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Chapter 5: Evidence-Based Practice

Test Bank
MULTIPLE CHOICE
1. To provide patient care of the highest quality, nurses utilize an evidence-based practice
approach because evidence-based practice is
a
.
A guide for nurses in making clinical decisions.
b
.
Based on the latest tetbook information.
c
.
!asily attained at the bedside.
d
.
Al"ays right for all situations.
A#$% A
!vidence-based practice &!B'( is a guide for nurses to structure ho" to make accurate, timely,
and appropriate clinical decisions. A tetbook relies on the scientific literature, "hich is often
outdated by the time the book is published and is not the most reliable source for !B'.
)nfortunately, most of the best information in evidence never reaches the bedside. !B' is not
to be blindly applied "ithout using good *udgment and critical thinking skills. +t is not
appropriate for all settings.
,+-% )nderstand .!-% /0 1B2% ,iscuss the benefits of evidence-based practice.
T1'% !valuation 3$4% Teaching56earning
7. +n caring for patients, it is important for the nurse to realize that evidence-based practice is
a
.
The only valid source of kno"ledge that should be used.
b
.
$econdary to traditional or standard care kno"ledge.
c
.
,ependent on patient values and epectations.
d
.
#ot sho"n to provide better patient outcomes.
A#$% 4
!ven "hen the best evidence available is used, application and outcomes "ill differ based on
patient values, preferences, concerns, and5or epectations. #urses often care for patients on
the basis of tradition or convenience, or the standard, 8+t has al"ays been done this "ay.9
Although these sources have value, it is important to learn to rely more on research evidence
than on non-research evidence. 'atients "ho receive care based on the most recent and best
evidence eperience 7:; better outcomes.
,+-% )nderstand .!-% /1 1B2% ,iscuss the benefits of evidence-based practice.
T1'% !valuation 3$4% Teaching56earning
<. The first step in evidence-based practice is to ask a clinical question. +n doing so, the nurse
needs to realize that in researching interventions, the question
a
.
+s more important than its format.
b
.
=ill lead you to hundreds of articles that must be read.
c
.
3ay be easier if in '+41 format.
d
.
3ay be more useful the more general it is.
A#$% 4
The '+41 format allo"s the nurse to ask questions that are intervention focused.
+nappropriately formed questions "ill likely lead to irrelevant sources of information. +t is not
beneficial to read hundreds of articles. +t is more beneficial to read the best four to si articles
that specifically address the question. The more focused the question asked, the easier it "ill
become to search for evidence in the scientific literature.
,+-% )nderstand .!-% /7 1B2% ,escribe the five steps of evidence-based practice.
T1'% !valuation 3$4% Teaching56earning
0. +n collecting the best evidence, the gold standard for research is
a
.
The randomized controlled trial &.4T(.
b
.
The peer-revie"ed article.
c
.
>ualitative research.
d
.
The opinion of epert committees.
A#$% A
+ndividual .4Ts are the gold standard for research. A peer-revie"ed article means that a panel
of eperts has revie"ed the article? this is not a research method. >ualitative research is
valuable in identifying information about ho" patients cope "ith or manage various health
problems and their perceptions of illness. +t does not usually have the robustness of an .4T.
!pert opinion is on the bottom of the hierarchical pyramid of evidence.
,+-% @no"ledge .!-% /<-/0 1B2% ,escribe the five steps of evidence-based practice.
T1'% Assessment 3$4% Teaching56earning
/. The nurse is "riting a research article on a patient care topic. The nurse realizes that the
section that "ill get the reader to read the article because of the value of the topic for the
reader is the
a
.
Abstract.
b
.
+ntroduction.
c 6iterature revie" or background.
.
d
.
.esults.
A#$% B
The introduction contains information about its purpose and the importance of the topic to the
audience "ho reads the article. The abstract is a brief summary of the article. The literature
revie" or background offers a detailed background of the level of science or clinical
information that is available about the topic of the article. The results section is the summary
section of the article.
