Chapter 65: Care of Patients with Pituitary and Adrenal Gland Problems Nursing School Test Banks

Chapter 65: Care of Patients with Pituitary and Adrenal Gland Problems

Test Bank

MULTIPLE CHOICE

1. A client has a hormone deficiency. Which deficiency is the highest priority?

a.

Growth hormone

b.

Luteinizing hormone

c.

Thyroid-stimulating hormone

d.

Follicle-stimulating hormone

ANS: C

A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1372

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

2. An adult client has been diagnosed with a deficiency of gonadotropin and growth hormone. Which fact reported in the clients history could have contributed to this problem?

a.

Mother with adult-onset diabetes mellitus

b.

Experienced head trauma 5 years ago

c.

Severe allergy to shellfish and iodine

d.

Has used oral contraceptives for 5 years

ANS: B

Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

3. Which safety measure does the nurse use for the adult client who has growth hormone deficiency?

a.

Avoid intramuscular medications.

b.

Place the client in protective isolation.

c.

Use a lift sheet to reposition the client.

d.

Assist the client to change positions slowly.

ANS: C

In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

4. The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. Which is the nurses best answer?

a.

When your blood levels of testosterone are normal, the therapy is no longer needed.

b.

When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever.

c.

When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy.

d.

When you start to have undesirable side effects, the dose is decreased to the lowest possible level, and treatment is continued until you are 50 years old.

ANS: B

Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1373

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

5. When performing personal care on a middle-aged woman, the nurse observes that the client has very little pubic and axillary hair. Which is the nurses best action?

a.

Ask the client if she has less pubic hair now than 5 years ago.

b.

Ask the client the date of her last menstrual period.

c.

Examine the clients scalp hair for texture and thickness.

d.

Draw blood for hormonal immune assays.

ANS: A

Although pubic hair thickness varies from person to person, loss of pubic hair is associated with gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for this client. A middle-aged woman may be postmenopausal, which would not give the nurse helpful information. Examining the clients scalp also would not yield helpful information. Diagnostic studies should not be undertaken without further assessment.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

6. A client thought to have a problem with the pituitary gland is given a stimulation test using insulin. A short time later, blood analysis reveals elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). Which is the nurses interpretation of this finding?

a.

Pituitary hypofunction

b.

Pituitary hyperfunction

c.

Pituitary-induced diabetes mellitus

d.

A normal pituitary response to insulin

ANS: D

Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. For example, the presence of insulin in those with normal pituitary function causes increased release of GH and ACTH. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 U/kg of body weight) and checking circulating levels of GH and ACTH.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1373

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Assessment)

7. A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurses best action?

a.

Counsel the client on the health risks of alcoholism.

b.

Assess for jaundice of the skin and eyes.

c.

Document the finding and monitor the client.

d.

Draw blood for liver function studies.

ANS: C

Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other than documenting the finding and monitoring the client, these actions would be inappropriate because the finding is commonly associated with acromegaly.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

8. A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment?

a.

I will drink whenever I feel thirsty after surgery.

b.

Im glad no visible incision will result from this surgery.

c.

I hope I can go back to wearing size 8 shoes instead of size 12.

d.

I will wear slip-on shoes after surgery so I dont have to bend over.

ANS: C

Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over, reassured that the incision will not be visible.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Evaluation)

9. A client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity. Which is the nurses priority action?

a.

Have the client do active range-of-motion exercises for the neck.

b.

Document the finding and monitor the client.

c.

Take the clients temperature and other vital signs.

d.

Assess using a pain scale and administer pain medication.

ANS: C

Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Although pain medication may be a palliative measure, it is not the most appropriate initial action. Documentation should be done after all assessments are completed and should not be the only action.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

10. A client is going home after an endoscopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions?

a.

I will wear dark glasses whenever I am outdoors.

b.

I will keep food on upper shelves so I do not have to bend over.

c.

I will wash the incision line every day with peroxide and redress it immediately.

d.

I will remember to cough and deep breathe every 2 hours while I am awake.

ANS: B

After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

11. A client with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. Which action by the nurse is best?

a.

