CNA Practice Test #1 (100 Questions with Correct Answers 2023), Exams of Health sciences

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CNA Practice Test #1 (100 Questions with

Correct Answers 2023)

Which of the following should you observe and record when admitting a patient? A. color of the stool and amount of urine voided B. how much the patient has eaten and drunk C. bruises, marks, rashes, or broken skin D. requests the patient makes - Correct answer C. bruises, marks, rashes, or broken skin Failure to notice bruises or marks on the skin on admission may later cause someone to believe you were involved in abuse. When responding to a patient on the intercom, you should A. ask for the patient's name B. say, May I help you? C. give your name and position D. say, The nurse will answer your call - Correct answer C. give your name and position When responding to a patient on the intercom, you should give your name and position. Which of the following things should you do to familiarize a new patient with his or her surroundings? A. show the patient where the call bell is and how to work it B. tell the patient not to operate the TV C. ask visitors to leave the room while you finish admitting the patient D. raise the side rails of the bed and raise the bed to high position - Correct answer A. show the patient where the call bell is and how to work it You should never leave a new admit until the patient knows how to call for help. When arranging a patient's room, you should do all of the following EXCEPT A. check signal cords B. fix the back and knee rests as directed C. administer medications D. check lighting - Correct answer C. administer medications Nursing assistants are never allowed to give medications. When assisting a patient in and out of bed, you should always

A. employ body mechanic techniques B. get another person to help C. pull the patient's feet out first, and then lift the back up D. put shoes on the patient because the patient may slip - Correct answer A. employ body mechanic techniques You should always use good body mechanics when moving patients. When should you wash your hands? A. when you notice they look or feel dirty B. when the head nurse tells you to C. at least twice a day D. before and after contact with a patient - Correct answer D. before and after contact with a patient You should wash your hands before and after contact with a patient. Which of the following is the correct procedure for serving a meal to a patient who must be fed? A. serve the tray along with all the other trays, and then come back to feed the patient B. bring the tray to the patient last; feed after you have served all the other patients C. bring the tray into the room when you are ready to feed the patient D. have the kitchen hold the tray for one hour - Correct answer C. bring the tray into the room when you are ready to feed the patient You should not bring the tray into the room until you have time to feed the patient. A newly admitted patient has dirty fingernails. When giving the patient a bath, you should first A. soak the nails B. trim the nails C. apply extra lotion D. clean the nails with a metal file - Correct answer A. soak the nails Soaking the nails first will make cleaning them easier. When you move a patient on a stretcher, you should stand at the patient's A. right side B. left side C. head D. feet - Correct answer C. head

Always control a stretcher from the head in case you lose control of it. The most serious problem that wrinkles in the bedclothes can cause is A. restlessness B. sleeplessness C. decubitus ulcers D. bleeding and shock - Correct answer C. decubitus ulcers The most serious problem that wrinkles in the bedclothes can cause patients are decubitus ulcers, or decubiti. When making a bed, you can save steps and time if you A. assemble all needed linen before starting to make the bed B. tuck in bottom linen and top linen at the foot of bed before going to the head of bed C. use only fitted sheets D. ask for help from the head nurse - Correct answer A. assemble all needed linen before starting to make the bed Gathering all supplies first is a timesaver. One important way to reduce the incidence of decubitus ulcers is to A. keep the patient in bed B. force fluids every 2 hours C. change position every 2 hours D. all of the above - Correct answer C. change position every 2 hours Changing the patient's position every 2 hours prevents bedsores. You are told to put a patient in Fowler's position. Before changing the position of the patient's bed, you should A. open the window B. explain the procedure to the patient C. check with the patient's family D. remake the bed - Correct answer B. explain the procedure to the patient You should always explain procedures first, so b is the correct answer You touch the inside of the sink while rinsing soap off your hands. You should A. allow the water to run over your hands for two minutes B. dry your hands and turn off the faucet with the paper towel

