A nurse is admitting a client who is having an exacerbation of heart failure

A nurse is admitting a client who is having an exacerbation of heart failure


A nurse is admitting a client who is having an exacerbation of heart failure. the stroke volume compared to body surface area 2. The nurse notes the client's 24-hr-intake is 1. in planning this client's care, when should the nurse initiate discharge planning? during the admission process a nurse is assessing a client who reports increased pain following physical therapy. You can get this type if you have a heart condition like coronary artery disease. Which is the priority nursing action?, The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. When reviewing the provider's orders, the nurse recognizes that clarification is needed for which of the following medications? A. In The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD) and has a history of heart failure. In planning this client's care, when should the nurse initiate discharge planning? a. a nursing student consults a former class mate to assist with her documentation A. Montelukast D. The nurse is admitting a client diagnosed with coronary artery disease (CAD) and angina. " Study with Quizlet and memorize flashcards containing terms like When instructing clients on how to decrease the risk of COPD, the nurse should emphasize which of the following? A. As soon as the client's condition is stable C. Which symptoms can they expect to find? Select all that apply. Oxygen via face mask at 8 L Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client with pericarditis. . Friction rub at the left lower sternal border. B. Head of the bed elevated to a 45 degree angle 2. In planning this client's care, when should the nurse initiate discharge planning? O During the admission process o As soon as the client's condition is stable During the initial team conference O After consulting with the client's family PREVIOUS CONTINUE Study with Quizlet and memorize flashcards containing terms like A client has intra-arterial blood pressure monitoring after a myocardial infarction. C. postoperative patient with a BP of 116/42 mm Hg. Clients with HF are A nurse is admitting a client who is having an exacerbation of heart failure. HF is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic Study with Quizlet and memorize flashcards containing terms like A nurse is evaluating teaching for a client who has heart failure. during the admission process b. Comfort. Study with Quizlet and memorize flashcards containing terms like 1. In planning this client's care, when should the nurse initiate discharge planning? - During the admission process A nurse is admitting a client who is having an exacerbation of heart failure. At which of the following times should the nurse initiate discharge planning? A. In planning the client's care, when should the nurse initiate discharge planning? During the admission process As soon as the client's condition is stable During the initial team conference After consulting with the client's family A. Have the client use the early-morning hours for exercise and activity. Aug 19, 2024 · People who have CHF exacerbation are usually admitted to the hospital for treatment. ) During the admission process B. A 59 year old woman who smokes cigarettes daily d. While assessing a 68-yr-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. Head of the bed elevated to a 60 degree angle 3. De novo acute heart failure. which of the following interventions is the priority for the nurse to take?, A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. The product of which factors determine a client's cardiac output? Heart rate and ejection fraction Heart rate and urinary output Stroke volume and urinary output Stroke volume and heart rate, A nurse is on orientation in the coronary A nurse is admitting a client who is having an exacerbation of heart failure. The nurse would plan on having which of the following medications readily available for use? Diltiazem (Cardizem) Digoxin (Lanoxin) Propranolol (Inderal) Metoprolol (Lopressor), Which of Study with Quizlet and memorize flashcards containing terms like A nurse assesses clients on a cardiac unit. The increasing prevalence of heart failure in the population is most likely secondary to the aging of the population, increased risk factors, better outcomes for acute coronary syndrome survivors, and a reduction in mortality from Study with Quizlet and memorize flashcards containing terms like A nurse assesses clients on a cardiac unit. As soon as the client's condition is stable C. A decrease in respirations and oxygen saturation, The nurse is assessing Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who is postoperative following a vaginal hysterectomy. During the admission process B. Glyburide is an antidiabetic medication and does not interact directly with digoxin. after consulting with the client's family Study with Quizlet and memorize