam.
,A eepatient eeis eeadmitted eeto eethe eehospital eewith eeCKD. eeYou eeunderstand eethat
eethis eecondition eeis eecharacterized eeby
A. eeProgressive eeirreversible eedestruction eeof eethe eekidneys
B. eeA eerapid eedecrease eein eeurinary eeoutput eewith eean eeelevated eeBUN eelevel
C. eeIncreasing eecreatinine eeclearance eewith eea eedecrease eein eeurinary eeoutput
D. eeProstration, eesomnolence, eeand eeconfusion eewith eecoma eeand eeimminent eedeath
ee- eeAnswer eeA. eeProgressive eeirreversible eedestruction eeof eethe eekidneys
CKD eeinvolves eeprogressive, eeirreversible eeloss eeof eekidney eefunction.
Measures eeindicated eein eethe eeconservative eetherapy eeof eeCKD eeinclude
A. eedecreased eefluid eeintake, eecarbohydrate eeintake, eeand eeprotein eeintake.
B. eeincreased eefluid eeintake; eedecreased eecarbohydrate eeintake eeand eeprotein
eeintake.
C. eedecreased eefluid eeintake eeand eeprotein eeintake; eeincreased eecarbohydrate
eeintake.
D. eedecreased eefluid eeintake eeand eecarbohydrate eeintake; eeincreased eeprotein
eeintake. ee- eeAnswer eeC. eedecreased eefluid eeintake eeand eeprotein eeintake; eeincreased
eecarbohydrate eeintake.
Water eeand eeany eeother eefluids eeare eenot eeroutinely eerestricted eein eethe eepre-end-
stage eerenal eedisease ee(ESRD) eestages. eePatients eeon eehemodialysis eehave eea
eemore eerestricted eediet eethan eepatients eereceiving eeperitoneal eedialysis. eeFor eethose
eereceiving eehemodialysis, eeas eetheir eeurinary eeoutput eediminishes, eefluid eerestrictions
eeare eeenhanced. eeIntake eedepends eeon eethe eedaily eeurine eeoutput. eeGenerally, ee600
eemL ee(from eeinsensible eeloss) eeplus eean eeamount eeequal eeto eethe eeprevious eeday's
eeurine eeoutput eeis eeallowed eefor eea eepatient eereceiving eehemodialysis. eePatients eeare
eeadvised eeto eelimit eefluid eeintake eeso eethat eeweight eegains eeare eeno eemore eethan ee1
eeto ee3 eekg eebetween eedialyses ee(interdialytic eeweight eegain). eeFor eethe eepatient
eewho eeis eeundergoing eedialysis, eeprotein eeis eenot eeroutinely eerestricted. eeThe
eebeneficial eerole eeof eeprotein eerestriction eein eeCKD eestages ee1 eethrough ee4 eeas eea
eemeans eeto eereduce eethe eedecline eein eekidney eefunction eeis eebeing eestudied.
eeHistorically, eedietary eecounseling eeoften eeencouraged eerestriction eeof eeprotein eefor
eeCKD eepatients. eeAlthough eethere eeis eesome eeevidence eethat eeprotein eerestriction
eehas eebenefits, eemany eepatients eefind eethese eediets eedifficult eeto eeadhere eeto. eeFor
eeCKD eestages ee1 eethrough ee4, eemany eeclinicians eeencourage eea eediet eewith
eenormal eeprotein eeintake. eeHowever, eeyou eeshould eeteach eepatients eeto eeavoid
eehigh-protein eediets eeand eesupplements eebecause eethey eemay eeoverstress eethe
eediseased eekidneys.
Nurses eeneed eeto eeeducate eepatients eeat eerisk eefor eeCKD. eeWhich eeindividuals eeare
eeconsidered eeto eebe eeat eeincreased eerisk ee(select eeall eethat eeapply)?
,A. eeOlder eeAfrican eeAmericans
B. eeIndividuals eeolder eethan ee60 eeyears
C. eeThose eewith eea eehistory eeof eepancreatitis
D. eeThose eewith eea eehistory eeof eehypertension
E. eeThose eewith eea eehistory eeof eetype ee2 eediabetes ee- eeAnswer eeA. eeOlder eeAfrican
eeAmericans
B. eeIndividuals eeolder eethan ee60 eeyears
D. eeThose eewith eea eehistory eeof eehypertension
E. eeThose eewith eea eehistory eeof eetype ee2 eediabetes
Risk eefactors eefor eeCKD eeinclude eediabetes eemellitus, eehypertension, eeage eeolder
eethan ee60 eeyears, eecardiovascular eedisease, eefamily eehistory eeof eeCKD, eeexposure
eeto eenephrotoxic eedrugs, eeand eeethnic eeminorities ee(e.g., eeAfrican eeAmerican,
eeNative eeAmerican).
Which eestatement eeregarding eecontinuous eeambulatory eeperitoneal eedialysis ee(CAPD)
eeis eeof eehighest eepriority eewhen eeteaching eea eepatient eenew eeto eethis eeprocedure?