C. repeat the wash from the beginning D. none of the above - Correct answer C. repeat the wash from the beginning You have contaminated your hands and must start over answer. As a safety measure, when you give mouth care to an unconscious patient, you should position the patient A. on her or his back B. in semi-Fowler's position C. with the head turned to the side D. in the supine position - Correct answer C. with the head turned to the side Turning the head to the side will assist in drainage out of the mouth. When you obtain a clean-catch urine specimen, you should A. wash the patient's hands B. use clean techniques C. use sterile techniques D. perform the procedure in the bathroom - Correct answer B. use clean techniques A clean-catch urine specimen does not require sterile technique. Mr. Roark, a newly admitted conscious patient, has been put to bed. Before leaving him alone, you should A. ask him if he is hungry B. inspect his skin C. complete the listing of his clothing and valuables D. make sure he knows how to use the call light - Correct answer D. make sure he knows how to use the call light Always make sure new patients can call for help. When lifting a heavy object, you should bend at the A. waist, keeping your legs straight B. waist, rounding your shoulders C. knees, keeping your back straight D. knees and waist - Correct answer C. knees, keeping your back straight Keeping your back straight forces you to use your strong leg muscles. Wrinkles in the bedclothes can

A. overheat the patient B. irritate the patient's skin C. result in torn sheets D. restrict the patient's activity - Correct answer B. irritate the patient's skin This irritation can result in bedsores. When shaving a patient, you should A. wet the patient's face B. apply aftershave lotion when done C. give the patient a mirror when done D. all of the above - Correct answer D. all of the above When cleaning a patient's dentures at the sink, the reason to either line the emesis basin with a paper towel or to fill the sink with water is to A. prevent contamination of the dentures B. hide the dentures from view C. guard against breaking the dentures D. protect the basin from scratches - Correct answer C. guard against breaking the dentures The purpose of this procedure is to prevent breakage. When assisting a patient with eating, one of the first things you should do is A. cut the food into large bite-size pieces B. wash your hands and the patient's hands C. butter the patient's bread D. provide the patient with privacy - Correct answer B. wash your hands and the patient's hands Always remember to consider infection control. A patient has a new cast on his right arm. While caring for him, you should observe for A. pulse above the cast B. color and hardness of the cast C. warmth and color of fingers D. signs of crumbling at the cast end - Correct answer C. warmth and color of fingers A new cast may cut off circulation. Choice c reminds you to check for circulatory impairment.

Encouraging a patient to take part in activities of daily living (ADLs) such as bathing, combing hair, and feeding is A. done only when time permits B. the family's responsibility C. necessary for rehabilitation D. a violation of patient rights - Correct answer C. necessary for rehabilitation Rehabilitation should always be part of the care plan. In caring for a confused elderly man, you should remember to A. keep the bedrails up except when you are at the bedside B. close the door to the room so that he does not disturb other patients C. keep the room dark and quiet at all times to keep the patient from becoming upset D. remind him each morning to shower and shave independently - Correct answer A. keep the bedrails up except when you are at the bedside Make sure to follow agency policy. The water temperature for a tub bath is A. 98° F B. 105° F C. 115° F D. 212° F - Correct answer B. 105° F The water temperature for a tub bath is 105° Fahrenheit When giving a complete bed bath, you should A. not wash the patient's genitals because the patient will feel embarrassed B. use the same water throughout the bath to save you from extra trips C. keep the patient covered as much as possible D. position yourself on one side of the bed and stay there - Correct answer C. keep the patient covered as much as possible The other choices are wrong because of proper care techniques or body mechanics. When assisting Mr. Cohen in learning to use a walker, you should A. stand behind him and use a transfer belt B. put padding all the way around the top rim C. let him walk by himself so he gains independence D. let him practice using the walker on the day he is discharged - Correct answer A. stand behind him and use a transfer belt

Standing behind him and using a transfer belt protects both the client and the aide. Before assisting a patient into a wheelchair, check to see if the A. patient is adequately covered B. floor is slippery C. door to the room is closed D. wheels of the chair are locked - Correct answer D. wheels of the chair are locked Before assisting a patient into a wheelchair, check to see if the wheels of the chair are locked. While giving an unconscious patient a bath, it is important to A. give passive range of motion to all joints B. let the team leader exercise the patient's joints C. call the physical therapist to exercise the patient afterwards D. exercise the patient only if the doctor has ordered it - Correct answer A. give passive range of motion to all joints Passive ROM should always be given with the bath on an unconsious patient. When reporting your patient's condition to your team leader, you should report immediately A. rash that appears suddenly B. warm, dry, and pink skin C. tough skin on the feet D. scarred skin - Correct answer A. rash that appears suddenly Of the answers listed, only a is an acute change. When shaving a male patient's face, you should A. apply shaving cream sparingly B. use upward strokes when shaving the cheeks C. apply Betadine to any nicks D. none of the above - Correct answer D. none of the above A decubitus ulcer is a A. stomach ulcer B. pressure sore C. duodenal ulcer D. sore on the toe - Correct answer D. sore on the toe