flashcards containing terms like A client is admitted to the ER with chest pain consistent with myocardial infarction based on elevated troponin levels. ) After consulting with the client's family Dec 28, 2023 · It occurs when the heart is unable to pump effectively and produce enough cardiac output to successfully perfuse the rest of the body’s tissues and organs. Feb 13, 2024 · Heart failure (HF) is a prevalent cardiovascular condition associated with substantial mortality and financial burden. Weight loss of 2 pounds in 24 hours b. The nurse is assessing the client 24 hr later. What action by the nurse is most appropriate? Select one: a. Teach the The nurse is caring for a client with heart failure who is receiving a prescribed angiotensin-converting enzyme inhibitor (ACEI). Study with Quizlet and memorize flashcards containing terms like A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. The nurse would know that the client is exhibiting signs of what kind of heart failure? A. A nurse is collecting data from a client who is being admitted for an exacerbation of congestive heart failure. jugular vein atherosclerosis. A nurse is admitting a client who is having an exacerbation of heart failure. 9% sodium chloride to a client who is postoperative and has fluid volume deficit. patient with a myocardial infarction who has a BP of 140/86 mm Hg. As soon as client's condition is stable C. Prednisone Nov 5, 2023 · Assessment. What should the nurse closely monitor when caring for this client?, A client has been admitted to the cardiac step-down unit with acute pulmonary edema, Which symptoms would the nurse expect to find during assessment?, A nurse is administering digoxin. An increase in creatinine and extremity edema c. ) A. The nurse has been carefully monitoring the trajectory of the patient's signs and symptoms of HF. Restrict the client's fluid intake to less than 2 L/day. The patient is asking how the drug works for heart failure. HF mortality rates have increased since 2012 for both men and women, with a greater annual Oct 27, 2022 · A nurse is admitting a client who is experiencing a heart failure exacerbation. During the initial team conference 4. the clients cardiovascular status can precipitate a brain attack D. Nursing questions and answers. peripheral circulation. The nurse will need to call the health care provider about the a. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?, A nurse assesses a client in an outpatient clinic. Why is the assessment of the client's sensorium and LOC important in clients with HF? HF ultimately affects oxygen transportation to the brain. Which clinical finding is the best indicator that the treatment has been effective? a. Chronic heart failure C. 5 million adults in the United States (US) have a diagnosis of heart failure (HF), and this prevalence is projected to increase to over 8 million people by 20301. A client is admitted to the ICU with a diagnosis of heart failure. during the initial team conference d. The OR report indicates that the patient received large volumes of IV fluids during surgery and the nurse recognizes that the patient is at risk for left-sided heart failure. Presence of a regular gallop rhythm. Sep 19, 2022 · Heart failure is a growing public health problem and is now the most common cause of hospitalizations in the United States (US). 4. Left-sided heart failure is also known as Congestive Heart Failure (CHF). Oxygenation. Which of the following Study with Quizlet and memorize flashcards containing terms like The nurse is admitting an older adult with decompensated congestive heart failure. During the admission process B. a nursing student discusses a client status with the assigned nurse at the bedside C. Which of the following actions should the nurse take first? A) Compare the client's wight to the previous day. Which of the following statements is priority for the nurse to make? Study with Quizlet and memorize flashcards containing terms like The nurse is admitting a client with heart failure. Study with Quizlet and memorize flashcards containing terms like The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient? a. Encourage the client to use the upper chest for respiration. When developing this client's plan of care, the nurse should include which of the following interventions? 1. Cardiac Tamp 3. Tachypnea, An 84-year-old client with heart failure presents to the emergency department with A nurse is caring for a client with heart failure who has signs of reduced cardiac output. Types of acute heart failure include: Acute decompensated heart failure (ADHF). b. What question would Study with Quizlet and memorize flashcards containing terms like A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician's office. Tachypnea, 1. What is the most important assessment for the nurse to Study with Quizlet and memorize flashcards containing terms like A home health nurse is planning care for a client who has COPD. When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Decreased urine outputC. 