Chapter 14: Clients Having Surgery Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 14: Clients Having Surgery

MULTIPLE CHOICE

1. The nurse explains to a client that because of alterations in liver function caused by cirrhosis, the client is predisposed to postoperative fluid shifts and wound infection related to

a.

elevated creatinine phosphokinase levels.

b.

elevated lactic dehydrogenase levels.

c.

low albumin levels.

d.

low blood urea nitrogen levels.

ANS: C

Low albumin levels predispose the client to fluid shifts, surgical wound infection, and ineffective coagulation.

DIF: Comprehension/Understanding REF: p. 189 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

2. A client who is extremely overweight has been advised to lose weight before surgery. To encourage the client, the nurse knows that the most appropriate statement is

a.

It will decrease the operating room time by half if you lose weight.

b.

Surgery requires more anesthesia if you are overweight.

c.

With the weight loss, you decrease the chance of complications after surgery.

d.

Youll feel better after surgery if you lose the weight before.

ANS: C

An obese client is more susceptible to postoperative pulmonary complications, immobility, wound infection, wound dehiscence, and wound evisceration.

DIF: Application/Applying REF: pp. 190-191 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

3. Preoperative assessment data that should be reported to the surgeon include

a.

complaining of mild anxiety.

b.

having a sore throat.

c.

potassium level within normal range.

d.

using acetaminophen for headaches.

ANS: B

Any pre-existing infection can adversely affect surgical outcome and should be reported preoperatively. Manifestations of infection include coughing, sore throat, and increased temperature. An elective procedure might need to be canceled because of an infection.

DIF: Application/Applying REF: p. 191 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

4. The preoperative assessment finding that the nurse would report to the surgeon for preoperative treatment is

a.

hemoglobin concentration of 13.5 mg/dl.

b.

partial thromboplastin time of 25 seconds.

c.

potassium level of 3.0 mEq/L.

d.

sodium level of 140 mEq/L.

ANS: C

Electrolyte imbalances increase operative risk. Preoperative laboratory results should be checked to see if they are within the normal range. The other three lab values are within normal range.

DIF: Application/Applying REF: p. 191 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

5. During the preoperative interview, the clients statement that would alert the nurse to an increased risk during surgery is I

a.

am a reformed smoker; I havent had a cigarette in 10 years.

b.

rarely eat red meat; it usually makes me feel bloated.

c.

take a couple of aspirin every day for my headaches.

d.

take a large assortment of vitamins daily.

ANS: C

Many clients take aspirin and other over-the-counter (OTC) medications that may increase the risk of bleeding.

DIF: Analysis/Analyzing REF: p. 184 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

6. A client scheduled for a dilation and evacuation following a miscarriage is visibly upset and states that she is frightened and does not know what to expect. The perioperative nurse best demonstrates understanding of the situation by saying

a.

Ill give you something to help you relax.

b.

Let me explain what is going to happen.

c.

This is a simple procedure; it will be over in no time.

d.

Youre still young, and you can have more children.

ANS: B

Fear of the unknown is one of the most prevalent causes of preoperative anxiety. The client should understand what the preoperative, intraoperative, and postoperative course entails.

DIF: Application/Applying REF: p. 193 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Interactions

7. The methodology likely to be most effective in meeting a clients teaching/learning needs preoperatively is

a.

teaching only the client.

b.

teaching the client and family.

c.

using brief verbal instructions.

d.

using only written instructions.

ANS: B

The nurse should determine learning needs preoperatively and teach both the client and the family before surgery if possible. Preferably, the nurse should provide both written and oral instructions. Good teaching techniques will help ensure the client retains the information during this stressful period.

DIF: Application/Applying REF: p. 192 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Principles of Teaching/Learning

8. The nurse explains to a preoperative class of six clients awaiting surgery that studies indicate the primary benefit of the class is to

a.

distribute information to the most individuals in a short time.

b.

explain legal responsibilities.

c.

promote a less complicated postoperative course.

d.

provide uniform information.

ANS: C

Numerous research studies have supported the value of preoperative instruction in reducing both the incidence of postoperative complications and the length of hospital stay.

DIF: Comprehension/Understanding REF: p. 192 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

9. The nurse will plan preoperative teaching about how to cough and deep-breathe for

a.