Consult with the registered dietitian about increased dietary sodium.

b.

Restrict the clients fluid intake to 900 mL/24 hr.

c.

Handle the client gently by using turn sheets for repositioning.

d.

Instruct the nursing assistants to measure intake and output.

ANS: B

With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. The client should be on intake and output (I&O); however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation)

12. Which safety measure is most important for the nurse to institute for a client who has Cushings disease?

a.

Pad the siderails of the clients bed.

b.

Assist the client to change positions slowly.

c.

Use a lift sheet to change the clients position.

d.

Keep suctioning equipment at the clients bedside.

ANS: C

Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. The client should not require suctioning. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

13. Which dietary alterations does the nurse make for a client with Cushings disease?

a.

High carbohydrate, low potassium

b.

Low carbohydrate, low sodium

c.

Low protein, low calcium

d.

High carbohydrate, low potassium

ANS: B

The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation)

14. A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurses best response?

a.

It is possible for the inflammation to recur if you stop the drugs.

b.

Once you start corticosteroids, you have to be weaned off them.

c.

You must decrease the dose slowly so your hormones will begin to work again.

d.

The drug suppresses your immune system, which needs to be built back up.

ANS: B

One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone (ACTH) and adrenal production of cortisol.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Teaching/Learning

15. A client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy?

a.

Urine output is increased; specific gravity is increased.

b.

Urine output is increased; specific gravity is decreased.

c.

Urine output is decreased; specific gravity is increased.

d.

Urine output is decreased; specific gravity is decreased.

ANS: C

Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Evaluation)

16. A client with hypercortisolism has an irregular pulse. Which is the nurses priority intervention?

a.

Documenting the finding and reassessing in 1 hour

b.

Assessing blood pressure in both arms

c.

Administering atropine sulfate

d.

Assessing the telemetry reading

ANS: D

Hypercortisolism causes potassium imbalances, which can lead to fatal dysrhythmias. With an irregular pulse, the nurse should assess the clients cardiac rhythm. The finding should be documented, but the nurse cannot wait an hour to take further action. Assessing bilateral blood pressures will not provide useful information. No indications for atropine are known.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

17. The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. Which is the nurses best response?

a.

I will ask your doctor to order a psychiatric consult for you.

b.

You feel this way because of your hormone levels.

c.

Can I bring you information about support groups?

d.

I will close the door to your room and restrict visitors.

ANS: B

Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1386

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Teaching/Learning

18. A client on medication after a bilateral adrenalectomy calls the clinic asking to be seen for stomach flu with nausea and vomiting. Which response by the nurse is best?

a.

I will call in a prescription for an antiemetic medication for you.

b.

Try to drink extra fluids until you can come in for an appointment.

c.

You need to go to the nearest emergency department today.

d.

Double the dose of your medication today and tomorrow.

ANS: C

The client with bilateral adrenalectomy is on lifelong cortisol replacement therapy. The client cannot skip any doses of his or her medication. If the client has nausea and vomiting for longer than 24 hours and cannot give himself or herself an injection of hydrocortisone, the client must go to the nearest emergency department to get it. The other answers are inappropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

19. A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client?

a.

Read the label before using salt substitutes.

b.

Do not add salt to your food when you eat.

c.

Avoid exposure to sunlight.

d.

Take Tylenol instead of aspirin for pain.

ANS: A

Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Reactions/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Teaching/Learning

20. The new nurse is assessing a client with suspected pheochromocytoma. Which action by the nurse requires the precepting nurse to intervene?

a.

Auscultating, palpating, and percussing the clients abdomen

b.

Taking the clients blood pressure for reports of chest pain

c.

Assessing the clients diet for red wine and aged cheeses

d.

Limiting visitors while the client is sleeping

ANS: A

Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and can precipitate a hypertensive crisis. The experienced nurse should intervene if the new nurse attempts this. The other actions would be appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

21. The client has chronic hypercortisolism. Which intervention is the highest priority for the nurse?

a.

Wash the hands when entering the room.

b.

