Evidence Based Practice in Nursing & Healthcare A Guide to Best Practice 2nd Edition By Bernadette Mazurek Melnyk-Test Bank

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Evidence Based Practice in Nursing & Healthcare A Guide to Best Practice 2nd Edition By Bernadette Mazurek Melnyk-Test Bank


Evidence Based Practice in Nursing & Healthcare A Guide to Best Practice 2nd Edition By Bernadette Mazurek Melnyk-Test Bank

chapter 2

1. Which of the following components of a clinical question represents the P in the PICOT format for asking clinical questions?
  A) The nurses preparation for patient teaching prior to surgery
  B) Early ambulation versus aggressive anticoagulant therapy
  C) Individuals who require peritoneal dialysis
  D) Deep vein thrombosis



2. An unacceptably high number of patients on a geriatric, subacute medicine unit have developed pressure ulcers during their period of care. The nurses on the unit have agreed on a goal of reducing the incidence of these wounds by 50% over the next 10 weeks. This goal represents which component of the PICOT format for asking clinical questions?
  A) O
  B) P
  C) I
  D) C



3. Which of the following scenarios represents the most common obstacle that nurses encounter when attempting to gain the knowledge necessary for EBP?
  A) A nurse identifies several articles relevant to a clinical question, but the methodology of each is significantly flawed.
  B) A nurse is overwhelmed by the number of hits during a CINAHL search.
  C) Current research that relates to the nurses clinical question does not exist.
  D) The research that the nurse locates is rooted in a medical, not nursing, perspective.



4. A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem?
  A) Narrow the scope of the clinical question
  B) Restrict the information search to publications from the past 24 months
  C) Seek recommendations for information sources from trusted colleagues
  D) Limit the search to articles that relate the findings of randomized control trials (RCTs)



5. A pediatric nurse provides care for many children who present to the emergency department (ED) with signs and symptoms of asthma. Which of the following questions is a background question that the nurse can utilize in the process of providing EBP?
  A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers (MDIs)?
  B) What patient populations respond best to nebulized bronchodilators?
  C) How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm?
  D) Are nebulizers provided to patients in the ED more often than metered-dose inhalers?



6. Which of the following statements is true of foreground questions?
  A) They focus on issues that can be addressed by applying scientific evidence.
  B) They have a broad, rather than narrow, scope.
  C) They can be answered by examining electronic information sources instead of print sources.
  D) They are rooted in the current practices of a nurses clinical setting.



7. An oncology nurse is engaged in increasing the quality of EBP that is provided on the cancer unit of the local hospital. Which of the following questions would the nurse consider to be an adequate and useful foreground question?
  A) Are benzodiazepines and analgesics provided before patients have a bone marrow biopsy?
  B) What is the clinical rationale for using bone marrow biopsy to gauge and predict the course of a patients cancer?
  C) Does guided imagery reduce the anxiety of patients who undergo bone marrow biopsy?
  D) How often is bone marrow biopsy performed on the unit?



8. Which of the following clinical questions would be most justified in lacking a comparison?
  A) An examination of the antipyretic qualities of cool bed-bathing
  B) A study on the perceived meaning of hope among palliative patients
  C) A study on the influence of prenatal care on preventing perineal tearing during delivery
  D) An examination of the effect of rehydration using lactated Ringers on patients energy levels



9. Which of the following clinical questions would be considered to be a meaning question?
  A) What factors underlie parents decisions to refuse immunizations for their children aged 3 months to 24 months?
  B) What factors, apart from asbestos exposure, may contribute to ex-miners diagnoses of mesothelioma?
  C) How do pregnant women with high-risk pregnancies who have been prescribed bed-rest perceive their situations?
  D) Are cigarette warning labels an effective deterrent to cigarette smoking among females aged 11 to 15 years?



10. Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question?
  A) The patient population should be as narrow a range as possible.
  B) The population in the clinical question should closely match the demographics of the nurses geographic region.
  C) A specific and defensible rationale should exist for the choice of patient population.
  D) The patient population in the clinical question should mirror the populations in prominent studies related to the issue.