1 week before the procedure.

b.

immediately postoperatively.

c.

the afternoon before surgery.

d.

the nurses first discussion about the surgery.

ANS: C

The timing of preoperative teaching is highly individualized. Ideally there will be enough time for the nurse to give instructions and answer questions. Often the client is admitted on the day of surgery. It is imperative that the client receives instructions before this time so that the nurse can simply reinforce instructions and answer questions. But if the teaching is done too far in advance, the client will forget the information.

DIF: Application/Applying REF: p. 192 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Principles of Teaching/Learning

10. When teaching the proper method of coughing, the nurse should instruct the client to

a.

breathe in and out through the nose.

b.

deep-breathe after coughing.

c.

relax the abdominal muscles.

d.

splint the incision.

ANS: D

Splinting minimizes pressure and helps to control pain when the person is coughing.

DIF: Application/Applying REF: p. 194 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

11. To lessen the postoperative complication of thrombophlebitis, the nurse would

a.

assist the client to sit up in bed after surgery.

b.

maintain the legs in an elevated position.

c.

massage the clients legs.

d.

remind the client to exercise the legs and feet.

ANS: D

Postoperative extremity exercise helps to prevent circulatory problems (e.g., thrombophlebitis) by facilitating venous return to the heart.

DIF: Application/Applying REF: p. 194 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

12. The most appropriate explanation by the nurse to explain why a client cannot eat before surgery is

a.

Anesthesia works best on an empty stomach.

b.

The stomach should be empty to prevent complications.

c.

There is not enough time before surgery to digest the food.

d.

You will not have to go to the bathroom frequently before surgery.

ANS: B

If a client undergoing surgery is to receive a general anesthetic, foods and fluids are restricted for 8 hours before surgery. This restriction significantly reduces the possibility of aspiration of gastric contents, which can cause aspiration pneumonia.

DIF: Comprehension/Understanding REF: p. 196 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

13. The item most likely to be left in place when the client is sent to the operating room (OR) is

a.

an engagement ring.

b.

a hearing aid.

c.

a wig.

d.

well-fitting dentures.

ANS: B

If the client is wearing a hearing aid, the perioperative nurse should be notified. Leaving the hearing aid in place enhances communication in the OR. The nurse should make certain to record that the appliance is in place.

DIF: Application/Applying REF: p. 199 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Sensory/Perceptual Alteration

14. Before administering the preoperative medication, the nurse should

a.

ensure that the permit has been properly signed.

b.

have the unlicensed assistive personnel call for transportation.

c.

make sure there is nothing else left to do.

d.

take and record a set of vital signs.

ANS: A

The purposes of various preoperative medications are to allay anxiety, reduce side effects of anesthetic agents, and create amnesia. Before administering any of them, make sure the permit has been correctly signed because once premedicated, the client can no longer sign the consent form.

DIF: Application/Applying REF: p. 199 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Informed Consent

15. After administration of preoperative medications, the nurse takes the precaution of

a.

confirming that the client has voided.

b.

monitoring vital signs every 15 minutes.

c.

placing the client in bed with the rails up.

d.

transporting the client immediately to the OR.

ANS: C

The nurse instructs the client not to get up without assistance because medications may cause drowsiness or dizziness.

DIF: Application/Applying REF: p. 199 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

16. The client who has received odansetron (Zofran) asks, What will the drug do? The nurse should base a reply on the knowledge that odansetron

a.

controls intraoperative secretions.

b.

produces an antiemetic effect.

c.

promotes rapid sedation.

d.

relieves postoperative pain.

ANS: B

Odansetron is given to reduce emesis.

DIF: Comprehension/Understanding REF: p. 203 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

17. A client is receiving anesthesia and is being inducted just before an operation. The most appropriate action by the nurse at this time is to

a.

apply wrist and leg restraints to ensure client safety.

b.

begin counting supplies with the surgical technician or scrub nurse.

c.

ensure all conversation in the operating room is appropriate.

d.

monitor the client for agitation and struggling.

ANS: C

During the induction phase of anesthesia, the last sense to be depressed is hearing. The nurse acting as the clients advocate will ensure that the room is quiet and all conversation is appropriate during this phase and throughout the operation.

