COMPLETE TEST BANK
PRIMARY CARE: ART AND SCIENCE OF ADVANCED PRACTICE NURSING -
AN INTERPROFESSIONAL APPROACH 5TH EDITION
BY DUNPHY ALL CHAPTERS COVERED(ANSWER KEY AT THE END OF
CHAPTER)
,Table of Contents
Chapter 1. Primary Care In The Twenty-First Century: A Circle Of Caring ......................... 5
Chapter 2. Caring And The Advanced Practice Nurse ...........................................................13
Chapter 3. Health Promotion ..................................................................................................23
Chapter 4. The Art Of Diagnosis And Treatment ..................................................................25
Chapter 5. Evidence-Based Care ............................................................................................38
Chapter 6. Common Neurological Complaints .......................................................................42
Chapter 7. Seizure Disorders ..................................................................................................53
Chapter 8. Degenerative Disorders .........................................................................................58
Chapter 9. Cerebrovascular Accident (Stroke) .......................................................................64
Chapter 10. Infectious And Inflammatory Neurological Disorders .......................................76
Chapter 11.Common Skin Complaints ...................................................................................77
Chapter 12. Parasitic Skin Infestations..................................................................................87
Chapter 13. Fungal Skin Infections ........................................................................................88
Chapter 14. Bacterial Skin Infections.....................................................................................90
Chapter 15. Viral Skin Infections ...........................................................................................93
Chapter 16. Dermatitis ...........................................................................................................95
Chapter 17. Skin Lesions ........................................................................................................97
Chapter 18. Common Eye Complaints ..................................................................................101
Chapter 19. Lid And Conjunctival Pathology .......................................................................110
Chapter 20. Visual Disturbances And Impaired Vision .......................................................123
Chapter 21. Common Ear, Nose, And Throat Complaints ...................................................126
Chapter 22. Hearing And Balance Disorders .......................................................................134
Chapter 23. Inflammatory And Infectious Disorders Of The Ear ........................................143
Chapter 24. Inflammatory And Infectious Disorders Of The Nose, Sinuses, Mouth, And
Throat ....................................................................................................................................157
Chapter 25. Epistaxis ............................................................................................................165
Chapter 26. Temporomandibular Disorders .........................................................................165
Chapter 27. Dysphonia ..........................................................................................................168
Chapter 28. Common Respiratory Complaints .....................................................................169
Chapter 29. Sleep Apnea .......................................................................................................180
Chapter 30. Infectious Respiratory Disorders ......................................................................181
Chapter 31. Inflammatory Respiratory Disorders................................................................189
Chapter 32. Lung Cancer ......................................................................................................194
,Chapter 33. Smoking Addiction ............................................................................................195
Chapter 34. Common Cardiovascular Complaints ...............................................................196
Chapter 35. Cardiac And Associated Risk Disorders ...........................................................206
Chapter 36. Dysrhythmias And Valvular Disorders ............................................................213
Chapter 37. Disorders Of The Vascular System ...................................................................221
Chapter 38. Common Abdominal Complaints ......................................................................233
Chapter 39. Infectious Gastrointestinal Disorders...............................................................241
Chapter 40. Gastric And Intestinal Disorders ......................................................................249
Chapter 41. Gallbladder And Pancreatic Disorders .............................................................257
Chapter 42. Cirrhosis And Liver Failure ..............................................................................265
Chapter 43. Common Urinary Complaints ...........................................................................269
Chapter 44. Urinary Tract Disorders ...................................................................................274
Chapter 45. Kidney And Bladder Disorders .........................................................................283
Chapter 46. Common Reproductive System Complaints .....................................................292
Chapter 47. Breast Disorders................................................................................................299
Chapter 48. Vaginal, Uterine, And Ovarian Disorders ........................................................307
Chapter 49. Prostate Disorders .............................................................................................316
