Foundations for Population Health in

Community Public Health Nursing 5th

Edition Stanhope Test Bank
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Chapter 10: Evidence-Based Practice
Stanhope: Foundations for Population Health in Community/Public Health Nursing,
5th Edition

MULTIPLE CHOICE

1. A nurse executive is implementing evidence-based practice at a community nursing center

that serves a large Cuban immigrant population. Which of the following actions would be
the most helpful for the nurse?
a. Review clinical policies with cultural competency experts from the local
university.
b. Conduct weekly staff meetings to discuss which methods work best when helping
immigrants.
c. Invite Cuban immigrants from the community to serve on the center’s advisory
board.
d. Send personnel to conferences and seminars that focus on treating Hispanic
immigrants.
ANS: C
To determine whether practice is serving the needs of the population, the nurse will need
to consult the population served. This means that evidence should be applied with input
from the community. For example, decisions related to the services to be offered in a
nurse-managed clinic should be made with input from the clinic’s advisory board, which
should include community leaders and consumers of the clinic’s services. Information
about the population needs to come from the population itself, not from cultural
competency experts within the community or from the staff members. Cuban immigrant
needs may not be the same as those of Hispanic immigrants from other places such as
Mexico or Spain.

2. A community health nurse is determining the best way to address an outbreak of a new
infectious disease using evidence-based practice. Which of the following actions would
the nurse most likely take?
a. Review policies and procedures.
b. Review outcomes of clinical trials.
c. Review several nursing textbooks.
d. Review reputable sites on the Internet.
ANS: B
Research findings, knowledge from basic science, clinical knowledge, and expert opinion
should be considered sources of evidence for EBP. The use of policies and procedures is
only helpful if they have been written using EBP, and depending on when they were
written there may be evidence that supports the use of a different practice. The problem
with nursing textbooks is that many are not grounded in evidence-based practice, because
the concept is relatively new to the United States. Scanning the Internet for ideas is helpful
only if evidence-based practice sites are accessed, and most internet sites are not EBP
sites.
3. A nursing administrator wants to develop a work environment conducive to the
implementation of evidence-based practice (EBP). Which of the following actions would
best achieve this goal?
a. Conducting market research to determine customer satisfaction with EBP
b. Eliciting opinions from nurses on how EBP will affect workload
c. Purchasing computers and Internet access for use by employees
d. Sending staff to conferences related to incorporation of EBP into practice
ANS: C
A lack of computers and Internet access can create a barrier to implementation of EBP in
community-based nursing agencies. If these are provided, nurses can quickly access
current evidence-based findings and recommendations. Conducting market research will
not change the work environment to make it more conductive to implementing EBP.
Learning about nurses opinions about how it will affect workload would not impact the
work environment and make it more conducive to implementing EBP. Rather the
administrator would need to discuss the benefits of the use of EBP with the staff. Sending
staff to a conference, although it may change staff attitudes, would not necessarily change
the work environment.

4. A busy school health nurse concerned over the rising incidence of obesity wants to
implement evidence-based practice (EBP) but faces barriers because of time constraints.
Which of the following actions should the nurse take first?
a. Identify students who are obese so that they may be closely monitored for weight
control success or failure.
b. Evaluate best practices to determine those that have the highest success rates for
weight control in children.
c. Schedule physician appointments for obese children.
d. Develop an obesity management program for children whose body mass index
exceeds normal.
ANS: B
The first step of the seven-step EBP process is step zero, which involves a curiosity about
the interventions that are being applied; this is not described in any of the topic
descriptors. Step one requires asking questions in a “PICOT” format; this is not described
in any of the topic descriptors. Step two involves searching for the best evidence to answer
the question. This is done through evaluating best practices. The first step of the
seven-step EBP process is step zero, which involves a curiosity about the interventions
that are being applied; this is not described in any of the topic descriptors. Step one
requires asking questions in a “PICOT” format; this is not described in any of the topic
descriptors. Step two involves searching for the best evidence to answer the question. This
is done through evaluating best practices.

5. The nurse has been reading everything she can find on a particular clinical problem, using
both the closest medical library and the Internet. Which of the following would be the
most helpful source?
a. A journal with a whole issue devoted to research on that clinical problem
b. A randomized controlled clinical trial related to that clinical problem
c. A researcher who has built a career on studying that clinical problem
d. A systematic review related to the clinical problem
ANS: D
 A systematic review is an approach to identifying, appraising, and synthesizing research
evidence to evaluate and interpret all available research that is relevant to a particular
research question. Systematic reviews can be accessed from most databases. Systematic
reviews require more rigor and contain less opinion of the author than typical reviews of
the literature. An entire journal devoted to research on a clinical problem may be helpful,
but it is unknown what type of research is being published in that journal. A well-designed
systematic review can provide stronger evidence than a single randomized controlled trial.
A researcher alone does not provide the best evidence, rather one would need to look at
the information that has been published by the researcher in peer-reviewed journals.

