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Chitty: Professional
Nursing: Concepts and Challenges, 6th Edition
Chapter 2: The History and Social Context of Nursing
Test Bank
MULTIPLE CHOICE
1. Which early nursing leader founded the first
training school for nurses that would later become a model for early nursing
education?
a.
|
Dorothea Dix
|
b.
|
|
c.
|
Clara Barton
|
d.
|
Mary Ann Bickerdyke
|
ANS: B
|
Feedback
|
A
|
Dorothea Dix is best known as an advocate for the
mentally ill and created a brief training program at two
|
B
|
Florence Nightingale founded the first training school
for nurses at
|
C
|
Clara Barton is known for founding the American Red
Cross.
|
D
|
Mary Ann Bickerdyke is best known for nursing services
during the Civil War.
|
DIF: Cognitive Level: Knowledge REF: Page 30
2. Who was the first educated African-American
professional nurse?
a.
|
Linda Richards
|
b.
|
Phoebe Pember
|
c.
|
Sojourner Truth
|
d.
|
Mary Eliza Mahoney
|
ANS: D
|
Feedback
|
A
|
Linda Richards was the first trained nurse in the
|
B
|
Phoebe Pember was one of the first women placed in charge
of a hospital.
|
C
|
Sojourner Truth was a famous abolitionist who served as a
nurse for the Union forces in the Civil War.
|
D
|
Mary Eliza Mahoney was the first African-American
professional nurse; she was educated at the
|
DIF: Cognitive Level: Knowledge REF: Page 32
3. To which early nursing leader is attributed
the founding of the American Red Cross?
a.
|
Clara Barton
|
b.
|
Dorothea Dix
|
c.
|
|
d.
|
Lavinia Lloyd Dock
|
ANS: A
|
Feedback
|
A
|
Founding the American Red Cross is attributed to Clara
Barton.
|
B
|
Dorothea Dix was superintendent of women nurses of the
Union Army.
|
C
|
Florence Nightingale was an English pioneer in nursing.
|
D
|
Lavinia Lloyd Dock was influential in forming the
National League for Nursing.
|
DIF: Cognitive Level: Knowledge REF: Page 31
4. What were some of the application
requirements of nursing education programs in the 1900s?
a.
|
Male, intelligent, strong
|
b.
|
Female, sensitive, subservient
|
c.
|
Female, docile, from poor background
|
d.
|
Male, high breeding, independent
|
ANS: B
|
Feedback
|
A
|
Men were not thought to be sensitive enough for nursing.
|
B
|
Sensitivity, breeding, intelligence, ladylike behavior,
and submission to authority were highly desired personal traits for nursing
students.
|
C
|
High breeding was desirable for nursing education program
applicants.
|
D
|
Males were not desired for nursing education program
applicants.
|
DIF: Cognitive Level: Knowledge REF: Page 32
5. Which of the following statements best
describes how the Chicago World’s Fair of 1893 became a pivotal point in the
history of nursing education in the United States ?
a.
|
Florence Nightingale’s work on sanitation and its
relationship to mortality rates was finally recognized.
|
b.
|
The organization today known as the National League for
Nursing (NLN) was formed to address issues in nursing education.
|
c.
|
The American Nurses Association was formed to oversee
nursing education in the
|
d.
|
The International Council of Nurses was formed to enhance
collaboration between practicing nurses and educators.
|
ANS: B
|
Feedback
|
A
|
Florence Nightingale’s paper was on scientific training
of nurses.
|
B
|
Several influential nursing leaders met at the Chicago
World’s Fair and started the National League for Nursing Education—the
precursor to the NLN.
|
C
|
The NLN, not the ANA, was formed to oversee nursing
education in the
|
D
|
The International Council of Nurses was not founded until
1899 and is not involved in
|
DIF: Cognitive Level: Comprehension REF: Page 33
6. Which early nursing organization is credited
with first recommending state registration for nurses?
a.
|
International Council of Nurses (ICN)
|
b.
|
National League for Nursing (NLN)
|
c.
|
American Nurses Association (ANA)
|
d.
|
National Association of Colored Graduate Nurses
|
ANS: A
|
Feedback
|
A
|
The ICN was formed to unite all nursing organizations.
