CNA Practice Test

Bathing a resident without his or her permission is an example of battery. Keeping a resident isolated from others as a form of punishment is an example of involuntary seclusion.

Abuse in nursing facilities, or even suspicion of abuse, should be reported immediately to the nursing assistant’s supervisor. This requires more intervention than the nursing assistant’s scope of practice covers. Waiting or notifying the nurse only about bruises may delay getting the resident help.

MRSA stands for methacillinn-resistant Staphylococcus aureus and is very resistant to most antibiotic treatments.

Frequent hand washing is the best way to prevent infection without a doubt. The other measures are supportive.

Allowing the resident to participate in care will raise their self esteem and allow autonomy. It is inappropriate to clean the perineal area before the face, or to use cool water rather than comfortably warm water.

It is the duty of the nursing assistant to report any red pressure spots on the resident to the nurse. The nursing assistant may not apply any prescription ointments. Talcum powder is not recommended. A second staff member is not needed for perineal care.

It is the duty of the nursing assistant to report any red pressure spots on the resident to the nurse. The nursing assistant may not apply any prescription ointments. Talcum powder is not recommended. A second staff member is not needed for perineal care.

It is necessary to check the shaving instructions in the resident’s plan of care to be aware of any problems clotting and the necessity of using an electric razor as opposed to a traditional one.

Maintaining a routine is incredibly important to Alzheimer’s patients. Hallucinations and a decrease in appetite are common. It is important to frequently reorient the patient.

Lowering the bed to the lowest level is important for safety. Mitering the corners of sheets is recommended, as is raising side rails. Never place soiled linens on the floor.

Any pulse outside the range of 60 to 100 should be reported immediately to the nurse for the resident’s safety.

High Fowlers is a description of the patient sitting straight up in bed, meaning the bed itself has to be at a 90 degree angle to support them.

The nursing assistant should wear a gown and gloves at most as correct contact precautions.

Infection, especially in older clients, tends to cause sudden onset confusion. Tented skin may be normal for an older client, as could pale skin. Aphasia could indicate the onset of a stoke.

NPO is a latin abbreviation that stands for “nil per os” or “nothing by mouth.” It indicates that the client is not allowed food, fluids, or oral medications.

Someone with diabetes should always eat regular meals to keep their blood sugar relatively stable. Numbness in the feet is neuropathy, a common side effect of diabetes.

Residents on bedrest must be turned every 2 hours to maintain skin integrity.

It is important to first assess whether or not the resident is choking. If they are able to answer, air is still moving through the trachea. If they nod yes, but are unable to speak, it is time to begin the Heimlich maneuver. The Heimlich should not be performed on anyone who is able to cough or speak.

HIPPA requires you to keep client’s health information confidential. Period.

Taking the client to the bathroom will most likely prompt a bowel movement, which supports GI tract health. A confused patient may not remember what the urge means.

Diabetic clients often have special instructions regarding nail trimming. Check the chart for specific orders.

Waiting fifteen minutes ensures the temperature of the mouth will be more accurate. Axillary temperatures in the elderly are often not the best measure.

The boots will ensure that the feet are dorsiflexed to prevent contractures and discomfort.

It is very important to report a symptomatic low blood pressure to the nurse for further investigation.

Support the client in their own individual religious needs. Treat any religious objects in their room with respect.

Bending at the knees is the only proper body mechanic listed. Avoid doing all the others!

Reorienting the patient frequently is the most important aspect of care. Keeping the client locked in their room could agitate them, as could asking them their name (which they might not remember).

Terminally ill clients may receive hospice care, which is designed to relieve pain rather than to cure disease.

Cheyne-Stokes respirations are a breathing pattern marked by increased respirations, labored breathing, and periods of apnea (no breathing). It is important to report these signs if discovered in a resident who is not expected to show them.

Orthopneic position is meant to assist in breathing. Leaning forward makes it easier to get air into the lungs.

Cantaloupe is a melon that contains massive amounts of potassium. Other foods that contain high potassium include bananas and dark leafy greens.

CPR is performed on a client that has no pulse and is not breathing.

The acronym “RACE” is used for fire situations- Rescue, alarm, contain, extinguish. First you must rescue the client to prevent harm.

A SCI patient is prone to further damage and injury to the spinal cord if the legs cross over the midline (in a twisting motion). This can be avoided with proper log-rolling technique.

