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

 

 

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Sample Test

Chapter 3- Finding Relevant Evidence to Answer Clinical Questions

 

1.	A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement EBP. Which of the following questions could those nurses best answer by consulting a textbook?
	A)	“What effect does a diagnosis of renal failure have on type 2 diabetics’ glucose monitoring behavior?”
	B)	“What factors influence clinicians’ decisions to recommend peritoneal dialysis over hemodialysis?”
	C)	“What are the anatomical characteristics and physiological functions of the kidneys?”
	D)	“What is the relationship between dosing of erythropoietin therapy and hemoglobin levels in patients with chronic renal failure?”

 

 

2.	A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first?
	A)	A newspaper article
	B)	A systematic review
	C)	A conference presentation
	D)	A journal article

 

 

3.	After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has “googled” the subject. How should the nurse best interpret the results of this search?
	A)	The nurse must carefully evaluate the results of this search.
	B)	The results of searching sites such as Google and Yahoo are not clinically useful.
	C)	The search is likely to yield inaccurate or biased results.
	D)	The search is a time-efficient substitute for searching online health databases.

 

 

4.	A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most likely to provide the nurse with specific interventions and practices to achieve this goal?
	A)	Cumulative Index to Nursing and Allied Health Literature (CINAHL)
	B)	National Guideline Clearinghouse
	C)	PsycINFO
	D)	MEDLINE

 

 

5.	A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital’s policy on the use of physical restraints. During the search, what parameters should the nurse establish for the dates of articles and other information sources?
	A)	Articles should be ranked according to publication date, with the most recent articles being prioritized.
	B)	The nurse should attempt to identify collaborative evidence for any source that is more than 3 years old.
	C)	The nurse should establish a cutoff for sources more than 5 years old.
	D)	The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication.

 

 

6.	While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching “beta blockers.” How should the nurse proceed?
	A)	Identify the appropriate MeSH term
	B)	Search for clinical guidelines in the Cochrane Library
	C)	Consult the reference lists in articles that appeared during the search
	D)	Search the trade names of specific beta-blocking drugs

 

 

7.	In light of the large number of gall bladder patients recently admitted to the unit, a nurse is searching PubMed for literature relating to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field?
	A)	“chole*”
	B)	“cholecystitis or cholecystectomy or cholelithiasis or cholecystography”
	C)	“gall bladder”
	D)	“chole-”

 

 

8.	A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results?
	A)	“nutrition OR (delirium OR dementia)”
	B)	“(delirium OR dementia) AND nutrition”
	C)	“delirium dementia nutrition”
	D)	“delirium AND dementia AND nutrition”

 

 

9.	In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search?
	A)	Only noncopyrighted resources will be available to the nurse.
	B)	The nurse will be guaranteed that each result will be from a peer-reviewed source.
	C)	The nurse will be unable to conduct a valid or useful search.
	D)	Articles that are relevant may be excluded from consideration.

 

 

10.	A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions?
	A)	Cochrane Database of Systematic Reviews (CDSR)
	B)	Cochrane Central Register of Controlled Trials (CENTRAL)
	C)	Cochrane Methodology Register
	D)	Health Technology Assessment (HTA) Database

 

 

11.	A nurse has conducted a search of PubMed to answer the question, What factors influence older adults’ decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue? The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed?
	A)	Date of publication
	B)	Number of times the article has been cited
	C)	Ranking by peer review
	D)	Date the article was added to the database

 

 

12.	A nurse is working on a literature review using a laptop computer while in a café that provides wireless Internet access but will not allow for connection to the hospital library’s server that provides the nurse’s normal access to database subscriptions. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection?
	A)	PubMed
	B)	Cochrane Library
	C)	MEDLINE
	D)	EMBASE

 

 

13.	Management of a county hospital has been resistant to providing time, facilities, and subscriptions to allow nurses to conduct online searches near the point of care. Which of the following arguments can the nurses present to strengthen their case for these tools?
	A)	“Online access at or near the point of care has been mandated by law.”
	B)	“Providing for literature searches has been shown to save money and shorten patient stays.”
	C)	“It is unethical for nurses to provide care that is not rooted in a recent literature search.”
	D)	“The increased confidence that nurses gain from accessing knowledge is linked to improved patient outcomes.”

