Maternity and Women's Health Care 13th Edition Lowdermilk Test
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
Chapter,.01:,.21st,.Century,.Maternity,.and,.Women’s,.Health,.Nursing,.Lowdermil
k:,.Maternity,.&,.Women’s,.Health,.Care,,.12th,.Edition
MULTIPLE,.CHOICE
1. In,.evaluating,.the,.level,.of,.a,.pregnant,.woman’s,.risk,.of,.having,.a,.low-birth-
weight,.(LBW),.infant,,.which,.factor,.is,.the,.most,.important,.for,.the,.nurse,.to,.consider?
a. African-American,.race
b. Cigarette,.smoking
c. Poor,.nutritional,.status
d. Limited,.maternal,.education
ANS:, . A
The,.rise,.in,.the,.overall,.LBW,.rates,.were,.due,.to,.increases,.in,.LBW,.births,.to,.non-
Hispanic,.black,.women,.(13.35%),.and,.Hispanic,.women,.(7.21%);,.non-
Hispanic,.black,.infants,.are,.almost,.twice,.as,.likely,.as,.non-
Hispanic,.white,.infants,.to,.be,.of,.LBW,.and,.to,.die,.in,.the,.first,.year,.of,.life..,.Race,.is,.a,.nonmo
difiable,.risk,.factor.,.Cigarette,.smoking,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.r
ates,,.but,.it,.is,.not,.the,.most,.important.,.Additionally,,.smoking,.is,.a,.modifiable,.risk,.factor.,.P
oor,.nutrition,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.rates,,.but,.it,.is,.not,.the,.mo
st,.important.,.Additionally,,.nutritional,.status,.is,.a,.modifiable,.risk,.factor.,.Maternal,.educatio
n,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.rates,,.but,.it,.is,.not,.the,.most,.importan
t.,.Additionally,,.maternal,.education,.is,.a,.modifiable,.risk,.factor.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Assessment
MSC:, . , . Client, . Needs:, . HealtN
hUPrRoS
mI ioG
otN nTanBd.M
CaOinMtenance,, . Antepartum, . Care
2. A,.23-year-old,.African-
American,.woman,.is,.pregnant,.with,.her,.first,.child.,.Based,.on,.current,.statistics,.for,.infant,.
mortality,,.which,.intervention,.is,.most,.important,.for,.the,.nurse,.to,.include,.in,.the,.client’s,.pl
an,.of,.care?
a. Perform,.a,.nutrition,.assessment.
b. Refer,.the,.woman,.to,.a,.social,.worker.
c. Advise,.the,.woman,.to,.see,.an,.obstetrician,,.not,.a,.midwife.
d. Explain,.to,.the,.woman,.the,.importance,.of,.keeping,.her,.prenatal,.care,.appointments.
ANS:, . D
Consistent,.prenatal,.care,.is,.the,.best,.method,.of,.preventing,.or,.controlling,.risk,.factors,.assoc
iated,.with,.infant,.mortality.,.Nutritional,.status,.is,.an,.important,.modifiable,.risk,.factor,,.but,.it,.i
s,.not,.the,.most,.important,.action,.a,.nurse,.should,.take,.in,.this,.situation.,.The,.client,.may,.need
,.assistance,.from,.a,.social,.worker,.at,.some,.time,.during,.her,.pregnancy,,.but,.a,.referral,.to,.a,.so
cial,.worker,.is,.not,.the,.most,.important,.aspect,.the,.nurse,.should,.address,.at,.this,.time.,.If,.the,.
woman,.has,.identifiable,.high-
risk,.problems,,.then,.her,.health,.care,.may,.need,.to,.be,.provided,.by,.a,.physician.,.However,,.it,.