Chapter 50. Penile And Testicular Disorders .......................................................................324
Chapter 51. Sexually Transmitted Infections.......................................................................331
Chapter 52. Common Musculoskeletal Complaints .............................................................350
Chapter 53. Spinal Disorders ................................................................................................360
Chapter 54. Soft-Tissue Disorders ........................................................................................363
Chapter 55. Osteoarthritis And Osteoporosis .......................................................................392
Chapter 56.Common Endocrine/Metabolic Complaints .......................................................396
Chapter 57. Glandular Disorders ..........................................................................................406
Chapter 58. Diabetes Mellitus ..............................................................................................412
Chapter 59. Metabolic Disorders ..........................................................................................417
Chapter 60. Common Hematologic And Immunological Problems ......................................437
Chapter 61. Hematologic Disorders ......................................................................................447
Chapter 62. Immunological Disorders ..................................................................................462
Chapter 63. Infectious Disorders ..........................................................................................472
Chapter 64. Common Psychosocial Complaints ...................................................................487
Chapter 65. Substance Use Disorders ..................................................................................496
,Chapter 66. Schizophrenia Spectrum Disorders ..................................................................507
Chapter 67. Mood Disorders..................................................................................................519
Chapter 68. Anxiety, Stress, And Trauma-Related Disorders .............................................524
Chapter 69. Obsessive-Compulsive Disorders ......................................................................532
Chapter 70. Behavioral Disorders Related To Physical/Physiological Disturbances ..........535
Chapter 71. Neurodevelopmental Disorders ........................................................................545
Chapter 72. Common Urgent Care Complaints....................................................................557
Chapter 73. Common Injuries ...............................................................................................568
Chapter 74. Toxic Exposures.................................................................................................575
Chapter 75. Environmental Exposures.................................................................................583
Chapter 76. Sports Physicals ................................................................................................590
Chapter 77. Primary Care Of Older Adults ..........................................................................601
Chapter 78. Palliative Care And Pain Management ............................................................611
Chapter 79. Ethical And Legal Issues Of A Caring-Based Practice ....................................617
Chapter 80. The Business Of Advanced Practice Nursing ...................................................624
Chapter 81. The 15-Minute Hour: Practical Approaches To Behavioral Health For Primary
Care........................................................................................................................................629
Chapter 82. Putting Caring Into Practice: Caring For Self..................................................633
,Chapter 1. Primary Care In The Twenty-First Century: A
Circle Of Caring
1. A Nurse Has Conducted A Literature Review In An Effort To Identify The Effect Of
Handwashing On The Incidence Of Nosocomial (Hospital-Acquired) Infections In
Acute Care Settings. An Article Presented Findings At A Level Of Significance Of
<0.01. This Indicates That
A) The Control Group And The Experimental Group Were More Than 99% Similar.
B) The Findings Of The Study Have Less Than 1% Chance Of Being Attributable To
Chance.
C) The Effects Of The Intervention Were Nearly Zero.
D) The Clinical Significance Of The Findings Was Less Than 1:100.
Answer: B
Feedback: The Level Of Significance Is The Level At Which The Researcher Believes
That The Study Results Most Likely Represent A Nonchance Event. A Level Of
Significance Of <0.01 Indicates That There Is Less Than 1% Probability That The Result Is
Due To Chance.
2. A Nurse Has Read A Qualitative Research Study In Order To Understand The Lived
Experience Of Parents Who Have A Neonatal Loss. Which Of The Following
Questions Should The Nurse Prioritize When Appraising The Results Of This
Study?
A) How Well Did The Authors Capture The Personal Experiences Of These Parents?
B) How Well Did The Authors Control For Confounding Variables That May Have
Affected The Findings?
C) Did The Authors Use Statistical Measures That Were Appropriate To The
Phenomenon In Question?
D) Were The Instruments That The Researchers Used Statistically Valid And Reliable?
,Answer: A
Feedback: Qualitative Studies Are Judged On The Basis Of How Well They Capture And
Convey The Subjective Experiences Of Individuals. Statistical Measures And Variables Are
Not Dimensions Of A Qualitative Methodology.
3. A Nurse Has Expressed Skepticism To A Colleague About The Value Of Nursing
Research, Claiming That Nursing Research Has Little Relevance To Practice. How
Can The Nurses Colleague Best Defend The Importance Of Nursing Research?
A) The Existence Of Nursing Research Means That Nurses Are Now Able To Access
Federal Grant Money, Something That Didnt Use To Be The Case.
