Medical-Surgical Nursing 75 Items Test | Pregnancy | Childbirth

1.

Atenolon hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse will perform which of the following as a priority action before administering the medication? a. b. c. d. Listen to the client’s lung sounds. Assess the client for muscle weakness. Check the client’s blood pressure. Check the most recent electrolyte levels.

2.

A nurse is preparing to administer Furosemide (Lasix) to a client with a diagnosis of heart failure. The most important laboratory test result for the nurse to check before administering this medication is: a. b. c. d. Blood urea nitrogen Cholesterol level Potassium level Creatinine level

3.

A nurse caring for a male client with a diagnosis of gastrointestinal (GI) bleeding reviews the client’s laboratory results and notes a hematocrit level of 30%. The nurse would: a. b. c. d. Report the abnormally low level Report the abnormally high level. Inform the client that the laboratory result is normal. Place the normal report in the client’s medical record.

4.

A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item? a. b. c. d. Cottage cheese Grapes Watermelon Spinach

5.

A client who has been receiving parenteral nutrition by way of a central venous access device complains of chest pain and dyspnea. The nurse quickly assesses the client’s vital signs and notes that the pulse rate has increased and that the blood pressure has dropped. The nurse determines that the client is most likely experiencing : a. b. c. d. Fluid imbalance Air embolism Sepsis Fluid overload

6.

A client receiving intravenous (IV) fluid therapy complains of burning and a feeling of tightness at the IV insertion site. On assessment, the nurse detects coolness and swelling at the site ad notes that the IV rate has slowed. The nurse determines that which of the following has occurred? a. b. c. d. Thrombosis Infection Infiltration Phlebitis

7.

A physician orders 1 unit of packed red blood cells to be infused over 4 hours. The unit of blood contains 250 mL. The drop factor is 15 drops per 1 mL. The nurse prepares to set the flow rate at how man drops per minute? a. b. c. d. 10 16 18 20 gtts. gtts. gtts. gtts.

8.

A nurse is preparing to administer 30 mEq of liquid potassium chloride (KCl) to an adult client. The label on the medication bottle reads 40mEq of KCl per 15 mL. The nurse prepares how many milliliters of KCl to administer the correct dose of medication? a. b. c. d. 11 mL 15 mL 2- mL 50 mL

9.

A nurse provides instructions to a client about the use of an incentive spirometer. The nurse determines that the client needs further instruction about its use if the client says she must: a. b. c. d. Place the lips completely over the mouthpiece Inhale slowly, maintaining a constant flow. After maximal inspiration, hold the breath for 10 seconds and then exhale. Sit upright when using the device

10. A nurse is monitoring a client with a closed chest tube drainage system. The nurse notes fluctuation of the fluid level in the water-seal chamber during inspiration and expiration. On the basis of this finding, the nurse determines that: a. b. c. d. There is a leak in the system. The chest tube is functioning as expected. The amount of suction needs to be decreased. The occlusive dressing at the insertion site needs reinforcement.

11. A nurse is providing morning care to a client who has a closed chest tube drainage system to treat a pneumothorax. When the nurse turns the client to the side, the chest tube is accidentally dislodged from the chest. The nurse immediately applies sterile gauze over the chest tube insertion and next: a. b. c. d. Calls the physician Places the client in Trendelenburg position Replaces the chest tube system Obtains a pulse oximetry reading

12. A nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During assessment of the client, the nurse asks which question to determine effectiveness? a. b. c. d. “Are you experiencing heartburn?” “Do you have any joint pain?” “Are you having any diarrhea?” “Do you have frequent headaches?”

13. A nurse is checking lochia discharge in a woman in the immediate postpartum period. The nurse notes that the lochia is bright read and contains some small clots. The nurse determines that this finding : a. b. c. d. Is normal Indicates that the client is hemorrhaging Indicates the need to increase oral fluids Indicates the need to contact he physician

14. A nulliparous woman asks the nurse when she will feel fetal movements. The nurse responds by telling the woman that the first recognition of fetal movement will occur at approximately: a. b. c. d. 10 12 14 18 weeks weeks weeks weeks of of of of gestation gestation gestation gestation

15. A nurse is performing a vaginal assessment of a pregnant client in labor. The nurse notes that the umbilical cord is protruding from the vagina. The nurse would immediately: a. b. c. d. Administer oxygen to the client. Transport the client to the delivery room. Place an external fetal monitor on the client. In gloved fingers into the vagina to the cervix and exert upward pressure against the presenting part.