The topic of the first meeting was registration for nurses by each country
and state.
|
B
|
The NLN was formed to oversee nursing education in the
|
C
|
The ANA was formed to enhance collaboration between
practicing nurses and educators.
|
D
|
The National Association of Colored Graduate Nurses was
formed to develop leadership among African-American nurses.
|
DIF: Cognitive Level: Knowledge REF: Page 36
7. Which of the following nursing leaders,
because of her work in the Henry Street Settlement, is considered the founder
of public health nursing?
a.
|
Margaret Sanger
|
b.
|
Clara Barton
|
c.
|
Lillian Wald
|
d.
|
Lavinia Lloyd Dock
|
ANS: C
|
Feedback
|
A
|
Margaret Sanger is known for her work on birth control
with immigrant women from the Lower East Side of New York City.
|
B
|
Clara Barton founded the American Red Cross.
|
C
|
Lillian Wald founded the Henry Street Settlement—the
first formalized public health nursing project.
|
D
|
Lavinia Lloyd Dock was instrumental in the formation of
the NLN.
|
DIF: Cognitive Level: Knowledge REF: Page 34
8. Despite the caring efforts of early public
health nurses in the Henry Street Settlement, racial disparity left many people
underserved. Which of the following African-American public health nurses was
instrumental in providing excellent nursing care to underserved families
despite these social challenges?
a.
|
Jessie Sleet Scales
|
b.
|
Margaret Sanger
|
c.
|
Lavinia Lloyd Dock
|
d.
|
Anita M. McGee
|
ANS: A
|
Feedback
|
A
|
Jessie Sleet Scales established the Stillman House—a part
of the Henry Street Settlement that provided care to African Americans.
|
B
|
Margaret Sanger worked to provide immigrant women on the
Lower East Side of New York City with birth control information.
|
C
|
Lavinia Lloyd Dock founded the NLN.
|
D
|
Anita M. McGee was a physician appointed as head of the
Hospital Corps who recruited nurses for the Spanish-American War of 1898.
|
DIF: Cognitive Level: Comprehension REF: Page 35
9. Which one of the following events occurring
during the first decade of the twentieth century brought sweeping changes to
nursing?
a.
|
It was required that all practicing nurses be licensed.
|
b.
|
Permissive licensing laws were passed, allowing RNs to
practice without a license if they registered with the state.
|
c.
|
All states required a standardized licensing examination.
|
d.
|
Nurses had to pass a licensing examination to use the
title RN.
|
ANS: D
|
Feedback
|
A
|
Practicing nurses did not have to be licensed but could
not use the title.
|
B
|
Permissive licensing laws required all nurses using the
title RN to be licensed.
|
C
|
Licensing examinations were not standardized until 1950.
|
D
|
Licensure laws were passed that required all persons
using the title of registered nurse to be licensed.
|
DIF: Cognitive Level: Comprehension REF: Page 36
10. What was the most significant impact on the
profession of nursing made by Mary Breckenridge in her role as a frontier
nurse?
a.
|
She demonstrated that nurses could provide primary care
in rural settings.
|
b.
|
She demonstrated that female nurses could protect
themselves in unsettled rural environments.
|
c.
|
She demonstrated that nurses were capable of teaching new
mothers to care for babies.
|
d.
|
She demonstrated that nurses could provide care to many
clients despite geographic boundaries.
|
ANS: A
|
Feedback
|
A
|
Mary Breckenridge established frontier nursing services.
She provided primary care to women and babies and demonstrated that nurses
could provide primary care.
|
B
|
Safety was not the primary impact of the success of
frontier nursing.
|
C
|
Although she was a nurse-midwife, this was not the most
significant impact.
|
D
|
Demonstrating that nurses could provide care to many
clients despite geographic boundaries was not the most significant impact
made by Mary Breckenridge.
|
DIF: Cognitive Level: Comprehension REF: Page 37
11. Which of the following trends in health care
delivery that began in the second half of the 20th century continues today?
a.
|
Widespread use of team nursing
|
b.
|
Massive movement of nurses out of acute care and into
home care
|
c.
|
Advent of primary care to replace specialized care
|
d.
|
Provision of care to the poor, elderly, and disabled
through Medicare and Medicaid
|
ANS: D
|
Feedback
|
A
|
Team nursing is rarely used today.
|
B
|
More nurses work in acute care today than in home care.
|
C
|
After World War II, specialization became popular.
