{"id":118266,"date":"2023-09-03T05:31:41","date_gmt":"2023-09-03T05:31:41","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=118266"},"modified":"2023-09-03T05:31:45","modified_gmt":"2023-09-03T05:31:45","slug":"introduction-to-maternity-and-pediatric-nursing-8th-edition-test-bank","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/09\/03\/introduction-to-maternity-and-pediatric-nursing-8th-edition-test-bank\/","title":{"rendered":"Introduction to Maternity and Pediatric Nursing 8th Edition test bank"},"content":{"rendered":"\n<p>Chapter 01: The Past, Present, and Future<br>MULTIPLE CHOICE<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>A patient chooses to have the certified nurse midwife (CNM) provide care during her<br>pregnancy. What does the CNMs scope of practice include?<br>a. Practice independent from medical supervision<br>b. Comprehensive prenatal care<br>c. Attendance at all deliveries<br>d. Cesarean sections<br>ANS: B<br>The CNM provides comprehensive prenatal and postnatal care, attends uncomplicated<br>deliveries, and ensures that a backup physician is available in case of unforeseen<br>problems.<br>DIF: Cognitive Level: Comprehension REF: Page 6 OBJ: 12<br>TOP: Advance Practice Nursing Roles KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of<br>Disease<\/li>\n\n\n\n<li>Which medical pioneer discovered the relationship between the incidence of puerperal<br>fever and unwashed hands?<br>a. Karl Cred<br>b. Ignaz Semmelweis<br>c. Louis Pasteur<br>d. Joseph Lister<br>ANS: B<br>Ignaz Semmelweis deduced that puerperal fever was septic, contagious, and transmitted by<br>the unwashed hands of physicians and medical students.<br>DIF: Cognitive Level: Knowledge REF: Page 2 OBJ: 1<br>TOP: The Past KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control<\/li>\n\n\n\n<li>A pregnant woman who has recently immigrated to the United States comments to the<br>nurse, I am afraid of childbirth. It is so dangerous. I am afraid I will die. What is the best<br>nursing response reflecting cultural sensitivity?<br>a. Maternal mortality in the United States is extremely low.<br>b. Anesthesia is available to relieve pain during labor and childbirth.<br>c. Tell me why you are afraid of childbirth.<br>d. Your condition will be monitored during labor and delivery.<br>ANS: C<br>Asking the patient about her concerns helps promote understanding and individualizes<br>patient care.<br>DIF: Cognitive Level: Application REF: Page 7-8 OBJ: 8<br>TOP: Cross-Cultural Care KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Psychosocial Integrity: Psychological Adaptation<br>1<\/li>\n\n\n\n<li>An urban area has been reported to have a high perinatal mortality rate. What information<br>does this provide?<br>a. Maternal and infant deaths per 100,000 live births per year<br>b. Deaths of fetuses weighing more than 500 g per 10,000 births per year<br>c. Deaths of infants up to 1 year of age per 1000 live births per year<br>d. Fetal and neonatal deaths per 1000 live births per year<br>ANS: D<br>The perinatal mortality rate includes fetal and neonatal deaths per 1000 live births per year.<br>DIF: Cognitive Level: Comprehension REF: Page 12, Box 1-6<br>OBJ: 9 TOP: The Present-Child Care<br>KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>What is the focus of current maternity practice?<br>a. Hospital births for the majority of women<br>b. The traditional family unit<br>c. Separation of labor rooms from delivery rooms<br>d. A quality family experience for each patient<br>ANS: D<br>Current maternity practice focuses on a high-quality family experience for all families,<br>traditional or otherwise.<br>DIF: Cognitive Level: Comprehension REF: Page 6 OBJ: 7<br>TOP: The Present-Maternity Care KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Health Promotion and Maintenance<\/li>\n\n\n\n<li>Who advocated the establishment of the Childrens Bureau?<br>a. Lillian Wald<br>b. Florence Nightingale<br>c. Florence Kelly<br>d. Clara Barton<br>ANS: A<br>Lillian Wald is credited with suggesting the establishment of a federal Childrens Bureau.<br>DIF: Cognitive Level: Knowledge REF: Page 4 OBJ: 1 | 2<br>TOP: The Past KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Growth and Development<\/li>\n\n\n\n<li>What was the result of research done in the 1930s by the Childrens Bureau?<br>a. Children with heart problems are now cared for by pediatric cardiologists.<br>b. The Child Abuse and Prevention Act was passed.<br>c. Hot lunch programs were established in many schools.