16. A nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit which a suspected diagnosis of abruption placentae. Which finding would the nurse expect to note if this condition is present? a. b. c. d. Abdominal pain Nontender uterus Soft uterus Painless vaginal bleeding

17. A nurse in the labor room is caring for client in the first stage of labor. On assessing the fetal patterns, the nurse notes an early deceleration of fetal heart rate (FHR) on the monitor strip. The appropriate nursing action is to: a. b. c. d. Place the mother in a Trendelenburg position. Document the findings and continue to monitor the fetal patterns. Administer oxygen to the client by face mask. Contact the physician.

18. A pregnant client in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home for gestation hypertension. The home care nurse teaches the client about the signs that need to be reported to the physician and tells the client to call the physician if: a. b. c. d. The blood pressure reading is between 122/80 and 138/88mmHg. Urine output increases. Weight increases by more than 1 pound in a week. Fetal movements are more than four per hour.

19. A client in the third trimester f pregnancy visits the clinic for a scheduled prenatal appointment. The client tells the nurse that she frequently has leg cramps, primarily when she is reclining. On the basis of the client’s complaint, the nurse would first: a. b. c. d. Tell the client to apply heat to the affected area when cramps occur. Check for Homan’s sign. Assess the dorsalis pedis pulses. Check for pedal edema.

20. A nurse is preparing a pregnant client for transvaginal ultrasound exam. The nurse tells the client that she will: a. b. c. d. Be placed in a supine left side-lying position. Feel some pain during the procedure. Need to drink 2 quarts of water to attain a full bladder. Feel some pressure when the vaginal probe is moved.

21. A client with a portal-systemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse checks which of the following to determine medication effectiveness? a. b. c. d. Blood pressure Lung sounds Serum potassium level Blood ammonia level

22. A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following? a. b. c. d. Human immunodeficiency virus (HIV) infection Pancreatitis Tonic-clonic seizures Pharyngitis

23. A nurse notes that a client is taking lansoprazole (Prevacid). On assessment of the client, the nurse asks which question to determine medication effectiveness? a. b. c. d. “Do you have any problems with vision?” “Has your appetite increased?” “Are you experiencing any heartburn?” “Do you experience any leg pain when walking?”

24. A client hospitalized with a paranoid disorder refuses to turn off the lights in the room at night and states, “My roommate will steal me blind.” The appropriate response by the nurse is: a. b. c. d. “Tell me more about the details of your belief.” “Why do you believe this?” “If you want a pass for a tomorrow evening’s movie, you’d better turn that light off this minute.” “I hear what you are saying, but I don’t share your belief.”

25. The client has just received a diagnosis of asthma says to the nurse, “This condition is just another nail in my coffin.” Which response by the nurse is therapeutic? a. b. c. d. “Do you think that having asthma will kill you?” “You seem very distressed over learning you have asthma.” “Asthma is a very treatable condition. It is important to properly administer your medications. Let’s practice with your inhalant. “I’m not going to work with you if you can’t view this as a challenge rather than a ‘nail in your coffin.”

26. An older client is seen in the clinic for a physical examination. Laboratory studies are performed and reveal that the hemoglobin and hematocrit are low, indicating the need for further diagnostic studies and a blood transfusion. The client is a Jehovah’s Witness and refuses to have a blood transfusion. The clinic nurse would most appropriately: a. b. c. d. Try to convince the client of the need for the transfusion. Discuss with the client the results of the hemoglobin and hematocrit levels as compared with the normal levels. Support the client’s decision not to receive a blood transfusion. Speak to the family regarding the need for a blood transfusion.

27. A postpartum client with mastitis in the right breast complains that the breast is too sore for her to breast-feed her infant. The nurse tells the client: a. b. c. d. To pump both breasts and discard the milk. To breast-feed the left breast and gently pump the right breast. That the infant should be bottle-fed temporarily To stop breast-feeding from both breasts until this condition resolves

28. A nurse is monitoring an infant for signs of increased intracranial pressure (ICP). On assessment of the fontanelle, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this findings, which of the following is the priority nursing action? a. b. c. d. Place the infant supine in a side-lying position. Notify the physician. Increase oral fluids. Document the finding.

29. A nurse caring for a client who is receiving oxytocin (Pitocin) for the induction of labor notes a nonreassuring fetal heart rate (FHR) pattern on the fetal monitor. On the basis of this finding, the nurse would first: a. b. c. d. Place the client in a knee-chest position. Stop the oxytocin infusion. Check the client’s blood pressure. Check the client for bladder distention.

