NUR 208 EAQ 1: Health and Maintenance (URI) | Answered with Rationales

NUR 208 EAQ 1: Health and Maintenance (URI) | Answered with Rationales A 26-year-old G1 P0 client at 29 weeks' gestation has gained 8 lb (3.6 kg) in 2 weeks; her blood pressure has increased from 128/74 Hg to 150/90 mm Hg; and she has developed 1+ proteinuria on urine dipstick. Which condition do these signs suggest? 1 Mild preeclampsia 2 Severe preeclampsia 3 Chronic hypertension 4 Gestational hypertension "Preeclampsia is hypertension that develops after 20 weeks' gestation in a previously normotensive woman. With mild preeclampsia the systolic blood pressure is below 160 mm Hg and diastolic BP is below 110 mm Hg. Proteinuria is present, but there is no evidence of organ dysfunction. Severe preeclampsia is a systolic blood pressure of greater than 160 mm Hg or diastolic blood pressure of at least 110 mm Hg and proteinuria of 5 g or more per 24-hour specimen. Chronic hypertension is hypertension that is present before the pregnancy or diagnosed before 20 weeks' gestation. Gestational hypertension is the onset of hypertension during pregnancy without other signs or symptoms of preeclampsia and without preexisting hypertension. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question." Which hormone aids in regulating intestinal calcium and phosphorous absorption? 1 Insulin 2 Thyroxine 3 Glucocorticoids 4 Parathyroid hormone Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity. Which information would the nurse base a response on to a mother who asks for guidance regarding who to tell of the diagnosis of diabetes of her child, who plays on the soccer team? 1 Children with diabetes who participate in active sports can have episodes of hypoglycemia. 2 Children may have to leave athletic teams if school authorities learn that they have diabetes. 3 The school nurse will treat the child if clinical findings of hypoglycemia are recognized early. 4 The coach might violate confidentiality by discussing the child's condition with other faculty members. The people associated with the school who are interacting with the child should be told about the child's condition. Knowledgeable people can be alert for early signs of hypoglycemia and have snacks available for the child to help prevent a hypoglycemic episode. Forcing the child to leave the team is a form of discrimination; children with diabetes are allowed to engage in activities as long as their diabetes remains under control. The adult who is with the child when the signs of hypoglycemia first appear should be prepared to treat the child; this person may or may not be the nurse. Information about the child's health status is on a "need to know" basis; professionals are expected to honor confidentiality. Which domain of the nursing intervention phase includes electrolyte and acid-base management? 1 Domain 1 2 Domain 2 3 Domain 3 4 Domain 4 Domain 2 of the nursing intervention phase includes electrolyte and acid-base management. Domain 2, or the physiological complex, includes care that supports homeostatic regulation. Domain 1 includes care that supports physical functioning. Domain 3 incorporates care that supports psychosocial functioning and facilitates lifestyle changes. Domain 4 involves care that supports protection against harm. The nurse is preparing to teach a community health program for senior citizens. Which physical findings would the nurse include that are typical in older adults? 1 Increased skin elasticity and an increase in testosterone production 2 Impaired fat digestion and an increase in pepsin production 3 Increased blood pressure and decreased cardiac output 4 An increase in body warmth and some swallowing difficulties With aging, narrowing of the arteries causes some increase in the systolic and diastolic blood pressures. Decreases occur in diastolic pressure, diastolic filling, and beta-adrenergic stimulation; increases occur in arterial pressure, systolic pressure, wave velocity, and left ventricular end diastolic pressure. Decreased cardiac output and cardiac reserve decrease the older adult's response to stress. Changes in libido may occur. Testosterone appears to influence the frequency of nocturnal erections; however, low testosterone levels do not affect erections produced by erotic stimuli. There is a loss of skin elasticity. By the age of 60, gastric secretions decrease 70% to 80% of those of the average adult. A decrease in pepsin may hinder protein digestion. There may be a decrease in subcutaneous fat and decreasing body warmth. Some swallowing difficulties occur because older people are susceptible to fluid loss and electrolyte imbalance. This results from decreased thirst sensation, difficulty swallowing, chronic disease, reduced kidney function, diminished cognition, or adverse medication reactions. Which cognitive developmental stage would the nurse expect for a 3-year-old child? 