 

 

14.	Which of the following sources would best provide critical appraisal during a nurse’s search for evidence on which to base practice?
	A)	A journal that provides assessments of notable articles recently published in other journals
	B)	The expert opinion of qualified and experienced nurse clinicians
	C)	A careful examination of the methodology of a study
	D)	The insight of a trusted hospital librarian

 

 

15.	Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy?
	A)	Organize a small-scale clinical trial to test current practices on the unit.
	B)	Elicit the views of the most senior nurses and those nurses who exemplify EBP.
	C)	Formulate a question and conduct a thorough search of the existing evidence.
	D)	Seek input from physicians with expertise in the area of VAP.

 

 

 

Answer Key

 

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

 

Chapter 4- Critically Appraising Knowledge for Clinical Decision Making

 

1.	A nurse is providing care for a 73-year-old female patient whose balance is compromised by a vestibular disorder. The nurse has advocated for the installation of balance bars and handholds throughout the patient’s home, but the patient is reluctant, saying, “Those are for old people.” Which of the following is the best guide for making the decision?
	A)	The patient’s preference and history of using such devices
	B)	Research that addresses the effectiveness of this intervention
	C)	Existing evidence: the nurse’s experience with the intervention and the patient’s opinion
	D)	The cost of installation, the opinion of the patient and her peers, and evidence-based articles regarding the intervention

 

 

2.	What is the relationship between research utilization (RU) and evidence-based practice (EBP)?
	A)	RU is based on an individual clinician’s personal research, while EBP is based on published research.
	B)	RU considers the personal expertise of nurses, while EBP is based solely on published evidence.
	C)	RU provides a general guide to practice, while EBP provides patient-specific insights.
	D)	RU is often based on a single study, while EBP considers the larger body of knowledge.

 

 

3.	A nurse has approached the unit educator with a recently-published article that calls into question the unit’s practices around routine changing of peripheral intravenous sites. How should the findings of this article be best translated into practice?
	A)	Unit practices should be amended to reflect the findings of the study.
	B)	The nurses on the unit should combine the study results with their own expertise to create a new guide for practice.
	C)	The nurses should search for further evidence before changing unit practices.
	D)	The nurses should conduct a trial similar to that in the published study.

 

 

4.	In light of the continually-changing clinical context in which she provides care, a nurse is aware of the need to ensure that her practice is current. Which of the following actions is most likely to help the nurse achieve this goal?
	A)	Continually eliciting input from more senior nurses
	B)	Staying current with published evidence that has been critically appraised
	C)	Regularly attending continuing education opportunities
	D)	Reviewing the practice guidelines and evidence that are presented in textbooks available on the unit and at the hospital library

 

 

5.	A nurse has called into question the unit protocol around the regular flushing of percutaneous endoscopic gastrostomy (PEG) tubes to prevent occlusion. Which of the following should guide the nurse’s reconsideration of the evidence around PEG tube flushing?
	A)	Certainty that a new protocol will reliably prevent occlusion
	B)	Expressions of patient preference during a designated period of study
	C)	The rigor and reliability of a chosen research study
	D)	The combination of expertise and internal evidence

 

 

6.	A nurse has reviewed a study on the use of signs, symptoms, and blood tests to diagnose acute sinus infections and has concluded that the study was of high quality. Which of the following criteria best describe the quality of a research study?
	A)	The degree to which the findings are corroborated by other similar studies
	B)	The degree to which the study has the ability to improve patient outcomes
	C)	The degree to which the study was designed to minimize biases
	D)	The degree to which the study cohort reflects the demographics of the nurse’s patient population

 

 

7.	A nurse is reluctant to recommend a change in practice around teaching deep breathing and coughing to postsurgical patients, citing a lack of randomized controlled trials (RCTs) that directly address the subject. Which of the following statements best captures the role of RCTs in evidence-based practice?
	A)	Only systematic reviews are considered more valuable than RCTs in establishing EBP.
	B)	RCTs provide very high levels of quantitative analysis but are prone to lapses in consistency.
	C)	A qualitative study with a sound and rigorous methodology is considered equal to a well-designed RCT.
	D)	RCTs are the highest level of evidence that can be used to guide practice.

