82|LATEST
Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring pz pz p z pz pz pz pz pz pz pz pz
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
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incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
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findings at a level of significance of <0.01. This indicates that
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A) the control group andthe experimental groupweremore than 99% similar.
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B) the findings ofthe studyhave lessthan 1% chance ofbeing attributable to chance.
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C) theeffects ofthe intervention were nearly zero.
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D) theclinical significance ofthefindings was less than 1:100.
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Ans: B pz
Feedback: The levelofsignificance is the level atwhich the researcher believes thatthestudyresults most
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likelyrepresent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
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probability that the result is due to chance.
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2. Anursehasreadaqualitativeresearchstudyinordertounderstandthelivedexperienceofparents who
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have a neonatal loss. Which of the following questions should the nurse prioritize when appraising the
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results of this study?
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A) Howwell did the authors capture the personalexperiences ofthese parents?
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B) Howwell did the authors controlfor confounding variables that may have affected the findings?
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C) Didthe authorsusestatisticalmeasures thatwere appropriatetothephenomenon in question?
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D) Weretheinstrumentsthatthe researchers usedstatisticallyvalid andreliable?
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Ans: A pz
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
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subjective experiences of individuals. Statistical measures and variables are not dimensions of a
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qualitative methodology.
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3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
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nursing research has little relevance to practice. How can the nurses colleague best defend the
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importance of nursing research?
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,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
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something that didnt use to be the case.
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B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatlypz pz pz pz pz z
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increased the credibility of the profession.
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C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan simply
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as a trade or a skill.
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D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
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outcomes.
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Ans: D pz
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
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ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
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programs, grant funding, or the public view of the profession.
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4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy urban
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hospital.She hasnoticedthatmanynew mothers abandon breast-feeding theirbabies when they
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experience early challenges and wonders what could be done to encourage more women to continue
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breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention
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aimed at promoting breast-feeding?
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A) Applying for grant funding for the research project pz pz pz pz pz pz pz
B) Posingthe clinical problemto one ormore nursing researcherspz pz pz pz pz pz pz pz pz
C) Planningthe methodology ofthe research project pz pz pz pz pz pz
D) Carryingouttheinterventionand submittingtheresultsforpublication pz pz pz pz tx pz z
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Feedback: A major role for staff nurses is to identify questions or problems for research. Grant
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applications, methodological planning, and publication submission are normally carried out by
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nurses who have advanced degrees in nursing.
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5. A patient signed the informed consent form for a drug trial that was explained to patient bya
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research assistant. Later, the patient admitted to his nurse that he did not understand the research
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assistantsexplanation orhis own rolein the study. Howshould this patients nurse respond to this
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revelation?
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A) Explainthe researchprocessto the patient ingreater detail. pz pz pz pz pz pz pz z
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B) Describethe details ofa randomized controlledtrial for the patient. pz pz pz pz pz pz pz pz pz pz
,C) Informthe research assistantthat the patientsconsent islikelyinvalid.
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D) Explaintothe patientthat hiswritten consentis nowlegally binding. pz pz pz pz pz pz pz pz pz z
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Ans: C pz
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible
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for research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty about
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participating, do not tryto convince them to participate. Ask the person from the
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researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
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patient has signed the consent forms.
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MultipleSelection pz
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among
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thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing?(Selectall that
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apply.)
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A) Interdisciplinary consensus p z
B) Nursingtradition pz
C) Researchstudies pz
D) Patientpreferencesandvalues pz pz pz
E) Clinicalexpertise
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
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approach to the delivery of healthcare that integrates the best evidence from studies and patient care data
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with clinician expertise and patient preferences and values.
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MultipleChoice pz
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to heal
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and which now poses a threat of osteomyelitis. The wound care nurse who has been working with
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Mrs.Mayes appliesevidence-based practice(EBP)wheneverpossible andhas proposedtheuse of maggot
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therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
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opposes this treatment despitethesizable bodyofevidencesupportingit. Howshould the nurse reconcile
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Mrs. Mayes views with the principles of EBP?
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A) Thenurse should explainthatreliable andvalid research evidenceoverrides the patients opinion.
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B) Thenurse should explainthe evidencetothe patient in greater detail.
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, C) Thenurse should integratethe patientspreferences into theplan ofcare.
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D) Thenurseshould involvethe patientsfamily membersin thedecision-making process.
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Ans: C pz
Feedback: Patient preferences should be integrated into EBP and considered alongside research evidence
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and the nurses clinical expertise; evidence does not trump the patients preferences. The familyshould be
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involved, but thisisnot an explicit dimension ofEBP. Similarly, explaining the evidence in more detail is
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not a demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of specialized, pressure-
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reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
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sought input from the nurses on the unit, all of whom are aware of the need to implement the principles
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of evidence-based practice (EBP) in this decision. Which of the following evidence sources should
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the nurses prioritize?
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A) Aqualitative studythat exploresthe experienceofliving with a pressure ulcer
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B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittooktoreducepressure ulcers
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among patients
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C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthe mattressinquestion pz pz pz z
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D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
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mattresses
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Ans: D pz
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
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opinion are low on the hierarchy of evidence.
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9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
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attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
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different units, a project that will consider many types of evidence. Which of the following information
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sources should the administrators prioritize?