11. In the context of the PICOT format for formulating clinical questions, which of the following may be considered to be an intervention?
  A) Levels of patient hygiene in an assisted-living facility
  B) The incidence and prevalence of stomach cancer among low-income males aged 65 to 85
  C) The prevalence of wound dehiscence among postmastectomy patients
  D) Occupational exposure to airborne silicon dust



12. Which of the following symptoms could be best clustered into a single outcome for the purposes of crafting a concise clinical question?
  A) Increased anxiety, increased serum cholesterol, and low rating of overall well-being
  B) Hypotension, tachycardia, and decreased level of consciousness
  C) Increased temperature, decreased mobility, and confusion
  D) Increased neonatal bilirubin levels and the mothers choice to feed with formula rather than breastfeed



13. Which of the following clinical questions can be best addressed by a meta-synthesis of qualitative studies?
  A) What is the meaning of spiritual support in hospice patients who are younger than 50?
  B) What is the effectiveness of physical activity compared with beta-blockers in reducing the blood pressure of adult, African-American men?
  C) Is the use of a stroke team in the emergency department, rather than standard assessment and treatment, associated with improved outcomes among patients diagnosed with stroke?
  D) Are single-occupancy hospital rooms, rather than shared rooms, associated with increased patient satisfaction reports?



14. Which of the following principles can help a nurse rank levels of evidence when answering clinical questions of all types and scopes?
  A) Quantitative research supersedes qualitative research.
  B) Randomized control trials must be included when answering clinical questions.
  C) Sources of evidence must be peer-reviewed.
  D) Syntheses are the highest level of evidence.



15. Which of the following groups would most likely be considered a self-selected cohort?
  A) Obese, Hispanic females
  B) Cigarette smokers
  C) Patients with hypertension who take diuretics
  D) Teenage females




Answer Key


1. C
2. A
3. B
4. A
5. D
6. A
7. C
8. B
9. C
10. C
11. D
12. B
13. A
14. D
15. B

chapter 10

1. Which of the following actions related to outcomes measurement falls within the scope of the outcomes management (OM) framework?
  A) Surveying the views of nurses to elicit effective interventions and outcomes
  B) Correlating specific interventions with their outcomes
  C) Assessing patients understanding of their own health status
  D) Quantifying patient satisfaction ratings as a key outcome



2. Staff on a burns-and-plastics unit have implemented a new, evidence-based algorithm around pain control prior to debridement and dressing changes that was based on the Health Outcomes Institutes Outcomes Management Model. Analysis of the outcomes following the implementation of the new practice reveals that patient reports of pain during the procedures actually increased slightly compared with preexisting practices. The caregivers should prioritize which of the following?
  A) Revisiting phase one of the process
  B) Disseminating the results of the process
  C) Continuing with data collection over a longer period
  D) Reexamining the evidence and chosen practices



3. Which of the following actions is most likely to promote acceptance of a new, evidence-based initiative aimed at reducing the incidence of pressure ulcers among stroke patients on a rehabilitative medicine unit?
  A) Having an expert talk to staff about the deleterious effects that pressure ulcers have on the quality of life of patients
  B) Quantifying and distributing the baseline incidence of pressure ulcers on the unit
  C) Encouraging staff to search the health literature for possible new interventions for pressure ulcer prevention
  D) Directing staff to be vigilant when charting interventions related to the prevention or treatment of pressure ulcers



4. The nursing leadership at a county hospital are alarmed by an apparent increase in the incidence of nosocomial methacillin-resistant staphylococcus aureus (MRSA) colonization and infection among inpatients. The leaders are eager to determine if this is a real or perceived phenomenon and should proceed by
  A) beginning a campaign of data collection related to MRSA.
  B) conducting a literature review related to MRSA infection and colonization.
  C) examining existing hospital data to see if their suspicions are valid.
  D) beginning a program of observation to assess the infection-control practices of care providers.



5. Which of the following data that are required for an EBP initiative are most likely to be obtained from the hospitals quality management department?
  A) Incident reports documenting patient assaults on nurses
  B) Patient demographic data
  C) Information on staffing levels at various times and locations
  D) Medication regimens of patients who have specific illnesses



6. Nurses are attempting to identify the relationship between patient satisfaction and the staffing complement of the hospital as part of the baseline data for an EBP initiative. Which of the following sources should the nurses approach in order to access existing patient satisfaction surveys?
  A) Finance
  B) Quality management
  C) Administration
  D) Clinical systems



7. Knowing that the healthcare organization utilizes the International Statistical Classification of Diseases and Related Health Problems Version 9 (ICD-9) for patient and third-party billing, a nurse has requested such records for patients admitted in the last 3 months to the emergency department. The nurse has requested that the records be provided in an electronic, rather than paper-based, format because
  A) confidentiality is easier to maintain when working with electronic data.
  B) electronic data are more likely to be current than paper-based records.
  C) patients often do not grant permission for release of their health records in hard copy.
  D) electronic data are easier to manipulate in order to perform statistical analysis.