cannot,.be,.assumed,.that,.all,.African-American,.women,.have,.high-
risk,.issues.,.In,.addition,,.advising,.the,.woman,.to,.see,.an,.obstetrician,.is,.not,.the,.most,.import
ant,.aspect,.on,.which,.the,.nurse,.should,.focus,.at,.this,.time,,.and,.it,.is,.not,.appropriate,.for,.a,.nu
rse,.to,.advise,.or,.manage,.the,.type,.of,.care,.a,.client,.is,.to,.receive.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Planning
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
3. The,.nurses,.working,.at,.a,.newly,.established,.birthing,.center,.have,.begun,.to,.compare,.the
ir,.performance,.in,.providing,.maternal-
newborn,.care,.against,.clinical,.standards.,.This,.comparison,.process,.is,.most,.commonl
y,.known,.as,.what?
a. Best,.practices,.network
b. Clinical,.benchmarking
c. Outcomes-oriented,.pracNtiUceR S
d. Evidence-based,.practice
ANS:, . C
Outcomes-
oriented,.practice,.measures,.the,.effectiveness,.of,.the,.interventions,.and,.quality,.of,.care,.again
st,.benchmarks,.or,.standards.,.The,.term,.best,.practice,.refers,.to,.a,.program,.or,.service,.that,.has,.
been,.recognized,.for,.its,.excellence.,.Clinical,.benchmarking,.is,.a,.process,.used,.to,.compare,.o
ne’s,.own,.performance,.against,.the,.performance,.of,.the,.best,.in,.an,.area,.of,.service.,.The,.ter
m,.evidence-
based,.practice,.refers,.to,.the,.provision,.of,.care,.based,.on,.evidence,.gained,.through,.research,.
and,.clinical,.trials.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Evaluation
MSC:, . Client,.Needs:,.Safe,.and,.Effective,.Care,.Environment
4. During,.a,.prenatal,.intake,.interview,,.the,.nurse,.is,.in,.the,.process,.of,.obtaining,.an,.init
ial,.assessment,.of,.a,.21-year-
old,.Hispanic,.client,.with,.limited,.English,.proficiency.,.Which,.intervention,.is,.the,.mo
st,.important,.for,.the,.nurse,.to,.implement?
a. Use,.maternity,.jargon,.to,.enable,.the,.client,.to,.become,.familiar,.with,.these,.terms.
b. Speak,.quickly,.and,.efficiently,.to,.expedite,.the,.visit.
c. Provide,.the,.client,.with,.handouts.
d. Assess,.whether,.the,.client,.understands,.the,.discussion.
ANS:, . D
Nurses,.contribute,.to,.health,.literacy,.by,.using,.simple,,.common,.words,,.avoiding,.jargon,,.a
nd,.evaluating,.whether,.the,.client,.understands,.the,.discussion.,.Speaking,.slowly,.and,.clearl
y,.and,.focusing,.on,.what,.is,.important,.will,.increase,.understanding.,.Most,.client,.education,.
materials,.are,.written,.at,.a,.level,.too,.high,.for,.the,.average,.adult,.and,.may,.not,.be,.useful,.for
,.a,.client,.with,.limited,.English,.proficiency.
PTS: 1 DIF:
Cognitive,.Level:,.Apply,.TOP:
Nursing,.Process:,.Implementation
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
5. Which,.statement,.best,.exemplifies,.contemporary,.maternity,.nursing?
a. Use,.of,.midwives,.for,.all,.vaginal,.deliveries
b. Family-centered,.care
c. Free-standing,.birth,.clinics
d. Physician-
driven,.care,.ANS:, . B
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
Contemporary,.maternity,.nursing,.focuses,.on,.the,.family’s,.needs,.and,.desires.,.Fathers,,.part
ners,,.grandparents,,.and,.siblings,.may,.be,.present,.for,.the,.birth,.and,.participate,.in,.activities,.su
ch,.as,.cutting,.the,.baby’s,.umbilical,.cord.,.Both,.midwives,.and,.physicians,.perform,.vaginal,.d
eliveries.,.Free-
standing,.clinics,.are,.an,.example,.of,.alternative,.birth,.options.,.Contemporary,.maternity,.nurs
ing,.is,.driven,.by,.the,.relationship,.between,.nurses,.and,.their,.clients.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Planning
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
6. A,.38-year-old,.Hispanic,.woman,.vaginally,.delivered,.a,.9-pound,,.6-
ounce,.baby,.girl,.after,.being,.in,.labor,.for,.43,.hours.,.The,.baby,.died,.3,.days,.later,.from,.sepsis.,
.On,.what,.grounds,.could,.the,.woman,.have,.a,.legitimate,.legal,.case,.for,.negligence?
