NR449 Evidence-Based Practice in Nursing Comprehensive Exam Practice MCQ's Questions and Answers

NR449 Evidence-Based Practice in Nursing Comprehensive Exam Practice MCQ's Questions and Answers 1. Nursing research is significant to the profession of nursing because it promotes what? a. More specifically defined nursing practice responsibilities b. Decreased liability within the practice of nursing c. Generation of a specialized body of nursing knowledge for use in nursing practice d. Expansion of the scope of nursing practice into areas formerly reserved for other disciplines Rationale: The correct answer is C. Nursing research generates a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet constantly shifting challenges of health care delivery to multiple populations. It provides a foundation for evidence- based nursing care and quality improvement activities. 2. Which aspect of the scientific investigation of nursing practice is also a fundamental concept of American Nurses Association (ANA)'s Code for Nurses? a. Professional accountability b. Standards of care c. Legal scope of practice d. Advanced practice nursing activities Rationale: The correct answer is A. Scientific investigation promotes accountability, a hallmark of the nursing profession and a fundamental concept of the ANA's Code for Nurses. 3. Nurses who do not conduct research need to understand the nursing research process for which of these reasons? a. To identify potential subjects for clinical research studies b. To assist as accurate data collectors in clinical research studies c. To teach patients and their families about the usefulness of consenting to participate in research d. To be able to evaluate nursing research reports for relevance to their own clinical practice Rationale: The correct answer is D. Nurses need to understand the research process in order to critically read research reports and determine if nursing practice should incorporate the research findings as valid evidence. 4. Which of these actions demonstrates the role of a knowledgeable consumer of nursing research? a. Designing a nursing research study b. Analyzing data to determine a study's outcomes c. Evaluating the credibility of research findings d. Implementing an intervention found to be effective in one clinical case study Rationale: The correct answer is C. A consumer of nursing research needs to understand the research process to determine the merit and relevance of evidence presented in research studies. 5. Members of the nursing staff are to participate in a unit-based clinical research study. Which research-related actions would be expected of a nurse with a baccalaureate nursing degree? a. Using critical appraisal skills to understand and assess the steps of the research process b. Providing expert nursing consultation about the way in which clinical services are delivered c. Developing research methods to monitor and evaluate the quality of nursing practice in the clinical setting d. Providing leadership in the application of scientific knowledge to nursing Practice Rationale: The correct answer is A. A baccalaureate-prepared nurse should be able to use skills of critical appraisal to both understand and appraise the steps of the research process. 6. Which statement describes the role of the nurse in research? a. Nurses must be prepared at the baccalaureate or higher level of education to have any role in nursing research. b. Nurses with master's or higher levels of education are solely responsible for applying research to clinical practice. c. The research role of nurses prepared at both the baccalaureate and master's levels of education includes critical appraisal skills. d. Regardless of the nursing education level, only the nurse with the most comprehensive understanding of statistical methods should interpret research findings. Rationale: The correct answer is C. To use research in evidence-based practice, the nurse must not necessarily be able to conduct research but should be able to understand and appraise the steps of the research process to read the research literature critically and use it to inform clinical decisions. 7. What is the primary value of evidence-based nursing practice? a. Implementing the most cost-effective nursing practices when providing patient care b. Incorporating research findings with clinical expertise when individualizing patient care c. Separating nursing research as unique from the research of other disciplines d. Developing new nursing theories to promote the growth of nursing science Rationale: The correct answer is B. Evidence-based practice allows the nurse to systematically integrate the best available research evidence with individual clinical expertise, as well as the patient's values and preferences, when making clinical decisions. 8. A novice nurse researcher is comparing the processes used in nursing research and evidence-based practice. What differences, if any, exist between the two processes? a. As scientific processes, they are fundamentally the same and should result in parallel outcomes. b. Both processes involve testing a question with an appropriate design and specific methodology. c. In a research study the question is tested with an appropriate design and specific methodology, whereas in evidence-based practice the question is used to search the research literature to find answers. d. In evidence-based practice, qualitative studies are critically appraised to answer a clinical question, whereas in nursing research, quantitative studies are reviewed to provide a foundation for the study. Rationale: The correct answer is C. Nursing research includes developing a design for a study, whether quantitative or qualitative, reviewing the literature, and carrying out a specific methodology to find answers to a question. In contrast, evidence-based practice includes a review of completed research studies to identify answers to a clinical question. 9. A nurse is analyzing a research article. Where in the article is the nurse likely to find the research question and study purpose? a. Introduction b. Data analysis c. Findings d. Data collection Rationale: The correct answer is A. The research question and study purpose is generally found early in the report: in the abstract, the introduction, or at the end of the literature review or conceptual framework section. 