8. Nurses are attempting to identify any relationship between staffing levels and the incidence of catheter-associated urinary tract infections (UTI). The nurse should begin by doing which of the following?
  A) Auditing the staffing records obtained from the human resources department
  B) Identifying which other variables may potentially affect UTI development
  C) Observing nurses current practices related to catheter care
  D) Revising the current policy and procedures manual for guidelines to catheter care



9. As a component of data collection for an evidence-based practice initiative, a nurse is constructing a document that is designed to measure the quality of working relationships between disciplines on the hospital unit. Which of the following principles should guide the nurses efforts?
  A) The instrument should be written by a staff member who is not directly participating in the initiative.
  B) The nurse should use a qualitative, rather than quantitative, approach.
  C) Complex phenomena, such as human relationships, are not amenable to analysis by documents and surveys.
  D) The instrument must be proven valid and reliable before it can be utilized.



10. The educator on an intensive care unit has drafted a new instrument aimed at gauging patient pain, but nurses have called into question the validity of the instrument. What is the nurses most likely criticism of the instrument?
  A) The instrument is more complex than instruments that already exist.
  B) Results of using the instrument will vary greatly from patient to patient.
  C) The instrument does not actually measure pain.
  D) The nurse did not integrate existing evidence into the development of the instrument.



11. Which of the following numeric measures would be most likely to produce invalid statistical analysis?
  A) Analysis of patients blood pressures in mmHg
  B) Pain rating as: none = 0; slight = 1; much = 2
  C) Assessment of oxygen saturation in percentage
  D) Analysis of neonatal birthweight in kilograms



12. An oncology nurse is in the habit of asking patients to describe the character and quality of their nausea during chemotherapy treatment. These descriptions would constitute what level of data?
  A) Ordinal
  B) Interval
  C) Nominal
  D) Ratio



13. As part of the data-gathering that is being conducted to identify baselines prior to an evidence-based practice initiative, a nurse will be using software to analyze the data statistically. Which of the following levels of data is most likely to produce clinically useful results?
  A) Ordinal
  B) Ratio
  C) Nominal
  D) Cardinal



14. In an effort to examine the possible relationship between a particular exercise regimen and serum lipid levels, researchers have opted to use a quasi-experimental design rather than the true experiment that they originally envisioned. Which of the following changes have the researchers likely made to the study?
  A) Participants will choose by themselves whether they will join the exercise group or the control group.
  B) Participants will not be required to stop participating in other forms of exercise.
  C) The researchers will perform qualitative, rather than statistical, analysis.
  D) The results may be used to strengthen existing evidence but will not constitute new evidence.



15. The leadership of a hospital unit has recently established a dashboard at the nurses station that addresses patient readmission rates. This initiative is likely to have what effect?
  A) Increasing adherence to evidence-based practice
  B) Gauging the quality of authorized policies and procedures on the unit
  C) Allowing nurses to see the cause-and-effect relationship between care and outcomes
  D) Allowing nurses to perform statistical analysis at the point of care




Answer Key


1. B
2. D
3. B
4. C
5. A
6. B
7. D
8. B
9. D
10. C
11. B
12. C
13. B
14. A
15. C

chapter 20

1. The leadership of a large, tertiary care hospital is under pressure from various sources to implement both evidence-based practice (EBP) and quality improvement (QI). Which of the following statements most accurately conveys an aspect of these philosophies?
  A) EBP integrates patient preferences into clinical care decisions.
  B) QI allows for the expertise of clinicians to be taken into account.
  C) QI does not account for effects on patients who will be excluded from care.
  D) EBP is linked to better patient outcomes than QI.



2. Which of the following factors differentiates evidence-based practice (EBP) implementation from clinical research?
  A) Clinical research has more stringent ethical standards than EBP implementation.
  B) EBP implementation is often less generalizable than clinical research.
  C) The implementation of EBP creates new knowledge while clinical research confirms or disputes existing knowledge.
  D) EBP implementation takes place on a larger scale than clinical research.



3. A leadership team is planning an evidence-based practice (EBP) initiative that will address the policies and protocols around wound care. Which of the following developments in the implementation may be construed as unethical?
  A) Evidence-based treatments may be a benefit to some patients healing but exacerbate others.
  B) The implementation of evidence-based wound care may be impractical from a staffing perspective.
  C) The clinical practice guidelines that form the basis of the practice change may have been developed at a different site.
  D) Clinicians may find that existing routines around wound care are difficult to change.



4. Which of the following activities would most likely be categorized as evidence-based practice (EBP) implementation rather than clinical research?
  A) Testing the effectiveness of new composite dressing in promoting wound healing
  B) Assessing whether a school-based antismoking initiative reduces smoking rates among teenagers
  C) Determining the efficacy of an innovative antihypertensive medication in patients who do not respond to standard therapy
  D) Examining whether the introduction of a clinical practice guideline around falls prevention results in a reduction in falls



5. Which of the following beliefs underlies many of the ethical debates surrounding evidence-based practice (EBP) implementation?
  A) It is sometimes claimed that ethics approval for the implementation of others research should be obtained by the person who originally conducted that research.
  B) Some believe that the implementation of existing research does not require ethical approval.
  C) Some nurses state that considering patient preferences and integrating these into practice is an adequate form of ethics approval.
  D) It is sometimes claimed that EBP is inherently ethical, negating the need for further ethics approval.