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A) Asystematicreviewabout communication in nursing contexts
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B) Nursesideasaboutcommunication methods pz pz pz pz
C) The results of a chart review pz pz pz pz pz
D) Thehospitalsaccreditation status tx
Ans: A
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Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring pz pz p z pz pz pz pz pz pz pz pz
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
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incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
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findings at a level of significance of <0.01. This indicates that
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A) the control group andthe experimental groupweremore than 99% similar.
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B) the findings ofthe studyhave lessthan 1% chance ofbeing attributable to chance.
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C) theeffects ofthe intervention were nearly zero.
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D) theclinical significance ofthefindings was less than 1:100.
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Ans: B pz
Feedback: The levelofsignificance is the level atwhich the researcher believes thatthestudyresults most
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likelyrepresent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
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probability that the result is due to chance.
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2. Anursehasreadaqualitativeresearchstudyinordertounderstandthelivedexperienceofparents who
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have a neonatal loss. Which of the following questions should the nurse prioritize when appraising the
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results of this study?
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A) Howwell did the authors capture the personalexperiences ofthese parents?
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B) Howwell did the authors controlfor confounding variables that may have affected the findings?
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C) Didthe authorsusestatisticalmeasures thatwere appropriatetothephenomenon in question?
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D) Weretheinstrumentsthatthe researchers usedstatisticallyvalid andreliable?
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Ans: A pz
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
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subjective experiences of individuals. Statistical measures and variables are not dimensions of a
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qualitative methodology.
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3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
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nursing research has little relevance to practice. How can the nurses colleague best defend the
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importance of nursing research?
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,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
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something that didnt use to be the case.
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B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatlypz pz pz pz pz z
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increased the credibility of the profession.
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C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan simply
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as a trade or a skill.
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D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
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outcomes.
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Ans: D pz
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
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ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
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programs, grant funding, or the public view of the profession.
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4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy urban
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hospital.She hasnoticedthatmanynew mothers abandon breast-feeding theirbabies when they
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experience early challenges and wonders what could be done to encourage more women to continue
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breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention
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aimed at promoting breast-feeding?
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A) Applying for grant funding for the research project pz pz pz pz pz pz pz
B) Posingthe clinical problemto one ormore nursing researcherspz pz pz pz pz pz pz pz pz
C) Planningthe methodology ofthe research project pz pz pz pz pz pz
D) Carryingouttheinterventionand submittingtheresultsforpublication pz pz pz pz tx pz z
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Feedback: A major role for staff nurses is to identify questions or problems for research. Grant
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applications, methodological planning, and publication submission are normally carried out by
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nurses who have advanced degrees in nursing.
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5. A patient signed the informed consent form for a drug trial that was explained to patient bya
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research assistant. Later, the patient admitted to his nurse that he did not understand the research
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assistantsexplanation orhis own rolein the study. Howshould this patients nurse respond to this
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revelation?
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B) Describethe details ofa randomized controlledtrial for the patient. pz pz pz pz pz pz pz pz pz pz
,C) Informthe research assistantthat the patientsconsent islikelyinvalid.
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D) Explaintothe patientthat hiswritten consentis nowlegally binding. pz pz pz pz pz pz pz pz pz z
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Ans: C pz
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible
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for research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty about
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participating, do not tryto convince them to participate. Ask the person from the
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researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
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patient has signed the consent forms.
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MultipleSelection pz
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among
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thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing?(Selectall that
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apply.)
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A) Interdisciplinary consensus p z
B) Nursingtradition pz
C) Researchstudies pz
D) Patientpreferencesandvalues pz pz pz
E) Clinicalexpertise
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
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approach to the delivery of healthcare that integrates the best evidence from studies and patient care data
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with clinician expertise and patient preferences and values.
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MultipleChoice pz
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to heal
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and which now poses a threat of osteomyelitis. The wound care nurse who has been working with
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Mrs.Mayes appliesevidence-based practice(EBP)wheneverpossible andhas proposedtheuse of maggot
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therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
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opposes this treatment despitethesizable bodyofevidencesupportingit. Howshould the nurse reconcile
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Mrs. Mayes views with the principles of EBP?
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A) Thenurse should explainthatreliable andvalid research evidenceoverrides the patients opinion.
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B) Thenurse should explainthe evidencetothe patient in greater detail.
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, C) Thenurse should integratethe patientspreferences into theplan ofcare.
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D) Thenurseshould involvethe patientsfamily membersin thedecision-making process.
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Ans: C pz
Feedback: Patient preferences should be integrated into EBP and considered alongside research evidence
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and the nurses clinical expertise; evidence does not trump the patients preferences. The familyshould be
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involved, but thisisnot an explicit dimension ofEBP. Similarly, explaining the evidence in more detail is
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not a demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of specialized, pressure-
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reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
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sought input from the nurses on the unit, all of whom are aware of the need to implement the principles
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of evidence-based practice (EBP) in this decision. Which of the following evidence sources should
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the nurses prioritize?
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A) Aqualitative studythat exploresthe experienceofliving with a pressure ulcer
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B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittooktoreducepressure ulcers
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among patients
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C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthe mattressinquestion pz pz pz z
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D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
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mattresses
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Ans: D pz
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
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opinion are low on the hierarchy of evidence.
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9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
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attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
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different units, a project that will consider many types of evidence. Which of the following information
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sources should the administrators prioritize?
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A) Asystematicreviewabout communication in nursing contexts
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B) Nursesideasaboutcommunication methods pz pz pz pz
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D) Thehospitalsaccreditation status tx
Ans: A
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