10. The nurse researcher is conducting a research study using subjects who will be interviewed regarding their experience with postpartum depression. For which of these reasons would the researcher selects a qualitative, rather than quantitative, research design? a. Quantitative research is usually conducted in natural settings using data that are words rather than numbers. b. Qualitative research seeks to explain cause-and-effect relationships between variables. c. Quantitative research typically uses a convenience sample, seeking to answer a clinical question about human experience. d. Qualitative research collects data from a small number of subjects, allowing for in-depth study of a phenomenon. Rationale: The correct answer is D. Qualitative research typically collects data from a small number of subjects, thus allowing for in-depth study of a phenomenon while using a subjective approach. 11. The nurse is analyzing a research article. To determine if an integrative review was performed as part of the study, the nurse must understand that this type of review is what? a. A summary of research studies on a focused topic that used a specific statistical methodology b. A synthesis of the research and theoretical literature on a specific area without a statistical analysis c. A synthesis of qualitative articles on a focused topic using a specific qualitative methodology d. A summary of articles in an attempt to develop a clinical practice statement or clinical guidelines Rationale: The correct answer is B. An integrative review is a synthesis of research or theoretical literature on a specific area that follows specific steps of literature integration without statistical analysis. 12. When assessing the strength of a body of evidence used in a research study for consistency, the nurse should determine what? a. Extent to which the study's design, implementation, and analysis minimize bias b. Number of studies that have evaluated the research question, including overall sample size across studies c. Degree to which studies with similar and different designs investigated the same research questions and report similar findings d. Significance of the findings based on the statistical methods used for data analysis Rationale: The correct answer is C. Consistency is the degree to which studies that had similar and different designs (but investigate the same research question) reported similar findings. 13. The nurse is analyzing a qualitative research article. In which section of the article is the nurse likely to find a summary of legal-ethical issues considered in the study? a. Data collection or procedures b. Findings or results c. Discussion or implications d. Abstract or introduction Rationale: A Legal-ethical issues are typically discussed in the article's data collection or procedures section, usually when discussing the sample. 14. The nurse is analyzing a qualitative research article. In which section of the article should the nurse expect to find a discussion of the research findings? a. Procedures b. Methods c. Sample d. Results Rationale: The correct answer is D. The discussion of the findings will be located in the results or discussion section. 15. The nurse is using the critical reading process to analyze a research article. The nurse identifies the main theme of the article and states it in two sentences, using the nurse's own words. The nurse is using a strategy to promote which type of understanding? a. Preliminary b. Comprehensive c. Analysis d. Synthesis Rationale: The correct answer is B. Strategies for comprehensive understanding include restating the main idea or theme of the article in one's own words. 16. The nurse is using the critical reading process to analyze a research article. The nurse is using a list of criteria to determine how well the researcher performed each step of the research process. The nurse is using a strategy to promote which type of understanding? a. Preliminary b. Comprehensive c. Analysis d. Synthesis Rationale: The correct answer is C. Strategies for analysis understanding include using criteria to critique the steps of the research process used in the study. 17. Which of the following is a critical step for the quality improvement process in health care settings? a. Outlining general long-range goals b. Identifying current successful practices c. Testing practice changes slowly and tentatively d. Adopting a practice change as a new standard of care Rationale: The correct answer is D. The goal of quality improvement activities is to bring about changes in practice that will make a positive difference in patient care. Therefore, adopting a practice change is a critical step in the process. 1. Which statement(s) describe the actions of the baccalaureate nurse graduate as a participant in the nursing research process? (Select all that apply.) a. Administering care at the bedside according to a research protocol b. Providing leadership by helping others apply scientific knowledge to practice c. Sharing with nursing colleagues research findings that are pertinent to practice d. Designing and conducting nursing research studies e. Functioning as a primary investigator for a research study Rationale: The correct answer is A, C. Following a research protocol at the bedside is an activity consistent with the practice of a nurse prepared at the baccalaureate level. Sharing research evidence with colleagues is an activity consistent with the practice of a nurse prepared at the baccalaureate level. Which aspects of the nursing research process are common to nurses at all educational levels? (Select all that apply.) a. Disseminating research findings in research reports b. Maintaining the protection of patients who are subjects in a study c. Using one's expertise to develop theoretical explanations for findings d. Knowing the relationship between research and nursing practice e. Being a member of a collaborative team that applies research to practice Rationale: The correct answer is B, D, E. All nurses are responsible for protecting the rights of patients. All nurses should be aware that research is related to practice. All nurses can be a part of a clinical team that applies research to practice. For the baccalaureate nursing student, education in nursing research has which outcomes? (Select all that apply.) a. Mastering the development of research protocols b. Gaining a basic