CCRN Exam Preparation: 190 Critical Care Nursing Questions and Answers, Exams of Nursing

Download CCRN Exam Preparation: 190 Critical Care Nursing Questions and Answers and more Exams Nursing in PDF only on Docsity! CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent deployment, For optimal care of the patient, the nurse should: - Correct Answer ✅ Continuously monitor the patient in lead II It is best practice to monitor the patient status post PCI with stent, in the lead that was most abnormal during the acute occlusion. The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely for which of the following? - Correct Answer ✅ Complication likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or dysfunction due to the anatomical distance between the RCA and the papillary muscle. Which of the following hemodynamic profiles would benefit from the aggressive fluid administration, pressers and antibiotics therapy? CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - Correct Answer ✅ B. the hemodynamic profile of RAP 5, PAOP 7, SVR 400 is typical of septic shock, and choice B would be the best approach. Which of the following is indicative of a mixed acid-base disorder? A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11 B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - Correct Answer ✅ The decrease in PaCO2 is evidence of respiratory alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt with severe sepsis or septic shock may present with this mixed acid-base disorder. The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is instructed to reposition the patient to try and correct the problem. The CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions The postoperative thoracic surgery patient has bubbling in the water seal drainage chamber of the chest tube. Which of the following interventions is indicated? - Correct Answer ✅ avoid high airway pressures Bubbling in the water seal chamber is due to a pleural air leak, and high airway pressure will either prevent resolution of the current air leak or make it worse. Which clinical sign might patients with both systolic and diastolic heart failure have in common? - Correct Answer ✅ Lung crackles Both a problem with systolic (ejection problem) and diastolic (filling problem) will increase left heart pressure and cause cardiogenic pulmonary edema (lung crackles). Which of the following is most likely to result in a low Sv02? A. Hypotermia CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions B. Fever C. Severe sepsis - Correct Answer ✅ Fever Fever increases metabolic rate and consumption, which may lead to a drop in mixed venous oxygen saturation. The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which of the following interventions will best assess this? - Correct Answer ✅ Perform a square wave test The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic injury. Which of the following interventions is most appropriate? - Correct Answer ✅ Warm blood products and crystalloids Warming fluids and blood needed for traumatic injury will prevent hypothermia and its related adverse effects. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Which of the following therapies should be avoided for the patient with cardiogenic shock? - Correct Answer ✅ high dose vasopressors Vasopressors increase left ventricular after load, which would increase myocardial work of a failing heart. The patient is status post repair of an aneurysm for subarachnoid hemorrhage. Which of the following interventions is indicated to prevent vasospasm? - Correct Answer ✅ Nimodipine (Nimotop) is a calcium channel blocker that is started immediately post- op to prevent arterial spasm of the brain. The patient presents with a rigid abdomen, rebound tenderness, and a free air in the peritoneum seen on KUB x- ray. Which of the following should the nurse anticipate? - Correct Answer ✅ Powell perforation; provide fluids, prepare for surgery. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions The patient has a massive pulmonary embolism. Which of the following would be expected? - Correct Answer ✅ Hypotension, increased alveolar dead space. Massive pulmonary embolism results in sudden extremely elevated pulmonary pressures with resultant right ventricular failure and decreased left ventricular pressure. The drop in CO results in hypotension. The clot obstructs pulmonary perfusion which results in increase headspace ventilation. The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The patient would benefit from which of the following interventions? - Correct Answer ✅ dependent position of legs The clinical signs are indicative of peripheral arterial occlusive disease. Dependent leg position will aid perfusion. Which of the following are clinical signs of variant (Prinzmetal's) angina? - Correct Answer ✅ ST-elevation, resolves with nitrate therapy. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions This type of angina is thought to be due to arterial spasm at the point of coronary artery plaque, not due to plaque rupture. The ST elevation is transient because the spasm is relieved with nitrates; therefore infarction does not occur. The most specific clinical sign for the presence of brain death would include which of the following? - Correct Answer ✅ Absent oculocephalic reflex If eyes remain midline or turn to the side of head rotation, it is a sign of cranial nerve VIII damage and possible brain death. The apnea test is positive in the presence of brain death; while coma is present during brain death, most patients with coma do not have brain death. The physician determines the patient has ARDS. The patient has developed refractory hypoxemia, bilateral infiltrates, and pulmonary edema on chest x-ray. What findings would be expected? CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions a. increased lung compliance b. PAOP normal or low c. decreased cardiac output - Correct Answer ✅ b. The pulmonary edema of ARDS is due to lung capillary leak at normal or even low left heart pressure, unlike cariogenic pulmonary edema, which results in pulmonary edema at higher than normal left heart pressure. The patient presents one month status post gastric bypass bariatric surgery with vomiting, headache, diplopia, and memory loss. These are clinical signs of which of the following? - Correct Answer ✅ Malabsorption The signs and symptoms are those of malabsorption, which results in vitamin deficiency and may occur after bariatric surgery. The remaining choices are not manifested by the signs and symptoms described. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Higher mortality than inferior: Heart Failure Complications of PCI: - Correct Answer ✅ Stent thrombosis is most likely to be on the test (most incidents occur acutely within 24hours of stent placement or sub acutely within the first 30 days. Retroperitoneal bleed is most likely to be on test What two drugs do you use for HTN crisis/emergency? - Correct Answer ✅ Nitroprusside and Labetalol Nitro is a preload and afterload reducer. Assess for cyanide toxicity secondary to drug metabolite (Thiocyanate): mental status change (restlessness, lethargy), tachycardia, seizure, a need for increase in dose. Tests to use for PAD? - Correct Answer ✅ Ankle-brachial Index - used to access lower extremity perfusion; normal is greater than 1 CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Doppler ultrasound testing Arteriography Position for PAD patient? - Correct Answer ✅ Bed in reverse Trendlenburg Do NOT elevate the affected extremity - will decrease perfusion Meds: Thromolytics, Anticoagulants, ASA, Vasodilators Drugs that cause Prolongation of the QT interval ? - Correct Answer ✅ Procainamide, haloperidol, quinidine, amiodarone Electrolyte problems: hypokalemia, hypocalcemia, hypomagnesemia Pacemaker code: - Correct Answer ✅ First initial: Paced 2nd initial: Sensed CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions 3rd: inhibited What is contraindicated with Diastolic heart failure? - Correct Answer ✅ Positive inotropes Dehydration further worsens filling Tachyarrhythmias decrease filling time and worsen symptoms Chest x-ray finding in systolic heart fx? - Correct Answer ✅ may be evidenced by large, dilated heart or by normal heart size on chest film. Causes of Right side heart failure? - Correct Answer ✅ Acute RV infarct Pulmonary Embolism Septal defects Pulmonary stenosis/regurgitation COPD Pulmonary htn CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Neuro Assessment: First sign of a neuro problem? - Correct Answer ✅ LOC - except for an epidural hematoma that may cause pupil changes before an LOC change. GSC Score: - Correct Answer ✅ 15 (best) 3 (worst) If the score is 8 or less, outcome is poor Which is worse, obtunded or stuporous? - Correct Answer ✅ Stuporous - pt cannot speak, moan, grimace. Obtunded - can speak, mumble words. Uncle Herniation: - Correct Answer ✅ Lateral shift, NO initial change in LOC Most often caused by epidural hematoma that occurs in temporal area, some strokes CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Central Herniation: - Correct Answer ✅ Swelling on both sides, downward displacement of hemispheres Slight change in LOC and then coma First both pupils are small (1-3mm) then parasympathetic innervation on both sides is suppressed and both pupils dilate Treatment of Vasospasm? - Correct Answer ✅ Prevent vasospasm by providing CCB - nimodipine (Nimotop) 60mg q 4hrs, for aneurysmal SAH The first sign of an increase in ICP? - Correct Answer ✅ LOC since the "higher" centers of the brain show symptoms first and then progress down toward the brain stem. Hypotension in the presence of Elevated ICP? - Correct Answer ✅ Can be devastating!!! Higher MAP