CNL Exam Questions and Correct Answers
fidelity
agreement to keep promises
veracity
telling the truth
justice
Fairness. Often r/t health care resources.
beneficence
taking positive actions to help others + interest of pt above self-interest
nonmaleficence
avoiding harm or hurt
negligence
conduct that falls below standard of care
malpractice
type of negligence (professional)
Slander vs libel?
Slander = verbal gossip/smearing/defamation. Libel = written
Even when disagreement occurs about decisions a client makes, the nurse maintains care of
the client, not abandoning the client. = example of?
fidelity
Nurse follows through with care offered to pts, like mnging pain - may need to make
revisions to plan to meet pain goal. = ex of?
fidelity
Liver transplants given to people on waiting list according to need and who fits criteria
(can't be current ETOH). Not by who can pay. = ex of?
justice (fairness)
RN has busy day, kid asks for pill w/apple sauce even though can swallow whole. You put
in applesauce = ex of?
beneficence
,commitment to provide least harmful interventions illustrates = ?
nonmaleficence
Taking extra step to look up options of SNIFF for pt vs educating about palliative care
options over chemo for 95 yr old = what 2 ethics?
beneficence & nonmaleficence
a pt asks if their A-fib is really something serious to be concerned about - you answer
truthfully w/educ about stroke risk. = ex of?
veracity
Are negligence and malpractice intentional or unintentional torts (suits ag person or
property?)
unintentional
assault vs battery?
assault = intentional threat to bring harm. Battery = intentional touching/contact w/o consent
(harmful or only offensive)
Assault or battery? Person sent hateful mail with pictures of beating other person up
Assault
Failure to properly delegate and supervise or a failure to ensure pt safety or hanging wrong
IV = ?
professional negligence (malpractice) or negligent acts
to avoid malpractice (prof negligence) follow standards of care, communicate, document, &
what 2 others?
know literature, know policies & procedures
malpractice insurance covers what?
liability insurance to provide defense when RN in lawsuit for professional negligence or med
malpractice
What format do you want to frame an EBP clinical question?
PICO: Patient/population, Intervention, Comparison, Outcome
5 Steps of researching and using EBP?
Ask the qstn (PICO), Collect evidence, critically appraise it, integrate w/pt prefs and clinical
expertise, evaluate the change once made
Why are CNLS innovators and early adopters, but not researchers?
,CNLs are Master's prepared and trained to critique and apply research. But only PHD prepared
do research studies
Most of your floor nurses are ADN prepared. Why is this important to remember when
presenting them with EBP for a change?
ADN's never take research class. Help educate them on how to use it - what it means.
Is it pointless to show a resistor EBP?
NO! Important to do so, and to educate them!
What are 3 main barriers to implementing EBP?
Practioners don't understand the research, lack of admin support, poor quality of research
support/findings
What makes a research article good: Large sample, rigor of methods (double blind/IRB
approval), Representative sample, clinical relevance, sufficient lit review...4 others?
strength of findings (p<0.05), bias?, limitations acknowledged? Can be replicated?
What makes a research article good: strength of findings (p<0.05), bias?, limitations
acknowledged? Can be replicated? + 5 others?
Large sample, rigor of methods (double blind/IRB approval), Representative sample, clinical
relevance, sufficient lit review
What are 3 broad questions to consder (Venn diagram) when considering to use EBP or
not?
Is the quality of the study good enough to validate results? Are findings applicable to my
practice? What do the results mean to my pts?
What type of biases may result in subjects in sample being unrepresentative of population
of interest?
Selection biases (sampling, attrition, exposure, time interval)
Selection biases (sampling, attrition, exposure, time interval) may mean what for the
study?
the subjects might be unrepresentative of population of interest (non-random sample or process
of choosing specific pple for study)
Measurement biases (systematic error) result from what?
How outcome measured...poor calibration, or human error.
If instruments in study were poorly calibrated, or observation technique was poor, it could
result in what bias?
, Measurement bias (systematic error)
What is exposure bias?
Involves diffs in how tx intervention was carried out or how subjects were exposed to factor of
interest
diffs in how tx intervention was carried out or how subjects were exposed to factor of
interest = __ bias?
exposure/intervention bias
What are the 7 levels of evidence from high to low?
Systematic Review (meta-analysis, narrative, meta-synthesis), Critically appraised, RCT, Cohort
Study, Case-control study, Expert committee, indvl clinical expertise
Distinguish b/w 3 types of systematic reviews:
1) Meta-analysis (quantitative and highest) 2) Systematic review including narratives 3) Meta-
synthesis (total qualitative)
Besides systematic review w/narratives, what are meta-analysis and meta-synthesis?
Meta-analysis = quantitative RCTs. Metat-synthesis = qualitative
Diff b/w cohort and case-control study?
Cohort = observational follows 2 groups forward for outcome. Case-control: observational
retrospective by ID pts with spcf dise/outcome and w/o and looking back. (relies on memory!)
Which type of study IDs group of pts w/outcome (brst cancer) and those without, and then
looks back to see for diffs? Why prone to error?
Case-control study. Relies on memory so prone to error.
Which is more prone to error cohort or case-control?
Case-control - It's always retrospective and relies on people's memories.
What type of study is observational and follows group before any dses showing forward
looking for outcomes?
cohort study
Cohort study (usually longitudinal prospective) and Case-control (usually observational
retrospective), but can each be reverse?
yes, cohort can use archives and be retrospective and case-control can be applied to propsective
What does it mean to have reliability of measures? What's minimum reliability?
a way to assess study rigor - how consistent are tools of measurement? Want >80% (0.80).
fidelity
agreement to keep promises
veracity
telling the truth
justice
Fairness. Often r/t health care resources.
beneficence
taking positive actions to help others + interest of pt above self-interest
nonmaleficence
avoiding harm or hurt
negligence
conduct that falls below standard of care
malpractice
type of negligence (professional)
Slander vs libel?