|
D
|
Two amendments to the Social Security Act in 1965
designed to ensure access to health care for elderly, poor, and disabled
Americans were the establishment of Medicare and Medicaid.
|
DIF: Cognitive Level: Comprehension REF: Page 40
12. A recent trend in nursing has been an
increase in the number of men and women with degrees in other fields or other
careers applying to nursing programs. What is the single most important reason
for this trend?
a.
|
Nursing as a career has gained increased status and
prestige.
|
b.
|
Nursing salaries have outpaced many other fields.
|
c.
|
A nursing career provides both job security and
meaningful employment.
|
d.
|
Working conditions in nursing have improved.
|
ANS: C
|
Feedback
|
A
|
While true, nursing’s increased status and prestige is
not a significant factor in the trend of people choosing it as a second
career.
|
B
|
Salary is not a major factor.
|
C
|
The current appeal to men and women with degrees in other
fields is that nursing can provide job opportunities, economic security, and
the opportunity to help others.
|
D
|
Working conditions are not identified as a reason for
choosing a second career in nursing.
|
DIF: Cognitive Level: Knowledge REF: Page 45
13. What specialty of nursing was considered well
suited for men at a time when other areas were excluding men from practicing?
a.
|
Obstetric nursing
|
b.
|
Pediatric nursing
|
c.
|
Psychiatric nursing
|
d.
|
Nurse educator
|
ANS: C
|
Feedback
|
A
|
Obstetric nursing was not considered an appropriate area
for men in nursing.
|
B
|
Pediatric nursing was not considered an appropriate area
for men in nursing.
|
C
|
Psychiatric nursing was considered well suited for men
because it required physical stamina and strength.
|
D
|
Education was not a specialty considered well suited for
men in nursing.
|
DIF: Cognitive Level: Knowledge REF: Page 43
14. When surveyed, what is the primary reason
given by men for entering nursing?
a.
|
To help people
|
b.
|
High salaries
|
c.
|
Flexible schedules
|
d.
|
|
ANS: A
|
Feedback
|
A
|
When surveyed, men entering nursing listed a desire to
help people, career opportunities, and stable career as the top three reasons
they chose nursing.
|
B
|
High salaries were not mentioned in the survey results.
|
C
|
Flexible schedules were not mentioned in the survey
results.
|
D
|
|
DIF: Cognitive Level: Knowledge REF: Pages 43 - 44
15. Men in nursing commonly experience role
strain. Which of the following is the best description of role strain as it
applies to men in nursing?
a.
|
Inability to provide total care to female clients
|
b.
|
Difficulty moving between the masculine role at home and
the feminine role in their career
|
c.
|
Stress incurred while working in a profession dominated
by members of the opposite sex
|
d.
|
Expectation that men in health care must be physicians or
dentists
|
ANS: C
|
Feedback
|
A
|
Males are capable of providing care to female clients.
|
B
|
Males do not report difficulty in moving from home to
work environments.
|
C
|
Role strain as it applies to men in nursing is an
emotional reaction felt by a person in a profession that has a social
structure dominated by persons of the opposite sex.
|
D
|
Society’s expectation that men in health care will be
physicians or dentists is changing.
|
DIF: Cognitive Level: Comprehension REF: Page 44
16. When surveyed, which profession was chosen by
the general public as highest in integrity and ethics?
a.
|
Physician
|
b.
|
Pharmacist
|
c.
|
Nurse
|
d.
|
Attorney
|
ANS: C
|
Feedback
|
A
|
Physicians were not ranked over nurses.
|
B
|
Pharmacists were not ranked over nurses.
|
C
|
|
D
|
Attorneys were not ranked over nurses in honesty and
ethics.
|
DIF: Cognitive Level: Knowledge REF: Page 46
17. In 2002 what major American corporation
partnered with nursing to design a media campaign to promote the image of
nursing?
a.
|
Johnson & Johnson
|
b.
|
Baxter
|
c.
|
Microsoft
|
d.
|
Wal-Mart
|
ANS: A
|
Feedback
|
A
|
In 2003 Johnson & Johnson began a $20 million
campaign—Campaign for Nursing’s Future—to enhance the image of nursing, to
recruit new nurses and educators, and to retain nurses.
|
B
|
Baxter did not launch a media campaign to promote the
image of nursing.