9% NaCl at 125 mL/hr b. newly admitted patient with a BP of 150/87 mm Hg. 3. The nurse educates the client with the goal of preventing readmission. A nurse is admitting a client who experiencing an exacerbation of heart failure. , 2 Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who develops a pulmonary embolism. 5 million adults in the United States (US) (1 in 4 people) will develop HF in their lifetime, with projections trending to upwards of 8. 750 mL and output is 425 mL. Which statement alerts the nurse to the possibility of left-sided heart failure?, A nurse assesses a client admitted to Click to highlight the finding below that require immediate follow-up, A nurse is caring for a client who is experience an exacerbation of heart failure. A nursing diagnosis of "decreased In the case of a client who has an exacerbation of heart failure, delaying discharge planning until this time could result in overlooking essential care needs. At which of the following times should the nurse initiate discharge planning? a. Ascites e. Symptoms of heart failure include those due to excess fluid accumulation (dyspnea, orthopnea, edema, pain from hepatic congestion, and abdominal distention from ascites) and those due to a reduction in cardiac output (fatigue, weakness) most pronounced with physical exertion. Depending on medical history, treatment may include diuretics to treat edema, beta-blockers to slow down the heart rate, and ACE inhibitors to lower blood pressure. Crackles in both lungs c. An individual can have right-sided or left-sided heart failure as well as systolic or diastolic heart failure. The nurse should alert the HCP because these changes are most consistent with which complications? Cardiogenic shock 2. How should the nurse position the client in order to decrease preload?, The nurse is gathering data from a client recently admitted to the hospital. Perfusion. Right-sided A nurse is admitting a client who is having an exacerbation of heart failure. Instruct the client to use pursed-lip breathing. In planning this client's care, when should the nurse initiate discharge planning? During the admission process As soon as the client's condition is stab! During the initial team conference After consulting with the client's family CONTINUE PREVIOUS Study with Quizlet and memorize flashcards containing terms like ?: the nurse completed an assessment on a client with a decreased cardiac output. A nurse is talking with the partner of a client who has dementia. Heart sounds are normal and VS are noted on the client's chart. In planning this client's care, when should the nurse initiate discharge planning? 1. Which should the nurse implement? Select all that apply. Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. increased right atrial pressure. You can get this type if you have no history of heart disease. 5 million people by 20301. Maintain a high-protein diet. The nurse should question which doctor's order? a. Your solution’s ready to go! 1) insert the suction catheter while the client is swallowing 2) apply intermittent suction when withdrawing the catheter 3) place the catheter in a location that is clean and dry for later use 4) hold the suction catheter with her clean, nondominant hand CORRECT: 2) apply intermittent suction when withdrawing the catheter 1) nurse should insert the suction catheter while the client is A nurse is admitting a client who is having an exacerbation of heart failure. , A nurse assesses clients on a cardiac unit. the client inserts the needle at a 30 degree angle A nurse is caring for a client who has heart failure. Avoid exposure to people with known respiratory infections. Which of the following questions should the nurse ask when assessing the quality of the client's pain?, A nurse is performing a skin assessment for a client who expresses concern about skin cancer. During initial team conference D. Peripheral edema b. In planning this client's care, when should the nurse initiate discharge planning? during the admission process - Discharge planning should begin as soon as the client is undergoing the admission process. Which nursing activity for this client would represent tertiary level prevention? A) Teaching about adhering to a low-sodium diet A client has received the diagnosis of right-sided heart failure. Which of the following changes should the nurse identify as an indication that the treatment was successful?, a nurse is caring for a client who is scheduled to be transferred to a long-term care facility. A decrease in blood pressure and urine output b. B) Reduce the client's sodium intake. Which of the following indicators demonstrates efficacy of this therapy?A. 2. Increased abdominal girth d. the volume of blood ejected from the ventricle in one minute 3. which of the following questions should the nurse ask when assessing A. Which of the following interventions should the