Incontinence can occur if the bladder becomes too full and is unrelieved.

Anticipatory grief occurs before the loss actually happens and is a normal part of grieving. Complicated, unresolved, and inhibited grieving indicate there is a problem with recovering from the loss.

Orange juice with pulp is not allowed — the pulp is not considered part of “clear liquid.” Tea, coffee, and water are all allowed on the clear liquid diet.

Keeping the bag below the level of the cavity ensures that bacteria cannot migrate up from the bag and up into the bladder due to gravity.

The physician needs to order restraints before they can be legally applied. No one else can ask for restraints for a patient or it is considered battery.

The abbreviation of “cc” is no longer appropriate in the medical field. Only ‘ml’ should be used. A large glass is 480 ml.

The sputum produced upon awakening is the most concentrated sputum and will yield the most accurate result.

Masturbation is a normal expression of sexual health. Attempt to exit quietly without disturbing the client in order to preserve his privacy and decency.

This patient is bargaining to be “forgiven” in order to cure his illness. This is a normal stage in the grieving process.

A mechanical lift should be used for immobile or NWB residents. A gait belt should never be used on an immobile resident to lift them and should be used on individuals who are FWB or PWB.

Securing the catheter to the lateral aspect of the patient’s thigh ensures it cannot be painfully pulled during the bath.

This is the best answer because it reflects what the patient is feeling (pain) and stays with the patient to comfort him.

It is best for the patient to perform as much of the bath as possible, with the nursing assistant helping out when necessary.

This describes a partial thickness burn. A total thickness burn appears waxy and white, while a superficial burn might be described as blotchiness of the skin with no blistering.

The restraint straps should be secured to the bed frame and never to the side rail to avoid accidental injury in the event that the side rail is released. A half-bow or safety knot should be used for applying a restraint because it does not tighten when force is applied against it and allows quick and easy removal of the restraint in case of emergency. The jacket restraint should be secured, and one to two fingers should slide easily between the restraint and the client’s skin.

The bag hangs from the bed frame, chair, or wheel chair. It must not touch the floor. The bag is always kept lower than the client’s bladder. If the drainage bag is higher than the bladder, urine can flow back into the bladder and an infection can occur. Therefore, do not hang the drainage bag on a bed rail. When the bed rail is raised, the bag is higher than the bladder level. When the person walks, the bag is held lower than the bladder. Emptying of the drainage should be done every 6-8 hours to prevent proliferation of microbes which can develop into infection. The tubing should not have dependent loops to prevent stasis of urine in the tubes which can promote backflow to the bladder.

Cauliflower is gas-forming. Other examples of gas-forming foods are beans, cabbage, radishes, and cucumbers.

The ideal temperature of the water for a hot Sitz bath is between 95°F and 110°F. Water that is too hot will burn the client, and water that is too cold will cause the muscles to tighten up rather than relax. A hot Sitz bath will provide relaxation and relieve muscle spasms, soften exudates, hasten the suppuration process, hasten healing (in cases of perianal surgeries), reduce congestion, and provide comfort in the perineal area.

In diabetes, some sugar appears in the urine (glucosuria or glycosuria). The diabetic person may also have acetone (ketone bodies, ketones) in the urine. To determine the presence of these substances in the urine, these tests are usually done four times a day – 30 minutes before meals and at bedtime. The doctor uses the test to make drug and diet decisions. Double-voided specimens are best for these tests.

Ostomy care is done aseptically (rules of cleanliness). It does not require a doctor’s order for changing the ostomy pouch. The collection bag must be changed when it is full or when the adhering seal is broken. A client with ostomy will have a change in the normal bowel movement. The fecal matter will be collected through an appliance that is held over the stoma by a special adhesive or paste.

Elastic stockings or anti-embolic stockings are applied before the client gets out of bed. Otherwise the legs can swell from sitting or standing. Stockings are hard to put on when the legs are swollen. The client lies in bed while they are off. This prevents the legs from swelling.

Elastic stockings exert pressure on the veins. The pressure promotes venous blood flow to the heart. By doing so, the stockings prevent blood clots.

The job of the nursing assistant is to make sure there are no kinks in the tubing and to secure the connecting tubing in place. The other choices are all responsibilities of a physician.

