Chapter71 Nursing School Test Banks

 

1.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention?

A)

Rashes on the palms of the hands and soles of the feet

B)

Cauliflower-like warts on the penis

C)

Painful, red papules on the shaft of the penis

D)

Foul-smelling discharge from the penis

Ans:

D

Feedback:

Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

2.

A nurse is caring for a child who was admitted to the pediatric unit with infectious diarrhea. The nurse should be alert to what assessment finding as an indicator of dehydration?

A)

Labile BP

B)

Weak pulse

C)

Fever

D)

Diaphoresis

Ans:

B

Feedback:

Assessment of dehydration includes evaluation of thirst, oral mucous membrane dryness, sunken eyes, a weakened pulse, and loss of skin turgor. Diaphoresis, labile BP, and fever are not characteristic signs and symptoms of dehydration.

3.

A nursing home patient has been diagnosed with Clostridium difficile. What type of precautions should the nurse implement to prevent the spread of this infectious disease to other residents?

A)

Contact

B)

Droplet

C)

Airborne

D)

Positive pressure isolation

Ans:

A

Feedback:

Contact precautions are used for organisms that are spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile. Droplet precautions are used for organisms that can be transmitted by close, face-to-face contact, such as influenza or meningococcal meningitis. Airborne precautions are required for patients with presumed or proven pulmonary TB or chickenpox. Positive pressure isolation is unnecessary and ineffective.

4.

A nurse who provides care in a busy ED is in contact with hundreds of patients each year. The nurse has a responsibility to receive what vaccine?

A)

Hepatitis B vaccine

B)

Human papillomavirus (HPV) vaccine

C)

Clostridium difficile vaccine

D)

Staphylococcus aureus vaccine

Ans:

A

Feedback:

Nurses should recognize their personal responsibility to receive the hepatitis B vaccine and an annual influenza vaccine to reduce potential transmission to themselves and vulnerable patient groups. HPV is not a threat because it is sexually transmitted. No vaccines are available againstC. difficile and S. aureus.

5.

When a disease infects a host a portal of entry is needed for an organism to gain access. What has been identified as the portal of entry for tuberculosis?

A)

Integumentary system

B)

Urinary system

C)

Respiratory system

D)

Gastrointestinal system

Ans:

C

Feedback:

The portal of entry for M. tuberculosis is through the respiratory tract.

6.

A patient has a concentration of S. aureus located on his skin. The patient is not showing signs of increased temperature, redness, or pain at the site. The nurse is aware that this is a sign of a microorganism at which of the following stages?

A)

Infection

B)

Colonization

C)

Disease

D)

Bacteremia

Ans:

B

Feedback:

Colonization refers to the presence of microorganisms without host interference or interaction. Infection is a condition in which the host interacts physiologically and immunologically with a microorganism. Disease is the decline in wellness of a host due to infection. Bacteremia is a condition of bacteria in the blood.

7.

An infectious outbreak of unknown origin has occurred in a long-term care facility. The nurse who oversees care at the facility should report the outbreak to what organization?

A)

Centers for Disease Control and Prevention (CDC)

B)

American Medical Association (AMA)

C)

Environmental Protection Agency (EPA)

D)

American Nurses Association (ANA)

Ans:

A

Feedback:

The goals of the CDC are to provide scientific recommendations regarding disease prevention and control to reduce disease, which it includes in publications. As such, outbreaks of unknown origin should normally be reported to the CDC. The AMA is the professional organization for medical doctors; the EPA oversees our environment; the ANA is the professional organization for American nurses.

8.

The infectious control nurse is presenting a program on West Nile virus for a local community group. To reduce the incidence of this disease, the nurse should recommend what action?

A)

Covering open wounds at all times

B)

Vigilant handwashing in home and work settings

C)

Consistent use of mosquito repellants

D)

Annual vaccination

Ans:

C

Feedback:

West Nile virus is transmitted by mosquitoes, which become infected by biting birds that are infected with the virus. Prevention of mosquito bites can reduce the risk of contracting the disease. Handwashing and bandaging open wounds are appropriate general infection control measures, but these actions do not specifically prevent West Nile virus for which no vaccine currently exists.

9.