a. Inexperienced,.maternity,.nurse,.was,.assigned,.to,.care,.for,.the,.client.
b. Client,.was,.past,.her,.due,.date,.by,.3,.days.
c. Standard,.of,.care,.was,.not,.met.
d. Client,.refused,.electronic,.fetal,.monitoring.
ANS:, . C
Not,.meeting,.the,.standard,.of,.care,.is,.a,.legitimate,.factor,.for,.a,.case,.of,.negligence.,.An,.inexp
erienced,.maternity,.nurse,.would,.need,.to,.display,.competency,.before,.being,.assigned,.to,.care,.
for,.clients,.on,.his,.or,.her,.own.,.This,.client,.may,.have,.been,.past,.her,.due,.date;,.however,,.a,.ter
m,.pregnancy,.often,.goes,.beyond,.40,.weeks,.of,.gestation.,.Although,.fetal,.monitoring,.is,.the,.s
tandard,.of,.care,,.the,.client,.has,.the,.right,.to,.refuse,.treatment.,.This,.refusal,.is,.not,.a,.case,.for,.
negligence,,.but,.informed,.consent,.should,.be,.properly,.obtained,,.and,.the,.client,.should,.have
,.signed,.an,.against,.medical,.advice,.form,.when,.refusing,.any,.treatment,.that,.is,.within,.the,.st
andard,.of,.care.
PTS: 1 DIF:
Cognitive,.Level:,.Analyze,.TOP:
Nursing,.Process:,.Implementation
MSC:, . Client,.Needs:,.Safe,.and,.Effective,.Care,.Environment
7. When,.the,.nurse,.is,.unsure,.how,.to,.perform,.a,.client,.care,.procedure,.that,.is,.high,.risk,.and,.l
ow,.volume,,.his,.or,.her,.best,.action,.in,.this,.situation,.would,.be,.what?
a. Ask,.another,.nurse.
b. Discuss,.the,.procedure,.with,.the,.client’s,.physician.
c. Look,.up,.the,.procedure,.in,.a,.nursing,.textbook.
d. First,.consult,.the,.agency,.procedure,.manual
ANS:, . D
Following,.the,.agency’s,.policies,.and,.procedures,.manual,.is,.always,.best,.when,.seeking,.info
rmation,.on,.correct,.client,.procedures.,.These,.policies,.should,.reflect,.the,.current,.standards,.of
,.care,.and,.the,.individual,.state’s,.guidelines.,.Each,.nurse,.is,.responsible,.for,.his,.or,.her,.own,.p
ractice.,.Relying,.on,.another,.nurse,.may,.not,.always,.be,.a,.safe,.practice.,.Each,.nurse,.is,.obliga
ted,.to,.follow,.the,.standards,.of,.care,.for,.safe,.client,.care,.delivery.,.Physicians,.are,.responsibl
e,.for,.their,.own,.client,.care,.activity.,.Nurses,.may,.follow,.safe,.orders,.from,.physicians,,.but,.t
hey,.are,.also,.responsible,.for,.the,.activities,.that,.they,,.as,.nurses,,.are,.to,.carry,.out.,.Informatio
n,.provided,.in,.a,.nursing,.textbook,.is,.basic,.information,.for,.general,.knowledge.,.Furthermore,
,.the,.information,.in,.a,.textbook,.may,.not,.reflect,.the,.current,.standard,.of,.care,.or,.the,.individ
ual,.state,.or,.hospital,.policies.