6. A school health nurse plans to use evidence-based practice (EBP) to guide the
development of health education programs most likely to increase retention of learning in
elementary schoolchildren. Which of the following would be the best way to use EBP in
this situation?
a. Ask other school health nurses what they included in their own education
programs.
b. Compare and contrast randomized controlled trials related to learning in
elementary schoolchildren.
c. Develop a series of games to accompany the programs developed to promote
health.
d. Seek out and examine health education programs for elementary school children
on the Internet.
ANS: B
Randomized controlled trials are generally ranked as the highest level of evidence. EBP is
not collected by word of mouth, rather the nurse must look in the literature to obtain the
best information. There is not evidence that a series of games will assist with the retention
of learning based on what is stated in this question. This may be an appropriate activity,
but this information must be gathered from the literature. Searching the Internet for ideas
is helpful only if evidence-based practice sites are accessed, and most Internet sites are not
EBP sites.

7. After finding several studies related to the clinical problem, a nurse knows the studies
must be evaluated. Which of the following characteristics should be present in the
literature?
a. Federally supported multiagency clinical studies
b. Multiple high-quality studies with large sample sizes and consistent findings
c. Research studies done by multidisciplinary teams in multiple settings
d. Controlled clinical trials
ANS: B
 The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used to
evaluate the quality of studies and strength of evidence. The report identified three
domains for evaluating systems that grade the strength of evidence: quality, quantity, and
consistency. The quality of a study refers to the extent to which bias is minimized.
Quantity refers to the number of studies, the magnitude of the effect, and the sample size.
Consistency refers to studies that have similar findings, using similar and different study
designs. Federally supported multiagency clinical studies, research studies completed by
multidisciplinary teams in multiple settings, and controlled clinical trials do not
necessarily meet the three domains for evaluating systems to grade the strength of the
evidence: quality, quantity, and consistency. These are the criteria that should be used to
evaluate the literature so additional information is needed about these studies in order to
evaluate them.

8. A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the
care of clients. Which of the following would present the biggest challenge?
a. Assessing one’s current practice and accessing evidence-based resources
b. Convincing administration that EBP is beneficial
c. Distinguishing EBP from practice based on old standards
d. Showing clients that EBP will improve their health outcomes
ANS: A
The first step toward implementing evidence-based practice in nursing is recognizing the
current status of one’s own practice and believing that care based on the best evidence will
lead to improved client outcomes. After the nurse has assessed his/her own practice, and
accessed EBP resources, the next steps would be to talk with administration and
implement EBP into practice. Without self-reflection first, the nurse would be ineffective
in implementing EBP. The challenge for the clinician is how to access the evidence and
integrate it into practice, thus moving beyond practice based solely on experience,
tradition, or ritual.

9. Which of the following groups is pressuring clinicians the most to use evidence-based
practice (EBP)?
a. Administrators
b. Insurance companies
c. Nurses
d. Physicians
ANS: B
Much of the pressure to use evidence-based practice comes from third-party payers and is
a response to the need to contain costs and reduce legal liability. Nurses,physicians, and
adminstrators are not pressuring the use of EBP as much as insurance companies as these
are not the payors of health care.

10. A nurse implements an education program that incorporates computer games to reinforce
learning for a group of older adults. Although the research demonstrates evidence of
improved retention of this information, the nurse experiences exactly the opposite with
this group. Which of the following is the most likely cause of such poor outcomes?
a. Failure to consider client and setting differences
b. Inadequate incorporation of evidence into practice
c. Inferior quality of the available research evidence
 d. Lack of skills when evaluating the evidence
ANS: A
EBP cannot be applied as a universal remedy without attention to client differences. When
EBP is applied at the community level, best evidence may point to a solution that is not
sensitive to cultural issues and distinctions and thus may not be acceptable to the
community. For example, computer games may be excellent for younger groups but are
often poorly suited for older Americans who may face challenges with learning new
technology. Because the nurse did not consider the client differences, the intervention was
unsuccessful. This does not mean that the research had poor quality, was not evaluated
correctly, or was not correctly incorporated into practice. The nurse should not assume that
an EBP intervention will work in a different setting or with a different population than
what it has been intended.

11. A health care provider is concerned about the high number of clients with type 2 diabetes
mellitus who have poor glucose control. What would be the best reference for the provider
to implement evidence-based practice (EBP) in the management of this problem?
a. Published protocols
b. Current research findings
c. Opinions of colleagues
d. Nursing journals
ANS: B
EBP in community-oriented nursing challenges nurses to integrate outcomes of the best
evidence into their clinical practice. Current research findings will explicate evidence of
most successful interventions. (Randomized controlled trials are the gold standard of
research for EBP.) Protocols and opinions often reflect tradition rather than the most
current scientific evidence. Although many nursing journals are peer reviewed, many are
not and, even if peer reviewed, many are not research based or focused on scientific
evidence.

