Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1
Test Bank-Brunner-Suddarth-Medical Surgical 14th Edition Hinkle 2017.
Table Table
of
Contents of Contents 1
Chapter
01: Health Care Delivery and Evidence-Based Nursing Practice 3
Chapter
02: Community-Based Nursing Practice 22
Chapter
03: Critical Thinking, Ethical Decision Making and the Nursing Process 41
Chapter
04: Health Education and Promotion 64
Chapter
05: Adult
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 14
Chapter
68: Management of Patients with Neurologic Trauma 1276
Chapter 69: Management of Autoimmune Disorders, and
Patients
Chapter 70: Management of Degenerative Neurologic Disorders
Patients
Chapter Chapter Chapter
71: 72: 73:
with
Neurologic
Infections, Neuropathies 1294
Management of Patients Emergency Nursing Terrorism, Mass Casualty,
With
Oncologic
With
Infectious
and
Disaster
or 1312 Diseases 1331 1349 Nursing 1367
Chapter 01: Health Nursing Practice
Care Delivery
and Evidence-Based
1.
is presenting mothers. How
a health promotion should the nurse best
class to define
life.
The public health nurse a group of new health?
A)
Health
is
being
disease free.
B)
Health
is
having fulfillment
in
all
C)
Health
is
having psychological
and
physiological
D)
Health
is
being
in
body,
Ans:
D
connected
domains
of
harmony.
mind, and
spirit.
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 15
Feedback: The its social The with 2.
World Health Organization (WHO) defines health in the preamble to constitution as a state of complete physical, mental, and well-being and not merely the absence of disease and infirmity. other answersare incorrect because they are not congruent the WHO definition of health.
Anurse is speaking to a about what it is like to characteristic the nurse would cite an effective nurse?
A)
Sensitivity to
cultural differences
B)
Team-focused
approach
C)
Strict
adherence
to
D)
Ability
to
criticism
Ans:
A
face
to
group of prospective be a nurse. What as necessary to
nursing students is one possess to be
problem-solving
routine
Feedback: To promote an effective nurse-patient relationship and outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused and strict adherence to routine are not characteristics needed to effective nurse. The ability to handle criticism is important, a lesser degree than cultural competence. 3.
With increases in longevity, people have had knowledgeable about their health and the professional health receive. One outcome of this phenomenon is organized self-care education programs. Which of these programs prioritize?
to care the the
positive nursing be an but to
become more that they development following
of do
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 16
A)
Adequate
prenatalcare
B)
Government advocacy
and
C)
Judicious
of
online communities
D)
Management
of
illness
Ans:
D
use
lobbying
Feedback: Organizedself-care disease prevention, the professional Internet activities 4.
The home planning development plan of level of need for
A)
Physiologic
B)
Transcendence
C)
Love
D)
Self-actualization
Ans:
D Feedback:
education programs emphasize management of illness, self-care, and health care system. Prenatal care, are secondary.
health promotion, judicious use lobbying, and
health nurse is assisting a patient and the patients return to work after surgery and of postsurgical complications. The nurse is care that addresses the patients multifaceted needs. Maslows hierarchy of basic needs does self-fulfillment relate?
and
belonging
of
his family in the preparing a To which the patients
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 17
Maslows highest level of human needs is self-actualization, self-fulfillment, desire to knowand understand, and aesthetic other answersare incorrect because self-fulfillment does not them. 5.
The view they exist systems. appreciating
that on When which
which includes needs. The relate directly to
health and illness are a continuum is planning care, this of the following?
not static states but that central to professional health care view aids the nurse in
treatment
A)
Careshould focus
primarily
on
B)
A
persons state
of
C)
A
person can
transition
from
D)
Careshould focus
on
patients compliance
Ans:
B
health is
the
the
of
disease.
ever-changing. health to
illness rapidly. with
interventions.
Feedback: By viewinghealth and illness on a to consider a person as being completely ill. Instead, a persons state and has the potential to range from extremely poor health and imminent incorrect because patient care should not of disease. Rapid declines in health and are not key to this view of 6.