Decubitus ulcers may also be called bedsores. You are assigned to assist Mrs. Kelley with her lunch. She is on bed rest. The best position for her, if permitted, would be A. Tredelenberg B. hyperextension C. dangling at the side of the bed D. semi-Fowler's - Correct answer D. semi-Fowler's Semi-Fowler's position is correct because the patient is on bedrest. When caring for a patient with a nasogastric tube, you should A. offer the patient water if she starts to gag B. take the tape off the nose if it bothers the patient C. never unfasten the connecting tubing from the patient's gown D. protect the tube when moving or changing the patient's position - Correct answer D. protect the tube when moving or changing the patient's position You must ensure that the tube is not dislodged. To prevent a patient from getting bedsores, you should A. wash urine and feces off with only water B. put baby powder on the skin to keep it dry C. rub the reddened area once a day D. turn the patient every 2 hours - Correct answer D. turn the patient every 2 hours Turning the patient is the best way to protect against bedsores. When moving a wheelchair on or off an elevator, you should stay A. behind the chair, pulling it toward you B. behind the chair, pushing it away from you C. in front of patient to observe his or her condition D. to the side and hold the door open - Correct answer A. behind the chair, pulling it toward you You must stay behind the chair to control it, but it should go on and come off an elevator backwards to prevent the wheels from falling into the door opening. Nursing orders frequently instruct you to assist patient to cough and deep breathe. This activity helps the patient avoid

A. decubitus ulcers B. pneumonia C. internal bleeding D. dyspnea - Correct answer D. dyspnea The correct answer is left Sim's. This allows better irrigation of the colon. What position should a patient be in to receive an enema? A. supine B. Fowler's C. prone D. left Sim's - Correct answer D. left Sim's Coughing and deep breathing forces lower lung movement. A patient who has difficulty chewing or swallowing will need what type of diet? A. clear liquid B. low residue C. bland D. mechanical soft - Correct answer D. mechanical soft A mechanical soft diet is easy to chew, swallow, and digest. How often should you total a patient's intake and output records? A. once each shift B. twice a day C. every 4 hours D. every 12 hours - Correct answer A. once each shift Input and output are totaled once per shift as well as every 24 hours. The Foley bag must be kept lower than the patient's bladder so that A. urine will not leak out, soiling the bed B. urine will not return to the bladder, causing infection C. the bag will be hidden and the patient will not be embarrassed D. the patient will be more comfortable in bed - Correct answer B. urine will not return to the bladder, causing infection Raising the bag above the bladder level can lead to backflow of the urine, with its bacteria, into the bladder.

When assisting a nurse to irrigate a patient's bladder, you notice that the nurse has contaminated the sterile field. You should A. tell the doctor right away B. tell the charge nurse right away C. offer to get the nurse another sterile pack D. ignore it because the nurse is doing the procedure - Correct answer C. offer to get the nurse another sterile pack When distributing drinking water, the nursing assistant should A. use only disposable cups and pitchers B. give ice to all patients C. follow the policy of the institution D. make sure that all pitchers are filled completely - Correct answer C. follow the policy of the institution Agencies may have different policies. Mr. Kaplan's orders include the notation, strain all urine. This means that you should report A. the output in millimeters B. the color of the urine C. any complaints the patient makes D. any particles in the strainer - Correct answer D. any particles in the strainer The purpose of the order to strain urine is to detect particles. Swelling caused by excess fluid in body tissues is called A. fluid intake B. diarrhea C. perspiration D. edema - Correct answer D. edema The term given to fluid held in body tissues that may make them swell isedema. Mrs. Black is a diabetic. For her mid-afternoon nourishment, the kitchen has sent a carton of chocolate ice cream. Your first action should be to A. substitute diet cola for ice cream B. hold the nourishment and report to the team leader C. ask the ward clerk to notify the kitchen of an error D. ask Mrs. Black if she likes ice cream - Correct answer B. hold the nourishment and report to the team leader