understanding of the research process c. Learning how research is related to clinical nursing practice d. Developing skill as a primary investigator in research e. Becoming a knowledgeable consumer of nursing research Rationale: The correct answer is B, C, E. The student should gain an initial understanding of the importance of research in nursing practice. The student should learn how research is related to clinical nursing practice. The student should learn skills in the critical analysis of research to assist in decisions about applying research findings in nursing practice. Developing nurse researchers at a younger age is a priority for the future in the nursing profession for which reasons? (Select all that apply.) a. Enhancing the discipline's scientific development b. Increasing the longevity of research careers c. Receiving more research funding for professional organizations d. Promoting mentoring opportunities for novice researchers e. Increasing nursing's role in pharmaceutical research Rationale: The correct answer is A, B, D. Developing young researchers increases the number of researchers contributing to the science of the discipline. Introducing nurses to research at a younger age allows them sufficient time to develop in-depth research programs in their careers. Introducing nurses to research at a younger age allows them time and opportunity to be mentored by experienced researchers, as well as to learn to become mentors themselves. 1. What difference, if any, exists between a research question and a hypothesis? a. A research question is practice based, and a hypothesis is theory based. b. A hypothesis attempts to answer the question posed by the research problem. c. A research problem defines clinical research and a hypothesis defines basic research. d. There is no difference between a research problem and hypothesis. Rationale: The correct answer is B. A hypothesis attempts to answer the research question. 2. How is a hypothesis related to a theory? a. Hypotheses can be developed in the absence of a theoretical framework. b. Hypotheses must be consistent with an existing theoretical framework. c. A theory can determine the validity of a hypothesis. d. A theory can be used to evaluate the merit of a hypothesis. Rationale: The correct answer is B. A sound hypothesis is consistent with an existing body of theory and research findings. 3. A nurse makes these statements. Which one has the greatest potential as an area of nursing research? a. "Most of our hospital's admissions come in at night." b. "It is difficult to find personnel willing to work the night shift." c. "It seems that most of the patient falls on our unit occur during the night shift." d. "The personnel on the night shift are not attending promptly to the needs of our patients." Rationale: C This statement identifies a specific, important patient problem. Its exploration has potential to contribute to the body of nursing knowledge. 4. The nurse has identified a clinical problem as a potential research question. Which of these steps should the nurse take next? a. Identify the variables b. Formulate the research hypothesis c. Perform a literature review d. Determine financial resources for the research project Rationale: The correct answer is C. The literature review helps to further define the research question by identifying gaps in the literature, the need for replication of prior research, or the need to extend the knowledge base in a particular research area. It also identifies variables essential to consider in refining the research question. 5. In a research study, what are the properties of interest that differ in value? a. The study's variables b. The study's concepts c. The study's hypotheses d. The study's assumptions Rationale: A This is the widely accepted and often-cited definition of variables. 6. A nurse researcher proposes a study of teenage mothers and their experience with postpartum depression. Which of these considerations would affect the feasibility of the study? a. Availability of participants b. Direction of the hypotheses c. Gaps in the literature d. Design of the study Rationale: The correct answer is A. A study's feasibility is determined by practical considerations, such as availability of subjects, equipment, facilities, and money. 7. What is the key difference between independent and dependent variables? a. The dependent variable should change in response to manipulation by the independent variable. b. The independent variable should change in response to manipulation by the dependent variable. c. Although both the dependent and independent variables are manipulated, only the dependent variable is considered an intervention. d. Although both the dependent and independent variables are manipulated, only the independent variable is considered an intervention. Rationale: A Dependent variables change in response to manipulation of independent variables in experimental research. 8. When designing a research study, the nurse should have which of these understandings about independent and dependent variables? a. All research problem statements should contain a dependent and an independent variable. b. There should only be one dependent variable associated with a single independent variable. c. The relationship between independent & dependent variable in any study should be causal. d. A given characteristic or situation may be the dependent variable in one study and the independent variable in another. Rationale: The correct answer is D. Depending on the particular study, a specific variable may be the dependent or the independent variable. The causal or associative direction between variables determines the classification of the variables as independent or dependent. 9. A nurse's research question is, "How does maternal employment among health care professionals affect infant health during the first 6 months of life?" In this question, what is the dependent variable? a. Infant health b. Maternal employment c. First 6 months of life d. Health care professionals Rationale: The correct answer is A. Infant health is the consequence or presumed effect that changes regarding maternal employment. Thus it is the dependent variable. 