nurse include in the plan of care?, A client is admitted to the emergency room with the diagnosis of advanced lung cancer, the client reports dyspnea on exertion and at rest and her family states that she has become A nurse is admitting a client who is having an exacerbation of heart failure. decreased blood flow. In planning this client's care, when should the nurse initiate discharge planning? A. C) Encourage the client to change positions frequently. the body's oxygen supply. A nurse is admitting a client who is having an exacerbation of asthma. When reviewing the provider's orders, the nurse recognizes that clarification is needed for which of the following prescribed medications? Propranolol. The nurse should evaluate the client even during admission procedure and plan the patient's care based on symptoms and needs while in the hospital and after discharge. After consulting with the client's family - answer During the admission process A nurse is admitting a client who is having exacerbation of heart failure. the increased BP can cause the graft to occlude B. After consulting with the client's family Question: A nurse is caring for a client admitted with an exacerbation of congestive heart failure. In planning this client's care, when should the nurse initiate discharge planning? During the admission process A nurse is admitting a client who is having an exacerbation of his asthma. Which assessment finding would the nurse expect to find? a. What indication does the nurse have that this is occurring? Heart rate of 72 beats/minute Respiratory rate of 20 breaths/minute Oxygen saturation 94% Blood pressure 80/46 mm Hg Study with Quizlet and memorize flashcards containing terms like a nurse is administering 1 L of 0. When should the nurse initiate discharge planning in planning this client's care? A. Which assessment findings will the nurse expect the client to have? (Select all that apply. Flatness of the jugular veinB. as soon as the client’s condition is stable A nurse is admitting a client who is having an exacerbation of heart failure In from NUR 2356 at Hillsborough Community College a nurse is admitting a client who is having an exacerbation of heart failure. Which of the following findings is a manifestation of DVT, Complete the diagram: the client present to the ED stating that they had a sudden on set of dyspnea while taking a shower, A nurse is caring for a client who is prescribed warfarin Aug 30, 2022 · If a nurse is admitting a client who is having an exacerbation of his asthma, the nurse would recognize that clarification is needed for Propranolol. Patient being discharged after an exacerbation of heart failure. S3 heart sound Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with right-sided heart failure. During the initial team conference D. ) During the initial team conference D. Thus, the correct A client with heart failure is having a decrease in cardiac output. Request a dietary consult for a sodium Study with Quizlet and memorize flashcards containing terms like A client is admitted with early-stage heart failure. Sep 20, 2011 · Heart failure exacerbations are very common reasons for hospitalization in the United States and Canada. ) As soon as the client's condition is stable C. During client education, the nurse informs the client that heart failure affects: the body's mechanism to eliminate CO and metabolic wastes. The Study with Quizlet and memorize flashcards containing terms like The nurse is performing an assessment on a 57-year-old client with newly diagnosed heart failure. The nurse administers the prescribed intravenousfurosemide. The client reports having several specialist providers who they visit on a regular basis. The ACEI reduces fluid volume B. The left ventricle of the heart is larger and is responsible for most of the pumping action. D. Theophylline C. Crackles on lung examD. A nurse is caring for a client who has COPD. the assigned nurse views the medical chart with a nursing student B. This position aids in the patient's chest expansion and oxygenation. patient with left ventricular failure who has a BP of 110/70 mm Hg. Science. Furosemide (Lasix) 20 mg PO now c. Propranolol , sold under brand names such as Inderal, is in the beta-blocker class of drugs. after consulting with the client's family Study with Quizlet and memorize flashcards containing terms like A nurse is admitting a client to a healthcare facility the nurse is placing the client on isolation precautions which of the following interventions should the nurse include, A client who is postoperative is verbalizing pain as a two on a pain scale of 0 to 10 which of the following statements are the nurse identify as an Study with Quizlet and memorize flashcards containing terms like A client with heart failure is having a decrease in cardiac output. The nurse should develop a plan of care that is based on the fact that the client may have a low tolerance for exercise related to: increased blood