Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
Chapter 1, Making the Case for Evidence- Based Practice and Cultivating a Spirit
of Inquiry
1. The EBP paradigm is composed of components that are integrated into the
seven-step EBP process. What are the key components of evidence-based
practice?
A) A quality-focused culture, patient outcomes, and cost/benefit
B) Relevant best evidence, clinician expertise, and patient preferences and
values
C) Relevant best evidence, quality outcomes, and patient voice
D) A quality-focused culture, clinical expertise, and patient preferences and
values
ANS: B
Feedback:
The EBP paradigm includes the systematic search for and critical appraisal of the most
relevant and best research (external evidence) to answer a clinical question; clinical expertise
includes the integration of internal evidence from various sources (practice, outcomes
management, patient assessment, and outcomes, etc.) to achieve desired patient outcomes; and
patient/family values and preferences. Together these inform evidence-based decision
making.
PTS: 1 DIF: Moderate
REF: Header: Differences Among EBP, Research, Quality Improvement, and Evidence-Based
Quality Improvement | Page: 9 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
2. Nurses on the postsurgical unit are wondering if the time of first patient ambulation after
surgery was impacting the length of stay, and if so, what could they do to reduce the length of
stay. They plan to complete a retrospective chart review for this baseline information. Which
component of EBP would this describe?
A) Integrating organizational priorities
B) Integrating patient preference
C) Integrating internal evidence
D) Integrating external evidence
ANS: C
Feedback:
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
The nurses are questioning their practice and want to know if there are ways to improve the
outcomes—Spirit of Inquiry. As part of this Step 0, internal evidence from chart reviews can
identify baseline information to support inquiry and best practice change.
PTS: 1 DIF: Moderate
REF: Header: Definition and Evolution of Evidence-Based Practice | Page: 8
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An experienced nurse working in a memory care home observed that reorienting residents
with dementia as frequently as possible seemed to minimize their agitation in the evening.
The nurse wonders if this is the best practice. As the EBP expert, what would you
recommend?
A) Conduct a research study on reorienting compared to not reorienting residents with
dementia in memory care homes
B) Pull a team together to create a policy so that all residents have decreased agitation
while in the memory care home
C) Identify a team to explore the external evidence, clinician expertise/experiences,
and preferences of the residents/families
D) Call the Quality Department to help with a PDSA project for the reorientation of
patients
ANS: C
Feedback:
The EBP paradigm includes the integration of evidence, clinical expertise, and patient
preferences to make best practice clinical decisions about care. An EBP initiative would
identify if the nurse’s practice is the best practice.
PTS: 1 DIF: Moderate
REF: Header: Components of Evidence-Based Practice | Page: 11 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
4. An EBP mentor is leading a team in the critical care department to implement the central
line–associated bloodstream infections (CLABSI) bundle across all critical care units in the
system. Which outcomes would indicate the effectiveness of this EBP implementation?
A) System-wide improvement of patient quality and safety outcomes for patients with
central lines
B) Provider satisfaction in trauma critical care
C) Consistency in care across the healthcare system in pain management
D) Cost reduction in supplies for all systems departments
ANS: A
Feedback:
EBP leads to the highest quality and safety of care and the best patient outcomes while
reducing costs. EBP implementation of best practice bundles in critical care can reduce
complications and improve care for this patient population. It is important to evaluate the
effectiveness of EBP practice change initiatives on patient outcomes.
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
PTS: 1 DIF: Easy
REF: Header: Why Evidence-Based Practice? | Page: 13 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. The Institute of Medicine’s Roundtable on Evidence-based Medicine set a landmark goal that
by 2020, 90% of clinical decisions would be supported by accurate, timely, and up-to-date
information based on the best available evidence. The EBP Council has been asked to assist
the organization to meet this goal by identifying best practice evidence to guide policies,
procedures, and patient care practices. Which of the goals of the IOM Roundtable would not
apply to the Council’s charge?
A) Generating evidence to support which healthcare strategies are most effective and
produce the greatest value
B) Accelerating the progress toward a learning healthcare system, in which evidence
is applied and developed as a product of patient care
C) Comparing the implementation of EBP in the United States with that of other
developed countries
D) Improving public awareness and understanding of the nature of evidence and its
importance for their healthcare
ANS: C
Feedback:
The IOM Roundtable was charged with accelerating the progress toward a learning healthcare
system, generating new evidence to support which healthcare strategies are most effective,
and improving public awareness and understanding of EBP. Comparison with other countries’
EBP implementation was not the focus of the IOM Roundtable recommendations.
PTS: 1 DIF: Moderate
REF: Header: The Institute of Medicine’s Roundtable on Evidence-Based Medicine | Page: 15
OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
6. Nurses working in a trauma unit have noticed that many of their patients on enteral feedings
are required to be NPO at midnight before each scheduled procedure. For many of the
patients, this has greatly extended their length of stay and resulted in weight loss. The nurses
were wondering “What can we do to assure the patient receives the nutrition that they need
while reducing the risks of aspiration during procedures?” This is an example of what step in
EBP?