30. A nurse performs an assessment of a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client’s deep tendon reflexes are absent. On the basis of this finding, the nurse determines that: a. b. c. d. The The The The magnesium sulfate is effective. client is experiencing cerebral edema. client is experiencing magnesium excess. infusion rate needs to be increased.

31. Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which of the following as the most important client parameter? a. b. c. d. Temperature Blood pressure Lochial flow Urine output

32. A nurse is monitoring a newborn infant who was circumcised. The nurse notes that the infant has a temperature of 100.6 F and that the dressing at the circumcised area is saturated with a foulsmelling drainage. The priority nursing action is to : a. b. c. d. Document the findings. Contact the physician. Swab the drainage and send the sample to the laboratory for culture. Reinforce the dressing.

33. A nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child’s arrival and plans to implement: a. b. c. d. Contact precautions Enteric precautions Droplets precautions Neutropenic precautions

34. A clinic nurse reads the results of a Mantoux test performed in a 5-year-old child. The result indicate an area of induration measuring 10mm. The nurse would interpret these results as: a. b. c. d. Negative Positive Inconclusive Definitive and requiring a repeat test.

35. A nurse is providing home care instructions to the mother of a child with bacterial conjunctivitis. The nurse tells the mother: a. b. c. d. That the child may attend school if antibiotics have been started. To save any unused eye medication in case a sibling gets the eye infection. To wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect. that the child’s towels and washcloths should not be used by other members of the household.

36. The mother of 6-year-old twins says to the nurse, “My mother-in-law doesn’t think our children should come to the funeral service for their grandfather. What do you advise?” The nurse appropriately responds by stating: a. b. c. d. “By all means have them attend. Not to do so would promote postmortem grief.” “I agree with your mother-in-law. Your mother-in-law is upset enough as it is. Tell your children that their grandfather is in heaven.” “What do you and your husband believe is the right thing for your children?” “It’s a difficult decision, but given their young age, perhaps omitting the wake and just including the funeral would be best.”

37. A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, “My daughter came over yesterday to help me move my husband’s things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn’t know how much I’m hurting.” Which statement by the nurse would be therapeutic? a. b. c. d. “It’s OK to grieve ad be angry with your daughter and anyone else for a time.” “I know just how you feel because I lost my husband last summer.” “Although it’s troubling time for you, try to focus on your children and grandchildren.” “You need to focus on the many good years you both enjoyed together and move on.”

38. After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position? a. b. c. d. Supine Trendelenburg Prone High Fowler’s

39. A nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle accident for signs of increased intracranial pressure (ICP). The nurse assesses the child frequently for which early sign of increased ICP? a. b. c. d. Decerebrate posturing Papilledema Alteration in pupil size Nausea

40. An older client says to the home care nurse, “I can’t believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house, ready to plan our activities for the day.” Which of the following is the therapeutic nursing response? a. b. c. d. “Try to focus on the fact that you have three wonderful children ad that you and your wife loved one another for years.” “It must be hard to accept that she has passed away.” “Are you saying that she made all the social plans for you?” “Focus on the fact that her suffering is over and that she had a good life with you.”

41. A nurse is preparing to administer digoxin (Lanoxin) to an infant with congestive heart failure (CHF). Before administering the medication, the nurse double-check the dose, counts the apical heart rate for 1 full minute, and obtains a rate of 88 beats/min. Based on this finding, which of the following is the appropriate nursing action? a. b. c. d. Administer the medication. Withhold the medication. Double-check the apical heart rate and administer the medication. Check the blood pressure and respirations and administer he medication.

42. A nurse is performing an admission assessment on a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement if made by the client would support the diagnosis of gastric ulcer? a. b. c. d. “The pain that I get is located on the right side of my chest.” “The pain gets so bad that it wakes me up at night.” “My pain comes shortly after I eat, maybe a half-hour or so later.” “The pain doesn’t usually come right after I eat.”

43. A nurse is developing a plan care for a client with immunodeficiency. The nurse formulates which priority nursing diagnosis for the client? a. b. c. d. Risk for infection Deficient knowledge Ineffective coping Disturbed body image

44. A nurse is preparing to care for a client who will be arriving from the recovery room after an above-the-knee amputation. The nurse ensures that which priority item is in the client’s hospital room? a. b. c. d. Dry sterile dressing Over-bed trapeze Surgical tourniquet Incentive spirometer

45. A registered nurse (RN) asks a licensed practical nurse (LPN) to set up a hospital room for a client who is being admitted with diagnosis of tonic-clonic seizures and asks the LPN to institute seizure precautions. The RN checks the client’s room before the arrival of the client and determines that which item placed in the room by the LPN is unsafe? a. b. c. d. Padded side rails Restraints Nasal cannula Suction catheter

46. A nurse provides home care instructions to a client after cataract removal and placement of an intraocular implant in the right eye. Which statement by the client indicates a need for further instruction? a. b. c. d. “I need to remove the eye dressing as soon as I get home and place a warm pack on my eye.” “I need to avoid lying on my right side.” “I need to wear the metal eye shield at night when I sleep.” “I should take stool softeners to prevent becoming constipated.”