A
group of
nursing students
are
continuum, it is possible neither completely healthy nor of health is ever-changing high-level wellness to death. The other answers are focus just on the treatment compliance with treatment health. participating
in
a
this context,
community
health clinic. When providing
care
in
should the
students
teach
about
disease prevention? A) It
is
achieved
through attending
best
participants
self-help
groups.
what
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 18
B)
It
is
best
achieved
by
reducing
psychological
C)
It
is the
best achieved community.
by
being
active participant
in
D)
It
is best health.
by
exhibiting
behaviors
promote
Ans:
D
achieved
an
stress.
that
Feedback:
7.
Today, increasing emphasis is placed on health, health wellness, and self-care. Health is seen as resulting lifestyleoriented toward wellness. Nurses in community not teach that disease prevention is best achieved self-help groups, by reducing stress, or by being participant in the community, though each of these consistent with a healthy lifestyle.
promotion, from a health clinics do through attending an active activities is
Anurse on a medical-surgical unit has asked to the unit on the hospitals quality committee. When quality improvement programs to nursing colleagues and other health disciplines, what characteristic should the nurse
represent describing members cite?
A)
These programs establish professionals actions.
consequences
B)
These care.
programs
focus
the
C)
These
programs
identify specific incidents
D)
These
programs
seek
Ans:
B
on
to
for
processes
health care
used
related to
justify health care
of
costs
to
provide
quality. and
systems.
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 19
Feedback: Numerousmodels seek A commonality are used to and justificationfor quality improvement 8.
Nurses in members care for than in return to
to improve the quality of health care delivery. among them is a focus on the processes that provide care. Consequences, a focus on incidents, health care costs are not universal characteristics of efforts.
acute care settings must work with other health care to maintain quality care while facing pressures patients who are hospitalized for shorter periods of the past. To ensure positive health outcomes when their homes, what action should the nurse prioritize?
A)
Promotion of
B)
Close
communication with
C)
Thorough
and
D)
Participationin
Ans:
C
team to time patients
health literacy during hospitalization insurers
evidence-based discharge
planning
continuing
initiatives
education
Feedback: Followingdischarges that occur after increasingly the community care for patients who need care servicesas well as long-term care dependenton effective discharge planning than continuing education, communication with of health literacy. 9.
You are admitting a patient has been transferred your priority nursing action at
short hospital stays, nurses in high-technology acute in the home. This is to a greater degree insurers, or promotion
patient to your medical unit from the emergency department. this time?
after What
the is
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 20
A)
Identifying the
immediate
needs
of
the
patient
B)
Checking
the
admitting
physicians
orders
C)
Obtaining
a
baseline
set
of
vital
signs
D)
Allowing
the
family to
be
with
the
patient
Ans:
A Feedback: Among the nurses important functions in identifying the patients immediate needs and with the patient to address them is most nursing functions are important, but they are functions.
health care working important. not the
10. Anurse on a clinical pathway. aid of a
postsurgical unit is providing care When performing assessments and interventions pathway, the nurse should prioritize
A)
Helping
the
patient to
B)
Balancing
risks
and
benefits of
C)
Documenting
the
patients response
D)
Staying
Ans:
A Feedback:
accountable
to
achieve specific outcomes
the
interventions to
therapy
interdisciplinary
team
delivery, in concert The other most important
based with what
on the goal?
a
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 21
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount. 11. Staff nurses in lower and fewer were consciously RN of this noise on the demonstrate a
an ICU setting have noticed that their patients required doses of analgesia when noise levels on the unit reduced. They informed an advanced practice and asked the APRN to quantify the effects of pain levels of hospitalized patients. How does this role of the APRN?
A)
Involving
patients in
B)
Contributingto
the
C)
Critiquing
quality of
patient care
D)
Explaining medical studies to
patients and
RNs
Ans:
B
purview of explaining studies their care.
the to
the
their
care
scientific
while
hospitalized
basis
of
nursing practice
Feedback: Research is does not involving 12. Nurses and nurse the the A)
now one in main
within the exemplify patients in
have the option to practice in a variety of of the fastest growing venues of practice for todays health care environment is home health care. basis for
growth in Chronic
APRN. The activity described RNs, critiquing care, or
this
health care
nursing shortage
setting?
settings the What is
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 22
B)
Western
focus
on
treatment
of
disease
C)
Nurses shifts
preferences
for
day
shifts
instead of
evening or
D)
Discharge
of
patients who
are
more
critically
ill
Ans:
D
night
Feedback: With shorter hospital stays care services, more community setting. The not the basis for the home setting.
and increased use of nursing care is provided in other answersare incorrect the growth in nursing care
outpatient the home because they delivered
health and are in
13. Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurses title? A)
Nursing
care
expert
B)
Clinical
nurse
specialist
C)
Nurse
manager
D)
Staff
nurse
Ans:
B Feedback:
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 23
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse. 14. Nursing with the a
continues to recognize and other health care disciplines to patient. Which of the following collaborative practice model?