,+-% )nderstand .!-% /0-// 1B2% ,escribe the five steps of evidence-based practice.
T1'% Assessment 3$4% Teaching56earning
A. The nurse is caring for a patient "ith chronic lo" back pain. +n providing care for this patient,
the nurse "onders "hether the guidelines utilized for this type of pain are adequate. The nurse
"ants to determine the best evidence-based practice regarding these guidelines. =hat is the
best database for the nurse to accessB
a
.
3!,6+#!
b
.
!3BA$!
c
.
'syc+#-1
d
.
AC.>
A#$% ,
The Agency for Cealthcare .esearch and >uality &AC.>( includes clinical guidelines and
evidence summaries. 3!,6+#! includes studies in medicine, nursing, dentistry, psychiatry,
veterinary medicine, and allied health. !3BA$! includes biomedical and pharmaceutical
studies. 'syc+#-1 deals "ith psychology and related health care disciplines.
,+-% )nderstand .!-% /< 1B2% ,escribe the five steps of evidence-based practice.
T1'% +mplementation 3$4% 4ommunication and ,ocumentation
D. The nurse is developing a '+41 question related to "hether her patientEs blood pressure is
more accurate "hile measuring "ith the patientEs legs crossed versus "ith the patientEs feet
flat on the floor. =ith ' being the population of interest, + the intervention of interest, 4 the
comparison of interest, and 1 the outcome, the nurse determines that this is
a
.
A true '+41 question, because the outcome al"ays comes before the
intervention.
b
.
A true '+41 question regardless of placement of elements.
c
.
#ot a true '+41 question, because the comparison comes after the intervention.
d
.
#ot a true '+41 question, because the outcome comes after the population.
A#$% B
#ote that a "ell-designed '+41 question does not have to follo" the sequence of ', +, 4, and
1. The aim is to ask a question that contains as many of the '+41 elements as possible.
,+-% )nderstand .!-% /7 1B2% ,evelop a '+41 question.
T1'% +mplementation 3$4% Teaching56earning
:. +n revie"ing literature for an evidence-based practice study, the nurse realizes that the most
reliable level of evidence is the
a
.
$ystematic revie" and meta-analysis.
b
.
.andomized control trial &.4T(.
c
.
4ase control study.
d
.
4ontrol trial "ithout randomization.
A#$% A
+n a systematic revie" or meta-analysis, an independent researcher revie"s all of the .4Ts
conducted on the same clinical question and reports "hether the evidence is conclusive, or if
further study is needed. A single .4T is not as conclusive as a revie" of several .4Ts on the
same question. 4ontrol trials "ithout randomization may involve bias in ho" the study is
conducted. 4ase control studies also have room for bias.
,+-% Analyze .!-% /<-/0 1B2% !plain the levels of evidence in the literature.
T1'% Assessment 3$4% Teaching56earning
F. >ualitative nursing research is valuable in that it
a
.
!cludes all bias.
b
.
)ses randomization in structure.
c
.
,etermines associations bet"een variables and conditions.
d
.
$tudies phenomena that are difficult to quantify.
A#$% ,
>ualitative nursing research is the study of phenomena that are difficult to quantify or
categorize, such as patientsE perceptions of illness. #o study can totally eclude bias.
Co"ever, randomization, such as that used in randomized control studies, helps. >ualitative
nursing research does not usually randomize its sub*ects. 4ontrol studies determine "hether
there is an association bet"een one or more predictor variables and the condition.
,+-% @no"ledge .!-% /F 1B2% !plain the levels of evidence in the literature.
T1'% Assessment 3$4% Teaching56earning
1G. The nurse has used her '+41 question to develop an evidence-based change in protocol for a
certain nursing procedure. Co"ever, to make these changes throughout the entire institution
"ould require more support staff than is available at this time. =hat is the nurseEs best optionB
a
.