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
Chapter,.01:,.21st,.Century,.Maternity,.and,.Women’s,.Health,.Nursing,.Lowdermil
k:,.Maternity,.&,.Women’s,.Health,.Care,,.12th,.Edition
MULTIPLE,.CHOICE
1. In,.evaluating,.the,.level,.of,.a,.pregnant,.woman’s,.risk,.of,.having,.a,.low-birth-
weight,.(LBW),.infant,,.which,.factor,.is,.the,.most,.important,.for,.the,.nurse,.to,.consider?
a. African-American,.race
b. Cigarette,.smoking
c. Poor,.nutritional,.status
d. Limited,.maternal,.education
ANS:, . A
The,.rise,.in,.the,.overall,.LBW,.rates,.were,.due,.to,.increases,.in,.LBW,.births,.to,.non-
Hispanic,.black,.women,.(13.35%),.and,.Hispanic,.women,.(7.21%);,.non-
Hispanic,.black,.infants,.are,.almost,.twice,.as,.likely,.as,.non-
Hispanic,.white,.infants,.to,.be,.of,.LBW,.and,.to,.die,.in,.the,.first,.year,.of,.life..,.Race,.is,.a,.nonmo
difiable,.risk,.factor.,.Cigarette,.smoking,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.r
ates,,.but,.it,.is,.not,.the,.most,.important.,.Additionally,,.smoking,.is,.a,.modifiable,.risk,.factor.,.P
oor,.nutrition,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.rates,,.but,.it,.is,.not,.the,.mo
st,.important.,.Additionally,,.nutritional,.status,.is,.a,.modifiable,.risk,.factor.,.Maternal,.educatio
n,.is,.an,.important,.factor,.in,.potential,.infant,.mortality,.rates,,.but,.it,.is,.not,.the,.most,.importan
t.,.Additionally,,.maternal,.education,.is,.a,.modifiable,.risk,.factor.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Assessment
MSC:, . , . Client, . Needs:, . HealtN
hUPrRoS
mI ioG
otN nTanBd.M
CaOinMtenance,, . Antepartum, . Care
2. A,.23-year-old,.African-
American,.woman,.is,.pregnant,.with,.her,.first,.child.,.Based,.on,.current,.statistics,.for,.infant,.
mortality,,.which,.intervention,.is,.most,.important,.for,.the,.nurse,.to,.include,.in,.the,.client’s,.pl
an,.of,.care?
a. Perform,.a,.nutrition,.assessment.
b. Refer,.the,.woman,.to,.a,.social,.worker.
c. Advise,.the,.woman,.to,.see,.an,.obstetrician,,.not,.a,.midwife.
d. Explain,.to,.the,.woman,.the,.importance,.of,.keeping,.her,.prenatal,.care,.appointments.
ANS:, . D
Consistent,.prenatal,.care,.is,.the,.best,.method,.of,.preventing,.or,.controlling,.risk,.factors,.assoc
iated,.with,.infant,.mortality.,.Nutritional,.status,.is,.an,.important,.modifiable,.risk,.factor,,.but,.it,.i
s,.not,.the,.most,.important,.action,.a,.nurse,.should,.take,.in,.this,.situation.,.The,.client,.may,.need
,.assistance,.from,.a,.social,.worker,.at,.some,.time,.during,.her,.pregnancy,,.but,.a,.referral,.to,.a,.so
cial,.worker,.is,.not,.the,.most,.important,.aspect,.the,.nurse,.should,.address,.at,.this,.time.,.If,.the,.
woman,.has,.identifiable,.high-
risk,.problems,,.then,.her,.health,.care,.may,.need,.to,.be,.provided,.by,.a,.physician.,.However,,.it,.
cannot,.be,.assumed,.that,.all,.African-American,.women,.have,.high-
risk,.issues.,.In,.addition,,.advising,.the,.woman,.to,.see,.an,.obstetrician,.is,.not,.the,.most,.import
ant,.aspect,.on,.which,.the,.nurse,.should,.focus,.at,.this,.time,,.and,.it,.is,.not,.appropriate,.for,.a,.nu
rse,.to,.advise,.or,.manage,.the,.type,.of,.care,.a,.client,.is,.to,.receive.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Planning
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
3. The,.nurses,.working,.at,.a,.newly,.established,.birthing,.center,.have,.begun,.to,.compare,.the
ir,.performance,.in,.providing,.maternal-
newborn,.care,.against,.clinical,.standards.,.This,.comparison,.process,.is,.most,.commonl
y,.known,.as,.what?