A. ee"It eeis eeessential eethat eeyou eemaintain eeaseptic eetechnique eeto eeprevent
eeperitonitis."
B. ee"You eewill eebe eeallowed eea eemore eeliberal eeprotein eediet eeafter eeyou eecomplete
eeCAPD."
C. ee"It eeis eeimportant eefor eeyou eeto eemaintain eea eedaily eewritten eerecord eeof eeblood
eepressure eeand eeweight."
D. ee"You eemust eecontinue eeregular eemedical eeand eenursing eefollow-up eevisits eewhile
eeperforming eeCAPD." ee- eeAnswer eeA. ee"It eeis eeessential eethat eeyou eemaintain
eeaseptic eetechnique eeto eeprevent eeperitonitis."
Peritonitis eeis eea eepotentially eefatal eecomplication eeof eeperitoneal eedialysis, eeand eeit
eeis eeimperative eeto eeteach eethe eepatient eemethods eeto eeprevent eeit eefrom eeoccurring.
eeAlthough eethe eeother eeteaching eestatements eeare eeaccurate, eethey eedo eenot
eeaddress eethe eepotential eefor eemortality eeby eeperitonitis, eemaking eethat eenursing
eeaction eethe eehighest eepriority.
How eeshould eeyou eeassess eethe eepatency eeof eea eenewly eeplaced eearteriovenous
eegraft eefor eedialysis?
A. eeIrrigate eethe eegraft eedaily eewith eelow-dose eeheparin.
B. eeMonitor eefor eeany eeincrease eein eeblood eepressure eein eethe eeaffected eearm.
C. eeListen eewith eea eestethoscope eeover eethe eegraft eefor eepresence eeof eea eebruit.
D. eeFrequently eemonitor eethe eepulses eeand eeneurovascular eestatus eedistal eeto eethe
eegraft. ee- eeAnswer eeC. eeListen eewith eea eestethoscope eeover eethe eegraft eefor
eepresence eeof eea eebruit.
, A eethrill eecan eebe eefelt eeby eepalpating eethe eearea eeof eeanastomosis eeof eethe
eearteriovenous eegraft, eeand eea eebruit eecan eebe eeheard eewith eea eestethoscope. eeThe
eebruit eeand eethrill eeare eecreated eeby eearterial eeblood eerushing eeinto eethe eevein.
What eeare eethe eemain eeadvantages eeof eeperitoneal eedialysis eecompared eeto
eehemodialysis?
A. eeNo eemedications eeare eerequired eebecause eeof eethe eeenhanced eeefficiency eeof
eethe eeperitoneal eemembrane eein eeremoving eetoxins.
B. eeThe eediet eeis eeless eerestricted eeand eedialysis eecan eebe eeperformed eeat eehome.
C. eeThe eedialysate eeis eebiocompatible eeand eecauses eeno eelong-term eeconsequences.
D. eeHigh eeglucose eeconcentrations eeof eethe eedialysate eecause eea eereduction eein
eeappetite, eepromoting eeweight eeloss. ee- eeAnswer eeB. eeThe eediet eeis eeless eerestricted
eeand eedialysis eecan eebe eeperformed eeat eehome.
Advantages eeof eeperitoneal eedialysis eeinclude eefewer eedietary eerestrictions eeand
eehome eedialysis eeis eepossible.
The eenurse eeteaches eea eeclient eewho eeis eerecovering eefrom eeacute eekidney eedisease
eeto eeavoid eewhich eetype eeof eemedication?
A eeNonsteroidal eeanti-inflammatory eedrugs ee(NSAIDs) ee
B eeAngiotensin-converting eeenzyme ee(ACE) eeinhibitors
C eeOpiates
D eeCalcium eechannel eeblockers eefiltration eerate eeand eeblood eeflow eewithin eethe
eekidney. ee- eeAnswer eeA eeNonsteroidal eeanti-inflammatory eedrugs ee(NSAIDs) ee
NSAIDs eemay eebe eenephrotoxic eeto eea eeclient eewith eeacute eekidney eedisease, eeand
eeshould eebe eeavoided. eeACE eeinhibitors eeare eeused eefor eetreatment eeof
eehypertension eeand eeto eeprotect eethe eekidneys, eeespecially eein eethe eediabetic
eeclient, eefrom eeprogression eeof eekidney eedisease. eeOpiates eemay eebe eeused eeby
eeclients eewith eekidney eedisease eeif eesevere eepain eeis eepresent; eehowever, eeexcretion
eemay eebe eedelayed. eeCalcium eechannel eeblockers eecan eeimprove eethe eeglomerular
A eeclient eewith eeend-stage eekidney eedisease eehas eebeen eeput eeon eefluid
eerestrictions. eeWhich eeassessment eefinding eeindicates eethat eethe eeclient eehas eenot
eeadhered eeto eethis eerestriction?
A eeBlood eepressure eeof ee118/78 eemm eeHg
B eeWeight eeloss eeof ee3 eepounds eeduring eehospitalization
C eeDyspnea eeand eeanxiety eeat eerest ee