A) Formulating the clinical search question/PICOT
B) Systematically searching for the best most relevant evidence
C) Cultivating a Spirit of Inquiry and curiosity
D) Evaluation and sustainability of practice
ANS: C
Feedback:
Step 0 in the EBP process—Spirit of Inquiry, occurs when there is curiosity and questioning
of “Why do we do it this way”? This step starts the EBP process by identifying a clinical issue
using internal evidence and inquiry.
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
PTS: 1 DIF: Easy
REF: Header: Step 0: Cultivate a Spirit of Inquiry Within an EBP Culture and Environment | Page:
19 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. New graduate nurses in a residency program are asked to identify best practices in the
evidence and need to create a PICOT question. Which of the following is a PICOT question?
A) What effect does parents' smoking have on the smoking habits of their children
aged 13 to 16 years?
B) In clients aged 8 to 12 years, is the effectiveness of a pain scale using faces
superior to a numeric rating scale in the emergency room context?
C) How do parents who raise children with fetal alcohol spectrum disorders (FASD)
cope and develop resilience?
D) In cancer patients, how does meditation compared to benzodiazepines affect
anxiety during radiation treatments?
ANS: D
Feedback:
The PICOT question will include population or problem, intervention or issue of interest,
comparison intervention or group, outcome, and time frame. Only the question about cancer
patients is written as a PICOT question. The other questions are background or research
questions.
PTS: 1 DIF: Difficult
REF: Header: Step 1: Formulate the Clinical PICOT Question OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
8. After developing a PICOT to guide the search, what strategies should be used for searching
for the best external evidence?
A) Start with each word/phrase in the PICOT and conduct a search, then combine the
searches to limit to the articles that answer your search
B) Start with GOOGLE to see if there are articles on the topic, then go to the
organization’s library to find full-text articles
C) Search MEDLINE or CINAHL only because they have the most nursing articles to
address the question
D) Search GOOGLE SCHOLAR to locate systematic reviews and systematic review
meta-analysis or metasynthesis
ANS: A
Feedback:
The PICOT will guide the search. Use each element of the PICOT separately, and then
combine elements to help find evidence that addresses the question. For a comprehensive,
systematic search, use multiple databases from nursing and other applicable disciplines.
PTS: 1 DIF: Easy
REF: Header: Step 2: Systematically Search for and Collect the Most Relevant Best Evidence |
Page: 20 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
Edition
Chapter 1, Making the Case for Evidence- Based Practice and Cultivating a Spirit
of Inquiry
1. The EBP paradigm is composed of components that are integrated into the
seven-step EBP process. What are the key components of evidence-based
practice?
A) A quality-focused culture, patient outcomes, and cost/benefit
B) Relevant best evidence, clinician expertise, and patient preferences and
values
C) Relevant best evidence, quality outcomes, and patient voice
D) A quality-focused culture, clinical expertise, and patient preferences and
values
ANS: B
Feedback:
The EBP paradigm includes the systematic search for and critical appraisal of the most
relevant and best research (external evidence) to answer a clinical question; clinical expertise
includes the integration of internal evidence from various sources (practice, outcomes
management, patient assessment, and outcomes, etc.) to achieve desired patient outcomes; and
patient/family values and preferences. Together these inform evidence-based decision
making.
PTS: 1 DIF: Moderate
REF: Header: Differences Among EBP, Research, Quality Improvement, and Evidence-Based
Quality Improvement | Page: 9 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
2. Nurses on the postsurgical unit are wondering if the time of first patient ambulation after
surgery was impacting the length of stay, and if so, what could they do to reduce the length of
stay. They plan to complete a retrospective chart review for this baseline information. Which
component of EBP would this describe?
A) Integrating organizational priorities
B) Integrating patient preference
C) Integrating internal evidence
D) Integrating external evidence
ANS: C
Feedback:
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
The nurses are questioning their practice and want to know if there are ways to improve the
outcomes—Spirit of Inquiry. As part of this Step 0, internal evidence from chart reviews can
identify baseline information to support inquiry and best practice change.
PTS: 1 DIF: Moderate
REF: Header: Definition and Evolution of Evidence-Based Practice | Page: 8
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An experienced nurse working in a memory care home observed that reorienting residents
with dementia as frequently as possible seemed to minimize their agitation in the evening.
The nurse wonders if this is the best practice. As the EBP expert, what would you
recommend?
A) Conduct a research study on reorienting compared to not reorienting residents with
dementia in memory care homes
B) Pull a team together to create a policy so that all residents have decreased agitation
while in the memory care home
C) Identify a team to explore the external evidence, clinician expertise/experiences,
and preferences of the residents/families
D) Call the Quality Department to help with a PDSA project for the reorientation of
patients
ANS: C
Feedback:
The EBP paradigm includes the integration of evidence, clinical expertise, and patient
preferences to make best practice clinical decisions about care. An EBP initiative would
identify if the nurse’s practice is the best practice.