Always report abnormal conditions. Your assignment sheet has the following notation: S & A, AC, tid for Mr. Able. This means that you should A. take axillary temperature and systolic blood pressure after care is given two times a day B. do a routine sugar and acetone urine test before meals three times a day. C. do a routine sugar and acid stool test after Mr. Able's next three stools D. offer snacks and ginger ale three times a day - Correct answer B. do a routine sugar and acetone urine test before meals three times a day. S & A is a diabetic test done on urine, before meals. Mr. Brook has a broken hip and needs to have an enema. The best type of bedpan to use would be a A. fracture pan B. plastic pan C. child-sized pan D. metal pan - Correct answer A. fracture pan Choose a fracture pan so Mr. Brook will have a minimal distance to lift his hips. Before you ambulate a patient who has a Foley catheter, you should A. clamp off the catheter and disconnect it, since the bag would be in the way B. leave the catheter dangling between the patient's legs C. carry the bag below the level of the bladder D. hide the bag in a pillowcase so the patient will not be embarrassed - Correct answer C. carry the bag below the level of the bladder You cannot disconnect the bag without an order, but you still must ensure that the bag remains below the bladder level. The best food choices for a geriatric patient with no teeth would include A. hamburger, french fries, corn, and ice cream B. baked chicken, dressing, green beans, and coconut macaroons C. spare ribs, macaroni and cheese, coleslaw, and fruit cocktail D. baked fish, whipped potatoes, spinach souffle, and tapioca. - Correct answer D. baked fish, whipped potatoes, spinach souffle, and tapioca. Of the choices listed, only d is a soft diet.

When checking a tray after a patient has eaten, you should note the total amount of A. food provided B. liquid and solids consumed C. food lost to spills D. caloric intake - Correct answer B. liquid and solids consumed Always note total food and liquid consumed for notation on food records. When assisting a patient to use the bedside commode, it is important to A. leave the signal cord within reach B. place toilet tissue close by C. return to check on the patient periodically D. all of the above - Correct answer D. all of the above When assisting Mr. Byrd, a blind patient, with his meal, you should A. sit next to him to help B. identify each item on his tray C. feed him so he won't spill his food D. insist that he use only a spoon - Correct answer B. identify each item on his tray A blind patient should know what you are giving him before it enters his mouth. In order to feed herself, a blind patient would need A. a clear liquid diet B. a large spoon as the only utensil C. help to identify items on the tray D. a mechanical soft diet - Correct answer C. help to identify items on the tray Many blind patients can feed themselves if aware of placement on the tray. Which of the following lists only items that would be included in fluid intake? A. milk, ham sandwich, ice cream bar B. water, mashed potatoes, gelatin C. milk, custard, soup D. orange juice, soft-boiled egg, toast - Correct answer C. milk, custard, soup Only choice c. lists liquids only. The purpose of cold applications is usually to A. speed the flow of blood to the area

B. prevent heat exhaustion C. prevent or reduce swelling D. prevent the formation of scar tissue - Correct answer C. prevent or reduce swelling The purpose of cold applications is usually to prevent or reduce swelling. The hot water bottle is an example of a A. local dry heat application B. generalized dry heat application C. local moist heat application D. generalized moist heat application - Correct answer A. local dry heat application A hot water bottle applied by itself is dry heat. Which of the following is true regarding visually challenged residents? A. Blind patients use a clock system to locate food. B. Residents usually prefer to eat alone. C. Patients prefer to be fed to prevent spills. D. All of the above are true. - Correct answer A. Blind patients use a clock system to locate food. Most blind patients can feed themselves in a dining room setting if they can visualize their food on a plate. A clock system allows them to do this. Sputum is material that is coughed up from the A. nose B. lungs C. throat D. stomach - Correct answer B. lungs Sputum is coughed up from the lungs. Patients receiving an enema are usually placed A. on the right side B. on the left side C. flat on the back D. in a semi-sitting position - Correct answer B. on the left side Placing the patient on the left side allows better entry into the colon. You should clean a female patient's perineal area before you collect a