An immunosuppressed patient is receiving chemotherapy treatment at home. What infection-control measure should the nurse recommend to the family?

A)

Family members should avoid receiving vaccinations until the patient has recovered from his or her illness.

B)

Wipe down hard surfaces with a dilute bleach solution once per day.

C)

Maintain cleanliness in the home, but recognize that the home does not need to be sterile.

D)

Avoid physical contact with the patient unless absolutely necessary.

Ans:

C

Feedback:

When assessing the risk of the immunosuppressed patient in the home environment for infection, it is important to realize that intrinsic colonizing bacteria and latent viral infections present a greater risk than do extrinsic environmental contaminants. The nurse should reassure the patient and family that their home needs to be clean but not sterile. Common-sense approaches to cleanliness and risk reduction are helpful. The family need not avoid vaccinations and it is unnecessary to avoid all contact or to wipe down surfaces daily.

10.

A medical nurse is careful to adhere to infection control protocols, including handwashing. Which statement about handwashing supports the nurses practice?

A)

Frequent handwashing reduces transmission of pathogens from one patient to another.

B)

Wearing gloves is known to be an adequate substitute for handwashing.

C)

Bar soap is preferable to liquid soap.

D)

Waterless products should be avoided in situations where running water is unavailable.

Ans:

A

Feedback:

Whether gloves are worn or not, handwashing is required before and after patient contact because thorough handwashing reduces the risk of cross-contamination. Bar soap should not be used because it is a potential carrier of bacteria. Soap dispensers are preferable, but they must also be checked for bacteria. When water is unavailable, the nurse should wash using a liquid hand sanitizer.

11.

A male patient with gonorrhea asks the nurse how he can reduce his risk of contracting another sexually transmitted infection. The patient is not in a monogamous relationship. The nurse should instruct the patient to do which of the following?

A)

Ask all potential sexual partners if they have a sexually transmitted disease.

B)

Wear a condom every time he has intercourse.

C)

Consider intercourse to be risk-free if his partner has no visible discharge, lesions, or rashes.

D)

Aim to limit the number of sexual partners to fewer than five over his lifetime.

Ans:

B

Feedback:

Wearing a condom during intercourse considerably reduces the risk of contracting STIs. The other options may help reduce the risk for contracting an STI, but not to the extent that wearing a condom will. A monogamous relationship reduces the risk of contracting STIs.

12.

The nurse places a patient in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection?

A)

Mode of transmission

B)

Agent

C)

Susceptible host

D)

Portal of entry

Ans:

A

Feedback:

Isolation techniques attempt to break the chain of infection by interfering with the transmission mode. These techniques do not directly affect the agent, host, or portal of entry.

13.

The nurse is caring for a patient who is colonized with methicillin-resistant Staphylococcus aureus (MRSA). What infection control measure has the greatest potential to reduce transmission of MRSA and other nosocomial pathogens in a health care setting?

A)

Using antibacterial soap when bathing patients with MRSA

B)

Conducting culture surveys on a regularly scheduled basis

C)

Performing hand hygiene before and after contact with every patient

D)

Using aseptic housekeeping practices for environmental cleaning

Ans:

C

Feedback:

Handwashing is the major infection control measure to reduce the risk of transmission of MRSA and other nosocomial pathogens. No convincing evidence exists to support that bathing patients with antibacterial soap is effective. Culture surveys can help establish the true prevalence of MRSA in a facility, but are used only to help implement where and when infection-control measures are needed. Hand hygiene is known to be more clinically important than housekeeping.

14.

A patient on Airborne Precautions asks the nurse to leave his door open. What is the nurses best reply?

A)

I have to keep your door shut at all times. Ill open the curtains so that you dont feel so closed in.

B)

Ill keep the door open for you, but please try to avoid moving around the room too much.

C)

I can open your door if you wear this mask.

D)

I can open your door, but Ill have to come back and close it in a few minutes.

Ans:

A

Feedback:

The nurse is placing the patient on airborne precautions, which require that doors and windows be closed at all times. Opening the curtains is acceptable. Antibiotics, wearing a mask, and standard precautions are not sufficient to allow the patients door to be open.

15.