47. A nurse provides dietary instructions to a client with Meniere’s disease. The nurse tells the client that which food or fluid item is acceptable to consume? a. b. c. d. Coffee Tea Sugar-free Jell-O Cold-cut meats

48. A nurse provides home care instruction to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which statement by the client indicates an understanding of the instructions? a. b. c. d. “I “I “I “I am glad that the laboratory will be able to draw my blood from the fistula.” should check my blood pressure in the arm where I have my fistula every week.” should wear a shirt with light arms to provide some compression on the fistula.” should check the fistula every day by feeling it for a thrill.”

49. A nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse indicates that the client is performing the technique correctly? a. b. c. d. The The The The client client client client breathes in breathes in through the mouth. breathes out slowly though the mouth. puffs out the cheeks when breathing out through the mouth. avoids using the abdominal muscles to breathe out.

50. A nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note? a. b. c. d. Complaints of night sweats. Flushed skin. Complaints of weight gain. High fever.

51. Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best take the insulin : a. b. c. d. 15 minutes before the morning meal. At bedtime Before each meal, on the basis of the blood glucose level 1 hour after each meal

52. A nurse in the physician’s office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should tell the client that: a. b. c. d. These sensation probably will be permanent. It is nothing to worry about because most women who have this type of surgery experiencing this problem. These sensation dissipate over several months and usually resolve after 1 year. These sensations are signs of a complication.

53. A hospitalized client with a diagnosis of schizophrenia who is experiencing delusions says to the nurse, “I know that the doctor is talking to the CIA to get rid of me.” The nurse’s best response is: a. b. c. d. “The doctor is not talking to the CIA.” “I don’t believe this is true.” “I don’t know anything about the CIA. Do you feel afraid that people are trying to hurt you?” “What makes you think the doctor wants to get rid of you?”

54. A nurse is gathering data from a client with a phobia. The client tells the nurse that he consistently avoids attending community functions because he fears that he will be asked to speak publicly to the members. On the basis of this information, the nurse determines that the client is experiencing: a. b. c. d. Social phobia. Agoraphobia Claustrophobia Nyctophobia

55. A nurse reviews the arterial blood gas results of a client and notes that the results indicate a pH of 7.30, Pco2 of 52mmHg, and HCO3 –of 22 mEq/L. The nurse interprets these results as indicating: a. b. c. d. Metabolic acidosis, compensated Metabolic alkalosis, uncompensated Respiratory alkalosis, compensated Respiratory acidosis, uncompensated

56. A nurse is monitoring a client who is attached to a cardiac monitor and notes the presence of U waves. The nurse assess the client and checks the results of the client’s most recent electrolyte results. The nurse expects to note which of the following electrolyte values? a. b. c. d. Sodium 135 mEq/L Sodium 140 mEq/L Potassium 3.0 mEq/L Potassium 5.0 mEq/L

57. A nurse provides dietary instructions to a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse tells the client that the fruit highest in potassium is: a. b. c. d. Pineapple Peaches Kiwi Apples

58. A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following cardiovascular manifestations would the nurse expect to note? a. b. c. d. Increased heart rate Bounding peripheral pulses Hypotension Shortened QT interval on ECG

59. A nurse is monitoring a female client with a diagnosis of depression. Which behavior observed by the nurse indicates that suicide precautions should be taken for this client? a. b. c. d. The The The The client client client client has an argument with her significant other during visiting hours. refuses to attend group therapy swears at her roommate because she takes too much time in the bathroom. asks to meet with a lawyer to take care of unfinished business.

