Nursing Leadership & Management 3rd Edition by Patricia Kelly Test Bank

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Nursing Leadership & Management 3rd Edition by Patricia Kelly Test Bank

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Chapter 5: Evidence-Based Health Care

MULTIPLE CHOICE

1. When engaging in evidence-based health care, the nurse understands that it was originally started as a way to:
a.
teach medical students the art and science of medicine.
b.
promote technological advances in medicine.
c.
integrate individual experience with clinical research.
d.
incorporate collaboration within all health care disciplines.

ANS: C
D. L. Sackett, well known in the EBM movement, encouraged evidenced-based medicine as a way to integrate individual clinical medical experience with external clinical evidence using a systematic research approach.

PTS: 1 DIF: Application REF: HISTORY OF EBP

2. A nurse manager is preparing to develop a research proposal. The manager reviews the Iowa Model of Evidence-based Practice to Promote Quality Care and decides to base the research question around one of the problem-focused triggers identified in the model. The nurse manager will most likely choose which of the following triggers?
a.
Philosophies of Care
b.
New Research or Other Literature
c.
Identification of Clinical Problem
d.
National Agencies or Organizational Standards and Guidelines

ANS: C
The nurse manager will most likely choose Identification of Clinical Problem as the problem-focused trigger. The Iowa Model identifies several problem-focused triggers, including risk management data, process improvement data, internal/external benchmarking data, financial data, and identification of clinical problem. According to the Iowa Model, philosophies of care, standards and guidelines, national agency or organizational standards and guidelines would be considered knowledge-focused triggers.

PTS: 1 DIF: Application REF: HISTORY OF EBP

3. A nurse researcher is planning a study using a procedure for quantitatively combining the results of many research studies that measure the same outcome. The data will be combined into a single pool or summary estimate of results. The nurses research will most likely involve which of the following designs?
a.
Correlation
c.
Follow-up study
b.
Meta-analysis
d.
Longitudinal research

ANS: B
The nurse researcher will most likely conduct a meta-analysis. Correlation research explores the interrelationship among variables of interest. A follow-up study is the subsequent or long-term study of people who have received a specific treatment. A longitudinal study is designed to collect data at more than one point in time, in contrast to a cross-sectional study.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

4. A nurse researcher is conducting a study that has as its main objective the accurate portrayal of the characteristics of people, situations, or groups, and the frequency with which certain phenomena occur. The research is implementing which type of study?
a.
Comparative research
c.
Correlation research
b.
Descriptive research
d.
Research utilization

ANS: B
Descriptive research studies have as their main objective the accurate portrayal of the characteristics of people, situations, or groups, and the frequency with which certain phenomena occur. Comparative research specifies the type of comparisons. Correlation research explores the interrelationships among variables of interest without any active intervention on the part of the researcher. Research utilization is the use of some aspect of a research or scientific investigation in an application unrelated to the original research.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

5. As part of your research, you wish to combine study results and thus integrate the results of multiple studies on a given topic. This action is referred to as:
a.
qualitative analysis.
c.
meta-analysis.
b.
quantitative analysis.
d.
matched case-control study.

ANS: C
Meta-analysis is a technique for combining study results and thus integrating the results of multiple studies on a given topic. Qualitative analysis is the non-numeric organization and interpretation of observations for the purpose of discovering important underlying dimensions and patterns of relationships. Quantitative analysis is the manipulation of numerical data through statistical procedures for the purpose of describing phenomena or assessing the magnitude and reliability of relationships among them. A matched case-control study is a research technique that uses select sample characteristics to match experimental subjects with a control group.

PTS: 1 DIF: Application REF: TABLE 5-5 RESEARCH TERMINOLOGY

6. You decide to conduct a study that begins with cigarette smoking and then looks at lung cancer. Which type of study will you conduct?
a.
Outcome study
c.
Retrospective study
b.
Prospective study
d.
Time series study

ANS: B
A prospective study begins with an examination of presumed causes (cigarette smoking) and then goes forward in time to observe presumed effects (lung cancer). An outcome study is an observation of a defined population at a single point in time or at intervals. A retrospective study begins with the manifestation of the dependent variable in the present (lung cancer) and then links this effect to some presumed cause occurring in the past (cigarette smoking). A time series study is a quasi-experimental design that involves the collection of information over an extended period of time, with multiple data collection points both prior to and after the introduction of a treatment.