10. A nurse has defined the research question as, "How does oral nutritional supplementation during dialysis treatments affect the serum albumin levels of adult patients who have chronic kidney disease Stage 5?" In this question, what is the independent variable? a. Adult patients with chronic kidney disease Stage 5 b. Oral nutritional supplementation c. During dialysis treatments d. Serum albumin levels Rationale: The correct answer is B Oral nutritional supplementation is the intervention administered to effect a change in the patients' serum albumin levels. Thus oral nutritional supplementation is the independent variable. 11. A nurse has defined the research question as, "Is there a relationship between self-esteem and body weight among postmenopausal women?" What type of research-question format (or research design) is implied by this question? a. Correlational nonexperimental b. Comparative non experimental c. Quantitative experimental d. Grounded theory nonexperimental Rationale: The correct answer is A. Self-esteem and body weight are variables that are related in an associative way. The word, relationship, strongly suggests correlational design studies. 12. A nurse has defined the research question as, "What is the lived experience of late-stage pregnancy loss among women older than 35 years?" What type of research-question format (or research design) is implied by this question? a. Correlational non experimental b. Comparative non experimental c. Quantitative experimental d. Grounded theory nonexperimental Rationale: The correct answer is D. The question concerns "lived experience," which implies a grounded-theory study design. 13. Which research question is testable as currently written? a. Should parents addicted to crack cocaine be permitted to raise their children? b. Is the classroom an appropriate place to teach sex education to 10-year-old children? c. Are older adults living in assisted-living facilities satisfied with their level of social interaction? d. Is a positive HIV/AIDS status a sufficient reason for limiting the employment of elementary school teachers? Rationale: The correct answer is C. This example implies variables that can be measured and suggests a comparative nonexperimental design study. The independent variable is residing in assisted-living facilities, as compared with not residing in assisted-living facilities. The dependent variable is social interaction. 14. What is the purpose of a hypothesis for any study? a. To identify the dependent and independent variables b. To provide direction for the study by indicating the expected outcomes c. To define the appropriate measures needed to test the research problem d. To provide a means of determining the feasibility of the proposed study Rationale: The correct answer is B. A hypothesis is a declarative statement about two or more variables that predicts an expected outcome. 15. Which hypothesis fails to meet the criteria of testability? a. Proper hand washing prevents the spread of infection. b. Consistent practice of low-impact aerobic exercise will increase coordination among older adults. c. Patients who used guided imagery during magnetic resonance imaging (MRI) procedures will have reduced perceptions of emotional distress compared with patients who do not use guided imagery during MRI. d. Postoperative patients who receive around-the-clock scheduled analgesics will have lower levels of pain compared with postoperative patients who receive analgesics on an as-needed (PRN) schedule. Rationale: The correct answer is A. This statement does not suggest that there is a predicted outcome as specifically as the other examples. The term proper is value laden and nonspecific. Both proper handwashing and spread of infection require more specific definition. 16. Which hypothesis is nondirectional? a. Hospitals with an infection-control nurse will have fewer instances of sepsis among inpatients than hospitals without an infection-control nurse. b. There will be a greater weight loss among dieting patients who receive a weekly supportive telephone call from a dietitian than among dieting patients who do not receive a weekly supportive phone call. c. There will be a difference in stage of disease for prostate cancer among men who had an abnormal prostate-specific antigen screening compared with men who had an abnormal digital rectal examination screening. d. Children who receive weekly counseling for 1 year after the death of a parent will perform better in school than children who do not receive weekly counseling after the death of a parent. Rationale: The correct answer is C. This hypothesis has no expected direction. It suggests a difference but does not indicate the direction of the difference. 17. The nurse has defined the hypothesis as, "There will be no difference in the number of adverse events among patients discharged two days after an abdominal hysterectomy compared with patients discharged 4 days after an abdominal hysterectomy." This statement is an example of what? a. Directional hypothesis b. Nondirectional hypothesis c. Research hypothesis d. Null hypothesis Rationale: The correct answer is D. This is a null (or statistical) hypothesis, stating that there is no relationship between the independent (postoperative days) and dependent (adverse events) variables. If in the statistical analysis a significant relationship is found, the null hypothesis would be rejected. 18. The nurse notes these statements in a research article: This study explores changes in coping and emotion that occur between the preoperative and the postoperative period. Further, the relationships between coping and emotion preoperatively and postoperatively are evaluated. Finally, the influence of preoperative coping and emotion on postoperative emotion is documented. This section represents which part of a research study? a. Results b. Methods c. Purpose d. Hypothesis Rationale: The correct answer is C. The statements describe the aims or goals that the investigator hoped to achieve with the research and thus reflect the purpose of the study. 19. A nurse states the purpose of a research study as, "This study will compare the effect of warm and cold applications on the resolution of intravenous (IV) infiltrations in hospitalized older-adult patients in the early postoperative period." In this statement, what constitutes the independent variable(s)? a. Postoperative older adult patients b. Early postoperative period c. Warm and cold applications d. Resolution of IV infiltrations Rationale: The correct answer is C. Warm and cold applications represent the independent variables, which will be manipulated and influence the dependent (outcome) variable resolution of IV infiltrations. 