In applying elastic bandage, expose fingers or toes to allow circulation checks. Check the color and temperature of the extremity every hour. If the person complains of pain, itching, tingling, or numbness, remove the bandage and tell the nurse at once.

T-binders secure dressings in place after rectal and perianal surgeries. The double T-binder is for men, while the single T-binder is for women. A breast binder is specifically used to support the breasts after breast surgery; not by breastfeeding mothers. Straight abdominal binders are applied with the person supine. It is secured in front of the body by safety pins, Velcro, zippers, hooks, or other closures. The top part is at the person’s waist. The lower part is over the hips.

A rubber sheet protects the client from soiled linens and excess drainage. It can even predispose the client to develop skin breakdown and pressure ulcers because it creates moisture and friction to the skin. Trochanter rolls are applied to prevent the hips and legs from turning outward and aids in proper positioning of the client. A bed cradle is placed on bed and over the person. Top linens are brought over the cradle to prevent pressure on the legs and feet.

Hypoxia means that the cells do not have enough oxygen. It is a life-threatening condition. The brain is very sensitive to inadequate oxygen. Restlessness is an early sign, as are dizziness and disorientation. Hypoxia will have increased respiratory rate, increased pulse rate, but not increased temperature. Cyanosis, or bluish discoloration of the skin, is a late sign of hypoxia.

Clients with difficulty breathing often prefer sitting up and leaning over a table to breathe. This is called orthopneic position. Place a pillow on the table to increase the client’s comfort.

It is unnecessary to use a new piece of floss for each tooth. Break off an 18-inch piece of floss from the dispenser; this will do for all the teeth. Just move to a new section of floss after every second tooth is flossed. The other choices are correct steps in flossing.

A 24-hour urine specimen is a collection of all urine by a client over a 24-hour period. All urine is collected for 24 hours, usually from 7 A.M. on the first day to 7 A.M. the following day. It is necessary to ask the client to void, and then discard this voided urine. This is done because this urine has been in the bladder an unknown length of time. The test should begin with the bladder empty. For the next 24 hours, save all the urine voided by the client in one collection bottle. Recording the amount of urine and the time voided is not important in this procedure.

The hearing aid should be adjusted to an audible level that the client can tolerate. A hearing aid helps the person hear more in both quiet and noisy environments.

If the client is incontinent (cannot control bowels and/or urine), record this on the output side of the I&O sheet each time the bed is wet. Even though the urine cannot be measured, it will be obvious that the client’s kidneys are functioning.

Fluid output is the sum total of liquids that come out of the body. Most fluid is discharged from the body as urine. Output also includes emesis (vomitus), drainage from a wound, loss of blood, and excessive perspiration. Every time the client uses the urinal, emesis basin, or bedpan, the urine and other fluids must be measured. For perspiration, wound discharges, or bleeding, indicate what was wet, how wet, the size of the wet area, and the time it occurred.

A client who is in oxygen therapy should have safety measures implemented in order to prevent explosion. Use of electric razors or hair dryers while the oxygen is running is not allowed. Combing a client’s hair can also create a spark of electricity from his hair that could set off an explosion. The face mask can be removed if the client wishes to eat and converse with visitors. Use of cotton bedclothes is also encouraged to decrease static electricity.

Clients with a pacemaker can use electrical appliances. Microwaves are allowed, but caution must be used in airports to avoid the magnetic wands used for detection. Some clients have difficulties being around lawn mowers and cellular phones.

The nurse aide should report to the nurse any abnormal stools. Carefully observe the color, amount, consistency, odor, shape, size, frequency of defecation, and complaints of pain.

Collecting the specimen at the convenience of the nursing assistant is not a rule to follow. It should be collected at the correct time. Specimens are collected and tested to prevent, detect, and treat disease. The doctor orders what specimen to collect and the test needed.

Clean gloves protect the hands and wrists from microorganisms in the linens. Sterile gloves allow one to touch a sterile object or area without contaminating it. A mask protects the wearer and client from droplet nuclei and large particle aerosols. Shoe protectors prevent static and microorganism transmission from the floor of one room to another.

The system is no longer a closed system and bacteria might have been introduced; the nursing assistant should report to the nurse immediately for the removal of the catheter and inserting a new one using sterile technique. Placing a towel under the bag and taping up the hole leave the system open, which increases the risk for infection. Replacing the drainage bag is not recommended due to the limitations of the duties of the nursing assistant and the increased risk of infection.