PTS: 1 DIF: Application REF: TABLE 5-5 RESEARCH TERMINOLOGY

7. In developing research, a possible variable the nurse may be considering would be which of the following?
a.
Study intervention
c.
Body temperature
b.
Placebo
d.
Control group

ANS: C
A variable is a characteristic or attribute of a person that varies within the population under study such as body temperature. In a randomized controlled trial, an experimental group receives a study intervention and the control group may receive a placebo. A control group consists of subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured.

PTS: 1 DIF: Application REF: TABLE 5-5 RESEARCH TERMINOLOGY

8. When using available evidence, the nurse must be aware of what two major challenges?
a.
Balancing the benefits and harm to justify a recommendation of the evidence
b.
Reviewing the body of knowledge and evaluating for clinical decision making
c.
Recommending or not recommending the research evidence for clinical practice
d.
Reviewing the clinical trials and grading the research according to the AHRQ scale

ANS: B
The two major challenges are (1) reviewing the rapidly growing body of scientific literature and (2) evaluating and transforming the literature in order to be useful for clinical decision making. Balancing the benefits and harm is a criterion for evaluating research. Recommending or not recommending the research is also a criterion for the evaluation process. Reviewing and grading research according to the AHRQ scale is a criterion for the evaluation process.

PTS: 1 DIF: Comprehension REF: LEVELS OF EVIDENCE

9. The nurse is engaged in a process approach of reviewing, interpreting, critiquing, and evaluating research and other relevant literature for direct application to patient care. When asked by a coworker, the nurse explains that this process is called:
a.
evidence-based medicine.
c.
evidence-based care.
b.
evidence-based practice.
d.
critical thinking.

ANS: C
Evidence-based care is the process approach to collecting, reviewing, interpreting, critiquing, and evaluating research and other relevant literature for direct application to patient care. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is about clinical competence in the individual care of patients, decision analysis, human value, use of information technology for best available clinical evidence from systematic research, and stewardship of resources. Evidence-based care should be viewed as the highest standard of care so long as critical thinking and sound clinical judgment support it.

PTS: 1 DIF: Application REF: IMPORTANCE OF EBP

10. The nurse is aware of the growing development of evidence-based care. The nurse would recognize that an issue driving this development is:
a.
increased variability in implementation of practice and variance analysis.
b.
requirement of evidence-based standards of care by PEW.
c.
decreased numbers of well-designed RCTs.
d.
growth of advanced practice roles.

ANS: D
Issues driving the development of evidence-based practice are growth of advanced practice roles; increased numbers of well-designed RCTs; need for decreased variability in implementation of practice and variance analysis; demand of the PEW Health Professions Commission Report for evidence-based, clinically competent care; increased experience in clinical pathways, standards, protocols, and algorithms; increase in integrated systematic reviews of research studies found in the nursing, medical, and health care literature; need for outcome data to guide patient care; explosion in information technology; improved knowledge base facilitating research capable of supporting evidence-based care models; need to collaborate in complex decision making with patients and other members of the health care team; and requirement for evidence-based standards of care by the Joint Commission.

PTS: 1 DIF: Application
REF: TABLE 5-1 CURRENT ISSUES AND TRENDS DRIVING DEVELOPMENT OF EBP IN NURSING

11. When engaging in evidence-based practice, the nurse would use which of the following criteria to determine the relevance of the study or report?
a.
Level of evidence
b.
Clearinghouse to purge outdated research
c.
Quasi-experimental pre-post study research
d.
Scale for grading research for recommendation

ANS: A
Level of evidence identifies the strength or quality of evidence generated from a study or report. Level I includes systematic reviews or meta-analyses of randomized controlled trials (RCTs) and evidence-based clinical practice guidelines are considered to be the strongest level of evidence upon which to guide practice decisions. Level II in the evidence hierarchy is that evidence which is generated by at least one well-designed RCT. An RCT is an experimental research study in which subjects are randomly assigned to experimental and control groups.