Slander = verbal gossip/smearing/defamation. Libel = written
Even when disagreement occurs about decisions a client makes, the nurse maintains care of
the client, not abandoning the client. = example of?
fidelity
Nurse follows through with care offered to pts, like mnging pain - may need to make
revisions to plan to meet pain goal. = ex of?
fidelity
Liver transplants given to people on waiting list according to need and who fits criteria
(can't be current ETOH). Not by who can pay. = ex of?
justice (fairness)
RN has busy day, kid asks for pill w/apple sauce even though can swallow whole. You put
in applesauce = ex of?
beneficence
,commitment to provide least harmful interventions illustrates = ?
nonmaleficence
Taking extra step to look up options of SNIFF for pt vs educating about palliative care
options over chemo for 95 yr old = what 2 ethics?
beneficence & nonmaleficence
a pt asks if their A-fib is really something serious to be concerned about - you answer
truthfully w/educ about stroke risk. = ex of?
veracity
Are negligence and malpractice intentional or unintentional torts (suits ag person or
property?)
unintentional
assault vs battery?
assault = intentional threat to bring harm. Battery = intentional touching/contact w/o consent
(harmful or only offensive)
Assault or battery? Person sent hateful mail with pictures of beating other person up
Assault
Failure to properly delegate and supervise or a failure to ensure pt safety or hanging wrong
IV = ?
professional negligence (malpractice) or negligent acts
to avoid malpractice (prof negligence) follow standards of care, communicate, document, &
what 2 others?
know literature, know policies & procedures
malpractice insurance covers what?
liability insurance to provide defense when RN in lawsuit for professional negligence or med
malpractice
What format do you want to frame an EBP clinical question?
PICO: Patient/population, Intervention, Comparison, Outcome
5 Steps of researching and using EBP?
Ask the qstn (PICO), Collect evidence, critically appraise it, integrate w/pt prefs and clinical
expertise, evaluate the change once made
Why are CNLS innovators and early adopters, but not researchers?
,CNLs are Master's prepared and trained to critique and apply research. But only PHD prepared
do research studies
Most of your floor nurses are ADN prepared. Why is this important to remember when
presenting them with EBP for a change?
ADN's never take research class. Help educate them on how to use it - what it means.
Is it pointless to show a resistor EBP?
NO! Important to do so, and to educate them!
What are 3 main barriers to implementing EBP?
Practioners don't understand the research, lack of admin support, poor quality of research
support/findings
What makes a research article good: Large sample, rigor of methods (double blind/IRB
approval), Representative sample, clinical relevance, sufficient lit review...4 others?
strength of findings (p<0.05), bias?, limitations acknowledged? Can be replicated?
What makes a research article good: strength of findings (p<0.05), bias?, limitations
acknowledged? Can be replicated? + 5 others?
Large sample, rigor of methods (double blind/IRB approval), Representative sample, clinical
relevance, sufficient lit review
What are 3 broad questions to consder (Venn diagram) when considering to use EBP or
not?
Is the quality of the study good enough to validate results? Are findings applicable to my
practice? What do the results mean to my pts?
What type of biases may result in subjects in sample being unrepresentative of population
of interest?
Selection biases (sampling, attrition, exposure, time interval)
Selection biases (sampling, attrition, exposure, time interval) may mean what for the
study?
the subjects might be unrepresentative of population of interest (non-random sample or process
of choosing specific pple for study)
Measurement biases (systematic error) result from what?
How outcome measured...poor calibration, or human error.
If instruments in study were poorly calibrated, or observation technique was poor, it could
result in what bias?
, Measurement bias (systematic error)
What is exposure bias?
Involves diffs in how tx intervention was carried out or how subjects were exposed to factor of
interest
diffs in how tx intervention was carried out or how subjects were exposed to factor of
interest = __ bias?
exposure/intervention bias
What are the 7 levels of evidence from high to low?
Systematic Review (meta-analysis, narrative, meta-synthesis), Critically appraised, RCT, Cohort
Study, Case-control study, Expert committee, indvl clinical expertise
Distinguish b/w 3 types of systematic reviews:
1) Meta-analysis (quantitative and highest) 2) Systematic review including narratives 3) Meta-
synthesis (total qualitative)
Besides systematic review w/narratives, what are meta-analysis and meta-synthesis?
Meta-analysis = quantitative RCTs. Metat-synthesis = qualitative
Diff b/w cohort and case-control study?
Cohort = observational follows 2 groups forward for outcome. Case-control: observational
retrospective by ID pts with spcf dise/outcome and w/o and looking back. (relies on memory!)
Which type of study IDs group of pts w/outcome (brst cancer) and those without, and then
looks back to see for diffs? Why prone to error?
Case-control study. Relies on memory so prone to error.
Which is more prone to error cohort or case-control?
Case-control - It's always retrospective and relies on people's memories.
What type of study is observational and follows group before any dses showing forward
looking for outcomes?
cohort study
Cohort study (usually longitudinal prospective) and Case-control (usually observational
retrospective), but can each be reverse?
yes, cohort can use archives and be retrospective and case-control can be applied to propsective
What does it mean to have reliability of measures? What's minimum reliability?
a way to assess study rigor - how consistent are tools of measurement? Want >80% (0.80).