Catching urine midstream reduces the amount of contamination by microorganisms at the meatus. Voiding in a urinal doesn’t allow for an uncontaminated specimen because the urinal is not sterile. When cleaning an uncircumcised male, the foreskin should be retracted, and the glans penis should be cleaned to prevent specimen contamination. Voiding in a clean container is done for a random specimen, not a clean-catch specimen for urine culture.

Careful drying is essential to avoid maceration of the penis. To decrease the risk for infection, wash the penis from the tip the base to reduce the risk for introducing microorganisms into the urethral meatus. Effective cleaning requires soap and thorough rinsing. It’s also essential to remove secretions that accumulate under the foreskin because they can lead to inflammation and are associated with the development of penile cancer. The foreskin of uncircumcised men must be retracted for cleaning, then replaced to prevent paraphimosis (capistration).

Careful drying is essential to avoid maceration of the penis. To decrease the risk for infection, wash the penis from the tip the base to reduce the risk for introducing microorganisms into the urethral meatus. Effective cleaning requires soap and thorough rinsing. It’s also essential to remove secretions that accumulate under the foreskin because they can lead to inflammation and are associated with the development of penile cancer. The foreskin of uncircumcised men must be retracted for cleaning, then replaced to prevent paraphimosis (capistration).

Leaving equipment in the room is appropriate to avoid organism transmission by inanimate objects. Disposing of equipment after each use prevents transmission of organisms but isn’t cost-effective. Wearing gloves protects the nursing assistant, not other clients. Using equipment for other clients spreads infectious organisms among clients.

Stretching the bandage slightly maintains uniform tension on the bandage. Wrapping the bandage loosely wouldn’t secure the bandage on the arm. Using heavy pressure would cause circulatory impairment. Beginning the wrapping at the upper arm would cause uneven application of the bandage. For example, elastic stockings are applied distal to proximal to promote venous return.

180 + 60 + 240 + 50 = 530 ml

Catheter tubing shouldn’t be allowed to develop dependent loops or kinks because this inhibits proper drainage by requiring the urine to travel against gravity to empty into the bag. Permitting the urine to collect in the tubing increases the risk of infection. Observing the catheter and tubing is the responsibility of nursing staff, not the client.

Clients on suicide precautions need constant observation by a staff member. This means that clients are in direct sight of, and no more than 2 to 3 feet away from, a staff member for all activities, including going to the bathroom. Not allowing him to leave his room and removing sharp and cutting objects are part of providing a safe environment, however the availability of an able staff member is a higher priority. Conversing with the client will come after his safety is established.

The client is experiencing an inability to recognize or name objects (agnosia) and needs single step instructions. Provide verbal connections about using implements.

By doing this, the nursing assistant is ensuring the safety of the client. The nurse can then refer the client to the healthcare provider for further assessment and planning for proper care. The other choices are not included in your responsibilities as nursing assistant.

In helping this client, the nursing aide can provide assistance by providing paper and pen for letter writing to his sons. Based on the scenario, the client has concerns for his love and belonging needs and these should not be neglected. The nursing aide can then give the letters to the nurse for evaluation/screening and proper mailing if appropriate.

Clients and families are unique individuals and define their own systems of daily living, which reflect their values, motives, and lifestyles. Providing care for clients coming from ethnic, cultural, or religious backgrounds deserve to receive appropriate and acceptable health care. You must respect and accept the person’s culture.

Major goals for dying clients include maintaining physiologic and psychological comfort and achieving a dignified and peaceful death, which includes maintaining personal control and accepting their declining health status.

he client is in the stage of denial, the first stage of grieving, when he demonstrates artificial cheerfulness and refuses to believe that loss is happening. This indicates that the client is not ready to deal with the reality of the situation. Bargaining is the third stage wherein the client seeks to bargain to avoid loss. The client may express feeling of guilt or fear of punishment for past sins, real or imagined. Depression is the fourth stage wherein the client grieves over what has happened and what he cannot be. The client may talk freely or may withdraw from the people trying to make contact with him. Acceptance is the last stage of the grieving process wherein the client comes to terms with loss. The client may have decreased interest in surroundings and support persons. In addition, the client may wish to begin making plans.