Family members are caring for a patient with HIV in the patients home. What should the nurse encourage family members to do to reduce the risk of infection transmission?

A)

Use caution when shaving the patient.

B)

Use separate dishes for the patient and family members.

C)

Use separate bed linens for the patient.

D)

Disinfect the patients bedclothes regularly.

Ans:

A

Feedback:

When caring for a patient with HIV at home, family members should use caution when providing care that may expose them to the patients blood, such as shaving. Dishes, bed linens, and bedclothes, unless contaminated with blood, only require the usual cleaning.

16.

A nurse is preparing to administer a patients scheduled dose of subcutaneous heparin. To reduce the risk of needlestick injury, the nurse should perform what action?

A)

Recap the needle before leaving the bedside.

B)

Recap the needle immediately before leaving the room.

C)

Avoid recapping the needle before disposing of it.

D)

Wear gloves when administering the injection.

Ans:

C

Feedback:

Used needles should not be recapped. Instead, they are placed directly into puncture-resistant containers near the place where they are used. Gloves do not prevent needlestick injuries.

17.

A 16-year-old male patient comes to the free clinic and is subsequently diagnosed with primary syphilis. What health problem most likely prompted the patient to seek care?

A)

The emergence of a chancre on his penis

B)

Painful urination

C)

Signs of a systemic infection

D)

Unilateral testicular swelling

Ans:

A

Feedback:

Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless chancre develops at the site of infection. Initial infection with syphilis is not associated with testicular swelling, painful voiding, or signs of systemic infection.

18.

A patient on the medical unit is found to have pulmonary tuberculosis (TB). What is the most appropriate precaution for the staff to take to prevent transmission of this disease?

A)

Standard precautions only

B)

Droplet precautions

C)

Standard and contact precautions

D)

Standard and airborne precautions

Ans:

D

Feedback:

Airborne precautions are required for proven or suspected pulmonary TB. Standard precaution techniques are used in conjunction with the transmission-based precautions, regardless of the patients diagnosis. Droplet and contact precautions are insufficient.

19.

An adult patient in the ICU has a central venous catheter in place. Over the past 24 hours, the patient has developed signs and symptoms that are suggestive of a central line associated bloodstream infection (CLABSI). What aspect of the patients care may have increased susceptibility to CLABSI?

A)

The patients central line was placed in the femoral vein.

B)

The patient had blood cultures drawn from the central line.

C)

The patient was treated for vancomycin-resistant enterococcus (VRE) during a previous admission.

D)

The patient has received antibiotics and IV fluids through the same line.

Ans:

A

Feedback:

In adult patients, the femoral site should be avoided in order to reduce the risk of CLABSI. Drawing blood cultures, receiving treatment for VRE, and receiving fluids and drugs through the same line are not known to increase the risk for CLABSI.

20.

What is the best rationale for health care providers receiving the influenza vaccination on a yearly basis?

A)

To decreased nurses susceptibility to health care-associated infections

B)

To decrease risk of transmission to vulnerable patients

C)

To eventually eradicate the influenza virus in the United States

D)

To prevent the emergence of drug-resistant strains of the influenza virus

Ans:

B

Feedback:

To reduce the chance of transmission to vulnerable patients, health care workers are advised to obtain influenza vaccinations. The vaccine will not decrease nurses risks of developing health care-associated infections, eradicate the influenza virus, or decrease the risk of developing new strains of the influenza virus.

21.

A patient has presented at the ED with copious diarrhea and accompanying signs of dehydration. During the patients health history, the nurse learns that the patient recently ate oysters from the Gulf of Mexico. The nurse should recognize the need to have the patients stool cultured for microorganisms associated with what disease?

A)

Ebola

B)

West Nile virus

C)

Legionnaires disease

D)

Cholera

Ans:

D

Feedback:

In the U.S., cholera should be suspected in patients who have watery diarrhea after eating shellfish harvested from the Gulf of Mexico.

22.

A patient is alarmed that she has tested positive for MRSA following culture testing during her admission to the hospital. What should the nurse teach the patient about this diagnostic finding?

A)

There are promising treatments for MRSA, so this is no cause for serious concern.

B)

This doesnt mean that you have an infection; it shows that the bacteria live on one of your skin surfaces.