|
C
|
Microsoft did not launch a media campaign to promote the
image of nursing.
|
D
|
Wal-Mart did not launch a media campaign to promote the
image of nursing.
|
DIF: Cognitive Level: Knowledge REF: Page 47
18. A shift in population growth is expected to
place stress on nursing resources. Which age-group is expected to experience
the greatest population growth in the next decade?
a.
|
Older than 85 years of age
|
b.
|
75 to 85 years of age
|
c.
|
35 to 65 years of age
|
d.
|
18 to 35 years of age
|
ANS: A
|
Feedback
|
A
|
Persons older than 85 years, known as the “very old,”
represent the fastest-growing segment of the total population.
|
B
|
Although the 75 to 85 age-group is growing, it is not the
fastest-growing segment of the population.
|
C
|
The group of individuals 35 to 65 years of age is not
expected to grow as dramatically as is the group termed “very old.”
|
D
|
The 18 to 35 age-group is not expected to be the
fastest-growing segment of the population in the next decade.
|
DIF: Cognitive Level: Knowledge REF: Page 48
19. The term emotional intelligence refers to
a.
|
The ability to use technology without losing the caring
aspect of nursing
|
b.
|
The tendency to use technology in place of face-to-face
patient contact
|
c.
|
The responsibility to treat the person instead of data
received through technology
|
d.
|
Making a good decision based on evidence and not feeling
|
ANS: A
|
Feedback
|
A
|
Successfully combining technology and caring requires
emotional connectivity. This is referred to as emotional intelligence.
|
B
|
Technology without the human touch is not emotional
intelligence.
|
C
|
Emotional intelligence addresses the use of compassion
and technology.
|
D
|
Emotional intelligence addresses the use of compassion
and technology.
|
DIF: Cognitive Level: Knowledge REF: Page 54
20. Which of the following was an unsuccessful
attempt by the American Medical Association (AMA) to alleviate the nursing
shortage of the time?
a.
|
Creation of the nurse manager position
|
b.
|
Creation of the registered care technician
|
c.
|
Recruitment of RNs from English-speaking countries
|
d.
|
Redistribution of qualified nurses to certain geographic
locations
|
ANS: B
|
Feedback
|
A
|
The nurse manager position was not created by the AMA.
|
B
|
In response to the nursing shortage in the late 1980s,
the AMA proposed a nurse extender called the registered care technician.
|
C
|
The recruitment of foreign nurses was not a proposal of
the AMA.
|
D
|
Travel nursing was not a proposal of the AMA.
|
DIF: Cognitive Level: Knowledge REF: Page 55
21. The first trained nurse in the United States graduated in 1873 from New England Hospital
for Women and Children. Who was this nurse who later became the supervisor of
the Boston Training School ?
a.
|
Mary Ann Bickerdyke
|
b.
|
Dorothea Dix
|
c.
|
Linda Richards
|
d.
|
Sallie Thompkins
|
ANS: C
|
Feedback
|
A
|
Mary Ann Bickerdyke was an uneducated widow who organized
the camp hospital in
|
B
|
Dorothea Dix, a well-known advocate for the mentally ill,
was instrumental in creating a month-long training program in two
|
C
|
In 1872 Linda Richards became the first student to enroll
in the inaugural class of five students in the first American nurses’
training school run by Dr. Susan Dimock. She graduated 1 year later.
|
D
|
Sallie Thompkins established a hospital in
|
DIF: Cognitive Level: Knowledge REF: Page 32
22. During the Depression, staffing of hospitals
changed with an impact lasting to the current day. This change was
a.
|
The employment of graduate nurses in hospitals
|
b.
|
The need for increased private duty nurses and rural
health nurses decreased the number of nurses seeking employment in hospitals
|
c.
|
The opening of more schools of nursing in hospitals
|
d.
|
The increased number of collegiate schools of nursing,
which allowed hospitals to increase the educational requirements for the
staff
|
ANS: A
|
Feedback
|
A
|
Hospitals were forced to close their schools of nursing,
families were no longer able to afford private duty nurses in their homes,
and hospitals hired the unemployed graduate nurses to care for the increased
numbers of patients seeking care in hospitals.
|
B
|
Although there was a need for nurses in rural areas
supported by the Civil Works Administration, the number of private duty
nurses decreased due to the inability of families to afford them.