DIF: Application/Applying REF: p. 202 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Parenteral/Intravenous Therapies

18. Which action should receive high priority in an elderly client being placed on the operating room table?

a.

Attach the client to a cardiac monitor.

b.

Ensure that the correct operative site is exposed.

c.

Provide extra padding for joints and bony prominences.

d.

Understand which anesthetic agents are being used.

ANS: C

The elderly tend to have a decrease in lean body mass, increased spinal compression, and an increased incidence of arthritis and osteoporosis, so extra padding is a precaution that the nurse should ensure for the elderly client to prevent injury.

DIF: Analysis/Analyzing REF: p. 224 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Age Related Differences

19. The nurse caring for a client who had spinal anesthesia will ensure that the plan of care includes

a.

administering oxygen to reduce the hypoxia produced by spinal anesthesia.

b.

elevating the clients feet to increase the blood pressure.

c.

elevating the head of the bed to decrease nausea.

d.

instructing the client to remain flat in bed for 6 hours.

ANS: D

One complication of spinal anesthesia is loss of cerebrospinal fluid, which cushions the brain. Clients can complain of severe headaches should this occur. Therefore the client is instructed to lie flat for 6 to 8 hours. Other interventions designed to replace fluids and indirectly replace lost spinal fluid include methods to increase fluid intake.

DIF: Application/Applying REF: p. 206 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

20. During the operative period, a client under general anesthesia experiences masseter muscle rigidity. The nurse-anesthetist recognizes this to be a manifestation of

a.

excessive heat loss.

b.

malignant hyperthermia.

c.

need for increased muscle relaxant.

d.

onset of anesthesia.

ANS: B

Initial manifestations of malignant hyperthermia are increased end-tidal carbon dioxide volume, masseter (jaw) muscle rigidity, cardiac dysrhythmias, and hypermetabolic state.

DIF: Analysis/Analyzing REF: p. 211 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

21. On the preoperative assessment, the nurse notes the suggestion of susceptibility to malignant hyperthermia during surgery in the clients statement that

a.

I frequently have numbness and tingling in my hands.

b.

I usually feel very warm and tend to perspire heavily.

c.

My mother died from anesthesia problems.

d.

On occasion Ive had muscle tenderness around my jaw.

ANS: C

A concern relative to the development of malignant hyperthermia can be made if a client has a personal or family history of anesthesia problems.

DIF: Comprehension/Understanding REF: pp. 184, 211 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

22. The recovery room nurse places the client in the lateral Sims position on admission to the post-anesthesia care unit (PACU) because this position

a.

allows the tongue to fall forward.

b.

discourages thrombophlebitis.

c.

helps stabilize blood pressure.

d.

prevents abdominal distention.

ANS: A

The lateral Sims position allows the tongue to fall forward to prevent it from falling backward and interfering with respiration. This position also allows mucus and vomitus to drain out, preventing aspiration.

DIF: Application/Applying REF: p. 214 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

23. The nursing action that should receive highest priority when a client returns from the OR to the PACU is

a.

checking the postoperative orders.

b.

observing the operative site.

c.

positioning the client.

d.

receiving the report from OR personnel.

ANS: C

The client is received in the PACU on a bed or stretcher. Proper positioning is necessary to ensure airway patency in a sedated, unconscious, or semi-conscious client.

DIF: Application/Applying REF: p. 214 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

24. The PACU nurse is informed that the client being admitted has not recovered his pharyngeal reflex. The nursing action that should receive greatest priority is to

a.

check for the gag reflex frequently.

b.

maintain an oral airway.

c.

remain with the client at all times.

d.

suction the client frequently.

ANS: C

Clients admitted to the PACU without pharyngeal (gag) reflex are positioned on their side. The immediate assessment includes the ABCs: airway, breathing, circulation. An impaired gag reflex could impair breathing. The nurse stays at the bedside until the clients pharyngeal reflex returns. The nurse would monitor for return of the reflex and would be prepared to suction the clients secretions if needed. An oral airway may or may not be used.

DIF: Application/Applying REF: p. 214 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

25. For a client admitted to the PACU with an oral airway in place, the nursing intervention that would be inappropriate is

a.

allowing the client to spit out the airway.

b.

removing the airway when the client becomes responsive.

c.

suctioning the clients secretions as needed.

d.

taping the airway in place so it does not fall out.