is better than low MAP Brain death is less 30mmHg CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions s&s of increased ICP? - Correct Answer ✅ Altered LOC Restlessness/agitation Headache Pupillary changes When using the fluid-filled system, the level of the transducer should be at the? - Correct Answer ✅ External auditory meatus, which is at the level of the foramen of Monro Neuro Waves? - Correct Answer ✅ "A" are awful "B" are bad "C" are common In the presence of Elevated ICP: AVOID? - Correct Answer ✅ Acidosis - causes vasodilation which increases ICP CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions A patient with an inferior wall MI has sinus bradycardia with a BP 110/70 and HR 52. A nurse should plan to ? - Correct Answer ✅ Continue to monitor vital signs A patient is at the highest risk of developing aspiration pneumonia? - Correct Answer ✅ Pt with endotracheal intubation with nasogastric tube Which of the following physiological changes should a nurse anticipate when caring for a postoperative pt with morbid obesity ? - Correct Answer ✅ Decreased functional residual capacity Which fluid is the initial treatment for severe DKA? - Correct Answer ✅ IV fluids 0.9% Which of the following complicating factors is the most crucial in the care of a critically ill patient with CKD? - Correct Answer ✅ Volume status, electrolyte imbalance, and vascular access CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions A pt with a diagnosis of small bowel obstruction has a Miller- Abbott tube in place. A nurse's first priority in the management of this tube is to? - Correct Answer ✅ Connect the tube to low intermittent suction A pt who is suspected to have developing SIRS, a nurse should monitor for? - Correct Answer ✅ WBC of 14,000 and HR 123 Leukocytosis and tachycardia, along with hyper/hypothermia and tachypnea, are the defining criteria for SIRS ABG of early STATUS ASTHMATICUS? - Correct Answer ✅ Respiratory Alkalosis Lab values of increased INR, PTT, and FSP. Hgb, platelets, and fibrinogen are decreased. These values indicate what? - Correct Answer ✅ DIC The goal of permissive hypothermia is to do what? - Correct Answer ✅ decrease the ICP 15 or less. Higher readings exert CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions pressure on the structures of the brain and impede adequate blood flow to the brain. During resuscitation phase of caring for a patient with a liver injury from acute abdominal blunt force trauma, the focus should be to ? - Correct Answer ✅ stabilize hemodynamics What lab value is consistent with Rhabdomyolysis? - Correct Answer ✅ hyperkalemia and hypocalcemia Is pulmonary fibrosis related to Status Asthmaticus? - Correct Answer ✅ PF is generally idiopathic and unrelated to Status Asthmaticus Which of the following alterations in pulmonary status is most likely to occur in a pt with status asthmaticus? - Correct Answer ✅ Hyperinflation Which acid-base problem is mostly seen in pts with renal failure? - Correct Answer ✅ metabolic acidosis CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions BUN in liver dz? - Correct Answer ✅ breakdown of BUN releases ammonia - so make sure patient is not dehydrated because this will lead to high levels of BUN Do you want people with liver dz to have high levels of protein? Why not? Do you want people with liver dz to have an increase in acid? - Correct Answer ✅ No - it leads to ammonia which will lead to hepatic encephalopathy No! Metabolic acidosis due to low BP Do you give Ringers Lactate to someone with Liver dz? - Correct Answer ✅ No! It cannot convert to bicarb because of the liver dz - it will convert to lactic acid Which medication do you give to someone with liver dz? - Correct Answer ✅ Neomycin - because it does not release ammonia, BUT it leads to Vitamin deficiency CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions How to tell if you have hepatic failure or billiary tract dz? - Correct Answer ✅ Bilirubin and albumin are unconjucated until they go to the liver, where they get conjucated and go to the gallbladder. If someone has indirect or unconjucated bilirubin is it hepatic failure or billiary tract dz? - Correct Answer ✅ Hepatic failure Opposite would be gallbladder problem Ruptured spleen has what signs? - Correct Answer ✅ Kehrs sign - left shoulder pain What does diuretics do to someone with liver dz? - Correct Answer ✅ Lowers their potassium Pre renal failure: - Correct Answer ✅ kidneys are healthy, but blood is not getting down to the kidneys, so no urinary output. TX: FLUIDS or INOTROPIC DRUGS CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Renal stage of acute renal failure: - Correct Answer ✅ Kidney damage - most common cause is acute tubular necrosis Nephrotoxicity is caused by: - Correct Answer ✅ eating heavy metals/Meds/street drugs/ rhabdomyolysis How to tell Pre renal vs Renal? - Correct