A. 24-hour urine specimen B. midstream clean-catch urine specimen C. pediatric routine urine specimen D. routine urine specimen - Correct answer B. midstream clean-catch urine specimen The clean-catch specimen requires cleaning the perineum. The phase when the heart is at rest is called A. systole B. diastole C. asystole D. cardiac arrest - Correct answer B. diastole The phase when the heart is at rest is called diastole. The most common site for counting the pulse is the A. carotid artery B. femoral artery C. brachial artery D. radial artery - Correct answer D. radial artery The other sites are rarely used by the nursing assistant. The nursing assistant must use a stethoscope to determine the A. apical pulse rate B. carotid pulse rate C. popliteal pulse rat D. brachial pulse rate - Correct answer A. apical pulse rate Only a stethoscope can hear the apical pulse. When taking an axillary temperature, the nursing assistant should leave the thermometer in place for A. 10 minutes B. 8 minutes C. 5 minutes D. 3 minutes - Correct answer A. 10 minutes A full ten minutes is required. When counting respirations, you should

A. wait until after the patient has exercised B. not tell the patient what you are going to do C. count 5 respirations and then check your watch D. have the patient count respirations while you take her pulse - Correct answer B. not tell the patient what you are going to do Telling the patient you are watching her breathing will cause her to slightly change her breathing pattern. The parts of the body involved in maintaining a sufficient intake of air include the A. mouth and nasopharynx B. trachea and larynx C. bronchi and alveoli D. all of the above - Correct answer D. all of the above All of the organs listed are part of the airway. With catheterized patients, which of the following is NOT the nursing assistant's responsibility? A. mouth and nasopharynx B. trachea and larynx C. bronchi and alveoli D. all of the above - Correct answer A. mouth and nasopharynx A nursing assistant is responsible for the other options but never inserts a catheter. Which statement about a routine urine specimen is correct? A. It must be taken first thing in the morning. B. It can be collected any time of the day. C. It does not have to be stored in the refrigerator. D. It does not have to be noted on the I & O sheet. - Correct answer B. It can be collected any time of the day. A routine urine specimen can be collected at any time, unless you are told otherwise. A specimen collected by having the patient cough from the lungs and bronchial tubes is called A. saliva B. mucus C. sputum D. spit - Correct answer C. sputum

Only sputum can be coughed up from the lungs. A sphygmomanometer is an instrument used for measuring A. temperature B. pulse C. respirations D. blood pressure - Correct answer D. blood pressure The sphygmomanometer is the correct term for a blood pressure cuff. When you shake down a thermometer, the mercury should be below A. 95 degrees F B. 96.8 degrees F C. 98.6 degrees F D. the arrow - Correct answer A. 95 degrees F Most thermometers go down to at least 95 degrees; if not, shake the thermometer down to below the lowest number When you complete an incident report, you should A. write in the patient's chart that an incident occurred B. keep the report in your personal file C. state the facts clearly D. give your opinions as to the cause of the incident - Correct answer C. state the facts clearly An incident report becomes a permanent part of the legal record. Make sure the facts are clear. When giving a backrub, what kind of strokes should you use? A. short, crisp stokes B. long, deep strokes C. long, fluid strokes D. none of the above - Correct answer C. long, fluid strokes A back rub should be relaxing; therefore, use long and fluid strokes. All long-term-care nursing assistants must be competency evaluated and must complete a distinct educational course. These requirements are set by A. OBRA B. OSHA

C. CDC

D. FDA - Correct answer A. OBRA OBRA stands for the Ombudsman Budget and Reform Act. You can safely identify your patient by A. asking his name B. calling his name and waiting for his response C. checking the bed plate D. checking the name tag - Correct answer D. checking the name tag A confused patient may answer to any name or lay down in any bed. OSHA rules specify that, when you wash out soiled linens, you must wear A. gloves B. goggles C. gloves and goggles D. gloves, goggles, and apron - Correct answer C. gloves and goggles To protect yourself, you must wear gloves and goggles. The vessels that carry oxygenated blood from the heart to the body are called A. veins B. arteries C. venules D. capillaries - Correct answer B. arteries The vessels that carry oxygenated blood from the heart to the body are called arteries. Sexuality changes in aging can result in A. decreased sexual desire B. unchanged sexual desire C. increased sexual desire D. all of the above - Correct answer D. all of the above Sexual desire is related to emotions as well as physical ability, so all the answers listed may be correct for different individuals. H.S. care is care that is given A. before meals B. before bedtime