ANS: D

Airways should not be taped in place. When clients awaken and the gag reflex returns, they may spit out the airway.

DIF: Application/Applying REF: p. 216 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

26. The PACU nurse notes that a client is beginning to become increasingly restless. Nursing assessment includes blood pressure measurements dropping from to mm Hg, with heart rate increased to 120 beats/min, and dressings dry and intact. Which action by the nurse takes priority?

a.

Increase rate of intravenous (IV) fluids.

b.

Increase rate of oxygen (O2) delivery.

c.

Notify the surgeon.

d.

Place the client in the Trendelenburg position.

ANS: B

When a client appears to be going into shock, the PACU nurse applies O2 or increases the rate of O2 delivery, and then raises the clients legs above heart level, increases IV flow rate (unless contraindicated), and notifies the surgeon or anesthesiologist.

DIF: Application/Applying REF: p. 217 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

27. In the teaching plan for a client being discharged from the PACU after ambulatory surgery, the nurse should include the instruction to

a.

Be sure that you have someone who can drive you home.

b.

Change your dressing frequently.

c.

Have someone wake you every 2 hours for the first 24 hours.

d.

Measure urine output for 48 hours.

ANS: A

A responsible adult must accompany the same-day surgery client being discharged from the ambulatory surgery center. Taxi cabs are not an appropriate means of transportation after surgery. This instruction would apply to any client being discharged from the ambulatory surgery center; the other instructions would be specific after specific types of operations.

DIF: Application/Applying REF: p. 219 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

28. A client has the nursing diagnosis Fear related to the unknown regarding upcoming surgery. The nurse would know that goals for this diagnosis have been met when the client says I feel a little better now because

a.

a nurse will be with me during the entire experience.

b.

I can tolerate anything for 2-3 hours.

c.

I know I wont have any complications.

d.

this operation is really routine and done all the time.

ANS: A

Clients are commonly fearful and anxious before surgery. There are many interventions the nurse can provide to alleviate fear; one of the most powerful is telling a client that a nurse will be with him/her the entire time.

DIF: Comprehension/Understanding REF: p. 193 OBJ: Evaluation

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

29. Assessing unilateral leg edema and warmth in a postoperative client complaining of pain, the surgical unit nurse suspects the complication of

a.

hypovolemia.

b.

myocardial infarction.

c.

pneumonia.

d.

thrombophlebitis.

ANS: D

Thrombus can form in any blood vessel, and the nurse should be alert to any complaints of extremity pain, unilateral edema, or warmth.

DIF: Application/Applying REF: p. 220 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

30. In the first 3 days after surgery, the nurse would anticipate the fluid and electrolyte adjustment of

a.

elevated hematocrit level.

b.

fluid retention.

c.

increase in serum potassium level.

d.

increased urine output.

ANS: B

The stress response to surgery stimulates the secretion of antidiuretic hormone (ADH) and aldosterone, which cause fluid retention.

DIF: Comprehension/Understanding REF: p. 218 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

31. The nurse explains to the postoperative ambulatory surgery client that his discharge will be delayed because of his

a.

blood pressure of mm Hg.

b.

inability to void.

c.

mild incisional discomfort.

d.

pulse rate of 92 beats/min.

ANS: B

Same-day surgery clients cannot be discharged until they are able to tolerate fluids by mouth, can ambulate with a steady gait and without orthostatic hypotension, have pain controlled with oral analgesics, and have voided. The vital signs in options a and d might be baseline for the client.

DIF: Application/Applying REF: p. 219 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

32. A client calls the Telehealth nurse on the third postoperative day and describes a giving way sensation in the abdomen that occurred after coughing. To assess for a possible evisceration, the nurse asks if

a.

bright-red bleeding from the wound edges is seen.

b.

fascia or internal organs are visible.

c.

fecal material is draining from the wound site.

d.

large amounts of pus are draining.

ANS: B

Evisceration occurs when an abdominal incision opens, with visible fascia or internal organs.

DIF: Comprehension/Understanding REF: p. 224 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

33. The nurse notes that a clients wound is beginning to eviscerate while ambulating. The nurses initial intervention is to

a.

cover the wound with moistened, sterile saline dressings.

b.

notify the surgeon immediately.

c.

replace the protruding loops of bowel using sterile gloves.

d.

return the client to bed as quickly as possible.