Answer ✅ Pre renal - needs fluids and inotropic drugs - check urinary sodium level: 20 or less is pre renal. Check BUN/Creatinine levels: BUN 20:1 or Bun of 60 and creatinine of 3 is pre renal Renal - urinary sodium level: 40 or more is renal stage. BUN/Creatinine levels: BUN 10:1 Bun of 60 and Creatine 6 is Renal Treatment for hyperkalemia ? - Correct Answer ✅ Calcium chloride and insulin and glucose and sodium bicarbonate CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Resp > 20 bpm WBC > 12,000 or < 4,000 OR bands > 10% (shift to the left) Sepsis clinical manifestations: - Correct Answer ✅ must include 2 or more of the SIRS criteria plus a documented infection (culture) or suspected infection. Suspected infection is the presence of one or more of the following: *positive culture results from blood, sputum, urine, etc. *receiving antibiotic, anti fungal, or other anti-infective therapy *altered mental status in elderly *possible pneumonia (infiltrate on chest radiograph) Severe Sepsis: - Correct Answer ✅ sepsis PLUS markers of organ dysfunction. Examples of organ dysfunction: Hypotension Acute hypoxemia Lactate greater than 2 CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Platelets below 100,000 Septic shock: - Correct Answer ✅ septic shock is severe sepsis plus one of the following: *Systemic MAP < 65mmHg despite adequate fluid resuscitation *Maintaining the MAP>65 requires a pressor, e.g., levo, dopamine, epi. S&S of early Septic Shock: S&S of late Septic Shock: - Correct Answer ✅ Tachycardia, bounding pulse B/P normal or low Skin warm, flushed Respirations deep, somewhat fast Fever (temp>38C) Hypotension Tachycardia, pulse weak and thready CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Skin cool, pale Temp <36C The patient with severe sepsis or septic shock always has positive blood culture T/F? - Correct Answer ✅ True What is the reversal agent for benzodiazepine? - Correct Answer ✅ Flumazenil (Romazicon) Tylenol poisoning: - Correct Answer ✅ N-acetylcysteine (MUCOMYST), dosing effective for 8 hours after ingestion GI lavage with activated charcoal within 4 hours of after ingestion *Tylenol damages the liver: I - nausea II - RUQ pain III - Liver function abnormalities CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Idiopathic (immune) Thrombocytopenic Purpura: - Correct Answer ✅ In ITP antibodies form and destroy the body's platelets resulting in thrombocytopenia Etiologies: Bone Marrow does not produce enough platelets Platelets become entrapped in enlarged spleen Use or destruction of platelets increases ITP s&s - Correct Answer ✅ Platelets are less than 50,000 Both Hb and HCT are decreased Pallor, petchiae, purpura, ecchymoses, and oozing of blood from venipuncture sites Difference between DIC and ITP: - Correct Answer ✅ DIC has increased fibrin splits products whereas ITP does not CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Multisystem Trauma: Know what? - Correct Answer ✅ AMPLE a- allergies m- meds p- past illnesses l - last meal e- event preceding injury Release of what substance into the circulation secondary to retained dead fetus, abruptio placenta, and stress may cause disseminated intravascular coagulation? - Correct Answer ✅ Tissue thromboplastin The beneficial effects of heparin in DIC are thought to be due to its: - Correct Answer ✅ Neutralizing of free-circulating thrombin Complications of PEEP? - Correct Answer ✅ Barotrauma (rupture of lung tissue) CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Renal transplant acute rejection occurs within? - Correct Answer ✅ 1-2 weeks A-sline, dicrotic notch is the closure of ? - Correct Answer ✅ aortic valve. ARDS...Keep patient what? Acidosis causes what? - Correct Answer ✅ keep patient dry (decrease fluids) Increased potassium levels A 55-year-old man has had an anterior myocardial infarction. He developed a third-degree AV heart block and required insertion of a temporary transvenous pacemaker. The pacemaker is functioning in VVI mode. The rhythm strip shows pacing spikes landing indiscriminately in relation to the patient's inherent rhythm. Which of the following would be the best action to correct the situation? - Correct Answer ✅ Increase the sensitivity CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Consider that failure to capture occurs when the electricity from the pacemaker does not cause depolarization of the ventricle (or atria if an atrial pacemaker). It would be logical to consider using more electricity (i.e., milliamperage). Which of the following statements about colloids is correct? - Correct Answer ✅ They increase intravascular colloidal oncotic pressure. She has had a craniotomy to evacuate the clot, and an intraventricular catheter was placed during surgery. While the nurse is monitoring the patient's intracranial pressure (ICP), the pressure climbs to 40 mm Hg but returns to 15 mm Hg almost immediately. This describes which of the following? - Correct Answer ✅ B wave Normal ICP has a pressure of 5 to 15 mm Hg. An elevation of ICP to 20 to 50 mm Hg occurring every 30 seconds to 2 minutes is a B wave. An elevation of ICP to 50 to 100 mm Hg lasting longer than 2 minutes is an A wave. An elevation of ICP to 20 to 25 mm Hg every 4 to 8 minutes is a C wave. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions What three things tell you heart catheter has flipped back into right ventricle? - Correct Answer ✅ Three things tell you that the catheter has flipped back into the right ventricle: drop in diastolic pressure, loss of dicrotic notch, and initiation of ventricular ectopy. Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected left anterior descending (LAD) artery occlusion? - Correct Answer ✅ V3 Normal osmolality of body fluids? - Correct Answer ✅ 275- 295 Normal urine osmolality? - Correct Answer ✅ 1.010 - 1.020 What is the biggest danger to hyponatremia? - Correct Answer ✅ Seizure What is the dilute urine range of DI? - Correct Answer ✅ 1.001 - 1.005 CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Treatment of DI? - Correct Answer ✅ Give ADH (Pitressin, DDAVP) Characteristics of DKA? - Correct Answer ✅ Blood sugar: >250 Elevated potassium in the presence of acidosis, although total body potassium is low, it decreases as acidosis is corrected Younger/Type 1 diabetes Insulin production: No Breathing pattern: Kussmaul Tx for DKA: - Correct Answer ✅ Insulin, fluids 0.9 saline, 0.45 saline (if sodium high and B/P normal or high) CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions S&S of HIT: - Correct Answer ✅ Platelets < 150,000 or drop 30% to 50% Early sign - PETECHIAE Clots may lead to PE, MI, stroke, amputation Tx for HIT: - Correct Answer ✅ Stop HEPARIN (fractionated as well as unfractionated) Test for presence of heparin antibodies, ELISA, but do not wait for test results to stop heparin and start treatment Start warfarin Platelets < 10,000, monitor for changes in LOC (intracranial bleed) What is decreased in Cardiogenic shock: - Correct Answer ✅ BP CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions CI/CO SvO2 Everything else is increased: RAP/PAOP/PAP/SVR/PVR What is increased in hypovolemic shock? - Correct Answer ✅ SVR Everything else is decreased What is increased in Septic shock (early)? - Correct Answer ✅ CO/CI/SV/SvO2 What is increased in Septic shock (late)? - Correct Answer ✅ Just SVR and maybe PAOP What is decreased in pulmonary edema? - Correct Answer ✅ CO/CI/SV/SvO2 CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions What does dopamine do in medium (4-10) dose and high (11- 20) dose do? Also, Levo/Neo and EPI doses? - Correct Answer ✅ It increases everything: B/P CO/CI SVR/PVR HR PAP/RAP/PAOP What does Nitro do? - Correct Answer ✅ It decreases everything except in cases of high dosage which could increase CO/CI/HR indirectly by decreasing Afterload What does Dobutamine do? - Correct Answer ✅ It decreases PAOP/SVR It increases CO/CI/HR Preload therapies: Increases? - Correct Answer ✅ Volume expanders: Crystalloids CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions >02 demand (fever, shivering, seizures, increased WOB) Giant V waves is most likely caused by? - Correct Answer ✅ Mitral Valve Insufficiency TIA RIND Cerebral Infarct - Correct Answer ✅ Transient Ischemic Attack - some one has a stroke, 24hrs later they're better. Reversible Ischemic Neuro deficit - same as TIA, except it takes three about 3 months to get better. Stroke - problem is caused by basal vestibular artery. Lacking blood to brain stem. When you have a stroke - what is the goal? - Correct Answer ✅ Reduce cerebral edema. Give d5w CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Problem with the cortex? - Correct Answer ✅ Decorticate Brainstem problem? - Correct Answer ✅ Decerebrate Positive babinski in both feet - problem with what? - Correct Answer ✅ Problems on both sides of your head. parasympathetic innervation makes pupil what? Sympathetic innervation makes pupil what? - Correct Answer ✅ Pinpoint Dilates Lateral shift in the brain is called what? - Correct Answer ✅ uncal herniation - first change is pupil dilation on affected side. CCRN QUESTIONS and Answers (Latest Update 2024) 190 Questions Uncal herniation - don't give this? - Correct Answer ✅ Mannitol - Supertorial herniation? - Correct Answer ✅ Whole brain is coming down - change in LOC, then dilated pupils on both sides, then hyperventilation (to decrease ICP), last thing you get is Cushings dz. Cushing Dz? Tx? - Correct Answer ✅ Brain is coming down through foramen magnum Widening pulse pressure (120/70, 200/70) <RESP and HR Tx: Mannitol Does acidosis increases ICP? - Correct Answer ✅ Yes - keep them alkalotic Do you give Dextrose or D5W to someone with ICP? - Correct Answer ✅ NO!