C)

The vast majority of patients in the hospital test positive for MRSA, but the infection doesnt normally cause serious symptoms.

D)

This finding is only preliminary, and your doctor will likely order further testing.

Ans:

B

Feedback:

This patients testing results are indicative of colonization, which is not synonymous with infection. The test results are considered reliable, and would not be characterized as preliminary. Treatment is not normally prescribed for colonizations.

23.

A patients diagnostic testing revealed that he is colonized with vancomycin-resistantenterococcus (VRE). What change in the patients health status could precipitate an infection?

A)

Use of a narrow-spectrum antibiotic

B)

Treatment of a concurrent infection using vancomycin

C)

Development of a skin break

D)

Persistent contact of the bacteria with skin surfaces

Ans:

C

Feedback:

Colonization can progress to infection if there is a portal of entry by which bacteria can invade body tissues. The use of vancomycin, or any other antibiotic, would not necessarily precipitate a VRE infection. Prolonged skin contact is similarly unlikely to cause infection, provided the skin remains intact.

24.

A clinic nurse is caring for a male patient diagnosed with gonorrhea who has been prescribed ceftriaxone and doxycycline. The patient asks why he is receiving two antibiotics. What is the nurses best response?

A)

There are many drug-resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment.

B)

The combination of these two antibiotics reduces the later risk of reinfection.

C)

Many people infected with gonorrhea are infected with chlamydia as well.

D)

This combination of medications will eradicate the infection twice as fast than a single antibiotic.

Ans:

C

Feedback:

Because patients are often coinfected with both gonorrhea and chlamydia, the CDC recommends dual therapy even if only gonorrhea has been laboratory proven. Although the number of resistant strains of gonorrhea has increased, that is not the reason for use of combination antibiotic therapy. Dual therapy is prescribed to treat both gonorrhea and chlamydia, because many patients with gonorrhea have a coexisting chlamydial infection. This combination of antibiotics does not reduce the risk of reinfection or provide a faster cure.

25.

A student nurse completing a preceptorship is reviewing the use of standard precautions. Which of the following practices is most consistent with standard precautions?

A)

Wearing a mask and gown when starting an IV line

B)

Washing hands immediately after removing gloves

C)

Recapping all needles promptly after use to prevent needlestick injuries

D)

Double-gloving when working with a patient who has a blood-borne illness

Ans:

B

Feedback:

Standard precautions are used to prevent contamination from blood and body fluids. Gloves are worn whenever exposure is possible, and hands should be washed after removing gloves. Needles are never recapped after use because this increases the risk of accidental needlesticks. Under ordinary circumstances, masks and gowns are not necessary for starting an IV line. Double-gloving is not a recognized component of standard precautions.

26.

A patient is admitted from the ED diagnosed with Neisseria meningitides. What type of isolation precautions should the nurse institute?

A)

Contact precautions

B)

Droplet precautions

C)

Airborne precautions

D)

Observation precautions

Ans:

B

Feedback:

This patient requires droplet precautions because the organism can be transmitted through large airborne droplets when the patient coughs, sneezes, or fails to cover the mouth. Smaller droplets can be addressed by airborne precautions, but this is insufficient for this microorganism.

27.

During a health education session, a participant asks the nurse how a vaccine can protect from future exposures to diseases against which she is vaccinated. What would be the nurses best response?

A)

The vaccine causes an antibody response in the body.

B)

The vaccine responds to an infection in the body after it occurs.

C)

The vaccine is similar to an antibiotic that is used to treat an infection.

D)

The vaccine actively attacks the microorganism.

Ans:

A

Feedback:

Vaccines are an antigen preparation that produces an antibody response in a human to protect him or her from future exposure to the vaccinated organism. A vaccine does not respond to an infection after it occurs; it does not act like an antibiotic and does not actively attack the microorganism.

28.

A 2-year-old is brought to the clinic by her mother who tells the nurse her daughter has diarrhea and the child is complaining of pain in her stomach. The mother says that the little girl had not eaten anything unusual, consuming homemade chicken strips and carrot sticks the evening prior. Which bacterial infection would the nurse suspect this little girl of contracting?