Food preferences for Hispanic clients often include beans and tortillas. These foods are a staple in the Hispanic diet.

The question does not present a client with hearing impairment. Elderly persons, with no underlying hearing problems, are sensitive to sound and can hear normally. By using a low-pitched voice, you will be able to convey your messages clearly to the client instead of shouting

Clients with depression are often overwhelmed by the intensity of their emotions. Talking about these feelings can be beneficial. Initially, the nursing assistant encourages clients to describe in detail how they are feeling. Sharing the burden with another person can provide some relief. At these times, the nursing assistant can listen attentively, encourage clients, and validate the intensity of their experience. It is important at this point that the nursing assistant does not attempt to “fix” the client’s difficulties or offer clichés. These remarks belittle the client’s feelings or make the client feel more guilty and worthless.

Having the conversation directed to the client meets the client’s needs while creating less disturbances. This will help decrease overstimulation, especially for the client who is hearing impaired. Lights in the room should be dimmed to reduce visual overload. Having too many family members with the client will only add to the already sensory-overloaded client.

A client’s chart is the property of the facility. It is the facility which sets the policy and makes appointments for viewing of the chart. Clients do have the right to read the information in their charts. Nevertheless, they do not have the right to see the chart on demand or remove anything from the chart, or remove the chart from the facility. The chart is not a property of the government. It can be used in court as evidence of the client’s problems, treatments, and care, if proper steps are followed.

This is an example of accountability, even when admitting that you did not properly carry out your duties. Flexibility is your ability to adapt to the situation. Dependability is a basic expectation set by your employer, and the nursing assistant demonstrates this by his or her commitment to the job and to the residents. Responsibility is the ability to fulfill duties and expectations in your role as a nursing assistant.

Retraining and a new competency evaluation program are required for nursing assistants who have not worked for 2 consecutive years (24 months). It does not matter how long you worked as a nursing assistant. What matters is how long you did not work.

For good communication, the nurse aid should use words that mean the same thing to the sender and the receiver. Avoid words with more than one meaning.

Because the telephone call is an emergency, the nurse aide may need to answer it. The other appropriate action is to ask another nurse aide on staff to accept the call. However, that is not one of the options given on this question. To maintain privacy and safety, the nurse aide covers the client and places the call light within the client’s reach. Additionally, the client’s door should be closed or the room curtains pulled around the bathing area.

The Kardex is a widely used, concise method of organizing and recording data about a client, making information quickly accessible to all members of the health care team. The Kardex reveals specific data about the client, including therapeutic management done and nursing care. A flow sheet enables nurses to record nursing data quickly and concisely to provide an easy-to-read record of the client’s condition over time. Progress notes provide information about the progress a client is making. Lastly, the nursing discharge summary is completed only when the client is being discharged.

The nurse aide should document only the facts of the situation. Based on the scenario, the cause of the fall was not identified. Thus the facts for documentation are that the client was found lying on the floor upon entering the room.

The nurse aide should never share computer access passwords with other colleagues, as another person could then use the nurse aide’s personal identifier to compromise a client’s confidentiality. The confidentiality of computerized medical records must be maintained.

Having an interpreter present during the communication is the best method to be practiced when communicating with clients who speak a different language. This is arranged by the nurse. Speaking to the family is inappropriate because it violates privacy and does not ensure correct translation. The other two choices are inappropriate and are ineffective ways in which to communicate.

In order to maintain privacy and keep a client warm, it is important to cover areas that are not being bathed. When cleaning the perineal area, wipe front to back. Have the client assist with ADLs, but support them. Do not lotion between toes because it predisposes them to fungal infections.

Inserting an indwelling urinary catheter requires sterile technique, which is not a component of nursing assistant skills.

OBRA requires facilities to help their residents achieve their highest points of physical, psychological, and mental functioning, as well as make choices about their lives.

The patient with hemiplegia should participate in range-of-motion exercises in order to maintain joint function and avoid blood clots. Hemiplegia is a form of paralysis that affects one side of the body, often just one arm and one leg, but at times extending partially to the torso.

Completing tasks as asked indicates reliability. Monitoring vital signs is good, but too general. Communication and tardiness are separate concepts from reliability.

MRSA is a disease transmitted by skin-to-skin contact. It does not require airborne or droplet precautions.