C. after meals D. upon awakening - Correct answer B. before bedtime H.S. is the abbreviation for hour of sleep When family members visit a resident, the visitors should A. stay in the day room B. stay a short while so as not to tire the resident C. be expected to help with care D. be allowed privacy with the resident - Correct answer D. be allowed privacy with the resident The family should expect and be allowed private time with their loved one. Your resident has a right hemiplegia. When up in a chair, the resident's right arm should be A. placed in her lap B. allowed to dangle freely C. be elevated on a pillow in her lap D. none of the above - Correct answer C. be elevated on a pillow in her lap Elevating a paralyzed limb will help prevent edema and injury. Urinary retention refers to A. normal output of urine B. inability to urinate C. incontinence D. large output of urine - Correct answer B. inability to urinate Retention of urine is a symptom that should be reported to the charge nurse as soon as it is noted. A prosthesis is A. an artificial substitute for a missing body part B. a device for moving patients C. an expected condition of the aging process D. a disease of the circulatory system - Correct answer A. an artificial substitute for a missing body part Examples of prostheses include artificial limbs, hearing aids, and dentures. You may attend resident council meetings if

A. you are invited to attend B. your superior assigns you to attend C. you are interested in what the residents are discussing D. none of the above - Correct answer A. you are invited to attend The resident council is a meeting of the residents, and no staff may attend unless invited. The proper medical abbreviation for before meals is A. p.c. B. b.i.d. C. a.c. D. t.i.d. - Correct answer C. a.c. The proper medical abbreviation for before meals is a.c. The proper medical term for high blood pressure is A. diabetes B. hypertension C. hypotension D. CVA - Correct answer B. hypertension The proper medical term for high blood pressure is hypertension. Which of the following is considered a resident's right? A. having curtains pulled during personal care B. having personal information kept confidential C. receiving and sending private mail D. all of the above - Correct answer D. all of the above A resident wishes to wash her own underwear. You should A. ignore the request B. tell her that clothing must go to the laundry C. tell her you will do it D. help her obtain supplies - Correct answer D. help her obtain supplies The patient has the right to wash her own clothes if she so wishes. You must help her to do so. When performing catheter care, the nursing assistant should wash the catheter

A. toward the meatus B. with Betadine soap C. away from the meatus D. with alcohol - Correct answer C. away from the meatus You should follow the clean-to-dirty principle, with the meatus considered cleaner than the catheter tubing. The enzyme secreted by the liver to help digest fats is A. bile B. insulin C. estrogen D. lactose - Correct answer A. bile The enzyme secreted by the liver to help digest fats is bile. The abbreviation TPN stands for A. total protein nutrients B. total parenteral nutrition C. total parietal nutrients D. none of the above - Correct answer B. total parenteral nutrition While rare in the past, this kind of nutrition is much more common in long-term care today. It is also called hyperalimentation The material in the digestive tract that helps provide lubrication for passage of food is A. stomach acid B. sputum C. mucus D. phlegm - Correct answer C. mucus The material in the digestive tract that helps provide lubrication for food passage is mucus. Ventricles is a term that refers to A. vessels and chambers in the heart B. chambers of the heart and lungs C. chambers of the heart and kidneys D. chambers of the heart and brain - Correct answer D. chambers of the heart and brain Ventricles is a term that refers to chambers of the heart and brain.

OSHA rules require all health care workers to be offered immunization against A. hepatitis B B. hepatitis A C. hepatitisC D. AIDS - Correct answer A. hepatitis B OSHA rules require all health care workers be offered immunization for hepatitis B. Which abbreviation means no food and no water should be given? A. NFW B. PON C. NPO D. ABR - Correct answer C. NPO NPO means nothing by mouth. The proper medical term for brittle bones is A. osteomalacia B. osteoarthritis C. osteosarcoma D. osteoporosis - Correct answer D. osteoporosis The proper medical term for brittle bones is osteoporosis. Lack of movement can cause wasting of muscle tissue. This is called A. contracture B. atrophy C. dystrophy D. anomaly - Correct answer B. atrophy Atrophy over a long period of time due to immobilization can also lead to contractures. Normal hearing loss in aging is usually related to the ability to hear A. high-pitched sounds B. loud sounds C. all sounds D. rapid speech - Correct answer A. high-pitched sounds Because of this aspect of hearing loss, the aged hear better if you lower your voice. Shouting in a high-pitched voice does not help.