A)
The nurse
and
the
physician
B)
The nurse
accompanying the
C)
The nurse
making a
referral on
D)
The nurse
attending
an
Ans:
A
participate meet the is the
in collaboration complex needs best example
jointly making clinical decisions.
physician
on
behalf of
appointment
with
rounds. the
patient.
the
patient.
Feedback: The collaborative model, or a variation shared participation, responsibility, and accountability environment that is striving to meet the needs of the public. The other answersare are not examples of a collaborative 15. Ahospice nurse lymphoma. dimension importance A)
Spiritual
is caring According of care when caring
of it, promotes in a health care complex health care incorrect because they practice model.
for a patient who is to Maslows hierarchy should the nurse consider for a dying patient?
dying of of needs, primaryin
what
of of
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 24
B)
Social
C)
Physiologic
D)
Emotional
Ans:
C Feedback: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing interventions. The other answersare incorrect because they are not of primaryimportance when caring for a dying patient, though each should certainly be addressed.
16. Anurse is planning a Maslows hierarchy of understanding, what would be
medical patients care needs. Within this the nurses first
A)
Allowing
the
family to
see
a
B)
Ambulating the
patient in
the
hallway
C)
Administering
pain
D)
Teaching
patient to
Ans:
C Feedback:
the
with consideration framework of priority?
newly admitted
medication self-administer insulin safely
patient
of
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 25
InMaslows hierarchy basic physiologic need. level need above the see family addresses belonging. Teaching related to the desire appropriate at this pain control must be higher level needs.
of needs, pain relief addresses Activity, such as ambulation, is physiologic need. Allowing the a higher level need related to the patient is also a higher to know and understand and time, as the basic physiologic addressed before the patient can
the patients a higher patient to love and level need is not need of address these
17. Amedical-surgical nurse defined in the state compliance with the which of the following?
is aware of the scope where the nurse provides care. nurse practice act demonstrates
of practice as This nurses adherence to
A)
National
Council of
Nursings
guidelines
for
care
B)
National
League for
Nursings
Code
Conduct
American
Nurses Associations
of
Social Policy Statement
C) Department of
Health and
Human Services
White Paper
on
Nursing
D) Ans:
C Feedback: Nurses have a responsibility to carry in the Social Policy Statement to act of the state in which they the Code of Ethics for Nurses as (2001) and the International Council of Nurses [ICN], 2006). The other answersare Ethics for nursing is not included in DHHS has not published a white the NLN published a specific code of
out their role as described comply with the nurse practice practice and to comply with spelled out by the ANA Nurses (International Council of incorrect; the Code of the ANAs white paper. The paper on nursing nor has conduct.
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 26
18. Nursing meet aging need
is, by both the population. for certified
necessity, a expectations and What is one nurse practitioners
A)
The increased
need
for
B)
The need
to
improve
C)
The push
to
drive
D)
The need
to
decrease
Ans:
A
flexible profession. It has the changing health needs of factor that has impacted (CNPs)?
primarycare
providers
patient diagnostic
institutional the
adapted to our the
services
excellence number of
medical errors
Feedback: CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primarycare or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primaryimpetus for the increased role for CNPs. 19. Anurse is day one colorectal competency
providing care for a patient who is postoperative following a bowel resection for the treatment of cancer. How can the nurse best exemplify the QSEN of quality improvement?
A)
By liaising with team
the
members
B)
By critically provided
appraising
C)
By integrating
the
the
of
the
outcomes
patients preferences
into
interdisciplinary
care
of
care
that
is
the
plan
of
care
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 27
D)
By documenting care timely fashion
Ans:
B
in
the
electronic
health record in
a
central to other listed but none
the QSEN competency of activities is a clearly exemplifies quality
Feedback: Evaluation of outcomes is quality improvements. Each of the component of quality nursing care, improvement activities.