,rop the idea of making the change at this time.
b
.
+nsist that management hire the needed staff to facilitate the change.
c
.
$eek employment in another institution that may have the staff needed.
d
.
4onduct a pilot study to develop evidence to support the change.
A#$% ,
=hen evidence is not strong enough to apply in practice, or if resources are limited, the net
option is to conduct a pilot study to investigate the '+41 question. ,ropping the idea "ould
be counterproductive? insisting that management hire staff could be seen as a mandate and
could produce negative results. $eeking employment at another institution most likely "ould
not be the ans"er because most institutions operate under similar established guidelines.
,+-% Apply .!-% // 1B2% ,iscuss "ays to apply evidence in practice.
T1'% +mplementation 3$4% #ursing 'rocess
11. The hospital policy states that "hen starting an intravenous &+H( catheter, the nurse must first
prepare the potential +H site "ith alcohol and dress it using a gauze dressing. The nurse has
done a literature revie" and believes that evidence-based practice dictates the use of a
transparent dressing to prevent catheter dislodgment. =hat should the nurse doB
a
.
Begin to use transparent dressing instead of gauze dressings.
b
.
Bring findings to the policy and procedure committee.
c
.
)se transparent dressings on half of her +H starts and gauze on the other.
d
.
4ontinue follo"ing hospital policy "ithout saying anything.
A#$% B
As a result of her finding, the nurse should meet "ith the policy and procedure committee to
recommend routine use of transparent dressings. Co"ever, until the policy is changed, or the
nurse receives approval to conduct a pilot study, the nurse is obligated to follo" hospital
procedure. +f the nurse has information that can lead to better patient care, he or she has an
obligation &moral and professional( to bring it to the attention of policy makers.
,+-% Apply .!-% // 1B2% ,iscuss "ays to apply evidence in practice.
T1'% +mplementation 3$4% #ursing 'rocess
17. The nurse is trying to identify common general themes relative to the effectiveness of cardiac
rehabilitation for patients "ho have had heart attacks and have gone through cardiac
rehabilitation programs. The nurse conducts intervie"s and focus groups. =hat type of
research is the nurse conductingB
a
.
!valuation research
b
.
!perimental research
c
.
>ualitative research
d
.
#oneperimental research
A#$% 4
>ualitative research involves using inductive reasoning to develop generalizations or theories
from specific observations or intervie"s. !valuation and eperimental research are forms of
quantitative research. #oneperimental descriptive studies describe, eplain, or predict
phenomena such as factors that lead to an adolescentEs decision to smoke cigarettes.
,+-% )nderstand .!-% /F
1B2% !plain ho" nursing research improves nursing practice. T1'% Assessment
3$4% Teaching56earning
1<. +n conducting a research study, the researcher must guarantee that any information the sub*ect
provides "ill not be reported in any manner that identifies the sub*ect and "ill not be
accessible to people outside the research team. This concept is kno"n as
a
.
Anonymity.
b
.
4onfidentiality.
c
.
+nformed consent.
d
.
The research process.
A#$% B
4onfidentiality guarantees that any information the sub*ect provides "ill not be reported in
any manner that identifies the sub*ect and "ill not be accessible to people outside the research
team. Anonymity occurs "hen even the researcher cannot link the sub*ect to the data.
+nformed consent means that research sub*ects &1( are given full and complete information
about the purpose of the study, procedures, data collection, potential harm and benefits, and
alternative methods of treatment? &7( are capable of fully understanding the research? &<( have
the po"er to voluntarily consent or decline participation? and &0( understand ho"
confidentiality or anonymity is maintained. The research process is a broader concept that
provides an orderly series of steps that allo" the researcher to move from asking a question to
finding the ans"er.
,+-% @no"ledge .!-% AG 1B2% ,iscuss the steps of the research process.