B) Nursing Research Has Allowed The Development Of Masters And Doctoral
Programs And Has Greatly Increased The Credibility Of The Profession.
C) The Growth Of Nursing Research Has Caused Nursing To Be Viewed As A True
Profession, Rather Than Simply As A Trade Or A Skill.
D) The Application Of Nursing Research Has The Potential To Improve Nursing
Practice And Patient Outcomes.
Answer: D
Feedback: The Greatest Value Of Nursing Research Lies In The Potential To Improve
Practice And, Ultimately, To Improve Patient Outcomes. This Supersedes The
Contributions Of Nursing Research To Education Programs, Grant Funding, Or The Public
View Of The Profession.
4. Tracy Is A Nurse With A Baccalaureate Degree Who Works In The Labor And
Delivery Unit Of A Busy Urban Hospital. She Has Noticed That Many New Mothers
Abandon Breast-Feeding Their Babies When They Experience Early Challenges And
Wonders What Could Be Done To Encourage More Women To Continue Breast-
Feeding. What Role Is Tracy Most Likely To Play In A Research Project That Tests
An Intervention Aimed At Promoting Breast-Feeding?
,A) Applying For Grant Funding For The Research Project
B) Posing The Clinical Problem To One Or More Nursing Researchers
C) Planning The Methodology Of The Research Project
D) Carrying Out The Intervention And Submitting The Results For Publication
Answer: B
Feedback: A Major Role For Staff Nurses Is To Identify Questions Or Problems For
Research. Grant Applications, Methodological Planning, And Publication Submission Are
Normally Carried Out By Nurses Who Have Advanced Degrees In Nursing.
5. A Patient Signed The Informed Consent Form For A Drug Trial That Was Explained
To Patient By A Research Assistant. Later, The Patient Admitted To His Nurse
That He Did Not Understand The Research Assistants Explanation Or His Own
Role In The Study. How Should This Patients Nurse Respond To This Revelation?
A) Explain The Research Process To The Patient In Greater Detail.
B) Describe The Details Of A Randomized Controlled Trial For The Patient.
C) Inform The Research Assistant That The Patients Consent Is Likely Invalid.
D) Explain To The Patient That His Written Consent Is Now Legally Binding.
Answer: C
Feedback: Just As The Staff Nurse Is Not Responsible For Medical Consent, The Staff
Nurse Is Not Responsible For Research Consent. If Patients Who Have Agreed To
Participate Exhibit Ambivalence Or Uncertainty About Participating, Do Not Try To
Convince Them To Participate. Ask The Person From The Research Team Who Is
Managing Consents To Speak With Concerned Patients About The Study, Even After A
Patient Has Signed The Consent Forms.
6. A Nurse Leader Is Attempting To Increase The Awareness Of Evidence-Based
Practice (Ebp) Among The Nurses On A Unit. A Nurse Who Is Implementing Ebp
Integrates Which Of The Following? (Select All That Apply.)
A) Interdisciplinary Consensus
,B) Nursing Tradition
C) Research Studies
D) Patient Preferences And Values
E) Clinical Expertise
Answer: C, D, E
Feedback: Fineout-Overholt, Melnyk, Stillwell, And Williamson Define Ebp As A
Problem-Solving Approach To The Delivery Of Healthcare That Integrates The Best
Evidence From Studies And Patient Care Data With Clinician Expertise And Patient
Preferences And Values.
7. Mrs. Mayes Is A 73-Year-Old Woman Who Has A Diabetic Foot Ulcer That Has
Been Extremely Slow To Heal And Which Now Poses A Threat Of Osteomyelitis.
The Wound Care Nurse Who Has Been Working With Mrs. Mayes Applies Evidence-
Based Practice (Ebp) Whenever Possible And Has Proposed The Use Of Maggot
Therapy To Debride Necrotic Tissue. Mrs. Mayes, However, Finds The Suggestion
Repugnant And Adamantly Opposes This Treatment Despite The Sizable Body Of
Evidence Supporting It. How Should The Nurse Reconcile Mrs. Mayes Views With
The Principles Of Ebp?