A)

Escherichia coli

B)

Salmonella

C)

Shigella

D)

Giardia lamblia

Ans:

B

Feedback:

Annually in the United States, Salmonella species contaminate approximately 2.2 million eggs (1 in 20,000 eggs) and one in eight chickens raised as meat. Diarrhea with gastroenteritis is a common manifestation associated with Salmonella. Recent outbreaks of E. coli have been associated with ingestion of undercooked beef. Shigella spreads through the fecaloral route, with easy transmission from one person to another. People infected with Giardia lambliacontract the disease by drinking contaminated water.

29.

A public health nurse is teaching a mother about vaccinations prior to obtaining informed consent for her childs vaccination. What should the nurse cite as the most common adverse effect of vaccinations?

A)

Temporary sensitivity to the sun

B)

Allergic reactions to the antigen or carrier solution

C)

Nausea and vomiting

D)

Joint pain near the injection site

Ans:

B

Feedback:

The most common adverse effects are an allergic reaction to the antigen or carrier solution and the occurrence of the actual disease (often in modified form) when live vaccine is used. Reactions to vaccines do not typically include sensitivity to the sun, nausea and vomiting, or joint pain.

30.

A mother brings her 12 month-old son into the clinic for his measles-mumps-rubella (MMR) vaccination. What would the clinic nurse advise the mother about the MMR vaccine?

A)

Photophobia and hives might occur.

B)

There are no documented reactions to an MMR.

C)

Fever and hypersensitivity reaction might occur.

D)

Hypothermia might occur.

Ans:

C

Feedback:

Patients should be advised that fever, transient lymphadenopathy, or a hypersensitivity reaction might occur following an MMR vaccination. Reactions to an MMR do not include photophobia or hypothermia.

31.

An older adult patient tells the nurse that she had chicken pox as a child and is eager to be vaccinated against shingles. What should the nurse teach the patient about this vaccine?

A)

Vaccination against shingles is contraindicated in patients over the age of 80.

B)

Vaccination can reduce her risk of shingles by approximately 50%.

C)

Vaccination against shingles involves a series of three injections over the course of 6 months.

D)

Vaccination against shingles is only effective if preceded by a childhood varicella vaccination.

Ans:

B

Feedback:

Zostavax, a vaccine to reduce the risk of shingles, is recommended for people older than 60 years of age because it reduces the risk of shingles by approximately 50%. It does not need to be preceded by childhood varicella vaccine. The vaccine consists of a single injection.

32.

The nurse educator is discussing emerging diseases with a group of nurses. The educator should cite what causes of emerging diseases? Select all that apply.

A)

Progressive weakening of human immune systems

B)

Use of extended-spectrum antibiotics

C)

Population movements

D)

Increased global travel

E)

Globalization of food supplies

Ans:

B, C, D, E

Feedback:

Many factors contribute to newly emerging or re-emerging infectious diseases. These include travel, globalization of food supply and central processing of food, population growth, increased urban crowding, population movements (e.g., those that result from war, famine, or man-made or natural disasters), ecologic changes, human behavior (e.g., risky sexual behavior, IV/injection drug use), antimicrobial resistance, and breakdown in public health measures. Not noted is an overall decline in human immunity.

33.

An older adult patient has been diagnosed with Legionella infection. When planning this patients care, the nurse should prioritize which of the following nursing actions?

A)

Monitoring for evidence of skin breakdown

B)

Emotional support and promotion of coping

C)

Assessment for signs of internal hemorrhage

D)

Vigilant monitoring of respiratory status

Ans:

D

Feedback:

The lungs are the principal organs of Legionella infection. The patient develops increasing pulmonary symptoms, including productive cough, dyspnea, and chest pain. Consequently, respiratory support is vital. Hemorrhage and skin breakdown are not central manifestations of the disease. Preservation of the patients airway is a priority over emotional support, even though this aspect of care is important.

34.

The nurse is caring for a patient with secondary syphilis. What intervention should the nurse institute when caring for this patient?

A)

Ensure that the patient is housed in a private room.

B)

Administer hydrocortisone ointment to the lesions as ordered.

C)

Administer combination therapy with antiretrovirals as ordered.