20. A nurse describes the hypothesis of a research study as, "There is a positive relationship between nurses' attitudes toward AIDS patients and the number of AIDS patients they have cared for in practice." This statement is an example of what? a. Null hypothesis b. Nondirectional hypothesis c. Directional hypothesis d. Causal hypothesis Rationale: The correct answer is C. Because a positive relationship is specified, the hypothesis is directional. 21. The nurse has identified a patient situation that may be an area for study. The initial review of the literature helps the investigator to identify what? a. The number of subjects required for the study b. The appropriate statistical tests to analyze the data c. The need to extend knowledge in a particular area d. The instruments needed to collect data during the study Rationale: The correct answer is C. The initial literature review helps further define the research question by identifying gaps in the literature, the need for replication of prior research, or the need to extend the knowledge base in a particular research area. It also identifies variables essential to consider in refining the research question. 22. Which hypothesis would be classified as a statistical hypothesis? a. Oxygen inhalation at 2 L/min by nasal catheter will decrease oral temperature measured with an electronic thermometer. b. Oxygen inhalation at 2 L/min by nasal catheter will not affect oral temperature measured with an electronic thermometer. c. There will be a greater decrease in anxiety scores in patients receiving informational videos before open heart surgery than in patients who receive standard written information. d. There will be a difference in anxiety scores in patients receiving informational videos before open heart surgery and patients who receive standard written information. Rationale: The correct answer is B. A statistical (or null) hypothesis indicates no relationship between variables, as represented in this statement. If in the statistical analysis, a significant relationship is found, the null hypothesis would be rejected. 23. Which of these statements is correctly phrased as a clinical question for evidence-based practice? a. What is the best method to insert an enteral feeding tube in an adult patient? b. Are there differences in the characteristics of various brands of enteral feeding tubes? c. In addition to aspiration, what are the most problematic complications of enteral tube feedings? d. What method of determining stomach placement of enteral feeding tubes helps to prevent aspiration in adult patients? Rationale: The correct answer is D. This statement is worded as a clinical question and includes the four PICO elements: population (adult patients), intervention (methods of determining stomach placement), comparison (among methods), and outcome (prevent aspiration). 1. The review of literature is important to the research process for which of these reasons? a. It guides all steps of the research process. b. It provides a vehicle to disseminate the findings of the study. c. It guides only the conceptualization of the problem statement. d. It identifies only gaps or inconsistencies in the knowledge base. Rationale: The correct answer is A. The review of the literature is important throughout all stages of a research study. 2. The "6S" pyramid hierarchy of preappraised evidence developed by DiCenso, Bayley, & Haynes (2009) provides a means to help nurse consumers of research find pre appraised evidence for clinical questions. Using this model, which level of evidence would be highest? a. Summaries such as clinical practice guidelines b. Synopsis of Synthesis such as summaries found in the journal Evidence-Based Nursing c. Synthesis of systematic reviews such as a Cochrane review d. Studies such as synopses of a single study Rationale: The correct answer is A. The highest level of those presented in the question is Summaries, which include clinical practice guidelines and electronic evidence-based textbooks. These summaries about specific conditions are updated regularly. An even higher level of the 6S pyramid is Computerized Decision Support Systems (CDSS), which integrate evidence- based clinical information into an electronic medical record. At present, these systems are not a reality in most institutions and, therefore, they were not included as an option in this question. 3. For which of these reasons would a nurse researcher include refereed journals in the literature review? a. The articles are critiqued by a panel of external reviewers. b. The articles selected for publication are related to a specific field of knowledge. c. The journals encourage competition among authors to have their articles published. d. The journals publish only articles that are primary sources of research findings. Rationale: The correct answer is A. The articles are critiqued by a panel of external expert readers. 4. A research article has undergone a blind review for a peer-reviewed journal. The nurse reading the research article should understand which of the following about this review process? a. The reviewers of the article did not know the identity of the other reviewers. b. The reviewers of the article did not know the identity of the author. c. The criteria used to review the article were not known to the author. d. The criteria used to review the article were determined by the reviewers. Rationale: The correct answer is B. In a blind review, the manuscript to be reviewed does not include the name of the author. 5. For which of these reasons would a nurse researcher decided to use secondary sources in a review of the literature? a. They provide material written by the person who conducted the study. b. They provide a different way of looking at specific issues or problems. c. They define the relationship of two or more variables affecting an outcome. d. They supplement the body of nursing knowledge in a specific area of practice. Rationale: The correct answer is D. Secondary sources published in refereed journals usually include implications for practice and the work's contributions to the development of nursing science. 