|
C
|
For economical reasons, hospitals could not afford to
fund schools of nursing.
|
D
|
Although the number of collegiate schools increased, most
nurses in hospitals were prepared in diploma programs.
|
DIF: Cognitive level: Comprehension REF: Page 38
23. Wars have often been the driving force in
creating social change. The profession of nursing has been influenced by wars
and nurses in the military over history by
a.
|
The need for increased education for nurses
|
b.
|
The integration of men and African Americans in
professional nursing organizations
|
c.
|
The development of specialty care and clinical
specialization for nurses
|
d.
|
The increased hierarchy within hospital systems
|
ANS: B
|
Feedback
|
A
|
Wars historically increased the demand for the numbers of
educated nurses, but the education level of military nurses mirrored that of
society in general until after World War II.
|
B
|
After the military integrated men and African Americans
into the nurse corps, the American Nurses Association also committed full
support to minority groups, as well as abolishment of discrimination in all
aspects of the profession.
|
C
|
Specialization was more of a result of the specialization
of medicine than the military.
|
D
|
Although the military and hospitals both have
hierarchical systems, the military did not increase the hierarchy in
hospitals.
|
DIF: Cognitive level: Synthesis REF: Page 34
24. Florence Nightingale is often credited as
being the first nurse researcher. This designation is based on
a.
|
Her methods of reorganizing British hospitals
|
b.
|
Her use of data on the morbidity and mortality of
soldiers in hospitals in Scutari
|
c.
|
Demonstration that trained nurses provided better nursing
care
|
d.
|
The publication of Notes on Nursing,
the first example of scholarly nursing publication
|
ANS: B
|
Feedback
|
A
|
Although Nightingale reformed both the British Army and
British civilian hospitals on the basis of data she collected, the
reformations were not researched.
|
B
|
Nightingale was educated in statistics and used the
detailed data collected to effectively argue the case for the reform of the
British Army hospital system.
|
C
|
Nightingale founded the first training school after she
had gained fame based on the hospital reforms supported by her data collection
during the Crimean War.
|
D
|
The publication reflected Nightingale’s philosophical
thoughts on nursing.
|
DIF: Cognitive level: Comprehension REF: Page 30
25. The nursing profession is responsible for
improving its own image. The most effective avenue for changing
the image of nursing is to
a.
|
Write letters to those responsible for negative images on
television and in films expressing concerns
|
b.
|
Have nurses as consultants to the media to ensure that
the media producers have accurate information about nursing
|
c.
|
Have nurses appear and behave professionally and explain
what nurses do in each patient interaction
|
d.
|
Support the Johnson & Johnson campaign by
distributing their information about nursing to students interested in
nursing
|
ANS: C
|
Feedback
|
A
|
While appropriate, writing letters to professionals in
television and film is not the most effective avenue for changing the image
of nursing.
|
B
|
While appropriate, having nursing consultants to the
media is not the most effective avenue for changing the image of nursing.
|
C
|
The major avenue for changing the image of nursing occurs
one nurse-patient encounter at a time, where nurses look and behave
professionally and demonstrate what it is nurses do.
|
D
|
While supporting Johnson & Johson’s Campaign for
Nursing’s Future is appropriate, it is not the most effective avenue for
changing the image of nursing.
|
DIF: Cognitive level: Application REF: Page 46
26. The diversity of the population entering the
health care system is a challenge for nurses because
a.
|
The portion of minorities in nursing is greater than the
portion of minorities in the general population
|
b.
|
Educators are culturally competent leaders for nurses and
students
|
c.
|
Lessons about culture and cultural
differences are not part of progressive education programs
|
d.
|
Ethnic minority group nurses are approximately 10% of
nurses
|
ANS: D
|
Feedback
|
A
|
Only 10% of nurses are minorities, but approximately 31%
of the general population is identified as a minority.
|
B
|
Managers, educators, and other nursing leaders will
require training so they can be culturally competent leaders for nurses and
students who may have backgrounds different from their own.
|
C
|
Culture and cultural differences are part of progressive
education programs. However, understanding of health and illness in the
context of cultural heritage is not consistently addressed in the health care
system.
|
D
|
Approximately 1 in 10 nurses identify themselves as a
member of a minority group.