T1'% Assessment 3$4% #ursing 'rocess
10. The researcher is preparing to publish his study findings. +n doing so, the researcher is a"are
of many "ays that the study could have been done better, but that he did not have the ability
to do. The researcher discloses these limitations in the manuscript, but they are most likely
detected during "hich phase of the research processB
a
.
'roblem identification
b
.
$tudy design
c
.
-ormulation of recommendations
d
.
Analysis of data
A#$% ,
,uring analysis of data, the researcher interprets the demographics of the study population, as
"ell as results, including limitations. 'roblem identification involves identifying the area of
interest and study variables, revie"ing the literature, formulating the theoretical frame"ork,
and devising research questions. $tudy design involves selection of research methods.
-ormulation of recommendations involves determining the implications of the study for
nursing.
,+-% )nderstand .!-% /F 1B2% ,iscuss the steps of the research process.
T1'% +mplementation 3$4% #ursing 'rocess
1/. =hen evaluating quality improvement &>+( programs in relation to evidence-based practice
&!B'(, it is easy to note that
a
.
Both are designed to improve performance.
b
.
=hen implementing !B' pro*ects, it is important to revie" >+ data.
c
.
!B' is not at all related to >+.
d
.
!valuation of processes is the realm of performance improvement &'+(, not >+.
A#$% B
!vidence-based practice and quality improvement go hand in hand. =hen implementing an
!B' pro*ect, it is important to revie" available >+ data. .eliable >+ data improve the
relevance and scope of an !B' pro*ect. 'erformance improvement &'+( analyzes performance.
>+ analyzes processes.
,+-% )nderstand .!-% AG-A1
1B2% !plain the relationship bet"een evidence-based practice and quality improvement.
T1'% 'lanning 3$4% #ursing 'rocess
1A. The hospitalEs quality improvement committee has identified a problem on one of the units. +n
using the ',$A method to help determine "ays to deal "ith the issue, the committee decides
to do a literature revie". This is an eample of quality improvement
a 4ombined "ith evidence-based practice.
.
b
.
=ith inability to make the right decision.
c
.
=ith delay in the action needed.
d
.
=ith no designated method for dealing "ith issues.
A#$% A
>uality improvement combined "ith evidence-based practice is the foundation for ecellent
patient care and outcomes. 1nce a committee defines a problem, it applies a formal model for
eploring and resolving quality concerns. 1ne part of the ',$A cycle is the 8,o9 section,
"hich requires the selection of an intervention on the basis of data revie"ed. Therefore the
committee is taking the right action and is not unduly delaying action? data must be obtained
that are needed to make the right decision as part of the ',$A method, "hich is in place.
,+-% )nderstand .!-% A1
1B2% !plain the relationship bet"een evidence-based practice and quality improvement.
T1'% 'lanning 3$4% #ursing 'rocess
1D. The quality improvement committee has been alerted to an increased number of falls in the
hospital. 3ost of these falls have occurred at night and have involved patients "ho "ere
trying to cra"l over bedrails. A literature revie" brought out that most falls occur because
patients are trying to go to the bathroom. The committee created a practice change that
bedrails should be left in the do"n position, and hourly nursing rounds should be conducted.
=hat is the committeeEs net stepB
a
.
!valuate the changes in 1 month.
b
.
=ait a month before implementing the changes.
c
.
+mplement the changes as a pilot study.
d
.
4ommunicate to staff the results of this inquiry.
A#$% ,
>uality improvement combined "ith evidence-based practice is the foundation for ecellent
patient care and outcomes. 1nce a >+ committee makes a practice change, it is important to
communicate the results to staff. 'ractice changes "ill not likely last "hen >+ committees fail
to report findings and results of interventions. 1nce communicated, changes should be put in
place as the committee deems reasonable &i.e., either fully or as a pilot study( and as soon as
practical? this should be follo"ed by re-evaluation.
,+-% Apply .!-% A7
1B2% ,escribe the components of a quality improvement program.