flow. the assigned nurse returns a call to the client's POA to discuss client's care D. In planning this client's care, when should the nurse initiate discharge planning? During the admission process (Discharge planning should begin as soon as the client is undergoing the admission process. [1] A nurse is admitting a client who is experiencing an exacerbation of heart failure. Propranolol B. Which signs/symptoms would the nurse expect to find when assessing this client?, The nurse is developing a nursing care plan for a client diagnosed with congestive heart failure. Participate regularly in aerobic exercises. d. During the admission process, the nurse should initiate discharge planning. Which concept is priority? Sleep, rest, activity. When a patient is having an exacerbation of congestive heart failure (CHF), the practical nurse (PN) must place the patient in Fowler's position, which is a reclined position with the back at a 30-60 degree angle. What indication does the nurse have that this is occurring?, A client has been admitted to the cardiac step-down unit with acute pulmonary edema. during the admission process B. On the day prior to d/c A nurse is admitting a client who is experiencing an exacerbation of heart failure. Left-sided heart failure B. The nurse is caring for an 84-year-old man who has just returned from the OR after inguinal hernia repair. A buildup of fluid occurs, causing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. Hourly urine output greater than Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who reports increased pain following physical therapy. As soon as the client's condition is stable 3. An increase in heart rate and respiratory rate d. Which client would the nurse identify as being at GREATEST risk for the development of left-sided heart failure? a. During the initial team conference D. after administrating high flow oxygen which of the following actions is the nurses highest Feb 7, 2024 · Over 6. ) a. incompetent jugular vein valves. None of the options is correct. increased blood viscosity. Which of the following findings should the nurse Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Feb 2, 2022 · Heart failure (HF), sometimes referred to as Congestive Heart Failure (CHF), occurs when the heart can’t supply blood effectively to the rest of the body. At which of the following times should the nurse initiate discharge planning? b. After consulting with the client's family A nurse is admitting a client who is experiencing an exacerbation of HF. the amount of blood returning Nov 29, 2023 · A nurse is admitting a client who is having an exacerbation of heart failure. Which symptoms would the nurse expect to find during assessment?, The nurse is caring for a client with suspected A nurse is admitting a client who is having an exacerbation of heart failure. The nurse asks the client about experiencing orthopnea. A nurse is admitting a client who is having an exacerbation of heart failure. A 42 year old man with pulmonary hypertension c. Acute heart failure D. Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who reports increased pain following physical therapy. Which is the "BEST" position for the nurse to place the client in when observing for JVD? #71941465 (20) 1. On the day prior to d/c The nurse is teaching a client with heart failure about nutrition. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. PE 4 A nurse is admitting a client who is having an exacerbation of heart failure. the hypervolemia needs to be corrected immediately C. In planning this client's care, when should the nurse initiate discharge planning? During the admission process A nurse is admitting a client who is having an exacerbation of heart failure. An 84-year-old client with heart failure presents to the emergency department Study with Quizlet and memorize flashcards containing terms like A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. The nurse notes the client's heart rate has increased from 88 to 110 beats/min, and the blood pressure dropped from 120/82 to 100/60 mm Hg. decreased pain. During admission process B. Why would it be important for the nurse to closely monitor an older adult Study with Quizlet and memorize flashcards containing terms like A client is diagnosed with right-sided heart failure. What medication can the nurse administer with a health care provider's order that will relieve anxiety and slow respiratory rate?, The nurse is Study with Quizlet and memorize flashcards containing terms like The nurse is performing an initial assessment of a client diagnosed with heart failure (HF) that includes the client's sensorium and level of consciousness (LOC). during the initial team conference D. At which of the following times should the nurse initiate d/c planning? A. A. A 70 year old man who had a Jun 19, 2023 · A nurse is admitting a client who is having an exacerbation of heart failure. In which of the following types of research studies is the nurse participating?, A nurse is teaching a class about citing references to use for evidence-based changes. Approximately 6. How should the nurse interpret the findings related to the diagnosis of heart failure? This content is intended as a Quick Reference for Congestive Heart Failure and Pulmonary Edema and will cover an overview and nursing considerations utilizing the nursing process. Which findings should recieve highest priority?, ?: the nurse is admitting a client with diagnosis of right sided heart failure resulting in pulmonary hypertension. 46. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. as soon as the client's condition is stable c. Abstain from cigarette smoking. This admission is the client's third admission within 90 days. What will the nurse include in teaching the client about this medication? (Select all that apply. Allow the A nurse is admitting a client who is experiencing an exacerbation of heart failure. , The nurse teaches a client with COPD to Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with a diagnosis of heart failure. In planning this client's care, when should the nurse initiate discharge planning? During the admission process As soon as the client's condition is stab! During the initial team conference After consulting with the client's family CONTINUE PREVIOUS Find step-by-step Health solutions and your answer to the following textbook question: A nurse is admitting a client with an exacerbation of heart failure. on the day prior to discharge Study with Quizlet and memorize flashcards containing terms like The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Medicate the client for pain. which best describes cardiac output 1. Patient admitted with a large acute myocardial infarction. Study with Quizlet and memorize flashcards containing terms like A patient has been prescribed a digitalis preparation for heart failure. V has been admitted for exacerbation of his chronic heart failure (HF). A client is diagnosed with right-sided heart failure. Coarse crackles in bilateral lung bases. As soon as the client's condition is stable C. The nurse knows this finding indicates a. The home health nurse is assigned a client diagnosed with heart failure. Which statement made by the client indicates an understanding of the teaching? "I need to reduce the amount of fluids I drink like the health-care provider said. Which A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. She has pitting edema in both ankles, and her vital signs are blood pressure (BP) 170/100 mm Hg, pulse 92 beats/min, and respiration 28 breaths/min. decreased fluid volume. among patients 65 years and older. Intravenous (IV) 500 mL of 0. What clinical manifestations are most likely found?, ?: the nurse evaluates 4 Jul 31, 2024 · Mr. Which of the following 3 statements by the client indicates an understanding of the teaching?, After reviewing the assessment findings, which of the following actions should the nurse plan to take? Select the 3 actions that the nurse should plan to take. Choice A rationale: A client who takes glyburide for type 2 diabetes mellitus is not at significant risk for developing digoxin toxicity. Heart rate that speeds up and slows down. Hourly urine output greater than Study with Quizlet and memorize flashcards containing terms like A nurse is collecting data from a group of clients regarding their feelings and experiences of living with congestive heart failure. Patient who had a mitral valve replacement with a mechanical valve The nurse is assessing for the presence of jugular venous distension (JVD) on a newly admitted client with a history of heart failure. What factor will worsen the client's myocardial function?, A client develops cardiogenic pulmonary edema and is extremely apprehensive. Which assessment finding does the nurse expect? a. During the admission process 2. In severe cases, the patient needs the mechanical support of a ventilator until the acute symptoms have resolved. c. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. Acute heart failure can happen even if you don’t have a previous heart issue. A 36 year old woman with aortic stenosis b. He starts coughing up frothy, pink sputum. Study with Quizlet and memorize flashcards containing terms like A patient with a history of chronic congestive heart failure is hospitalized with severe dyspnea and a dry, hacking cough. the volume of blood ejected from the ventricle with each heartbeat 4. , In preparing for discharge teaching, which of the following actions can the client take to most accurately monitor for an exacerbation of chronic heart failure?, When a client is admitted for Heart failure A client with heart failure has decreased cardiac output caused by the heart's decreased pumping ability. the clients intraarterial pressure may compromise the graft's viability, A nurse is caring for a client with a diagnosis of right ventricular heart failure. hpkk aaaj uqvanv rydww lpyul nlc bkwxpd xzdnb hqkm qwrv