A) The Nurse Should Explain That Reliable And Valid Research Evidence Overrides
The Patients Opinion.
B) The Nurse Should Explain The Evidence To The Patient In Greater Detail.
C) The Nurse Should Integrate The Patients Preferences Into The Plan Of Care.
D) The Nurse Should Involve The Patients Family Members In The Decision-Making
Process.
Answer: C
Feedback: Patient Preferences Should Be Integrated Into Ebp And Considered Alongside
Research Evidence And The Nurses Clinical Expertise; Evidence Does Not Trump The
Patients Preferences. The Family Should Be Involved, But This Is Not An Explicit
Dimension Of Ebp. Similarly, Explaining The Evidence In More Detail Is Not A
Demonstration Of Ebp.
, 8. The Administrators Of A Long-Term Care Facility Are Considered The Use Of
Specialized, Pressure- Reducing Mattresses In Order To Reduce The Incidence Of
Pressure Ulcers Among Residents. They Have Sought Input From The Nurses On
The Unit, All Of Whom Are Aware Of The Need To Implement The Principles Of
Evidence-Based Practice (Ebp) In This Decision. Which Of The Following Evidence
Sources Should The Nurses Prioritize?
A) A Qualitative Study That Explores The Experience Of Living With A Pressure Ulcer
B) A Case Study That Describes The Measures That Nurses On A Geriatric Unit Took
To Reduce Pressure Ulcers Among Patients
C) Testimonials From Experienced Clinicians About The Effectiveness Of The Mattress
In Question
D) A Randomized Controlled Trial That Compared The Pressure-Reducing Mattress
With Standard Mattresses
Answer: D
Feedback: The Most Reliable Evidence Is Considered Rcts. Qualitative Studies, Case
Studies, And Expert Opinion Are Low On The Hierarchy Of Evidence.
9. Hospital Administrators Are Applying The Principles Of Evidence-Based Practice
(Ebp) In Their Attempt To Ascertain The Most Efficient And Effective Way To
Communicate Between Nurses Who Are On Different Units, A Project That Will
Consider Many Types Of Evidence. Which Of The Following Information Sources
Should The Administrators Prioritize?
A) A Systematic Review About Communication In Nursing Contexts
B) Nurses Ideas About Communication Methods
C) The Results Of A Chart Review
D) The Hospitals Accreditation Status
Answer: A
, Feedback: Systematic Reviews Are Assigned A High Value In Ebp. Reviews Would Be
Prioritized Over Nurses Ideas Or A Chart Review, Though Both Are Potential
Considerations. The Hospitals Accreditation Status Is Not A Relevant Consideration.
10. A Nurse Has Resolved To Apply The Evidence-Based Practice (Ebp) Process To The
Way That Admission Assessments Are Conducted And Documented On A Unit. How
Should The Nurse Begin The Process Of Establishing Ebp?
A) Gather Evidence Showing The Shortcomings Of Current Practices
B) Formulate A Clear And Concise Question To Be Addressed
C) Elicit Support From The Nurses Who Are Most Often Responsible For Admissions
D) Search The Literature For Evidence That Is Potentially Relevant To The Practice
Need
Answer: B
Feedback: The First Step In Applying Ebp Is To Ask A Clear, Focused Question. This
Should Precede A Search Of The Literature Or The Recruitment Of Participants. An
Assessment Of The Shortcomings Of The Current System Is Not An Explicit Component Of
The Ebp Process.
11. Which Of The Following Questions Best Exemplifies The Picot Format For Asking
Evidence-Based Questions?
A) What Affect Does Parents Alcohol Use Have On The Alcohol Use Of Their Teenage
Children?
B) Among Postsurgical Patients, What Role Does Meditation Rather Than
Benzodiazepines Have On Anxiety Levels During The 48 Hours Following Surgery?
C) Among High School Students, What Is The Effectiveness Of A Sexual Health
Campaign Undertaken During The First 4 Weeks Of The Fall Semester As Measured By
Incidence Of New Sexually Transmitted Infections?
D) In Children Aged 68, Is The Effectiveness Of A Descriptive Pain Scale Superior To A
Numeric Rating Scale In The Emergency Room Context?