PTS: 1 DIF: Application REF: LEVELS OF EVIDENCE

12. A group of nurses wishes to create an evidenced-based environment within the institution where they work. Which of the following is an attribute of such an environment?
a.
Maintaining the status quo
b.
Using the organizational external structure
c.
Maintaining the culture
d.
Creating a capacity to change

ANS: D
Three specific attributes of establishing an evidence-based environment within an institution are (1) create a capacity for change, (2) establish the culture, and (3) use the organizational infrastructure to sustain and reinforce change.

PTS: 1 DIF: Application REF: ATTRIBUTES OF EBP

13. The nurse wishes to employ Melnyk & Fineout-Overholts five-step process of evidence-based practice. The nurse recognizes that the five-step process includes:
a.
asking relevant questions, searching for evidence, appraising the evidence, integrating evidence with clinical practice and patient preferences in order to make practice decisions, and evaluating the practice decision.
b.
knowledge discovery, evidence summary, translation into practice, integration into practice, evaluation.
c.
grading the research, leveling the evidence, source of evidence, strength of evidence, publishing the evidence.
d.
designing the research study, selecting research subjects, controlling variables, collecting data, analyzing.

ANS: A
Melnyk & Fineout-Overholts five-step process of evidence-based practice includes asking relevant questions, searching for evidence, appraising the evidence, integrating evidence with clinical practice and patient preferences in order to make practice decisions, and evaluating the practice decision.

PTS: 1 DIF: Comprehension
REF: EVIDENCE FROM THE LITERATURE

14. An instructor wants to determine whether a group of nursing students understands the process for conducting evidence reports in nursing using a PICO-based approach. Which of the following comments by the students would indicate that learning has occurred?
a.
Select problem, identify methods for assigning level of evidence, report evidence, report findings, make recommendations, give summary
b.
Select problem, report evidence, identify methods for assigning level of evidence, report findings, make recommendations, give summary
c.
Select problem, report findings, report the evidence, identify methods for assigning level of evidence, give summary, and make recommendations
d.
Formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement

ANS: D
The steps in the method for conducting evidence reports in nursing based on a PICO-based method are to formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement.

PTS: 1 DIF: Application
REF: PICO-BASED APPROACH TO GUIDING AN EVIDENCE SEARCH

15. The nurse follows practice protocols and clinical guidelines primarily because they help to produce better patient care by reducing:
a.
variations in care and increasing efficiency.
b.
the need for individual patient variations.
c.
waste of resources available in the hospital.
d.
the number of inpatient care days per year.

ANS: A
Using tools such as clinical guidelines may help reduce variations in care and has the potential to increase efficiency. Practice protocols are no substitution for the need to assess each patients unique individual needs and variations with the care. Using practice protocols may have an influence on reducing waste; however, reducing waste does not necessarily produce better patient care. Practice protocols are not used primarily to reduce the number of inpatient care days.

PTS: 1 DIF: Comprehension
REF: TABLE 5-5 RESEARCH TERMINOLOGY

16. A nurse researcher develops a research proposal to determine if there is a relationship between the number of days female oncology patients spend in the hospital and their scores on a patient satisfaction survey. Which of the following would be the independent variable?
a.
Female
c.
Score on satisfaction survey
b.
Oncology patient
d.
Number of hospital days

ANS: D
The independent variable would be the number of hospital days and the dependent variable would be the participants score on the satisfaction survey. Female and oncology patient are considered demographic variables.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

17. Which of the following would be a potential positive outcome for an organization when it integrates evidence-based practice?
a.
Improved recruitment of nurses
c.
Higher turnover of nurses
b.
Reduced mortality and morbidity
d.
Reduced patient satisfaction

ANS: A
A potential positive outcome for the organization that integrates evidence-based practice would include improved recruitment of nurses. Reduced mortality and morbidity rates are benefits for the patients. Increased nurses salaries would not necessarily be a benefit for the organization. Higher turnover of nurses and reduced patient satisfaction are more common in organizations that do not integrate evidence-based practice.

PTS: 1 DIF: Analysis
REF: TABLE 5-6 POTENTIAL OUTCOMES OF INTEGRATING EVIDENCE-BASED PRACTICE INTO ORGANIZATIONAL CULTURE

18. Decisions regarding the care of patients should not be based on :
a.
research evidence.
c.
nurse values and preferences.
b.
clinical experience.
d.
patient values and preferences.