PTS: 1 DIF: Moderate
REF: Header: Components of Evidence-Based Practice | Page: 11 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
4. An EBP mentor is leading a team in the critical care department to implement the central
line–associated bloodstream infections (CLABSI) bundle across all critical care units in the
system. Which outcomes would indicate the effectiveness of this EBP implementation?
A) System-wide improvement of patient quality and safety outcomes for patients with
central lines
B) Provider satisfaction in trauma critical care
C) Consistency in care across the healthcare system in pain management
D) Cost reduction in supplies for all systems departments
ANS: A
Feedback:
EBP leads to the highest quality and safety of care and the best patient outcomes while
reducing costs. EBP implementation of best practice bundles in critical care can reduce
complications and improve care for this patient population. It is important to evaluate the
effectiveness of EBP practice change initiatives on patient outcomes.
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
PTS: 1 DIF: Easy
REF: Header: Why Evidence-Based Practice? | Page: 13 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. The Institute of Medicine’s Roundtable on Evidence-based Medicine set a landmark goal that
by 2020, 90% of clinical decisions would be supported by accurate, timely, and up-to-date
information based on the best available evidence. The EBP Council has been asked to assist
the organization to meet this goal by identifying best practice evidence to guide policies,
procedures, and patient care practices. Which of the goals of the IOM Roundtable would not
apply to the Council’s charge?
A) Generating evidence to support which healthcare strategies are most effective and
produce the greatest value
B) Accelerating the progress toward a learning healthcare system, in which evidence
is applied and developed as a product of patient care
C) Comparing the implementation of EBP in the United States with that of other
developed countries
D) Improving public awareness and understanding of the nature of evidence and its
importance for their healthcare
ANS: C
Feedback:
The IOM Roundtable was charged with accelerating the progress toward a learning healthcare
system, generating new evidence to support which healthcare strategies are most effective,
and improving public awareness and understanding of EBP. Comparison with other countries’
EBP implementation was not the focus of the IOM Roundtable recommendations.
PTS: 1 DIF: Moderate
REF: Header: The Institute of Medicine’s Roundtable on Evidence-Based Medicine | Page: 15
OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
6. Nurses working in a trauma unit have noticed that many of their patients on enteral feedings
are required to be NPO at midnight before each scheduled procedure. For many of the
patients, this has greatly extended their length of stay and resulted in weight loss. The nurses
were wondering “What can we do to assure the patient receives the nutrition that they need
while reducing the risks of aspiration during procedures?” This is an example of what step in
EBP?
A) Formulating the clinical search question/PICOT
B) Systematically searching for the best most relevant evidence
C) Cultivating a Spirit of Inquiry and curiosity
D) Evaluation and sustainability of practice
ANS: C
Feedback:
Step 0 in the EBP process—Spirit of Inquiry, occurs when there is curiosity and questioning
of “Why do we do it this way”? This step starts the EBP process by identifying a clinical issue
using internal evidence and inquiry.
, Test Bank For Melnyk and Fineout-Overholt Evidence-Based Practice in Nursing and Healthcare, 5th
Edition
PTS: 1 DIF: Easy
REF: Header: Step 0: Cultivate a Spirit of Inquiry Within an EBP Culture and Environment | Page:
19 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. New graduate nurses in a residency program are asked to identify best practices in the
evidence and need to create a PICOT question. Which of the following is a PICOT question?
A) What effect does parents' smoking have on the smoking habits of their children
aged 13 to 16 years?
B) In clients aged 8 to 12 years, is the effectiveness of a pain scale using faces
superior to a numeric rating scale in the emergency room context?
C) How do parents who raise children with fetal alcohol spectrum disorders (FASD)
cope and develop resilience?
D) In cancer patients, how does meditation compared to benzodiazepines affect
anxiety during radiation treatments?
ANS: D
Feedback:
The PICOT question will include population or problem, intervention or issue of interest,
comparison intervention or group, outcome, and time frame. Only the question about cancer
patients is written as a PICOT question. The other questions are background or research
questions.
PTS: 1 DIF: Difficult
REF: Header: Step 1: Formulate the Clinical PICOT Question OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
8. After developing a PICOT to guide the search, what strategies should be used for searching
for the best external evidence?
A) Start with each word/phrase in the PICOT and conduct a search, then combine the
searches to limit to the articles that answer your search
B) Start with GOOGLE to see if there are articles on the topic, then go to the
organization’s library to find full-text articles
C) Search MEDLINE or CINAHL only because they have the most nursing articles to
address the question
D) Search GOOGLE SCHOLAR to locate systematic reviews and systematic review
meta-analysis or metasynthesis
ANS: A
Feedback:
The PICOT will guide the search. Use each element of the PICOT separately, and then
combine elements to help find evidence that addresses the question. For a comprehensive,
systematic search, use multiple databases from nursing and other applicable disciplines.
PTS: 1 DIF: Easy
REF: Header: Step 2: Systematically Search for and Collect the Most Relevant Best Evidence |
Page: 20 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