PRIMARY CARE: ART AND SCIENCE OF ADVANCED PRACTICE NURSING -
AN INTERPROFESSIONAL APPROACH 5TH EDITION
BY DUNPHY ALL CHAPTERS COVERED(ANSWER KEY AT THE END OF
CHAPTER)
,Table of Contents
Chapter 1. Primary Care In The Twenty-First Century: A Circle Of Caring ......................... 5
Chapter 2. Caring And The Advanced Practice Nurse ...........................................................13
Chapter 3. Health Promotion ..................................................................................................23
Chapter 4. The Art Of Diagnosis And Treatment ..................................................................25
Chapter 5. Evidence-Based Care ............................................................................................38
Chapter 6. Common Neurological Complaints .......................................................................42
Chapter 7. Seizure Disorders ..................................................................................................53
Chapter 8. Degenerative Disorders .........................................................................................58
Chapter 9. Cerebrovascular Accident (Stroke) .......................................................................64
Chapter 10. Infectious And Inflammatory Neurological Disorders .......................................76
Chapter 11.Common Skin Complaints ...................................................................................77
Chapter 12. Parasitic Skin Infestations..................................................................................87
Chapter 13. Fungal Skin Infections ........................................................................................88
Chapter 14. Bacterial Skin Infections.....................................................................................90
Chapter 15. Viral Skin Infections ...........................................................................................93
Chapter 16. Dermatitis ...........................................................................................................95
Chapter 17. Skin Lesions ........................................................................................................97
Chapter 18. Common Eye Complaints ..................................................................................101
Chapter 19. Lid And Conjunctival Pathology .......................................................................110
Chapter 20. Visual Disturbances And Impaired Vision .......................................................123
Chapter 21. Common Ear, Nose, And Throat Complaints ...................................................126
Chapter 22. Hearing And Balance Disorders .......................................................................134
Chapter 23. Inflammatory And Infectious Disorders Of The Ear ........................................143
Chapter 24. Inflammatory And Infectious Disorders Of The Nose, Sinuses, Mouth, And
Throat ....................................................................................................................................157
Chapter 25. Epistaxis ............................................................................................................165
Chapter 26. Temporomandibular Disorders .........................................................................165
Chapter 27. Dysphonia ..........................................................................................................168
Chapter 28. Common Respiratory Complaints .....................................................................169
Chapter 29. Sleep Apnea .......................................................................................................180
Chapter 30. Infectious Respiratory Disorders ......................................................................181
Chapter 31. Inflammatory Respiratory Disorders................................................................189
Chapter 32. Lung Cancer ......................................................................................................194
,Chapter 33. Smoking Addiction ............................................................................................195
Chapter 34. Common Cardiovascular Complaints ...............................................................196
Chapter 35. Cardiac And Associated Risk Disorders ...........................................................206
Chapter 36. Dysrhythmias And Valvular Disorders ............................................................213
Chapter 37. Disorders Of The Vascular System ...................................................................221
Chapter 38. Common Abdominal Complaints ......................................................................233
Chapter 39. Infectious Gastrointestinal Disorders...............................................................241
Chapter 40. Gastric And Intestinal Disorders ......................................................................249
Chapter 41. Gallbladder And Pancreatic Disorders .............................................................257
Chapter 42. Cirrhosis And Liver Failure ..............................................................................265
Chapter 43. Common Urinary Complaints ...........................................................................269
Chapter 44. Urinary Tract Disorders ...................................................................................274
Chapter 45. Kidney And Bladder Disorders .........................................................................283
Chapter 46. Common Reproductive System Complaints .....................................................292
Chapter 47. Breast Disorders................................................................................................299
Chapter 48. Vaginal, Uterine, And Ovarian Disorders ........................................................307
Chapter 49. Prostate Disorders .............................................................................................316