6. Which is an example of a primary source in a literature review? a. A video recorded interview of a nurse researcher b. A critique of a nursing research study c. An edited textbook on nursing research d. A review of theoretical frameworks used in nursing research Rationale: The correct answer is A. Primary sources include articles, books, diaries, films, and oral histories of the person who conducted the study or developed the theory. 7. Which is an example of a secondary source in a literature review? a. An oral history of a nurse researcher b. An investigator's report of a research study c. A summary and critique of another's scholarly work d. An autobiography of a developer of a nursing theory Rationale: The correct answer is C. Secondary sources include materials written by persons other than the person who conducted a research study or developed a particular theory. 8. Which of these electronic databases is the most relevant and frequently used source for nursing literature? a. MEDLINE b. CINAHL c. Cochrane Collaboration d. National Guideline Clearinghouse Rationale: The correct answer is B. CINAHL is the most relevant and frequently used source for nursing literature, covering nursing and related literature from 1956 to the present. 9. When comparing MEDLINE & CINAHL databases, which difference will the nurse find? a. Coverage of MEDLINE dates back to 1975, whereas coverage of CINAHL to 1980. b. MEDLINE's journal coverage includes more than 10,000 biomedical journals, whereas CINAHL's coverage includes more than 5000 journals. c. MEDLINE's database size is more than 21 million records, whereas CINAHL's database size is more than 3.2 million records. d. MEDLINE has more than 500 Evidence-Based Care Sheets, whereas CINAHL has more than 50 Evidence-Based Care Sheets. Rationale: The correct answer is C. MEDLINE's database size is more than 21 million records, whereas CINAHL's database size is more than 3.2 million records. 10. A general timeline for a literature search for an academic paper or project is to go back how far in the literature? a. At least the last 6 months to 2 years b. At least the past 3 to 5 years c. At least the past 6 to 10 years d. At least the past 12 to 15 years Rationale: The correct answer is B. The past 3 to 5 years is a sufficient timeline for an academic paper or project because recent literature is relevant and may include classic references in reference lists. 11. A nurse is encouraged to use a Boolean operator to more efficiently perform an electronic search of the literature. The nurse should understand that a Boolean operator is what? a. A specialized reference librarian who can assist in searches of electronic medical and nursing databases b. A software program that enables combinations of permissions and restrictions for a database search c. A definition of the relationship between words or groups of words in a literature search such as "and" d. A clinical query that can be performed to focus on a particular clinical issue or practice question Rationale: The correct answer is C. A Boolean operator defines the relationships between words or groups of words in the literature search. These include the words, "and," "or," and "not." 12. Which command is an example of a Boolean connection used when ordering an electronic literature search? a. Explode topic b. Limit search to abstracts c. Search from years 2003 to 2013 d. Search diabetes diagnosis and treatment Rationale: The correct answer is D. Boolean connections include the terms "and," "not," and "or," which link thesaurus terms and influence the search. 13. Which website is an important source for clinical evidence but limited as a provider of primary documents for literature reviews? a. CINAHL b. MEDLINE c. Cochrane Library d. PsychINFO Rationale: The correct answer is C. The Cochrane Library is important as a source for clinical evidence but limited as a provider of primary documents for literature reviews. 14. What is considered to be essential to a thorough and relevant review of the literature? a. Use of both published and unpublished sources b. Critical evaluation of mainly primary sources c. Liberal use of secondary sources d. Evaluation of both quantitative and qualitative sources Rationale: The correct answer is B. A thorough and accurate evaluation of mainly primary sources of information is necessary for a thorough and relevant literature review. 15. Which objective of a review of the literature is unique to a review for research purposes, rather than a review for evidence-based practice? a. Discover conceptual frameworks used to examine problems b. Generate useful research questions and hypotheses c. Determine what is unknown about a subject, as well as what requires clarification d. Uncover a new practice intervention or gain support for current interventions and policies Rationale: The correct answer is B. For research purposes, the literature review focuses on the study by discovering gaps or conflicts in the literature and identifying areas where little research evidence exists. This helps define the research questions and hypotheses. 16. Which of these factors limits the usefulness of the World Wide Web as a source of information for research consumers? a. Downloading from the Web can be a slow process. b. Nontext capabilities reduce the professionalism of presentations. c. There is little quality control over the information on many websites. d. Much of the available information is too technical to be understood by the casual reader. Rationale: The correct answer is C. Many sources are not data based and primary sources. It is not always evident which sources are data based and which are not. 17. When the nurse researcher conducts an electronic literature search, the search yields more than 7000 citations for the topic. The researcher should make which of these interpretations of the findings? a. The search was comprehensive. b. The key words were not sufficiently narrowed. c. The topic does not require additional investigation. d. The topic has broad application across health care disciplines. Rationale: The correct answer is B. Limiting the focus is necessary using thesaurus terms. 18. Why would a nurse researcher choose to use multiple online fee-based databases such as CINAHL and MEDLINE? a. The charges for these services are minimal. b. Databases are updated weekly or monthly. c. An independent professional critique of each work accompanies the full text. d. The service provides translations to English of articles written in other languages. Rationale: The correct answer is B. Databases are updated monthly or weekly. 