ANS: D

Evisceration constitutes an emergency. The nurse returns the client to bed, does not attempt to replace the organs, covers the wound with dressings moistened in sterile normal saline, and notifies the surgeon.

DIF: Application/Applying REF: p. 224 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

34. During preoperative teaching, the nurse advises the client who smokes on an important health promotion measure to take before elective surgery, which is to

a.

ask the physician for nicotine patches.

b.

cut down by half the amount smoked per day.

c.

increase fluid intake to reduce risk of thrombosis.

d.

stop smoking at once.

ANS: D

Smoking can cause postoperative complications including thrombosis formation and respiratory problems. The best health promotion measure this client can take is to stop smoking at once. Using nicotine patches or gum is not appropriate as nicotine still enters the bloodstream where it continues to act as a potent vasoconstrictor.

DIF: Application/Applying REF: p. 185 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

MULTIPLE RESPONSE

1. A client has left to go to the operating room. Important supportive interventions the nurse can provide the family include (Select all that apply)

a.

asking them for a way to contact them if they leave the area.

b.

giving families a way to contact the nurses station.

c.

letting the physician meet with them in person instead of the nurse.

d.

showing them where the family waiting room is.

ANS: A, B, D

Options a, b, and d show caring and concern. Another option would be to provide families with pagers so they can leave the immediate area and still know that you can contact them. The physician should meet with the family, especially after the operation to give them a report, but caring for the family remains a nursing priority.

DIF: Application/Applying REF: p. 200 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Interactions

2. The nurse should complete a detailed cognitive assessment on an elderly client before surgery because (Select all that apply)

a.

confusion and psychosis are commonly seen in postoperative elderly clients.

b.

elders often experience intraoperative strokes.

c.

neurologic changes resulting from surgery can last longer in an older client.

d.

temporarily impaired cognition can be mistaken for a neurologic event.

ANS: C, D

The effects of an operation and its associated medications can cause temporary cognitive deficits that can be mistakenly attributed to permanent conditions in the elderly, such as stroke or dementia. These temporary changes are seen in most clients and are considered normal, but may last longer in an elderly client than in younger clients. The nurse should conduct and document a thorough neurologic status exam preoperatively, and nurses who encounter the client postoperatively should use those data as a baseline. Psychosis is not a common condition seen in the elderly, nor do they experience intraoperative strokes on a frequent basis.

DIF: Analysis/Analyzing REF: p. 189 OBJ: Assessment

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Aging Process

3. A nurse on the surgical floor has several clients who had surgery during the day. Which of the following actions can this nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.)

a.

Encouraging the use of the incentive spirometer

b.

Outlining drainage present on dressings

c.

Providing comfort measures

d.

Recording output from drains

e.

Taking vital signs

ANS: A, C, D, E

Once the client has been taught the use of the incentive spirometer and the nurse has completed a respiratory assessment, the UAP can encourage the client to use the device and reinforce correct technique. The UAP can provide nonpharmacologic comfort measures such as back rubs or positioning and can assist with surveillance for pain relief. The nurse should ensure that drains are secured and appropriately labeled; then the UAP can empty and record the drainage. The nurse should instruct the UAP on frequency of drain emptying and on the frequency of vital signs, which is also within the scope of a UAPs practice. However, the registered nurse should assess all drainage on dressings and outline the amount to establish a baseline. New or increased drainage is immediately reportable by the UAP to the RN.

DIF: Analysis/Analyzing REF: p. 221 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

4. Important actions the nurse takes to avoid wrong site surgery include (Select all that apply)

a.

asking the surgeon to initial the marked site and operate through the initials.

b.

calling a time-out to verify right client, right surgical site before starting the operation.

c.

having the client mark the surgical site with permanent marker.

d.

involving multiple surgeons in the case to check each other.

ANS: A, B, C

Preventing wrong site surgery is vital and is an important safety consideration. Several things can help prevent it, including options a, b, and c. A root factor analysis identified several contributing factors to this problem, one of which was the involvement of multiple surgeons in a case.

DIF: Application/Applying REF: pp. 208-209, 210

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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