20. Professional nursing expands and grows because of factors driven by the changing needs of health care consumers. Which of the following is a factor that nurses should reflect in the planning and provision of health care? A)
Decreased
B)
access to
health care
information
by
individuals
Gradual increases population
in
cultural unity
of
the
American
C)
Increasing
median age
of
American
population
D)
Decreasing consumer
expectations
related to
health care
outcomes
Ans:
C
mean
and
the
the
Feedback: The decline in birth rate improved health care have and more senior citizens, The population numbers of
and the resulted in many of
increase in lifespan due fewer school-age children whom are women.
has become more culturally people from different national
diverse as backgrounds
increasing enter the
to
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 28
country.Access to increase.
information
and
21. Apublic health nurse program that the community. influence the nurses
has been meets the Which of choice of
commissioned to health care needs the following interventions?
A)
Management
of
chronic conditions
B)
Increasing
need
for
self-care
C)
A
shifting focus
to
disease management
D)
An increasing
focus
on
Ans:
A
acute
consumer
and
among a
conditions
expectations
continue
to
draft a health promotion and expectations of focuses is most likely to
disability younger
and
population
rehabilitation
Feedback: Inresponse management times. The health care our aging management, management
to current priorities, health care must focus more on of chronic conditions and disability than in previous other answersare incorrect because the change in focus of is not an increasing need for self-care among population; our focus is shifting away from disease not toward it; and we are moving away from the of acute conditions to managing chronic conditions.
22. Acommunity health nurse has disease over the course of focuses most clearly demonstrates the United States?
witnessed significant shifts in a four-decade career. Which of the the changing pattern of disease
A)
Type
1
diabetes
management
B)
Treatment
of
community-acquired
pneumonia
patterns of following in
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 29
C)
Rehabilitation
from
traumatic
D)
Management
of
acute
Ans:
A
brain
injuries
Staphylococcus aureus infections
Feedback: Management of priority focus of the treatment
chronic diseases such as diabetes the current health care environment. This of acute infections and rehabilitation
23. The ANA has identified several phenomena nursing care should be directed, and a nurse that reflects these priorities. Which of the demonstrates these priorities?
toward which the is planning nurses actions best
A)
Encouragingthe
patients dependence
on
caregivers
B)
Fostering
the
patients ability to
make
choices
C)
Teaching
the
patient about
D)
Assessing
the
patients adherence
Ans:
B
nurses roles to
in
is a supersedes needs.
the
health care
focus care
of
system
treatment
Feedback: The ANA including because they
identifies several focuses for nursing care the ability to make choices. The other are not phenomena identified by
24. The role of a dominant Which of the the CNP role?
the certified nurse role for nurses in following activities Select all that apply.
and research, answersare incorrect the ANA.
practitioner (CNP) has become all levels of health care. are considered integral to
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 30
A)
Educating
B)
Coordinating
care
C)
Using
direct
provision
D)
Educating
registered
E)
Coordinating
Ans:
A,B,
patients and
family members with
other
disciplines
of
interventions
nurses and
payment
plans
practical for
nurses
patients
C
Feedback: This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in homecare and community nursing.Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to performcare, and by coordinating and collaborating with other disciplines to provide needed services. The other answersare incorrect because NPs not commonly performeducation of nurses and they do not focus matters related to payment.
do on
25. The ANA has are applicable nurses practice. performing which
identified across the A nurse of the
central characteristics of nursing practice that wide variety of contexts in which can best demonstrate these principles by following actions?