19. A study published in a nursing research journal is titled, "Effects of nocturnal hemodialysis on physiological and psychological parameters of patients with end-stage kidney disease." The nurse should recognize that this study belongs to which of these types of reference? a. Primary b. Secondary c. Tertiary d. Historical Rationale: The correct answer is A. The example is a research study, a primary source. 20. Literature reviews are usually organized according to what? a. The order in which materials are retrieved b. The conceptual or theoretical concepts c. The importance or credibility of authors d. The variables being studied Rationale: The correct answer is D. The variables being studied provide a useful organizational approach to the literature review. 1. Which phrase correctly defines a theory? a. The operational definition of the study's conceptual framework b. The assumptions and beliefs of the worldview of the researcher c. A set of interrelated concepts that provides a systematic view of a phenomenon d. A researcher's best guess of the direction of the relationship between variables Rationale: The correct answer is C. A theory is a set of interrelated concepts that provides a systematic view of a phenomenon. 2. In which way are theory and practice interrelated for the hospital-based nurse researcher? a. Practice is the operational definition of theory. b. Practice provides the opportunity to test theory. c. Theory provides the evidence on which practice is based. d. Theory generates questions that are used to refine practice. Rationale: The correct answer is B. Practice environments provide settings in which to test theory. 3. Which nursing theory is classified as a Grand Nursing Theory? a. Polk's Theory of Resilience b. Mishel's Uncertainty in Illness Theory c. Orem's Self-Care Deficit Nursing Theory d. Im's Theory of Caucasians' Cancer Pain Experience Rationale: The correct answer is C. Orem's theory is a Grand Nursing Theory since it is an all- inclusive conceptual structure that includes views on person, health, and environment. 4. Situation-specific nursing theories are becoming more popular in nursing research for which of these reasons? a. Increased emphasis on evidence-based practice b. Increased need for broad and generalizable models to explain phenomena c. Decreased resources for funding of grand theory development d. Decreased use of theories borrowed from other disciplines Rationale: The correct answer is A. Situation-specific theories provide closer links between theory and practice, which is important because of the increased demand for evidence-based practice. 5. A graphic or symbolic representation of a phenomenon not directly observable, which allows the reader to visualize key constructs and their interrelationships, is called what? a. A concept b. A conceptual definition c. An operational definition d. A model Rationale: The correct answer is D. A model is a graphic or symbolic representation of a phenomenon that allows the reader to visualize the key concepts/constructs and their identified interrelationships. 6. How is a model related to a concept or concepts? a. A model tests conceptual theories. b. A concept defines the purpose of a model. c. Relationships between or among concepts are demonstrated in a model. d. Concepts generate the theoretical basis for knowledge depicted in a model. Rationale: The correct answer is C. A model allows the reader to visualize the key concepts and their identified interrelationships. 7. Pender's health promotion model is an example of what type of theory? a. Grand nursing theory b. Middle-range nursing theory c. Situation-specific nursing theory d. Another discipline's theory applied to nursing Rationale: The correct answer is B. Pender's health promotion model is a middle-range nursing theory focused on a limited aspect of reality. 8. Which statement is an operational definition of a concept? a. Death anxiety is an uncomfortable feeling on contemplation of one's own death, measured by Templar's Death Anxiety Scale (Templar, 1986). b. Pain is a pattern of responses to protect the organism from harm (Sternbach, 1979). c. Maternal identity entails maternal cognitions and affect with regard to the maternal-infant relational system (Walker and Montgomery, 1994). d. Spirituality is a way of being or experiencing that comes about through an awareness of a transcendent dimension and one's identifiable values with regard to self, other, nature, and whatever one considers to be ultimate (Elkins, 1988). Rationale: The correct answer is A. An operational definition of death anxiety is provided because it states how death anxiety will be measured. 9. When reading a report of the results of a nursing research study, the nurse notices that the theoretical framework is drawn from a discipline other than nursing. When critiquing the theoretical framework, the nurse should determine the answer to which of these questions? a. Does the research have implications across disciplines? b. Is the researcher a recognized leader in the discipline of nursing? c. Does the author have special expertise or education in the discipline from which the theoretical framework is derived? d. Has the author clearly indicated the meaning of the theoretical framework to the study and linked it to nursing? Rationale: The correct answer is D. The theoretical framework does not have to come from nursing but should be linked to the practice of nursing. 10. Which research report title suggests that theory was generated as the outcome of the study, rather than being used as the framework for the study? a. Women's experiences of undergoing CABG surgery (Banner, D., et al., 2011) b. Couple functioning and post-traumatic stress symptoms in U.S. army couples: The role of resilience (Melvin, K.C., et al., 2011) c. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management (Thomas, M.L., et al., 2012) d. A predictive and moderating model of psychosocial resilience in adolescents (Tusaie, K., et al., 2007) Rationale: The correct answer is A. The study of women's experiences of a specific cardiac surgical procedure suggests a qualitative research study and the generation of a situation- specific theory or model. 