12. Staff members have agreed to implement evidence-based practice; they have chosen a
specific problem and searched the literature. The group has selected the interventions that
seem the easiest to implement. Which of the following actions would the staff take next?
a. Assess the quality of the evidence in the literature.
b. Decide how best to orient the staff and community to the proposed changes.
c. Eliminate all nursing interventions that are not evidence based.
d. Choose another specific problem for the next literature search.
ANS: A
After the group has chosen the topic and evaluated the literature for approaches that seem
feasible, specific interventions are chosen. The quality of the evidence must be assessed
before recommending specific changes or writing a protocol to resolve the problem.
Grading the strength of evidence or determining the quality, quantity, and consistency of
research studies must be done before making recommendations for practice. Deciding how
to orient staff and the community to the change would occur at the end of the process after
the findings have been summarized and written recommendations or protocols have been
developed. Elimination of nursing interventions that are not evidence based would be part
of the written recommendations and proposal that happen at the end of the process. The
nurse should not plan another literature search or topic to explore until after completing
the process with the current issue.
13. A school nurse is developing a primary prevention strategy for school-aged children.
Which of the following interventions would the nurse most likely implement?
a. Developing individualized exercise programs for overweight children
b. Drafting policy for increases in noncompetitive physical activity programs
c. Monitoring body mass index (BMI) in children to identify elevations before they
become difficult to manage
d. Notifying parents and/or guardians of their child’s height–weight scale in
comparison with national norms
ANS: B
At the primary prevention level, campaigns to support regular exercise, greater emphasis
on school-based physical education programs, and environmental and policy initiatives to
create or enhance places for physical activity in communities can make significant
contributions to improving the lifestyle of sedentary children. Exercise programs are an
example of tertiary prevention. Monitoring BMI in children is an example of secondary
prevention. Notifying parents of their children’s height-weight scale increases family
awareness but does not meet the definition of a preventive measure.

14. Which of the following is the best way to increase the number of persons who come to
their screening test appointments?
a. Reminding clients via telephone, e-mail, or mail
b. Emphasizing long life and happy family when conditions are caught early and
treated successfully
c. Pointing out how inexpensive and convenient screening tests are
d. Stressing the dangerousness of the condition if not caught early
ANS: A
Client reminders and recalls via mail, telephone, or e-mail—or a combination of these
strategies—are effective in increasing compliance with screening activities such as those
for colorectal and breast cancer. Emphasizing the importance of screening, how it is
inexpensive, and the dangers of the condition if it is not diagnosed early can all occur as
clients are reminded of the screening via telephone, e-mail, or mail. Without the reminder,
clients are likely to lose sight of the benefits of receiving the screening.

15. A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the
clinical setting. Which of the following would be the best strategy to accomplish this goal?
a. Eliminate all protocols and standards that are not evidence based.
b. Encourage group reflection on the ideals and expectations of nursing care.
c. Refer agency nurses to Internet sources of research findings.
d. Support nurses using practice-oriented research findings in decision making.
ANS: D
 EBP demands changes. It requires incorporating more practice-oriented research and more
collaboration between clinicians and researchers. Emphasis should be on decision making
using the varied sources of evidence. The environment and climate must be supportive in
order to implement EBP. Rather than eliminating protocols and standards that are not
evicence based, the nurse manager should make it a priority to begin to update these
practices based on EBP. Self-reflection on one’s own nursing practice and how EBP can
be implemented would be more important than group reflection on the large ideals of
nursing practice. Referring the nurses to the Internet for ideas is helpful only if
evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

MULTIPLE RESPONSE

1. A nurse has decided to increase the evidence base of current nursing practice in an agency.
Which of the following describes a barrier that could be encountered by the nurse? (Select
all that apply.)
a. Colleagues who do not know how to search the literature or critique research
b. Dedication to the history and tradition of the agency
c. Little or no research published in the clinical area of concern
d. Several meta-analyses in the literature with inconsistent results
ANS: A, B, C
Barriers to evidence-based practice exist when the following are limited or lacking: time,
access to journal articles, search skills, critical appraisal skills, and an understanding of
research terminology. Other barriers include miscommunication about the process; inferior
or unavailable research or other evidence; unwillingness of organizations to fund research
or make decisions based on evidence; and concern that evidence-based practice will
decrease emphasis on individual client needs or the nurse’s clinical decisions. Dedication
to the history and tradition of the agency may pose a barrier as this may influence the
philosophy of the practice environment and the willingness to embrace EBP. The number
of meta-analyses in the literature, regardless if the results are consistent or not, would not
be a barrier to the practice environment when implementation is considered.