1 Intuitive 2 Abstract 3 Concrete 4 Preconceptual According to Piaget, at approximately 2 years of age the toddler enters the preconceptual phase of cognitive thought, which lasts, at most, until about 4 years of age; the preconceptual phase is a subdivision of the preoperational stage, which lasts from 2 years to 7 years of age. Four-year-old children are in the stage of intuitive thought, which gives rise to imaginative play. Abstract thought is developed during the adolescent ages of 15 to 20 years. Concrete operational thought occurs in school-age children when they perform actions mentally rather than through behavior, as in the earlier years. On a routine prenatal visit, which is the sign or symptom that a healthy primigravida at 20 weeks' gestation will most likely report for the first time? 1 Quickening 2 Palpitations 3 Pedal edema 4 Vaginal spotting The recognition of fetal movement or quickening commonly occurs in primigravidas at 18 to 20 weeks' gestation; it is felt about 2 weeks earlier in multigravidas. Palpitations should not occur in the healthy primigravidas. Pedal edema may occur at the end of the pregnancy as the gravid uterus presses on the femoral arteries, impeding circulation. Immediate follow-up care is required when it occurs this early in the pregnancy. Vaginal spotting is abnormal and requires immediate follow-up care. Which is the most important nursing intervention when working with an older adult client? 1 Encouraging frequent naps 2 Strengthening the concept of ageism 3 Reinforcing the client's strengths and promoting reminiscing 4 Teaching the client to increase calories and focusing on a high-carbohydrate diet Reinforcing strengths promotes self-esteem; reminiscing is a therapeutic tool that provides a life review that assists adaptation and helps achieve the task of integrity associated with older adulthood. Frequent naps may interfere with adequate sleep at night. Reinforcing ageism may enhance devaluation of the older adult. A well-balanced diet that includes protein and fiber should be encouraged; increasing calories may cause obesity. The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, which is the best recommendation? 1 "Join a gym." 2 "Drink fewer diet sodas." 3 "Decrease fast-food intake." 4 "Take a multivitamin daily." Which statement is true for collaborative problems in a client? 1 They are the identification of a disease condition. 2 They include problems treated primarily by nurses. 3 They are identified by the primary health care provider. 4 They are identified by the nurse during the nursing diagnosis stage. They are identified by the nurse during the nursing diagnosis stage. The nurse assesses the client to gather information for reaching diagnostic conclusions. Collaborative problems are identified by the nurse during this process. If the client's health problem requires treatment by other disciplines, such as medical or physical therapy, the client has a collaborative problem. A medical diagnosis is the identification of a disease condition. Problems that require treatment by the nurse are referred to as nursing diagnoses. A medical diagnosis is identified by the primary health care provider based on the results of diagnostic tests. Which point is included in the World Professional Association for Transgender Health (WPATH) document regarding core principles of care for transgender clients? Seeking informed consent before providing treatment What is the nurse's first action when developing a teaching plan for self-administration of insulin to a school-aged child? 1 Assessing the child's developmental level 2 Determining the family's understanding of the procedure 3 Discussing community resources for the child in the future 4 Collaborating with the school nurse to ensure continuity of care in school Which synovial joint movement is described as turning the sole away from the midline of the body? 1 Pronation 2 Eversion 3 Adduction 4 Supination The nurse observes that an 18-month-old toddler is crawling up stairs but needs assistance when climbing the stairs upright. Which would this indicate to the nurse? 1 Presence of talipes equinovarus 2 Presence of neurological damage 3 Expected behavior in a toddler of this age 4 Existence of developmental dysplasia of the hip It is not until 2 years of age that toddlers are able to use their feet to walk up stairs instead of crawling. Talipes equinovarus is identified with the use of other criteria. At 18 months of age the inability of the toddler to use the feet to go up stairs is not a problem; it is expected and does not indicate neurological damage. Developmental dysplasia of the hip is identified with the use of other criteria. The nurse is differentiating between cephalhematoma and caput succedaneum. Which finding is unique to caput succedaneum? 