6. In preparation for a credentialing process, a county hospital will be conducting an audit. What is the primary focus of this activity?
  A) Evaluating whether ethical principles are being integrated into bedside care
  B) Determining caregivers knowledge base around evidence-based practice (EBP)
  C) Determining whether patient outcomes at the hospital align with patient expectations
  D) Evaluating whether current practice is based on the best available evidence



7. Which of the following activities most clearly requires ethical approval?
  A) Implementation of a new clinical practice guideline
  B) Recruitment for a case-control study
  C) Modification of hospital policy and procedures
  D) Modification of a nurses practice habits



8. Which of the following factors should be prioritized in the decision of whether to seek ethical approval for a project involving a change in practice?
  A) The projects classification as either quality improvement (QI) or clinical research
  B) The stated values and mission statement of the site where it will be implemented
  C) The question of whether the implementation represents a risk to participants
  D) The stance of the agency or foundation that is funding the implementation



9. An evidence-based quality improvement (EBQI) initiative will soon be commenced at a university hospital. Which of the following characteristics of the project cause it to be categorized as EBQI?
  A) The project is aimed at changing practice to improve outcomes so that they are more evidence based.
  B) The project is being spearheaded by individuals who possess knowledge and experience in evidence-based practice (EBP).
  C) The implementation of the project is based on valid research and does not represent a risk to participants.
  D) The project has dual goals of improving outcomes while producing new knowledge that is generalizable.



10. Which of the following characteristics of a practice change is most closely associated with evidence-based quality improvement (EBQI)?
  A) The change is implemented by the individuals who provide patient care.
  B) The funding source for the practice change is an organization external to the clinical site.
  C) The ultimate goal of the project is to generate new evidence that can be applied universally.
  D) The individuals who carry out the change are brought in from outside the organization.



11. The nurses at a long-term care facility have recently completed an evidence-based quality improvement (EBQI) project that aimed to improve the outcomes of residents with dementia. Which of the following principles should guide the decision of whether to publish the results of the initiative?
  A) The results of the project should be submitted for publication if they have produced new knowledge.
  B) The results should be considered for publication if they are thought to be applicable to other settings.
  C) Publication should be considered if it was an explicit goal of the project and if participants have granted consent for publication.
  D) The nurses are obligated to disseminate their results as part of the evidence-based practice (EBP) process.



12. The nursing leaders at a county hospital are aware of the need for rigor during the implementation of an EBQI project that will address emergency department triage. How should the leaders apply rigor to this project?
  A) By ensuring that instruments for measuring effectiveness have face and content validity
  B) By justifying their choice of methodology in terms of the clinical question and the characteristics of the site
  C) By seeking ethical approval and patient consent prior to beginning the project
  D) By ensuring that resources will not be wasted and patients will not be placed at risk



13. An evidence-based quality improvement (EBQI) project has been proposed that will increase the number of school-aged children who receive an annual influenza vaccination. The project will be implemented in an affluent suburban community despite the fact that vaccination rates are much lower in poorer neighborhoods. The implementation of this project may be in violation of which of the following ethical principles?
  A) Respect for potential and enrolled subjects
  B) Social or scientific value
  C) Scientific validity
  D) Fair subject selection



14. Members of the nursing leadership at a hospital disagree about the need for informed consent from patients who are participating in an evidence-based quality improvement (EBQI) project. Which of the following principles should guide the teams decision of whether to seek informed consent from patients?
  A) The decision should be deferred to the ethical review board of the hospital.
  B) EBQI is a part of normal clinical care and likely does not require written consent.
  C) Proceeding with EBQI without informed consent violates patient autonomy.
  D) Participation in clinical research is a tacit understanding of seeking hospital care.



15. A group of nurses is taking measures to ensure that an evidence-based quality improvement (EBQI) initiative is conducted ethically. Which of the following actions most clearly demonstrates appropriate selection of subjects?
  A) Distributing risks and benefits fairly
  B) Maximizing the number of participants in the sample
  C) Randomly assigning patients to receive or not receive the changed practice
  D) Sampling selectively to ensure equivalence between groups




Answer Key


1. A
2. B
3. A
4. D
5. B
6. D
7. B
8. C
9. A
10. A
11. B
12. D
13. D
14. B
15. A


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