Keep the client in protective isolation.

c.

Observe the client for increased white blood cell counts.

d.

Assess the daily chest x-ray.

ANS: A

Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1388

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Analysis)

22. A female client is beginning treatment with bromocriptine (Parlodel). The nurse has initiated teaching sessions about potential side effects. Which is the most important point of instruction?

a.

Take and record your temperature daily.

b.

Be sure to eat 20 to 30 grams of fiber daily.

c.

Plan to take the medication on an empty stomach.

d.

I will need to teach you how to give the injection.

ANS: B

Constipation is an expected side effect of treatment with bromocriptine, so the client should be taught ways to prevent and/or manage it. Eating plenty of fiber and drinking fluids is a good plan. Taking the clients temperature daily is not necessary. The medication, which is given orally, should be taken with food to reduce side effects.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

23. The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurses priority postoperative intervention?

a.

Keep the head of the bed flat and the client supine.

b.

Instruct the client to cough, turn, and deep breathe hourly.

c.

Report clear or yellow drainage from the nose or incision site.

d.

Apply petroleum jelly to the clients lips to avoid mouth dryness.

ANS: C

A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal leakage. Although application of petroleum jelly to the lips will help with mouth dryness, this instruction is not as important as reporting the yellowish drainage.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

24. A client has cortisol deficiency and is being treated with prednisone (Deltasone). Which instruction by the nurse is most appropriate?

a.

You will need to learn how to rotate the injection sites.

b.

If you work outside when its hot, you may need another drug.

c.

Be sure to stay on your salt restriction even though its difficult.

d.

Take one tablet in the morning and two tablets at night to start.

ANS: B

Steroid dosage adjustment may be needed and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Teaching/Learning

25. A client is brought to the emergency department via rescue squad in acute adrenal crisis. Which action by the nurse is the priority?

a.

Start an IV line if the client does not already have one.

b.

Administer hydrocortisone sodium succinate (Solu-Cortef).

c.

Instruct the nursing assistant to check the clients blood glucose.

d.

Administer 20 units of insulin and 20 mg of dextrose in normal saline.

ANS: A

All actions are appropriate for the client with adrenal crisis. However, therapy is given IV, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities)

MSC: Integrated Process: Nursing Process (Implementation)

26. A female client has a decrease in all pituitary hormones. Which assessment question by the nurse elicits the best information?

a.

Do you have any biological children?

b.

Do you have a decreased sex drive?

c.

Have you noticed increased facial hair?

d.

Are you more intolerant of heat?

ANS: A

Hypofunction of all anterior pituitary hormones is often caused by postpartum hemorrhage of the anterior pituitary gland. This usually occurs immediately after delivery but may be delayed for several years. Asking the client if she has children of her own would let the nurse know of this possibility. The other questions are assessments for specific hormone dysfunction.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

MULTIPLE RESPONSE

1. Which physical characteristics are indicative of anterior pituitary hyperfunction? (Select all that apply.)

a.

Protrusion of the lower jaw

b.

High-pitched voice

c.

Enlarged hands and feet

d.

Kyphosis

e.

Barrel-shaped chest

f.

Excessive sweating

ANS: A, C, D, E, F

Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

DIF: Cognitive Level: Knowledge/Remembering REF: Chart 65-2, p. 1376

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. Which conditions may cause hypopituitarism? (Select all that apply.)

a.

Benign pituitary tumors

b.

Diplopia

c.

Anorexia nervosa

d.

Hypotension

e.

Shock

f.

Weight gain

ANS: A, C, D, E

These four conditions can cause hypopituitarism. The other options are not causes of hypopituitarism.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1372

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

3. Which serum laboratory values alert the nurse to the possibility of hyperaldosteronism? (Select all that apply.)

a.

Sodium, 150 mEq/L

b.

Sodium, 130 mEq/L

c.

Potassium, 2.5 mEq/L

d.

Potassium, 5.0 mEq/L

e.

pH, 7.28

f.

pH, 7.50

ANS: A, C, E

Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. The other values are not indicative of hyperaldosteronism.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

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