IV drug use is one of the many ways that it is possible to contract the hepatitis C virus.

Legal documentation must be composed with a black or a blue pen in order to be valid.

The blood pressure cuff size is a direct influence on the reading. The blood pressure will read higher with a tight cuff and lower with a cuff that is too large.

This correctly describes how Sims position is different than left lateral position. A pillow is placed between the knees in both positions listed.

Residents should be fully assisted and supervised when turning in order to prevent falls.

Breathing is always priority number one for patients. After that, concentrate on how to apply the vest properly.

The number of respirations is slightly too fast to be considered normal and could be considered a respiratory problem.

Speaking with a patient about a recent, potentially devastating diagnosis, shows a willingness to discuss feelings and issues that may be difficult to talk about.

Convulsions are also sometimes known as seizures.

Milk and other dairy products are usually fortified with vitamin D. This is the best snack to increase intake.

Diabetes is a disease process that occurs due to a disease of the endocrine system and subsequently affects all other systems.

Falls are the number one cause of accidental death in this age group. Work hard to prevent them!

Family stress does not typically interfere with elimination. Aging, medications, and infection do have a direct effect on elimination.

As a nursing assistant, you can’t just leave your patients without transferring their care elsewhere. The nursing supervisor can assist with this process if you are too sick to do so yourself. A fever means that you are an infection risk to residents.

This statement is the only correct documentation because it reflects events as they happened and does not assign blame.

Emphysema is the only truly irreversible disease listed. Asthma may be “outgrown” after childhood, and chicken pox is an acute, short-lived illness. Hypertension may be “cured” with diet, exercise, and medication.

The abbreviation Rx stands for ‘treatment’ or ‘prescription.’

Emesis (vomiting) in the diabetic client can indicate a potential for blood sugar imbalance. This should be reported to the nurse for further assessment.

Visibly soiled hands require scrubbing, soap, and water to clean.

This patient is bargaining to be “forgiven” in order to cure his illness. This is a normal stage in the grieving process.

Clean gloves protect the hands and wrists from microorganisms in the linens. Sterile gloves allow one to touch a sterile object or area without contaminating it. A mask protects the wearer and client from droplet nuclei and large particle aerosols. Shoe protectors prevent static and microorganism transmission from the floor of one room to another.

Falls are the number one cause of accidental death in this age group. Work hard to prevent them!

Emphysema is the only truly irreversible disease listed. Asthma may be “outgrown” after childhood, and chicken pox is an acute, short-lived illness. Hypertension may be “cured” with diet, exercise, and medication.

The nursing assistant cannot ask the patient to measure his own urine, or delay in emptying it. Once the patient is finished, he should ring the bell so that she can measure it and empty it herself.

Bowel training is used with ostomy patients to ensure a regular elimination pattern.

A patient who pockets food may be having a difficult time swallowing.

This should be reported to the patient’s nurse immediately.

Unconscious patients cannot close their mouths around an oral thermometer. Any of the other patient types would be resistant and/or fearful to a rectal thermometer.

If the patient has IV catheters in both arms, a blood pressure cuff will impede their intravenous flow.

Hand gestures are an example of nonverbal communication.

Tai chi is excellent for balance and would help the patient to decrease her risk of falls. Meditation may increase happiness and decrease any depression. Watching TV encourages stasis, not movement, and the rest are perhaps too active.

The apical pulse is assessed through a stethoscope placed over the heart, while the radial pulse is typically taken by applying finger pressure to the inner wrist and counting the number of heartbeats. The difference between the two pulse rates is called the pulse deficit.

AIDS patients require standard precautions. Gloves must be worn at all times when handling blood or other body fluids.

Memory loss after a fall can indicate a concussion. Report it to the nurse immediately.

A soft diet should be tried before a pureed diet for this patient.

Rehabilitation should begin as soon as possible in order to get the most recovery.

Reporting it to the charge nurse will ensure that it is handled properly.

First, check the fingers on the other hand. The client may have overall decreased circulation. If the fingers on the other hand are warm, however, the cast may need to be adjusted.

Clients who want to leave AMA (against medical advice) may do so, but they need to sign an AMA form or their insurance will often not pay for treatment.

Drinking fluids will help to lubricate the secretions so that the patient can cough them up easier.

A cool washcloth can make a patient with a fever feel better. The nursing assistant may not administer medications.