ANS: C
Nurses make critical judgement about the care of patients based on research evidence, clinical experience, and patient values and preferences. The search for best evidence should be systematic. A systematic critical appraisal of literature is an effective strategy for identifying recommendations for improving practice. Nurse values and preferences should not be the basis for patient care.

PTS: 1 DIF: Comprehension REF: HISTORY OF EBP

19. A nurse researcher is analyzing the results of a descriptive research study. The analysis involves the interpretation of scores for a number of statistical tests. The nurse researcher would be conducting which of the following types of analysis?
a.
Qualitative analysis
c.
Meta-analysis
b.
Quantitative analysis
d.
Integrative review

ANS: B
Quantitative analysis is the manipulation of numeric data through statistical procedures for the purpose of describing phenomena or assessing the magnitude and reliability of relationships among them. A qualitative analysis is the organization and interpretation of non-numeric data for the purpose of discovering important underlying dimensions and patterns of relationships. Meta-analysis is a procedure for quantitatively combining the results of many research studies that measure the same outcome into a single pooled or summary estimate of the results, and an integrative review is a type of evidence summary.

PTS: 1 DIF: Application REF: TABLE 5-5 RESEARCH TERMINOLOGY

20. A nurse researcher is conducting a study that consists of subjects who are randomly placed in two groups. Individuals in Group I receive a new experimental treatment. Individuals in Group II receive the traditional treatment. The nurse is most likely conducting which type of study?
a.
Cohort study
c.
Outcome research
b.
Case-control study
d.
Randomized clinical trial

ANS: D
The nurse is most likely conducting a randomized clinical trial. In a randomized clinical trial, individuals are randomly allocated to receive or not receive an experimental preventive, therapeutic, or diagnostic procedure.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

MULTIPLE RESPONSE

1. A nurse researcher conducts a study of pregnant African American women between the ages of 15 and 35. The purpose of the study is to determine if weekly nutritional counseling sessions and participation in a structured weekly support group have any impact on the mothers post-delivery B/P or the infants APGAR score. What would be the independent variable or variables in the study? Select all that apply.
a.
Age of subjects
d.
Infants APGAR score
b.
Nutritional counseling sessions
e.
African American female
c.
Mothers post-delivery B/P
f.
Structured weekly support group

ANS: B, F
The nutritional counseling sessions and the structured weekly support group are the independent variables. Independent variables are the variables believed to cause or influence the dependent variables. Also, the independent variables are the variables that are manipulated. In this study, the age of the subject and her being an African American are considered demographic variables. The mothers post-delivery B/P and the infants APGAR score are the dependent variables.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

2. A nurse researcher conducts a study of pregnant African American women between the ages of 15 and 35. The purpose of the study is to determine if weekly exercise classes and participation in a structured weekly support group have any impact on the mothers post-delivery B/P, request for pain medication, or the infants APGAR score. What would be the dependent variable or variables in the study? Select all that apply.
a.
Age of subjects
d.
Infants APGAR score
b.
Weekly exercise classes
e.
Request for pain medication
c.
Mothers post-delivery B/P
f.
Structured weekly support group

ANS: C, D, E
The mothers post-delivery B/P, request for pain medication, and the infants APGAR score are the dependent variables. Dependent variables are the outcome variables that are hypothesized or thought to depend on or be caused by another variable, called the independent variable. In this study, participation in weekly exercise classes and the structured support group are the independent variables.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

3. A nurse conducts a study of perceptions of caring on five oncology units. At the beginning of the study, all of the nurses on the oncology units were asked to complete a survey identifying what they perceived as nurses demonstration of caring. Prior to discharge, each patient that the nurses had cared for and their family members were given a short questionnaire to evaluate their perceptions of the nurses demonstration of caring. Which of the following were the dependent variables? Select all that apply.
a.
Age
b.
Gender
c.
Ethnicity
d.
Patients perception of nurses caring
e.
Nurses caring behaviors
f.
Family members perception of nurses caring

ANS: D, F
The dependent variables of the study were patients and family members perceptions of nurses caring, Age, gender, and ethnicity were the demographic variables. Nurses caring behaviors were the independent variable.

PTS: 1 DIF: Analysis REF: TABLE 5-5 RESEARCH TERMINOLOGY

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