a. Best,.practices,.network
b. Clinical,.benchmarking
c. Outcomes-oriented,.pracNtiUceR S
d. Evidence-based,.practice
ANS:, . C
Outcomes-
oriented,.practice,.measures,.the,.effectiveness,.of,.the,.interventions,.and,.quality,.of,.care,.again
st,.benchmarks,.or,.standards.,.The,.term,.best,.practice,.refers,.to,.a,.program,.or,.service,.that,.has,.
been,.recognized,.for,.its,.excellence.,.Clinical,.benchmarking,.is,.a,.process,.used,.to,.compare,.o
ne’s,.own,.performance,.against,.the,.performance,.of,.the,.best,.in,.an,.area,.of,.service.,.The,.ter
m,.evidence-
based,.practice,.refers,.to,.the,.provision,.of,.care,.based,.on,.evidence,.gained,.through,.research,.
and,.clinical,.trials.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Evaluation
MSC:, . Client,.Needs:,.Safe,.and,.Effective,.Care,.Environment
4. During,.a,.prenatal,.intake,.interview,,.the,.nurse,.is,.in,.the,.process,.of,.obtaining,.an,.init
ial,.assessment,.of,.a,.21-year-
old,.Hispanic,.client,.with,.limited,.English,.proficiency.,.Which,.intervention,.is,.the,.mo
st,.important,.for,.the,.nurse,.to,.implement?
a. Use,.maternity,.jargon,.to,.enable,.the,.client,.to,.become,.familiar,.with,.these,.terms.
b. Speak,.quickly,.and,.efficiently,.to,.expedite,.the,.visit.
c. Provide,.the,.client,.with,.handouts.
d. Assess,.whether,.the,.client,.understands,.the,.discussion.
ANS:, . D
Nurses,.contribute,.to,.health,.literacy,.by,.using,.simple,,.common,.words,,.avoiding,.jargon,,.a
nd,.evaluating,.whether,.the,.client,.understands,.the,.discussion.,.Speaking,.slowly,.and,.clearl
y,.and,.focusing,.on,.what,.is,.important,.will,.increase,.understanding.,.Most,.client,.education,.
materials,.are,.written,.at,.a,.level,.too,.high,.for,.the,.average,.adult,.and,.may,.not,.be,.useful,.for
,.a,.client,.with,.limited,.English,.proficiency.
PTS: 1 DIF:
Cognitive,.Level:,.Apply,.TOP:
Nursing,.Process:,.Implementation
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
5. Which,.statement,.best,.exemplifies,.contemporary,.maternity,.nursing?
a. Use,.of,.midwives,.for,.all,.vaginal,.deliveries
b. Family-centered,.care
c. Free-standing,.birth,.clinics
d. Physician-
driven,.care,.ANS:, . B
, Maternity and Women's Health Care 13th Edition Lowdermilk Test
Contemporary,.maternity,.nursing,.focuses,.on,.the,.family’s,.needs,.and,.desires.,.Fathers,,.part
ners,,.grandparents,,.and,.siblings,.may,.be,.present,.for,.the,.birth,.and,.participate,.in,.activities,.su
ch,.as,.cutting,.the,.baby’s,.umbilical,.cord.,.Both,.midwives,.and,.physicians,.perform,.vaginal,.d
eliveries.,.Free-
standing,.clinics,.are,.an,.example,.of,.alternative,.birth,.options.,.Contemporary,.maternity,.nurs
ing,.is,.driven,.by,.the,.relationship,.between,.nurses,.and,.their,.clients.