60. A nurse is preparing to administer Furosemide (Lasix) 40mg by intravenous (IV) injection (IV push) to a client. The nurse administers the medication over a period of : a. b. c. d. 10 seconds 30 seconds. 1 minute 5 minutes

61. A nurse is preparing to care for a client with acquired immunodeficiency syndrome (AIDS) who has Pneumocystis jiroveci pneumonia. In planning infection control for this client, which of the following would be the appropriate form of isolation to use to prevent the spread of infection to others? a. b. c. d. Strict isolation Contact precaution Enteric precautions Blood and body fluid precautions

62. A child seen in the clinic is found to have rubeola (measles), and the mother asks the nurse how to care for the child. The nurse tells the mother that she should: a. b. c. d. Allow the child to play outdoors because sunlight will help the rash. Take the child’s temperature every 4 hours and administer 1 baby aspirin for fever. Give the child warm baths to help prevent itching. Keep the child in room with dim lights.

63. A nurse reinforces medication instructions to a client about who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction? a. b. c. d. “ I need to obtain a yearly influenza vaccine.” “I need to self-monitor my blood pressure at home.” “I need to call the physician if my urine volume decreases or my urine becomes cloudy.” “I need to have dental checkups every 3 months.”

64. A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instruction? a. b. c. d. “I “I “I “I need to watch for sign of infection.” need to discontinue the medication after 14 days of use.” need to call the physician if more than one dose is missed.” can take the medication with meals to minimize nausea.”

65. A nurse is providing home care instructions to the mother of an infant who has just been found to have hemophilia. The nurse tells the mother to: a. b. c. d. Use Pad Use Use a soft toothbrush for dental hygiene. crib rails and table corners. a generous amount of lubricant when taking a temperature rectally. aspirin for pain relief.

66. A physician writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to: a. b. c. d. Check the blood pressure every morning and evening. Count the radial and carotid pulses every morning. Withhold the medication and call the physician if the pulse is below 60 beats/min. Stop taking the medication if the pulse is higher than 100 beats/min.

67. A nurse is assigned to care for a client experiencing episodes of postural hypotension. Which action would the nurse take to ensure safety while transferring the client from the bed to the chair? a. b. c. d. Perform the transfer using a hydraulic lift only. Put the client’s shoes on to help the client avoid slipping on the floor during the transfer. Arrange for a transfer board to be used. Allow the client to dangle the legs in a sitting position on the bed before transfer to a chair.

68. A client is found to have rape trauma syndrome. The nurse plans care for the client knowing that rape trauma syndrome is a condition that involves: a. b. c. d. More than one assault. Imagining the use of force in sexual situation. Actively initiating situation in which sex is forced. Re-experiencing recollection of the trauma

69. A nurse is preparing to care for a newborn with respiratory distress syndrome. Which initial action would the nurse plan to best facilitate bonding between the newborn and parents? a. b. c. d. Explain the equipment used and how it functions to assist their newborn. Encourage the parents to touch their newborn. Identify specific caregiving tasks that may be assumed by the parents. Give the parents pamphlets that will help them understand their newborns condition.

70. A client has an order for continuous monitoring of oxygen saturation by pulse oximetry. The nurse performs which of the following as the best action to ensure accurate readings on the oximeter? a. b. c. d. Apply the sensor to a finger that is cool to the touch. Place the sensor distal to an intravenous (IV) site with a continuous IV infusion. Apply the sensor to a finger with very dark nail polish. Ask the client to limit motion in the hand attached to the pulse oximeter.

71. A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client to avoid which of the following while taking this medication? a. b. c. d. Acetaminophen (Tylenol) Acetylsalicylic acid (Aspirin) Vitamin C Vitamin D

72. A nurse is assessing a dark-skinned client for the presence of petechiae. Which body area is the best for the nurse to check in this client? a. b. c. d. Oral mucosa Palms of the hand Soles of the foot Sclera

73. A client in the postpartum unit complains of sudden, sharp chest pain. The client is tachycardic and the respiratory rate is increased, and the physician diagnoses a pulmonary embolism. Select all interventions that apply for this client. a. b. c. d. e. f. Place the client on bedrest in a supine position. Assess the blood pressure. Start an intravenous (IV) line. Administer oxygen. Prepare to administer morphine sulfate. Prepare to administer warfarin sodium (Coumadin).

74. A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client’s pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is the most important for the nurse to check before administering the medication? a. b. c. d. Temperature. Respirations. Blood pressure. Radial pulse rate

75. A nurse is preparing to auscultate a client’s abdomen for bowel sounds. The nurse listens for bowel sounds in which abdominal quadrant first? a. b. c. d. Right upper quadrant Left upper quadrant right lower quadrant Left lower quadrant

Sign up to vote on this title
UsefulNot useful

Master Your Semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master Your Semester with a Special Offer from Scribd & The New York Times

Cancel anytime.