Chapter 50. Penile And Testicular Disorders .......................................................................324
Chapter 51. Sexually Transmitted Infections.......................................................................331
Chapter 52. Common Musculoskeletal Complaints .............................................................350
Chapter 53. Spinal Disorders ................................................................................................360
Chapter 54. Soft-Tissue Disorders ........................................................................................363
Chapter 55. Osteoarthritis And Osteoporosis .......................................................................392
Chapter 56.Common Endocrine/Metabolic Complaints .......................................................396
Chapter 57. Glandular Disorders ..........................................................................................406
Chapter 58. Diabetes Mellitus ..............................................................................................412
Chapter 59. Metabolic Disorders ..........................................................................................417
Chapter 60. Common Hematologic And Immunological Problems ......................................437
Chapter 61. Hematologic Disorders ......................................................................................447
Chapter 62. Immunological Disorders ..................................................................................462
Chapter 63. Infectious Disorders ..........................................................................................472
Chapter 64. Common Psychosocial Complaints ...................................................................487
Chapter 65. Substance Use Disorders ..................................................................................496
,Chapter 66. Schizophrenia Spectrum Disorders ..................................................................507
Chapter 67. Mood Disorders..................................................................................................519
Chapter 68. Anxiety, Stress, And Trauma-Related Disorders .............................................524
Chapter 69. Obsessive-Compulsive Disorders ......................................................................532
Chapter 70. Behavioral Disorders Related To Physical/Physiological Disturbances ..........535
Chapter 71. Neurodevelopmental Disorders ........................................................................545
Chapter 72. Common Urgent Care Complaints....................................................................557
Chapter 73. Common Injuries ...............................................................................................568
Chapter 74. Toxic Exposures.................................................................................................575
Chapter 75. Environmental Exposures.................................................................................583
Chapter 76. Sports Physicals ................................................................................................590
Chapter 77. Primary Care Of Older Adults ..........................................................................601
Chapter 78. Palliative Care And Pain Management ............................................................611
Chapter 79. Ethical And Legal Issues Of A Caring-Based Practice ....................................617
Chapter 80. The Business Of Advanced Practice Nursing ...................................................624
Chapter 81. The 15-Minute Hour: Practical Approaches To Behavioral Health For Primary
Care........................................................................................................................................629
Chapter 82. Putting Caring Into Practice: Caring For Self..................................................633
,Chapter 1. Primary Care In The Twenty-First Century: A
Circle Of Caring
1. A Nurse Has Conducted A Literature Review In An Effort To Identify The Effect Of
Handwashing On The Incidence Of Nosocomial (Hospital-Acquired) Infections In
Acute Care Settings. An Article Presented Findings At A Level Of Significance Of
<0.01. This Indicates That
A) The Control Group And The Experimental Group Were More Than 99% Similar.
B) The Findings Of The Study Have Less Than 1% Chance Of Being Attributable To
Chance.
C) The Effects Of The Intervention Were Nearly Zero.
D) The Clinical Significance Of The Findings Was Less Than 1:100.
Answer: B
Feedback: The Level Of Significance Is The Level At Which The Researcher Believes
That The Study Results Most Likely Represent A Nonchance Event. A Level Of
Significance Of <0.01 Indicates That There Is Less Than 1% Probability That The Result Is
Due To Chance.
2. A Nurse Has Read A Qualitative Research Study In Order To Understand The Lived
Experience Of Parents Who Have A Neonatal Loss. Which Of The Following
Questions Should The Nurse Prioritize When Appraising The Results Of This
Study?
A) How Well Did The Authors Capture The Personal Experiences Of These Parents?
B) How Well Did The Authors Control For Confounding Variables That May Have
Affected The Findings?
C) Did The Authors Use Statistical Measures That Were Appropriate To The
Phenomenon In Question?
D) Were The Instruments That The Researchers Used Statistically Valid And Reliable?
,Answer: A
Feedback: Qualitative Studies Are Judged On The Basis Of How Well They Capture And
Convey The Subjective Experiences Of Individuals. Statistical Measures And Variables Are
Not Dimensions Of A Qualitative Methodology.
3. A Nurse Has Expressed Skepticism To A Colleague About The Value Of Nursing
Research, Claiming That Nursing Research Has Little Relevance To Practice. How
Can The Nurses Colleague Best Defend The Importance Of Nursing Research?
A) The Existence Of Nursing Research Means That Nurses Are Now Able To Access
Federal Grant Money, Something That Didnt Use To Be The Case.