<br>d. Childrens asylums were founded.<br>ANS: C<br>School hot lunch programs were developed as a result of research by the Childrens Bureau<br>on the effects of economic depression on children.<br>DIF: Cognitive Level: Knowledge REF: Page 4 OBJ: 2 | 3<br>TOP: The Past KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care<br>2<\/li>\n\n\n\n<li>What government program was implemented to increase the educational exposure of<br>preschool children?<br>a. WIC<br>b. Title XIX of Medicaid<br>c. The Childrens Charter<br>d. Head Start<br>ANS: D<br>Head Start programs were established to increase educational exposure of preschool<br>children.<br>DIF: Cognitive Level: Knowledge REF: Page 3 OBJ: 5<br>TOP: Government Influences in Maternity and Pediatric Care KEY: Nursing Process Step:<br>N\/A<br>MSC: NCLEX: Health Promotion and Maintenance: Growth and Development<\/li>\n\n\n\n<li>What guidelines define multidisciplinary patient care in terms of expected outcome and<br>timeframe from different areas of care provision?<br>a. Clinical pathways<br>b. Nursing outcome criteria<br>c. Standards of care<br>d. Nursing care plan<br>ANS: A<br>Clinical pathways, also known as critical pathways or care maps, are collaborative<br>guidelines that define patient care across disciplines. Expected progress within a specified<br>timeline is identified.<br>DIF: Cognitive Level: Knowledge REF: Page 12 OBJ: 14<br>TOP: Health Care Delivery Systems KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>A nursing student has reviewed a hospitalized pediatric patient chart, interviewed her<br>mother, and collected admission data. What is the next step the student will take to develop<br>a nursing care plan for this child?<br>a. Identify measurable outcomes with a timeline.<br>b. Choose specific nursing interventions for the child.<br>c. Determine appropriate nursing diagnoses.<br>d. State nursing actions related to the childs medical diagnosis.<br>ANS: C<br>The nurse uses assessment data to select appropriate nursing diagnoses from the NANDAI list. Outcomes and interventions are then developed to address the relevant nursing<br>diagnoses.<br>DIF: Cognitive Level: Application REF: Page 11 OBJ: 13<br>TOP: Nursing Process KEY: Nursing Process Step: Nursing Diagnosis<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>A nursing student on an obstetric rotation questions the floor nurse about the definition<br>of the LVN\/LPN scope of practice. What resource can the nurse suggest to the student?<br>a. American Nurses Association<br>b. States board of nursing<br>3<br>c. Joint Commission<br>d. Association of Womens Health, Obstetric and Neonatal Nurses<br>ANS: B<br>The scope of practice of the LVN\/LPN is published by the states board of nursing.<br>DIF: Cognitive Level: Comprehension REF: Page 3, Legal and Ethical Considerations<br>OBJ: 18 TOP: Critical Thinking<br>KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>What was recommended by Karl Cred in 1884?<br>a. All women should be delivered in a hospital setting.<br>b. Chemical means should be used to combat infection.<br>c. Podalic version should be done on all fetuses.<br>d. Silver nitrate should be placed in the eyes of newborns.<br>ANS: D<br>In 1884 Karl Cred recommended the use of 2% silver nitrate in the eyes of newborns to<br>reduce the incidence of blindness.<br>DIF: Cognitive Level: Knowledge REF: Page 2 OBJ: 1<br>TOP: Use of Silver Nitrate KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of<br>Disease<\/li>\n\n\n\n<li>What is the purpose of the White House Conference on Children and Youth?<br>a. Set criteria for normal growth patterns.<br>b. Examine the number of live births in minority populations.<br>c. Raise money to support well-child clinics in rural areas.<br>d. Promote comprehensive child welfare.<br>ANS: D<br>White House Conferences on Children and Youth are held every 10 years to promote<br>comprehensive child welfare.<br>DIF: Cognitive Level: Knowledge REF: Page 4 OBJ: 3<br>TOP: White House Conferences KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of<br>Disease<\/li>\n\n\n\n<li>How many hours of hospital stay does legislation currently allow for a postpartum<br>patient who has delivered vaginally without complications?<br>a. 24<br>b. 48<br>c. 36<br>d. 72<br>ANS: B<br>Postpartum patients who deliver vaginally stay in the hospital for an average of 48 hours;<br>patients who have had a cesarean delivery usually stay 4 days.