T1'% +mplementation 3$4% #ursing 'rocess
1:. The hospital quality improvement committee has noted that the incidence of needlestick
in*uries on a particular unit has increased. =hen faced "ith issues, the committee applies the
',$A model, a formal model for eploring and resolving quality concerns. Because the
committee is multidisciplinary in nature, and fe" members are nurses, it is imperative that the
committee first
a
.
'lan.
b
.
,o.
c
.
$tudy.
d
.
Act.
A#$% A
8'lan9 is the first step of the process? it involves a revie" of available data to understand
eisting practice conditions or problems to identify the need for change. 8,o9 involves
selecting an intervention on the basis of the data revie"ed and implementing the change.
8$tudy9 means to evaluate the results of the change. 8Act9 involves incorporating the change
if it is successful.
,+-% Apply .!-% A1
1B2% ,escribe the components of a quality improvement program.
T1'% +mplementation 3$4% #ursing 'rocess
1F. The quality improvement committee is eamining an increase in medication errors on a
particular unit. +n conducting its analysis, "hat should be the committeeEs primary focusB
a
.
#urses "ho administer the medications
b
.
'harmacy that prepares the medications
c
.
$ecretaries "ho enter the orders
d
.
#one of the above
A#$% ,
A "ell-organized >+ program focuses on systems that significantly contribute to outcomes,
not on individuals. Therefore, the entire process needs to be evaluated to determine
effectiveness.
,+-% Analyze .!-% A1
1B2% ,escribe the components of a quality improvement program.
T1'% !valuation 3$4% #ursing 'rocess
MULTIPLE RESPONSE
1. The nurse is preparing to conduct research that "ill allo" precise measurement of a
phenomenon. =hich of the follo"ing methods "ill provide the nurse "ith the right kind of
dataB (Select all that apply.)
a
.
!perimental research
b
.
$urveys
c
.
!valuation research
d
.
'henomenology
e
.
Irounded theory
A#$% A, B, 4
!perimental research, surveys, and evaluation research are all forms of quantitative research.
'henomenology and grounded theory are forms of qualitative research.
,+-% )nderstand .!-% /:
1B2% !plain ho" nursing research improves nursing practice. T1'% Assessment
3$4% Teaching56earning
7. Before conducting any study "ith human sub*ects, the researcher must obtain approval from
the agencyEs human sub*ects committee or institutional revie" board &+.B(. The +.B ensures
that the researcher (Select all that apply.)
a
.
1btains informed consent.
b
.
3inimizes risk to sub*ects.
c
.
!nsures confidentiality.
d
.
+dentifies risks and benefits of participation.
e
.
!nsures that sub*ects complete the study.
A#$% A, B, 4, ,
.esearchers must protect the confidentiality of those "ho participate in the study, obtain
informed consent, minimize risk to sub*ects, identify risks and benefits of participation, ensure
that participation in the study is voluntary, and allo" sub*ects to "ithdra" from studies at any
time.
,+-% )nderstand .!-% AG 1B2% ,iscuss the steps of the research process.
T1'% +mplementation 3$4% #ursing 'rocess
<. The nurse is doing a literature revie" related to a potential problem that has been identified on
the nursing unit. The nurse realizes that nursing research is important in that it is designed to
(Select all that apply.)
a !nhance the nurseEs chance at promotion.
.
b
.
+dentify ne" kno"ledge.
c
.
+mprove professional practice.
d
.
!nhance effective use of resources.
e
.
6ead to decreases in budget ependitures.
A#$% B, 4, ,
#ursing research is a "ay to identify ne" kno"ledge, improve professional education and
practice, and use resources effectively. !ffective use of resources does not al"ays result in
lo"er budget ependitures, but rather more effective use of resources. A promotion is not a
direct result of research.
,+-% )nderstand .!-% /A 1B2% ,iscuss priorities for nursing research.
T1'% Assessment 3$4% 4aring