B) Nursing Research Has Allowed The Development Of Masters And Doctoral
Programs And Has Greatly Increased The Credibility Of The Profession.
C) The Growth Of Nursing Research Has Caused Nursing To Be Viewed As A True
Profession, Rather Than Simply As A Trade Or A Skill.
D) The Application Of Nursing Research Has The Potential To Improve Nursing
Practice And Patient Outcomes.
Answer: D
Feedback: The Greatest Value Of Nursing Research Lies In The Potential To Improve
Practice And, Ultimately, To Improve Patient Outcomes. This Supersedes The
Contributions Of Nursing Research To Education Programs, Grant Funding, Or The Public
View Of The Profession.
4. Tracy Is A Nurse With A Baccalaureate Degree Who Works In The Labor And
Delivery Unit Of A Busy Urban Hospital. She Has Noticed That Many New Mothers
Abandon Breast-Feeding Their Babies When They Experience Early Challenges And
Wonders What Could Be Done To Encourage More Women To Continue Breast-
Feeding. What Role Is Tracy Most Likely To Play In A Research Project That Tests
An Intervention Aimed At Promoting Breast-Feeding?
,A) Applying For Grant Funding For The Research Project
B) Posing The Clinical Problem To One Or More Nursing Researchers
C) Planning The Methodology Of The Research Project
D) Carrying Out The Intervention And Submitting The Results For Publication
Answer: B
Feedback: A Major Role For Staff Nurses Is To Identify Questions Or Problems For
Research. Grant Applications, Methodological Planning, And Publication Submission Are
Normally Carried Out By Nurses Who Have Advanced Degrees In Nursing.
5. A Patient Signed The Informed Consent Form For A Drug Trial That Was Explained
To Patient By A Research Assistant. Later, The Patient Admitted To His Nurse
That He Did Not Understand The Research Assistants Explanation Or His Own
Role In The Study. How Should This Patients Nurse Respond To This Revelation?
A) Explain The Research Process To The Patient In Greater Detail.
B) Describe The Details Of A Randomized Controlled Trial For The Patient.
C) Inform The Research Assistant That The Patients Consent Is Likely Invalid.
D) Explain To The Patient That His Written Consent Is Now Legally Binding.
Answer: C
Feedback: Just As The Staff Nurse Is Not Responsible For Medical Consent, The Staff
Nurse Is Not Responsible For Research Consent. If Patients Who Have Agreed To
Participate Exhibit Ambivalence Or Uncertainty About Participating, Do Not Try To
Convince Them To Participate. Ask The Person From The Research Team Who Is
Managing Consents To Speak With Concerned Patients About The Study, Even After A
Patient Has Signed The Consent Forms.
6. A Nurse Leader Is Attempting To Increase The Awareness Of Evidence-Based
Practice (Ebp) Among The Nurses On A Unit. A Nurse Who Is Implementing Ebp
Integrates Which Of The Following? (Select All That Apply.)
A) Interdisciplinary Consensus
,B) Nursing Tradition
C) Research Studies
D) Patient Preferences And Values
E) Clinical Expertise
Answer: C, D, E
Feedback: Fineout-Overholt, Melnyk, Stillwell, And Williamson Define Ebp As A
Problem-Solving Approach To The Delivery Of Healthcare That Integrates The Best
Evidence From Studies And Patient Care Data With Clinician Expertise And Patient
Preferences And Values.
7. Mrs. Mayes Is A 73-Year-Old Woman Who Has A Diabetic Foot Ulcer That Has
Been Extremely Slow To Heal And Which Now Poses A Threat Of Osteomyelitis.
The Wound Care Nurse Who Has Been Working With Mrs. Mayes Applies Evidence-
Based Practice (Ebp) Whenever Possible And Has Proposed The Use Of Maggot
Therapy To Debride Necrotic Tissue. Mrs. Mayes, However, Finds The Suggestion
Repugnant And Adamantly Opposes This Treatment Despite The Sizable Body Of
Evidence Supporting It. How Should The Nurse Reconcile Mrs. Mayes Views With
The Principles Of Ebp?
