Chapter 5: Evidence-Based Practice in Medical-Surgical Nursing Nursing School Test Banks

Chapter 5: Evidence-Based Practice in Medical-Surgical Nursing
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. A nurse identifies clinical practice problems on a cardiac unit. Which question is a background question?
a. How should a client experiencing chest pain be prioritized?
b. What is the experience of a cardiac catheterization like for middle-aged men?
c. How are a clients vital signs affected by anxiety?
d. What is the best treatment for a myocardial infarction?
ANS: C
A background question asks for a fact. The response of anxiety on vital signs is a background question. A foreground question asks a question of relationship and may be controversial (best treatment). Questions related to a clients experience and best treatment are foreground questions.

DIF: Understanding/Comprehension REF: 65
KEY: Foreground| background
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

2. A nurse researcher is evaluating clinical questions. Which is a quantitative question?
a. What are the effects of hourly rounding on client fall rates?
b. How do middle-aged men respond to premature balding?
c. What are the lived experiences of postoperative clients with pain?
d. What is the experience of having breast cancer like for young women?
ANS: A
Quantitative questions ask about the relationship between or among defined, measurable phenomena and include statistical analysis of information that is collected to answer a question. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people, and usually analyze the content of what a person says during an interview or what a researcher observes.

DIF: Understanding/Comprehension REF: 65
KEY: Foreground| background
MSC: Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A nurse is looking for the best interventions for postoperative pain control. When are the facilitys policies and procedures an appropriate source of evidence?
a. When policies are based on high-quality clinical practice guidelines
b. When evidence is derived from a valid and reliable quantitative research study
c. When procedures originated from opinions of the facilitys chief surgeon
d. When evidence is founded on recommendations from experienced nurses
ANS: A
Facility policies and procedures can be used as evidence of specific nursing practice in the clinical setting if the policies are based on high-quality evidence. Clinical practice guidelines are based on systematic reviews, which provide the highest level of evidence. Policies based on quantitative research, opinions, and experience should not be used because they are not founded on evidence of the highest quality.

DIF: Understanding/Comprehension REF: 67
KEY: Policies| clinical practice guidelines
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

4. A medical-surgical nurse asks the nurse researcher, What is the difference between qualitative and quantitative questions? How should the nurse researcher respond?
a. Quantitative questions analyze the content of what a person says or does.
b. Qualitative questions utilize a strict statistical analysis of information.
c. Quantitative questions identify relationships between measurable concepts.
d. Qualitative questions ask about associations among defined phenomena.
ANS: C
Quantitative questions ask about the relationship between or among defined, measurable phenomena and include statistical analysis of information that is collected to answer a question. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people and usually analyze the content of what a person says during an interview or what a researcher observes.

DIF: Understanding/Comprehension REF: 65
KEY: Qualitative research| quantitative research
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

5. A nurse is searching for evidence related to a qualitative PICOT question. Which type of evidence should the nurse search first?
a. Meta-analyses with credible synthesized findings
b. Systematic reviews
c. Multi-site randomized clinical trials
d. Meta-syntheses
ANS: D
If searching for answers to qualitative questions, the nurse should first look for meta-syntheses. Top-level evidence for quantitative questions includes meta-analyses, systematic reviews, and multi-site randomized clinical trials.

DIF: Remembering/Knowledge REF: 67 KEY: Level of evidence
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

6. A nurse assesses this PICOT question: In the adult hospitalized client, does a COX-2 inhibitor decrease the risk of gastrointestinal bleeding compared with other NSAIDs? What is the outcome component in this question?
a. Adult hospitalized client
b. Cyclooxygenase-2 (COX-2) inhibitor
c. Decreased risk of gastrointestinal bleeding
d. Other nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: C
The outcome component of the clinical question specifies the measureable and desired outcomes of the practice innovation. In this question, the decreased risk of gastrointestinal bleeding is the outcome. The population is adult hospitalized clients, the comparison component is NSAIDs, and innovative practice is COX-2 inhibitors.

DIF: Remembering/Knowledge REF: 66 KEY: PICOT question
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

7. A health care facility is implementing a new evidence-based nursing protocol. Which action is necessary to ensure successful implementation?
a. Develop evaluation processes to validate the protocol.
b. Ask for recommendations from senior nursing administration.
c. Assess cost-effectiveness of the evidence-based protocol.
d. Attain support from nurses who are implementing the protocol.
ANS: D
Complete buy-in from the people who will be involved in implementing the new protocol is essential to the success of implementation.