1 Edema that crosses the suture line 2 Scalp tenderness over the affected area 3 Edema that increases during the first day 4 Scalp over the area becomes ecchymosed Which intervention would the nurse do before formulating a teaching plan for a child who is to undergo ostomy surgery? 1 Assess the child's developmental level. 2 Determine the family's comprehension of the procedure. 3 Provide a list of available community resources to the family. 4 Collaborate with the school in ensuring the child's smooth return Teaching methods in each age group vary with the child's cognitive ability; individual differences depend on a variety of factors, including both intelligence and emotional status. Also, the child's readiness to learn must be assessed before a teaching plan that will support success can be developed. Although determining the comprehension of the treatment by family members is important, it does not focus on the learning needs of the child, which is the priority. Providing a list of community resources will be important later, but not initially. Working with the school's staff will be important later, but not initially. Which nursing action is most accurate when assessing the chest circumference of a newborn? 1 Measuring during expiration only 2 Taking 3 measurements and recording the average 3 Measuring during inspiration and plotting this data on the growth chart 4 Placing the measuring tape around the rib cage at the nipple line During the assessment of a client in labor, the cervix is determined to be dilated 4 cm. Which stage of labor would the nurse record? 1 First 2 Second 3 Prodromal 4 Transitional The first stage of labor is from zero cervical dilation to full cervical dilation (10 cm). The second stage is from full cervical dilation to delivery. The prodromal stage is before cervical dilation begins. The transitional phase is the first stage of labor, from 8 cm of dilation to 10 cm of dilation. The first stage of labor is from zero cervical dilation to full cervical dilation (10 cm). The second stage is from full cervical dilation to delivery. The prodromal stage is before cervical dilation begins. The transitional phase is the first stage of labor, from 8 cm of dilation to 10 cm of dilation. Which activity by the community nurse is an illness prevention strategy? 1 Encouraging the client to exercise daily 2 Arranging an immunization program for chickenpox 3 Teaching the community about stress management 4 Teaching the client about maintaining a nutritious diet An illness prevention program protects people from actual or potential threats to health. A chickenpox immunization program is an illness prevention program. It motivates the community to prevent a decline in health or functional levels. A health promotion program encourages the client to maintain his or her present levels of health. The nurse promotes the health of the client by encouraging the client to exercise daily. Wellness education teaches people how to care for themselves in a healthy manner. The nurse provides wellness education by teaching about stress management. The nurse promotes the health of the client by teaching the client to maintain a nutritious diet. The nurse is helping a client maintain and regain health, manage his or her disease and symptoms, and attain a maximal level of function and independence through the healing process. Which role is the nurse playing? 1 Manager 2 Advocate 3 Caregiver 4 Communicator As a caregiver, the nurse helps clients maintain and regain health, manage diseases and symptoms, and attain a maximal level of function and independence through the healing process. As a manager, the nurse coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency. As a client's advocate, the nurse protects the client's human and legal rights and provides assistance in asserting these rights if the need arises. As a communicator, the nurse learns about a client's strengths and weaknesses and his or her needs through effective communication. Which identified clinical manifestation is a sign of allergic rhinitis? 1 Presence of high-grade fever 2 Reduced breathing through the mouth 3 Presence of pinkish nasal discharge 4 Reduced transillumination on the skin over the sinuses Reduced transillumination on the skin overlying the sinuses indicates allergic rhinitis. This effect is caused by the sinuses becoming inflamed and blocked with thick mucoid secretions. Generally, fever does not accompany allergic rhinitis unless the client develops a secondary infection. In allergic rhinitis, the client is unable to breathe through the nose because it gets stuffy and blocked. Instead, the client will resort to mouth breathing. Clients with allergic rhinitis will have clear or white nasal discharge. According to Piaget's theory of cognitive development, which milestone would the nurse expect a 6-month-old infant to demonstrate? 