 

 

8.	On an acute medicine unit, the results of a pilot program that implemented a new screening tool for drug and alcohol abuse has been shown to be effective at identifying patients who may require intervention. In light of these results, the unit has included the screening tool in the nursing assessment of every patient who is admitted to the unit. The nurses on this unit have made this change in practice based on
	A)	evidence-based practice.
	B)	internal evidence.
	C)	clinician experience.
	D)	randomized controlled trial (RCT).

 

 

9.	The manager of a subacute geriatric unit has referenced the Agency for Healthcare Research and Quality National Healthcare Quality Report during the annual review of the unit’s operations. The report will provide the manager with
	A)	incidence and prevalence statistics for major infectious diseases.
	B)	measurements of national trends in the effectiveness of patient care.
	C)	evidence-based practice guidelines.
	D)	systematic reviews of the 15 most common areas of nursing intervention.

 

 

10.	A quality improvement initiative at a large university hospital has referred to the National Quality Forum’s list of 15 nursing standards for inpatient care (NQF-15). The NQF-15 are
	A)	important processes and outcomes that are within the scope of nursing personnel.
	B)	nursing interventions related to the top 15 causes of morbidity and mortality in the United States.
	C)	the nursing practices identified each year as being most in need of improvement.
	D)	evidence-based patient guidelines that are updated annually by the NQF.

 

 

11.	During a quality improvement initiative aimed at improving patient outcomes in falls prevention, the nursing staff of a long-term care facility utilized the PDSA cycle. This cycle would conclude with which of the following actions?
	A)	Publishing or presenting the results of the quality improvement initiative
	B)	Revising, refining, and repeating the change that was implemented
	C)	Analyzing the results of the change in falls-prevention practice
	D)	Enacting the change in practice on a small scale

 

 

12.	Which of the following changes in practice would be most amenable to the PDSA cycle?
	A)	A change to care guidelines for patients presenting to emergency departments with chest pain
	B)	A change to the parameters of prescriptive authority held by a state’s nurse practitioners
	C)	A change to the national guidelines for childhood immunizations
	D)	A change in a medical unit’s schedule of turning immobilized patients

 

 

13.	The nursing leadership of a large, urban hospital are dissatisfied with the results of the hospital’s most recent nursing quality audit when the results were examined through the lens of the National Database of Nursing Quality Indicators® (NDNQI®). Which of the following results of the hospital’s review would fall with the scope of the NDNQI’s structure indicators?
	A)	The incidence of pressure ulcers among inpatients was unacceptably high during the past year.
	B)	Eleven percent fewer nurses expressed satisfaction with the way their work schedules are organized than the previous year.
	C)	The number of nurses who possessed baccalaureate degrees increased by 0.9% over the previous year.
	D)	The average length of stay on the hospital’s post-surgical units decreased from 2.1 days to 1.95 days.

 

 

14.	The effectiveness of change that is implemented according to the PDSA cycle can be best improved by which of the following measures?
	A)	The inclusion of external evidence
	B)	Recognition of the importance of clinician experience
	C)	An increase in the size of the sample
	D)	Consultation with outside stakeholders

 

 

15.	A nurse educator has reviewed a study on the coping strategies of freshman nursing students that presents conclusions that differ markedly from other studies that have examined the issue. The study in question may possibly have a flaw in which of the following domains?
	A)	Consistency
	B)	Believability
	C)	Veracity
	D)	Utility

 

 

 

Answer Key

 

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