<br>DIF: Cognitive Level: Knowledge REF: Page 6 OBJ: 7<br>TOP: Hospital Terms for Postpartum Patients<br>KEY: Nursing Process Step: Planning<br>4<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of<br>Disease<\/li>\n\n\n\n<li>How does the clinical pathway or critical pathway improve quality of care?<br>a. Lists diagnosis-specific implementations<br>b. Outlines expected progress with stated timelines<br>c. Prioritizes effective nursing diagnoses<br>d. Describes common complications<br>ANS: B<br>Critical pathways outline expected progress with stated timelines. Any deviation from those<br>timelines is called a variance.<br>DIF: Cognitive Level: Comprehension REF: Page 12 OBJ: 14<br>TOP: Critical Pathway KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>A patient asks the nurse to explain what is meant by gene therapy. What is the nurses<br>best response?<br>a. Gene therapy can replace missing genes.<br>b. Gene therapy evaluates the parents genes.<br>c. Gene therapy can change the sex of the fetus.<br>d. Gene therapy supports the regeneration of defective genes.<br>ANS: A<br>Gene therapy can replace missing or defective genes.<br>DIF: Cognitive Level: Knowledge REF: Page 8 OBJ: 7<br>TOP: Gene Therapy KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of<br>Disease<\/li>\n\n\n\n<li>The nurse is clarifying information to a patient regarding diagnosis-related groups<br>(DRGs). What is the nurses best response when the patient asks how DRGs reduce<br>medical care costs?<br>a. By determining payment based on diagnosis<br>b. By requiring two medical opinions to confirm a diagnosis<br>c. By organizing HMOs<br>d. By defining a person who will require hospitalization<br>ANS: A<br>DRGs determine the amount of payment and length of hospital stay based on the diagnosis.<br>DIF: Cognitive Level: Comprehension REF: Page 8 OBJ: 11<br>TOP: DRGs KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>What is the best example of a Nursing Interventions Classification (NIC) intervention?<br>a. Patient will ambulate in the hall independently for 10 minutes three times a day.<br>b. Nurse will report temperature elevations to the charge nurse.<br>c. Nurse will offer extra liquids at all meals.<br>d. Patient will express pain relief after massage.<br>ANS: C<br>NIC is a guide to nursing actions.<br>5<br>DIF: Cognitive Level: Comprehension REF: Page 12 | Page 14<br>OBJ: 15 TOP: NICs KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>How does electronic charting ensure comprehensive charting more effectively than<br>handwritten charting?<br>a. Provides a uniform style of chart<br>b. Requires certain responses before allowing the user to progress<br>c. All documentation is reflective of the nursing care plan<br>d. Requires a daily audit by the charge nurse<br>ANS: B<br>Comprehensive electronic documentation is ensured by requiring specific input in<br>designated categories before the user can progress through the system.<br>DIF: Cognitive Level: Comprehension REF: Page 15-16 OBJ: 22<br>TOP: Computer Charting KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care<\/li>\n\n\n\n<li>The nurse reminds family members that the philosophy of family-centered care is to<br>provide control to the family over health care decisions. What is the appropriate term for this<br>type of control?<br>a. Empowerment<br>b. Insight<br>c. Regulation<br>d. Organization<br>ANS: A<br>The term empowerment refers to the control a family has over its own health care decisions.<br>DIF: Cognitive Level: Knowledge REF: Page 2 OBJ: 7<br>TOP: Empowerment KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Physiological Integrity: Basic Care and Comfort<\/li>\n\n\n\n<li>A patient in the prenatal clinic is concerned about losing her job because of her<br>pregnancy. The nurse instructs her that the Family Medical Leave Act (FMLA) allows an<br>employee to be absent from work without pay. How many weeks does the FMLA allow a<br>woman to recover from childbirth or care for a sick family member without loss of benefits or<br>pay status?<br>a. 4<br>b. 6<br>c. 10<br>d. 12<br>ANS: D<br>The FMLA allows for employees to leave work for up to 12 weeks to recover from childbirth<br>or to care for an ill family member without losing benefits or pay status.<br>DIF: Cognitive Level: Knowledge REF: Page 3 OBJ: 5<br>TOP: FMLA KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation<\/li>\n\n\n\n<li>What term appropriately describes the nurse who is able to adapt health care practices<br>to meet the needs of various cultures?