|
DIF: Cognitive level: Comprehension REF: Page 52
27. Biomedical technology involves the use of
complex machines or devices in patient care situations. Because of the highly
technological environment in which nurses work, it is important that nurses
a.
|
Assume total responsibility for monitoring data generated
by these devices
|
b.
|
Use human touch and words of reassurance frequently to
convey caring
|
c.
|
Maintain the device's safety by assuring routine
assessment by physicians
|
d.
|
Be careful not to frighten the patient and family with
information about the device
|
ANS: B
|
Feedback
|
A
|
The monitoring and safety of machines and devices are
most often the responsibility of nurses and technicians.
|
B
|
The use of technology needs to be combined with caring to
maintain patient and family satisfaction. Technology must never take the
place of human-to-human contact.
|
C
|
The monitoring and safety of machines and devices are
most often the responsibility of nurses and technicians.
|
D
|
The patient and family need information about the use of
the device, as well as the meaning of the information produced, to decrease
stress and anxiety.
|
DIF: Cognitive level: Application REF: Page 54
28. Margaret Sanger, as a nurse and activist,
worked on the Lower East Side of New York City in the early 1900s with
immigrant women. The focus of her work was
a.
|
Sanitation to prevent disease transmission
|
b.
|
Health education for children
|
c.
|
Providing nursing care to underserved African-American
families
|
d.
|
Safe contraception and family planning for women
|
ANS: D
|
Feedback
|
A
|
Sanitation to prevent disease transmission may have been
part of her work in her early years but Sanger devoted her life to the birth
control movement and became a national figure in that cause.
|
B
|
Health education for children may have been part of her
work in her early years, but Sanger devoted her life to the birth control
movement and became a national figure in that cause.
|
C
|
Providing nursing care to underserved African-American
families may have been part of her work in her early years, but Sanger
devoted her life to the birth control movement and became a national figure
in that cause.
|
D
|
Margaret Sanger, inspired by the death of an immigrant
woman from a self-attempted abortion, became determined to teach women about
birth control.
|
DIF: Cognitive level: Knowledge REF: Page 34
MULTIPLE RESPONSE
1. Nursing practices during the Civil War
advanced the cause of professional nursing. The move toward formal education
and training was supported by (select all that apply):
a.
|
Endorsement by the Catholic nursing orders (Sisters of
Charity, Sisters of Mercy, and Sisters of the Holy Cross)
|
b.
|
Proposal by Dr. Samuel Gross in 1869 that large hospitals
develop training schools for nurses
|
c.
|
Reports of inadequate conditions in hospitals reported by
social reformers after the Civil War
|
d.
|
Lobbying by the United States Sanitary Commission for the
creation of nursing schools
|
ANS: B, C, D
|
Feedback
|
Correct
|
The proposal by Dr. Samuel Gross in 1869 that large
hospitals develop training schools for nurses, reports of inadequate
conditions in hospitals reported by social reformers after the Civil War and
lobbying by the United States Sanitary Commission for the creation of nursing
schools all led towards formal education and training for nursing practices.
Support for the development of schools to train nurses was given by
physicians who had observed the difference training made in hospitals during
the war, as well as by the United States Sanitary Commission. Social
reformation that started before the Civil War identified the shocking
conditions in hospitals.
|
Incorrect
|
“Endorsement by the Catholic nursing orders (Sisters of
Charity, Sisters of Mercy, and Sisters of the Holy Cross)” is incorrect
because, although the Catholic nursing orders provided significant organized
nursing care during the war, even they did not develop formal education
programs until later.
|
DIF: Cognitive level: Comprehension REF: Page 31
2. Historically, one solution that attempted to
correct the shortage of registered nurses was to increase the supply of nurses.
Means of increasing the supply of nurses included (select all that apply):
a.
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Implementation of team nursing
|
b.
|
Use of “traveling nurses”
|
c.
|
Development of associate degree programs
|
d.
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Importation of nurses from English-speaking countries
|
ANS: B, C, D
|
Feedback
|
Correct
|
“Use of traveling nurses,” “Development of associate
degree programs” and “Importation of nurses from English-speaking countries”
are correct because all have been used to increase the numbers of practicing
nurses.
|
Incorrect
|
“Implementation of team nursing” is incorrect because
although the implementation of team nursing was intended to improve nurse
availability, it did not increase the number of nurses.
|
DIF: Cognitive level: Comprehension REF: Page 55
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