1 Early traces of memory 2 Beginning sense of time 3 Repetitious reflex responses 4 Beginning of object permanence The concept of object permanence begins to develop around 6 months of age. Early traces of memory and beginning sense of time occur at between 13 and 24 months. Repetitious reflex responses occur during the first several months of life. These diminish as the newborn grows. Which is the primary focus of nursing care in the "family as context" approach? 1 The relationship among family members 2 The health and development of an individual 3 The ability of the family to meet its basic needs 4 The family's process of caregiving for a sick member The nurse at the well-baby clinic is assessing the gross motor skills of a 5-month-old infant. Which finding is a cause for concern? 1 The baby has a head lag when pulled to sit. 2 The baby can turn from the side to the back. 3 The baby can turn from the abdomen to the back. 4 The baby supports much of her or his own weight when she or he is pulled to stand Which of these statements about pregnancy in the adolescent population are true? Select all that apply. One, some, or all responses may be correct. 1 Pregnant adolescents often seek out less prenatal care. 2 Infants of teen mothers are at risk of delivering babies late. 3 Adolescent mothers need competent daycare for their infants. 4 Infants of adolescent mothers are at increased risk for prematurity. 5 Fetuses of adolescent mothers are at higher risk for chromosomal defects Which range of heart rate is acceptable for a preschooler? 1 60 to 100 2 80 to 110 3 75 to 100 4 90 to 140 Under which type of health care services would the student nurse include sports medicine? 1 Primary care 2 Tertiary care 3 Preventive care 4 Restorative care Which is a primary focus of teaching for a pregnant adolescent at her first prenatal clinic visit? 1 Instructing her about the care of an infant 2 Informing her of the benefits of breast-feeding 3 Advising her to watch for danger signs of preeclampsia 4 Encouraging her to continue regularly scheduled prenatal care It is not uncommon for adolescents to avoid prenatal care; many do not recognize the deleterious effect that lack of prenatal care can have on them and their infants. Instruction in the care of an infant can be done in the later part of pregnancy and reinforced during the postpartum period. Informing the client of the benefits of breast-feeding should come later in pregnancy but not before the client's feelings about breast-feeding have been ascertained. Advising the client to watch for danger signs of preeclampsia is necessary, but it is not the priority intervention at this time. Which substance is released in response to low serum levels of calcium? 1 Renin 2 Erythropoietin 3 Parathyroid hormone 4 Atrial natriuretic peptide Which is the recommended protein intake for preschoolers? 1 1 g/day 2 13 g/day 3 300 mg/day 4 700 mg/day The recommended protein intake for preschoolers is 13 to 19 g/day. The recommended protein intake for preschoolers is not 1 g/day. The recommended cholesterol consumption for children over the age of 2 years should be less than 300 mg/day, whereas the recommended daily allowance for calcium for children 1 to 3 years old is 700 mg. Which is the average annual increase in the height of preschoolers? 1 2 inches (5 cm) 2 2 to 8 inches (5-20 cm) 3 4 to 8 inches (10-30 cm) 4 2.5 to 3 inches (6.2-7.5 cm) The average increase in the height of preschoolers per year is 2.5 to 3 inches (6.2-7.5 cm). The average increase in the height of school-aged children per year is 2 inches (5 cm). The average increase in the height of adolescent girls is 2 to 8 inches (5-20 cm). The average increase in the height of adolescent boys is 4 to 8 inches (10-30 cm). A child watches an older sibling playing with a ball but makes no effort to participate in the play. Which social character is the child exhibiting? 1 Parallel play 2 Pretend play 3 Onlooker play 4 Associative play In onlooker play a child actively observes other children playing and does not attempt to enter into the activity; the child is interested only in observation and not in participation. In parallel play children play independently among other children. In pretend play children act out any event of daily life and practice the roles and identities as established in their surroundings. In associative play children play together and are engaged in a similar or identical activity. Which method would the nurse use to best elicit the Moro reflex in a full-term newborn? 