PTS: 1 DIF:
Cognitive,.Level:,.Understand,.TOP:
Nursing,.Process:,.Planning
MSC:, . Client,.Needs:,.Health,.Promotion,.and,.Maintenance
6. A,.38-year-old,.Hispanic,.woman,.vaginally,.delivered,.a,.9-pound,,.6-
ounce,.baby,.girl,.after,.being,.in,.labor,.for,.43,.hours.,.The,.baby,.died,.3,.days,.later,.from,.sepsis.,
.On,.what,.grounds,.could,.the,.woman,.have,.a,.legitimate,.legal,.case,.for,.negligence?
a. Inexperienced,.maternity,.nurse,.was,.assigned,.to,.care,.for,.the,.client.
b. Client,.was,.past,.her,.due,.date,.by,.3,.days.
c. Standard,.of,.care,.was,.not,.met.
d. Client,.refused,.electronic,.fetal,.monitoring.
ANS:, . C
Not,.meeting,.the,.standard,.of,.care,.is,.a,.legitimate,.factor,.for,.a,.case,.of,.negligence.,.An,.inexp
erienced,.maternity,.nurse,.would,.need,.to,.display,.competency,.before,.being,.assigned,.to,.care,.
for,.clients,.on,.his,.or,.her,.own.,.This,.client,.may,.have,.been,.past,.her,.due,.date;,.however,,.a,.ter
m,.pregnancy,.often,.goes,.beyond,.40,.weeks,.of,.gestation.,.Although,.fetal,.monitoring,.is,.the,.s
tandard,.of,.care,,.the,.client,.has,.the,.right,.to,.refuse,.treatment.,.This,.refusal,.is,.not,.a,.case,.for,.
negligence,,.but,.informed,.consent,.should,.be,.properly,.obtained,,.and,.the,.client,.should,.have
,.signed,.an,.against,.medical,.advice,.form,.when,.refusing,.any,.treatment,.that,.is,.within,.the,.st
andard,.of,.care.
PTS: 1 DIF:
Cognitive,.Level:,.Analyze,.TOP:
Nursing,.Process:,.Implementation
MSC:, . Client,.Needs:,.Safe,.and,.Effective,.Care,.Environment
7. When,.the,.nurse,.is,.unsure,.how,.to,.perform,.a,.client,.care,.procedure,.that,.is,.high,.risk,.and,.l
ow,.volume,,.his,.or,.her,.best,.action,.in,.this,.situation,.would,.be,.what?
a. Ask,.another,.nurse.
b. Discuss,.the,.procedure,.with,.the,.client’s,.physician.
c. Look,.up,.the,.procedure,.in,.a,.nursing,.textbook.
d. First,.consult,.the,.agency,.procedure,.manual
ANS:, . D
Following,.the,.agency’s,.policies,.and,.procedures,.manual,.is,.always,.best,.when,.seeking,.info
rmation,.on,.correct,.client,.procedures.,.These,.policies,.should,.reflect,.the,.current,.standards,.of
,.care,.and,.the,.individual,.state’s,.guidelines.,.Each,.nurse,.is,.responsible,.for,.his,.or,.her,.own,.p
ractice.,.Relying,.on,.another,.nurse,.may,.not,.always,.be,.a,.safe,.practice.,.Each,.nurse,.is,.obliga
ted,.to,.follow,.the,.standards,.of,.care,.for,.safe,.client,.care,.delivery.,.Physicians,.are,.responsibl
e,.for,.their,.own,.client,.care,.activity.,.Nurses,.may,.follow,.safe,.orders,.from,.physicians,,.but,.t
hey,.are,.also,.responsible,.for,.the,.activities,.that,.they,,.as,.nurses,,.are,.to,.carry,.out.,.Informatio
n,.provided,.in,.a,.nursing,.textbook,.is,.basic,.information,.for,.general,.knowledge.,.Furthermore,
,.the,.information,.in,.a,.textbook,.may,.not,.reflect,.the,.current,.standard,.of,.care,.or,.the,.individ
ual,.state,.or,.hospital,.policies.