<br>6<br>a. Culturally aware<br>b. Culturally sensitive<br>c. Culturally competent<br>d. Culturally adaptive<br>ANS: C<br>The nurse who is able to adapt health care to meet the needs of various cultures is said to<br>be culturally competent.<br>DIF: Cognitive Level: Knowledge REF: Page 7 OBJ: 8<br>TOP: Cultural Competency KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: N\/A<\/li>\n\n\n\n<li>What is one major advantage to the application of critical thinking?<br>a. Problem-free care<br>b. Limitation of approaches to care<br>c. Decreased need for assessment<br>d. Problem prevention<br>ANS: D<br>Critical thinking results in problem prevention in designing nursing care.<br>DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 19<br>TOP: Critical Thinking KEY: Nursing Process Step: N\/A<br>MSC: NCLEX: N\/A<\/li>\n\n\n\n<li>Student practical nurses are discussing the North American Nursing Diagnosis<br>Association International (NANDA-I) taxonomy in post conference on the acute care clinical<br>setting. The students are aware that the role of the LPN with nursing diagnosis formulation<br>is what?<br>a. To initiate and identify nursing diagnosis specific to patient<br>b. To update changes in nursing diagnosis as needed<br>c. To have an understanding of nursing diagnosis terminology<br>d. To accurately document nursing diagnosis on patient plan of care<br>ANS: C<br>The registered nurse is responsible to initiate, identify, update, and document nursing<br>diagnoses. The licensed practical nurse is responsible to have an understanding of nursing<br>diagnosis terminology.<br>DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 17<br>TOP: NANDA-I taxonomy KEY: Nursing Process Step: Nursing Diagnosis<br>MSC: NCLEX: Health Promotion and Maintenance: Data Collection Techniques<br>MULTIPLE RESPONSE<\/li>\n\n\n\n<li>What services are birthing centers able to provide? (Select all that apply.)<br>a. Prenatal care<br>b. Labor and delivery services<br>c. Classes for new mothers<br>d. Adoption referrals<br>e. Family planning<br>ANS: A, B, C, E<br>7<br>Birthing centers are capable of providing full-service obstetric care, classes for new<br>mothers, and family planning. Birthing centers do not offer adoption services.<br>DIF: Cognitive Level: Comprehension REF: Page 6 OBJ: 7<br>TOP: Birthing Centers KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care<\/li>\n\n\n\n<li>What developments in the early 20th century encouraged women to seek hospitalization<br>for childbirth? (Select all that apply.)<br>a. Use of specialized obstetric instruments<br>b. Use of anesthesia<br>c. Physicians closer relationships with hospitals<br>d. Focus on family-centered care<br>e. Insurance coverage<br>ANS: A, B, C<br>In the early 1900s, the development of specialized obstetric instruments, better modes of<br>anesthesia, and the physicians reliance on hospital services were instrumental in<br>encouraging women to seek hospitalization for childbirth.<br>DIF: Cognitive Level: Comprehension REF: Page 3 OBJ: 7<br>TOP: Hospitalization for Childbirth KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control<\/li>\n\n\n\n<li>What nonfamily-centered policies were prevalent in the 1960s? (Select all that apply.)<br>a. Waiting room for fathers<br>b. Sedation of mother during labor<br>c. Delay of reunion of mother and infant<br>d. Lenient visiting hours<br>e. Restrictions of visitations by minor children<br>ANS: A, B, C, E<br>Hospital policies in the 1960s provided a separate waiting room for fathers while the mother<br>went through labor in a sedated state. The reunion of mother and infant was delayed for<br>several hours because of the sedation. Visiting hours were rigid and disallowed the<br>visitation of minor children.<br>DIF: Cognitive Level: Comprehension REF: Page 3 OBJ: 7<br>TOP: Nonfamily-centered Practices KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control<\/li>\n\n\n\n<li>The nurse is aware that there is a legal responsibility to report certain diseases and<br>conditions to county or state health authorities. Which would be included? (Select all that<br>apply.)<br>a. Tuberculosis<br>b. Child abuse<br>c. Industrial accidents<br>d. Sexually transmitted diseases<br>e. Food-borne infections<br>ANS: A, B, D, E<br>The nurse has a legal responsibility to report communicable diseases (such as tuberculosis<br>8<br>and sexually transmitted diseases), food-borne infections, child abuse, and threats of<br>suicide.