1 Touching the infant's cheek 2 Striking the surface of the infant's crib suddenly 3 Allowing the infant's feet to touch the surface of the crib 4 Stroking the sole of the foot along the outer edge from the heel to the toe Jarring the crib produces a startle response (Moro reflex); the legs and arms extend, and the fingers fan out, while the thumb and forefinger form a C. When the cheek is touched, the head turns toward the side that was touched; this is the rooting reflex. When the feet touch the crib surface the stepping reflex is elicited; one foot is placed before the other in a simulated walk with the weight on the toes. When the bottom of the foot is stroked along the outer edge of the sole from the heel to the toe, the toes flare out. This is the Babinski reflex, which is expected because of the newborn's immature nervous system. In an adult, this reflex is a sign of neurological damage. Which domain of the Nursing Interventions Classification (NIC) taxonomy includes care that supports homeostatic regulation? 1 Domain 1 2 Domain 2 3 Domain 3 4 Domain 4 Domain 2 of the NIC taxonomy includes care that supports homeostatic regulation. Domain 1 includes care that supports physical functioning. Domain 3 includes care that supports psychosocial functioning and facilitates life style changes. Domain 4 includes care that supports protection against harm. Which clinical finding is associated with high-dose lead exposure? 1 Blindness 2 Hyperactivity 3 Hearing impairment 4 Mild intellectual deficit Blindness could indicate that the client is suffering from encephalopathy as a result of high-dose exposure to lead. Hyperactivity, hearing impairment, and mild intellectual deficit are clinical signs of low-dose exposure to lead. Which is the best way for a school nurse to determine a young child's readiness to learn? 1 By assessing the child's vision and hearing 2 By making a referral for psychological and intelligence testing 3 By ensuring that the teacher has an understanding of the child's needs 4 By confirming that the parents understand the importance of homework Vision and hearing are vital to the child's ability to learn because they provide pathways for stimuli to reach and be interpreted by the brain. Neither psychological nor intelligence testing is necessary for all children. Although important in the learning process, ensuring that the teacher understands the child's needs and confirming that the parents understand the importance of homework are not related to a child's readiness to learn. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts. Which is a common attribute that the nurse assesses in an "easy" child? 1 Passive resistance 2 Predictable habits 3 Intense mood expressions 4 Slow adaptation to change The nurse anticipates that the "easy" child will have predictable habits. Passive resistance is a trait assessed in the "slow to warm up" child. Intense mood expressions and slow adaptation to change are characteristics of the "difficult" child. Which is a characteristic of the glands that secrete a thick substance in response to emotional stimulation and become odoriferous because of bacterial action? 1 Highly active in childhood 2 Absent around the umbilicus 3 Widely distributed throughout the body 4 Grow in conjunction with axillary hair follicles The apocrine sweat glands secrete a thick substance in response to emotional stimulation and become odoriferous because of bacterial action. These glands grow in conjunction with hair follicles around the axillae. The apocrine glands are inactive during childhood and reach their secretory potential at the time of puberty. The apocrine glands are situated around the umbilicus. They have limited distribution and are found only around the axillae, areolae, external auditory canal, and anal and genital regions. Eccrine sweat glands, not the apocrine glands, have wide distribution throughout the body. An 80-year-old client is admitted to the hospital with severe dehydration. The client's daughter asks the nurse how her mother could have become dehydrated. Which response by the nurse is correct? 1 "The body's fluid needs decrease with age because of tissue changes." 2 "Access to fluid may be insufficient to meet the daily needs of the older adult." 3 "Memory declines with age, and the older adult may forget to ingest adequate amounts of fluid." 4 "The thirst reflex diminishes with age, and the recognition of the need for fluid is decreased." For reasons that are still unclear, the thirst reflex diminishes with age, and this may lead to a concomitant decline in fluid intake. There are no data to support the statement "The body's fluid needs decrease with age because of tissue changes." The statement "Access to fluid may be insufficient to meet the daily needs of the older adult" is not true for an alert person who is able to perform the activities of daily living. Research does not support progressive memory loss in normal aging as a contributor to decreased fluid intake. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. The nurse is educating parents about the changes to expect when their child enters toddlerhood. Which information would the nurse include? 1 The toddler's body appears slender. 2 The toddler has a protruded abdomen. 3 The toddler's feet are severely everted. 4 The toddler has inconspicuous cervical curves. The nurse explains to the parents that at the start of toddlerhood, the abdomen of the child will be protruded. The bodies of toddlers start appearing slender by the age of 3 years, not in the beginning of toddlerhood. As the child walks, the legs and feet are usually far apart, and the feet are slightly everted, not severely everted. Toward the end of toddlerhood, curves in the cervical and lumbar vertebrae are accentuated. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience. Which client statement indicates understanding of teaching about a nonstress test? 1 "I'll need to have an intravenous (IV) line so the medication can be injected before the test." 2 "My baby may get very restless after I have this test." 3 "I hope this test doesn't cause my labor to start too early." 4 "If the heart reacts well, my baby should do OK when I give birth. The nonstress test is used to evaluate the response of the fetus to movement and activity. A reactive test indicates that the fetus is healthy. No injections of any kind are used during a nonstress test; it involves only the use of a fetal monitor to record the fetal heart rate during periods of activity. The nonstress test will not influence the activity of the fetus because no exogenous stimulus is used. Early labor is unlikely because the nonstress test is noninvasive. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. In which settings would the nurse prepare to administer developmental assessment for pediatric clients? Select all that apply. One, some, or all responses may be correct. 1 Home 2 School 3 Hospital 4 Daycare center 5 Assisted living center Which stage of Kohlberg's theory can be seen in an individual seeking to modify a law if it is not fair to a particular group? 1 Social contract orientation 2 Society-maintaining orientation 3 Instrument relativist orientation 4 Universal ethical principle orientation The universal ethical principle orientation stage is associated with a person who wants to modify a law if it does not seem just. According to the social contract orientation stage, a person tends to follow a law even if it is not fair. During the society-maintaining stage, an individual shows concerns for his or her society and makes decisions in accordance to his or her society. During the instrument relativist orientation stage, a child recognizes that there is more than 1 correct view. Test-Taking Tip: After you have eliminated 1 or more choices, you may discover that 2 of the options are very similar. This can be very helpful because it may mean that 1 of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. At which age does the anterior fontanel of the skull close? 1 12 to 18 months 2 20 to 24 months 3 26 to 30 months 4 32 to 36 months The school nurse would teach the students that the ovum is no longer viable at which time interval after ovulation? 1 12 hours 2 24 hours 3 48 hours 4 72 hours The ovum is viable for about 24 hours after ovulation; if not fertilized before this time, it degenerates. For this reason, 12 hours, 48 hours, and 72 hours are all incorrect answers. Which activity can be performed by infants aged 6 to 8 months? 1 Holding a pencil 2 Showing hand preference 3 Placing objects into containers 4 Transferring objects from hand to hand Infants aged 6 to 8 months may be able to transfer objects from hand to hand. Infants aged 10 to 12 months may be able to hold a pencil. Infants aged 8 to 10 months may show a hand preference. Infants aged 10 to 12 months may be able to place objects into a container. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process. Which gross motor skill is found in children between 2 to 4 months of age? 1 The child can creep on its hands and knees. 2 The child has predominant inborn reflexes. 3 The child can sit alone without any kind of support. 4 The child can bear weight on forearms when prone. A child between 2 and 4 months of age is able to bear his or her weight on the forearms when in the prone position. A child between 8 and 10 months of age can creep on his or her hands and knees. A child between birth and 1 month has predominant inborn reflexes. A child between 6 and 8 months of age can sit alone without support. According to Kohlberg's theory, which stage comes before the society-maintaining orientation stage? 1 Social contract orientation 2 Good boy-nice girl orientation