A) The Nurse Should Explain That Reliable And Valid Research Evidence Overrides
The Patients Opinion.
B) The Nurse Should Explain The Evidence To The Patient In Greater Detail.
C) The Nurse Should Integrate The Patients Preferences Into The Plan Of Care.
D) The Nurse Should Involve The Patients Family Members In The Decision-Making
Process.
Answer: C
Feedback: Patient Preferences Should Be Integrated Into Ebp And Considered Alongside
Research Evidence And The Nurses Clinical Expertise; Evidence Does Not Trump The
Patients Preferences. The Family Should Be Involved, But This Is Not An Explicit
Dimension Of Ebp. Similarly, Explaining The Evidence In More Detail Is Not A
Demonstration Of Ebp.
, 8. The Administrators Of A Long-Term Care Facility Are Considered The Use Of
Specialized, Pressure- Reducing Mattresses In Order To Reduce The Incidence Of
Pressure Ulcers Among Residents. They Have Sought Input From The Nurses On
The Unit, All Of Whom Are Aware Of The Need To Implement The Principles Of
Evidence-Based Practice (Ebp) In This Decision. Which Of The Following Evidence
Sources Should The Nurses Prioritize?
A) A Qualitative Study That Explores The Experience Of Living With A Pressure Ulcer
B) A Case Study That Describes The Measures That Nurses On A Geriatric Unit Took
To Reduce Pressure Ulcers Among Patients
C) Testimonials From Experienced Clinicians About The Effectiveness Of The Mattress
In Question
D) A Randomized Controlled Trial That Compared The Pressure-Reducing Mattress
With Standard Mattresses
Answer: D
Feedback: The Most Reliable Evidence Is Considered Rcts. Qualitative Studies, Case
Studies, And Expert Opinion Are Low On The Hierarchy Of Evidence.
9. Hospital Administrators Are Applying The Principles Of Evidence-Based Practice
(Ebp) In Their Attempt To Ascertain The Most Efficient And Effective Way To
Communicate Between Nurses Who Are On Different Units, A Project That Will
Consider Many Types Of Evidence. Which Of The Following Information Sources
Should The Administrators Prioritize?
A) A Systematic Review About Communication In Nursing Contexts
B) Nurses Ideas About Communication Methods
C) The Results Of A Chart Review
D) The Hospitals Accreditation Status
Answer: A
, Feedback: Systematic Reviews Are Assigned A High Value In Ebp. Reviews Would Be
Prioritized Over Nurses Ideas Or A Chart Review, Though Both Are Potential
Considerations. The Hospitals Accreditation Status Is Not A Relevant Consideration.
10. A Nurse Has Resolved To Apply The Evidence-Based Practice (Ebp) Process To The
Way That Admission Assessments Are Conducted And Documented On A Unit. How
Should The Nurse Begin The Process Of Establishing Ebp?
A) Gather Evidence Showing The Shortcomings Of Current Practices
B) Formulate A Clear And Concise Question To Be Addressed
C) Elicit Support From The Nurses Who Are Most Often Responsible For Admissions
D) Search The Literature For Evidence That Is Potentially Relevant To The Practice
Need
Answer: B
Feedback: The First Step In Applying Ebp Is To Ask A Clear, Focused Question. This
Should Precede A Search Of The Literature Or The Recruitment Of Participants. An
Assessment Of The Shortcomings Of The Current System Is Not An Explicit Component Of
The Ebp Process.
11. Which Of The Following Questions Best Exemplifies The Picot Format For Asking
Evidence-Based Questions?
A) What Affect Does Parents Alcohol Use Have On The Alcohol Use Of Their Teenage
Children?
B) Among Postsurgical Patients, What Role Does Meditation Rather Than
Benzodiazepines Have On Anxiety Levels During The 48 Hours Following Surgery?
C) Among High School Students, What Is The Effectiveness Of A Sexual Health
Campaign Undertaken During The First 4 Weeks Of The Fall Semester As Measured By
Incidence Of New Sexually Transmitted Infections?
D) In Children Aged 68, Is The Effectiveness Of A Descriptive Pain Scale Superior To A
Numeric Rating Scale In The Emergency Room Context?