<br>DIF: Cognitive Level: Comprehension REF: Page 6, Legal and Ethical Considerations box<br>OBJ: 6 TOP: Reportable Diseases<br>KEY: Nursing Process Step: Planning<br>MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control<\/li>\n\n\n\n<li>An inservice program at a long-term care facility is reviewing the Nursing Outcomes<br>Classification (NOC) with nursing staff. After the presentation the nurses review resident<br>care plans. Which of the following are found to be appropriately written outcomes? (Select<br>all that apply.)<br>a. Suction patient orally every 4 hours and as needed.<br>b. Auscultate lung sounds every 2 hours.<br>c. Provide Tylenol as ordered by health care provider.<br>d. Patient states Pain has decreased after medication administration.<br>e. Patient blood pressure recorded as 120\/72 after dressing change.<br>ANS: D, E<br>NOC was developed to identify outcomes of nursing care that are directly influenced by<br>nursing actions. Outcomes are defined as the behaviors and feelings of the patient in<br>response to the nursing care given. Suctioning patient, auscultating lung sounds, and<br>providing Tylenol are nursing actions.<br>DIF: Cognitive Level: Application REF: Page 12-14 OBJ: 16<br>TOP: Nursing Outcomes Classification (NOC)<br>KEY: Nursing Process Step: Evaluation<br>MSC: NCLEX: Physiological Integrity: Basic Care and Comfort<\/li>\n\n\n\n<li>Practical nursing students are using critical thinking skills to study for an upcoming test.<br>What will these students include when studying? (Select all that apply.)<br>a. Memorization of facts first<br>b. Prioritizing information<br>c. Relating facts to other facts<br>d. Making assumptions<br>e. Reviewing before the test<br>ANS: B, C, E<br>Using critical thinking when studying involves understanding facts before memorizing,<br>prioritizing information to be memorized, relating facts to other facts, using all five senses,<br>reviewing before tests, and reading critically. Critical thinking does not involve assumption<br>as does general thinking.<br>DIF: Cognitive Level: Comprehension REF: Page 15 OBJ: 20<br>TOP: Critical Thinking KEY: Nursing Process Step: Evaluation<br>MSC: NCLEX: Safe, Effective Care Environment<\/li>\n\n\n\n<li>What factors have played a role in meeting the goals of Healthy People 2020 as it<br>relates the goals for outcomes of pregnancy? (Select all that apply.)<br>a. Early prenatal care<br>b. Increased number of surgical births<br>c. NICU care<br>9<br>d. Use of prenatal glucocorticoids<br>e. Fetal surgery<br>ANS: A, C, D, E<br>Early prenatal care, fetal surgery, use of prenatal glucocorticoids, technology, and NICU<br>care have played a role in increasing the positive outcome of pregnancy, and the goals of<br>Healthy People 2020 may well be met. Increase in surgical births and multiple gestations do<br>not work toward meeting the goals of Healthy People 2020.<br>DIF: Cognitive Level: Comprehension REF: Page 16-17 OBJ: 21<br>TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection<\/li>\n\n\n\n<li>A community health nurse is providing specialized care to patients in the home setting.<br>What kind of specialized care may this nurse be providing? (Select all that apply.)<br>a. Glucose monitoring<br>b. Heparin therapy<br>c. Family education<br>d. Total parenteral nutrition<br>e. Provision of referral services<br>ANS: A, B, D<br>Glucose monitoring, heparin therapy, and total parenteral nutrition are categorized as<br>specialized care that may be provided by the community health nurse. Family education<br>and provision of referral are categorized as therapeutic care.<br>DIF: Cognitive Level: Application REF: Page 16-17 OBJ: 23<br>TOP: Community Health KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Physiological Integrity: Basic Care and Comfort<br>COMPLETION<\/li>\n\n\n\n<li>The nurse who is very conscientious about hand hygiene is following the concepts set<br>out by and .<br>ANS:<br>Lister, Pasteur OR Pasteur, Lister<br>Both Lister and Pasteur set out that handwashing could reduce incidence of infection by<br>cross-contamination.<br>DIF: Cognitive Level: Knowledge REF: Page 2 OBJ: 1<br>TOP: Handwashing KEY: Nursing Process Step: Implementation<br>MSC: NCLEX: Health Promotion and Maintenance: Safety and Infection Control<\/li>\n\n\n\n<li>The first White House Conference on Children and Youth was called by President<br>.<br>ANS:<br>Theodore Roosevelt<br>Theodore Roosevelt called the first White House Conference in 1909.<br>10<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Chapter 01: The Past, Present, and FutureMULTIPLE 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