A)
Teaching
the
public about
the
role
of
nursing
B)
Taking
action to
control the
costs
of
health care
C)
Ensuring
that
all
of
his
or
her
actions exemplify
D)
Making
sure
to
carry
adequate
liability insurance
caring
Test
Ans:
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 31
C Feedback: The ANA practice of the public a central
26. Anurse new role,
has role the
emphasizes the fact that the registered nurse. The about nursing,controlling costs, tenet of nursing practice.
caring is central to the ANA does not identify teaching or maintaining insurance as
accepted a positionas a that has been launched within the nurse should prioritize which of
clinical nurse leader (CNL), a past decade. In this the following activities?
as
nursing profession
A)
Acting
a
B)
Generating and
disseminating new
C)
Diagnosing and course
treating health problems
D)
Helping
Ans:
D
patients to
spokesperson
navigate
for
the
nursing knowledge
the
that
have
health care
a
predictable
system
Feedback: The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role. 27. Our that the has
world is makes much patient is impacted
connected by a sophisticated health information instantly accessible, being treated. This instant access to health care delivery strategies,
communication system no matter where health information including the
to
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 32
delivery health care
of has
nursing care. What been impacted
is one way by this
A)
Brisk
changesas
well
as
B)
Rapid
change that
is
nearly permanent
C)
Limitations on
the
settings where care
D)
Increased
for
social acceptance
Ans:
A
need
swift
the delivery phenomenon?
of
obsolescence
can
be
provided
Feedback: The sophisticated communication systems that connect most world, with the capability of rapid storage, retrieval, information, have stimulated brisk change as well in health care delivery strategies. The other because, although we have rapid change in nursing care, it does not last a long time; as health care itself evolves. Giving nursing care easier, it becomes more complex with every does not need to be more socially acceptable; more culturally sensitive. 28. With the changing has become necessary nurses, as when acute home health nurses. What importance because of
parts of the and dissemination of as swift obsolescence answersare incorrect the delivery of it is evolving has not become change; and it it needs to be
population of health care consumers, it for nurses to work more closely with other care nurses collaborate with public health and nursing function has increased in this phenomenon?
A)
Prescribing medication
B)
Performing discharge
C)
Promoting family involvement
planning
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 33
D)
Forming
Ans:
B
collegial
relationships
Feedback: The importance of effective discharge planning and quality improvement cannot be overstated. The other answersare incorrect because giving medication and family involvement in the patients care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible. 29. Anurse care.
has EBP
integrated has the
the principles potential to
A)
Increasing
career satisfaction
B)
Obtaining
federal grant
Ensuring
high
quality patient care
C) D)
Ans:
Enhancing the publics esteem for nursing C Feedback:
money
of evidence-based practice into help thenurse achieve what goal?
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 34
Quality improvement is the satisfaction, public esteem, and 30. Acase manager has been combined medical-surgical the following outcomes leadership? for
ultimate goal grant money are
of not
hired at a rural unit. When defining this should be prioritized
A)
Decreased
need
physician
B)
Improved
patient and
family education
C)
Increased
adherence
to
the
D)
Increased
coordination
of
health services
Ans:
D
EBP. Career priorities. hospital that new role, by the
has a which of hospitals
services
principles
of
EBP
Feedback: Case management is a system of coordinating health care servicesto ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician servicesis not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role. 31. Ahospitals principles Million Lives goals of
current quality improvement of the Institute Campaign. How can reducing preventable
A)
By adhering
to
EBP
B)
By reducing
nurse-to-patient ratios
program has integrated the for Healthcare Improvement (IHI) 5 the hospital best achieve the campaign harm and death?
guidelines and
increasing
accountability
Test
Bank Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 35
C)
By having researchers
from
outside the
facility evaluate
D)
By involving
patients and
familiesin
their
Ans:
A
care
care
planning
Feedback: The 5 Million Lives Campaign posits that if it advocated were voluntarily implemented by million lives would be saved from either harm or twoyearperiod. Nurse-to-patient ratios, family participation, evaluation are not stated components of the
evidence-based guidelines U.S. hospitals, 5 death over a and independent campaign.
32. Over the past expanded in the strongest
several decades, nursing roles have many ways. Which of the following impetus for this change?
A)
The need
to
decrease
the
cost
B)
The need
to
improve
the
quality of
nursing education
C)
The need
to
increase
the
number of
nursing jobs
D)
The need
to
increase
the
public perception
Ans:
A
of
changed factors has
and provided
health care
of
available nursing
Feedback: The role of the nurse has expanded to improve the distribution of health care servicesand to decrease the cost of health care. The other answersare incorrect because the expansion of roles in nursing did not occur to improve education, increase the number of nursing jobs, or increase public perception.