D)

Wear gloves if contact with lesions is possible.

Ans:

D

Feedback:

Lesions of primary and secondary syphilis may be highly infective. Gloves are worn when direct contact with lesions is likely, and hand hygiene is performed after gloves are removed. Isolation in a private room is not required. Corticosteroids antiviral medications are not indicated.

35.

A long-term care facility is the site of an outbreak of infectious diarrhea. The nurse educator has emphasized the importance of hand hygiene to staff members. The use of alcohol-based cleansers may be ineffective if the causative microorganism is identified as what?

A)

Shigella

B)

Escherichia coli

C)

Clostridium difficile

D)

Norovirus

Ans:

C

Feedback:

The spore form of the bacterium C. difficile is resistant to alcohol and other hand disinfectants; therefore, the use of gloves and handwashing (soap and water for physical removal) are required when C. difficile has been identified. Each of the other listed microorganisms is susceptible to alcohol-based cleansers.

36.

The nurse is providing care for an older adult patient who has developed signs and symptoms ofCalicivirus (Norovirus). What assessment should the nurse prioritize when planning this patients care?

A)

Respiratory status

B)

Pain

C)

Fluid intake and output

D)

Deep tendon reflexes and neurological status

Ans:

C

Feedback:

The vomiting and diarrhea that accompany Norovirus create a severe risk of fluid volume deficit. For this reason, assessments relating to fluid balance should be prioritized, even though each of the listed assessments should be included in the plan of care.

37.

The nurse who provides care at a wilderness camp is teaching staff members about measures that reduce campers and workers risks of developing Giardia infections. The nurse should emphasize which of the following practices?

A)

Making sure not to drink water that has not been purified

B)

Avoiding the consumption of wild berries

C)

Removing ticks safely and promptly

D)

Using mosquito repellant consistently

Ans:

D

Feedback:

Transmission of the protozoan Giardia lamblia occurs when food or drink is contaminated with viable cysts of the organism. People often become infected while traveling to endemic areas or by drinking contaminated water from mountain streams within the United States. Berries, mosquitoes, and ticks are not sources of this microorganism.

38.

A nurse is participating in a vaccination clinic at the local public health clinic. The nurse is describing the public health benefits of vaccinations to participants. Vaccine programs addressing which of the following diseases have been deemed successful? Select all that apply.

A)

Polio

B)

Diphtheria

C)

Hepatitis

D)

Tuberculosis

E)

Pertussis

Ans:

A, B, E

Feedback:

The most successful vaccine programs have been ones for the prevention of smallpox, measles, mumps, rubella, polio, diphtheria, pertussis, and tetanus. There is no vaccine for tuberculosis. Hepatitis is not counted as one of the most successful vaccination programs, because vaccination rates for hepatitis leave room for improvement.

39.

A public health nurse promoting the annual influenza vaccination is focusing health promotion efforts on the populations most vulnerable to death from influenza. The nurse should focus on which of the following groups?

A)

Preschool-aged children

B)

Adults with diabetes and/or renal failure

C)

Older adults with compromised health status

D)

Infants under the age of 12 months

Ans:

C

Feedback:

Influenza vaccination is particularly beneficial in preventing death among older adults, especially those with compromised health status or those who live in institutional settings. It is recommended for children and adults, but carries the greatest reduction in morbidity and mortality in older adults.

40.

The nurse receives a phone call from a clinic patient who experienced fever and slight dyspnea several hours after receiving the pneumococcus vaccine. What is the nurses most appropriate action?

A)

Instruct the patient to call 911.

B)

Inform the patient that this is an expected response to vaccination.

C)

Encourage the patient to take NSAIDs until symptoms are relieved.

D)

Ensure that the adverse reaction is reported.

Ans:

D

Feedback:

Nurses should ask adult vaccine recipients to provide information about any problems encountered after vaccination. As mandated by law, a Vaccine Adverse Event Reporting System (VAERS) form must be completed with the following information: type of vaccine received, timing of vaccination, onset of the adverse event, current illnesses or medication, history of adverse events after vaccination, and demographic information about the recipient. NSAIDs are not necessarily required and no evidence of distress warrants a call to 911. This is not an expected response to vaccination.

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