DIF: Remembering/Knowledge REF: 68 KEY: PICOT question
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

8. A research nurse meets with the nurse manager to discuss plans for the development of evidence-based practice (EBP) guidelines using the Reavy and Tavernier model. Which statement should the nurse include in the discussion?
a. Our efforts should focus on forming a team to develop an EBP initiative.
b. I will assist staff nurses with literature reviews and the synthesis of evidence.
c. You should identify barriers to evidence-based implementation.
d. I will develop a PICOT question and share it with the staff nurses.
ANS: B
The Reavy and Tavernier model views the staff nurse as the clinical expert and believes that the expertise of a nurse researcher should facilitate the EBP process by supporting nursing staff in identifying areas for improvement, assisting staff with literature reviews and synthesis of evidence, and helping with the implementation and evaluation of EBP projects. Team forming is a component of the Iowa model. Identification of strengths and barriers to EBP implementation is a component of the ARCC model. Staff nurses should identify their own PICOT questions from burning clinical questions.

DIF: Applying/Application REF: 69
KEY: Reavy and Tavernier model
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

9. A nurse who wants to incorporate evidence-based practices into client care on a medical unit is meeting resistance. Which barrier does the nurse identify as preventing nurses from engaging in evidence-based practices?
a. Difficulty accessing research materials
b. Lack of value for client preferences
c. Trouble understanding client needs
d. Inadequate nurse-client ratios
ANS: A
Major barriers that prevent nurses from engaging in evidence-based practice include lack of time, lack of value for research in practice, lack of understanding of organization or structure of electronic databases, difficulty accessing research materials, lack of computer skills, and difficulty understanding research articles.

DIF: Remembering/Knowledge REF: 66
KEY: Barriers| nurse engagement MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

10. A nurse wants to explore why clients who receive patient-controlled analgesia (PCA) after abdominal surgery ambulate sooner than clients who receive nurse-administered pain medications. Which action should the nurse take first?
a. Contact the medical centers clinical pharmacist.
b. Search the medical library for the best evidence.
c. Recommend PCA for all clients.
d. Appraise data obtained through client chart audits.
ANS: B
After asking the burning question, the nurse should find the very best evidence to try to answer it. The clinical pharmacist may be knowledgeable, but this is not the best evidence available. Information from client chart audits may demonstrate better outcomes with PCA, but this again is not the best evidence. The nurse should wait and recommend clinical practice changes until best evidence is found, appraised, and synthesized.

DIF: Applying/Application REF: 67
KEY: Steps of evidence-based practice
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

11. A nurse manager educates staff nurses in the use of clinical practice guidelines. Which statement should the nurse include in this teaching?
a. Clinical practice guidelines are implemented by The Joint Commission.
b. Practice guidelines are based on hospital management staffs expertise.
c. Clinical practice guidelines are official recommendations based on evidence.
d. Practice guidelines allow for greater reimbursement from insurance companies.
ANS: C
Clinical practice guidelines are based on evidence and provide an official recommendation for the diagnosis and/or management of health problems. These are usually developed from high-quality evidence. Although The Joint Commission publishes guidelines, clinical practice guidelines are not implemented by The Joint Commission. The hospitals management staff may be involved in the development and implementation of clinical practice guidelines, but these guidelines should not be based solely on management expertise. Clinical guidelines provide for better client outcomes. These guidelines are not focused on reimbursement.

DIF: Understanding/Comprehension REF: 67
KEY: Steps of evidence-based practice; level of evidence
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

12. A cardiac nurse wants to know about the best practices to prevent pneumonia after open-heart surgery. In what order do the steps of the evidence-based practice (EBP) process take place?
1. Asking burning clinical questions
2. Making recommendations for practice improvement
3. Implementing accepted recommendations
4. Finding the very best evidence to try to answer those questions
5. Evaluating outcomes
6. Critically appraising and synthesizing the relevant evidence
a. 5, 1, 4, 6, 3, 2
b. 1, 5, 4, 3, 2, 6
c. 1, 4, 6, 2, 3, 5
d. 5, 2, 1, 4, 6, 3
ANS: C
The process of EBP is systematic and includes the following steps: (1) asking burning clinical questions; (2) finding the very best evidence to try to answer those questions; (3) critically appraising and synthesizing the relevant evidence; (4) making recommendations for practice improvement; (5) implementing accepted recommendations; and (6) evaluating outcomes.

DIF: Remembering/Knowledge REF: 65
KEY: Steps of evidence-based practice
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. A nurse is developing a clinical question in a PICOT format. What components are included in the question? (Select all that apply.)
a. Patient
b. Comparison
c. Outcome
d. Implementation
e. Time
ANS: B, C, E
The major components of a PICOT question are population, intervention, comparison, and outcome, with an added time component when appropriate.

DIF: Remembering/Knowledge REF: 65 KEY: PICOT question
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

2. A nurse plans evidence-based care for a client on a medical-surgical unit. Which elements should the nurse assess when developing this plan of care? (Select all that apply.)
a. Client values
b. Nurses experiences
c. Organizational budget
d. Staffing ratios
e. Best available evidence
ANS: A, B, E
Evidence-based practice incorporates best current evidence with the expertise of the clinician and the clients values.

DIF: Understanding/Comprehension REF: 64
KEY: Steps of evidence-based practice
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

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