11. Which research report title suggests that theory was used as the framework for the study, rather than being generated as the outcome of the study? a. The experiences of nurse practitioners providing health care to the homeless (Seilor, A.J. & Moss, V.A., 2012) b. A transformative decision-making process for mammography screening among rural, low- income women (Purtzer, M.S., 2012) c. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management (Thomas, M.L., et al., 2012) d. Older adults' perceptions of feeling safe in an intensive care unit (Lasiter, S., 2011) Rationale: The correct answer is C. The title describes a quantitative study regarding the effect on cancer pain management (dependent variable) of two approaches—educational coaching versus standard care (independent variables). Thus the theoretical framework for the study has to do with motivational-interviewing-based coaching. 1. When critiquing a research study's theoretical framework, the nurse should keep in mind which information? (Select all that apply.) a. Theoretical frameworks guide hypothesis formulation in qualitative and quantitative research studies. b. Theoretical frameworks can be implicitly or explicitly stated in a research report. c. A theoretical framework of a nursing research study must be based on nursing theories or models. d. A theoretical framework may not be identified in all types of nursing research. Rationale: The correct answer is B, D. A theoretical framework can be implicitly or explicitly stated, depending on the type of research performed. Not all research studies have a stated theoretical framework. In fact, qualitative research reports rarely cite theoretical frameworks. 1. The measures used by a nurse researcher to maintain uniformity of conditions in a quantitative research study refer to which aspect of the study? a. Accuracy b. Methods c. Control d. Validity Rationale: The correct answer is C. Control is the term used for measures taken by the researcher to keep the conditions of a study uniform. 2. What is the overall purpose of the research design in a quantitative research study? a. To determine sample size b. To identify the problem statement c. To assist the researcher in identifying gaps in the knowledge base d. To provide a plan for answering the research question Rationale: The correct answer is D. The purpose of the research design is to provide a plan for answering the research question(s). 3. In which of these ways does the nurse researcher's literature review help select the appropriate study design? a. By enlarging the scope of the study's hypotheses b. By objectively assessing available knowledge of the area c. By comparing current findings with previous study findings d. By ensuring faithfulness to the study's purpose Rationale: The correct answer is B. Objectivity in the conceptualization of the research question is derived from a thorough review of the literature. 4. When reviewing a research report, the nurse determines that all aspects of a study systematically and logically follow from the research problem. Which condition has been met? a. Accuracy b. Feasibility c. Internal validity d. External validity Rationale: The correct answer is A. Accuracy indicates that all aspects of a study systematically and logically flow from the research question. 5. Which factor is most likely to be a mediating variable in a study to determine if high doses of vitamin C help reduce the subjects' susceptibility to influenza? a. The subjects' use of influenza vaccine b. The subject' knowledge of vitamin C's functions c. The gender of the potential subjects d. The marital status of the potential subjects Rationale: The correct answer is A. An extraneous or mediating variable is one that interferes with the operations of the variables being studied, such as the study's outcome, which is susceptibility to influenza. 6. A nurse researcher is designing a quantitative research study involving a specific group of patients admitted to local hospitals. Which factor would negatively affect the feasibility of this study? a. The local region has a high percentage of families that could participate in the study. b. Potential study subjects represented less than 1% of hospital admissions during the year previous to the study. c. Study participants who were hospitalized children younger than 5 years could not give direct informed consent to participate in the study. d. A comprehensive review of the literature revealed no studies were conducted that examined this question during the past 15 years. Rationale: The correct answer is B. Feasibility refers to the pragmatic considerations of a study (e.g., availability of subjects, cost). 7. A nurse is designing a study to determine whether a videotape or a written pamphlet is more effective in teaching young women how to perform a breast self-examination (BSE). Which of these actions would provide the best control for a mediating variable? a. Include identical content in both BSE teaching methods b. Exclude subjects who already perform BSE on a regular basis c. Limit the study subjects to women who are heterosexual d. Determine what breast cancer means to the individual participants Rationale: The correct answer is B. Subjects who were already performing BSE would not be appropriate to include in the study. 8. How would a nurse researcher ensure that the sample used in a quantitative study is homogeneous? a. Use eligibility criteria to limit extraneous variables relevant to the study. b. Randomly assign subjects to either the experimental or the control group. c. Assign one research assistant to collect data from all subjects. d. Collect data from all subjects at the same time of day. Rationale: The correct answer is A. Homogeneity of a sample is ensured by restricting eligibility criteria. 9. How could a nurse researcher's use of a homogeneous sample weaken a research study? a. By decreasing the reliability of the findings b. By decreasing the generalizability of the findings c. By increasing the number of subjects needed to reach statistical significance d. By increasing the risk that the findings were the result of chance alone Rationale: The correct answer is B. Homogeneity of a sample can decrease the generalizability of the findings to other populations. 10. Why should a nurse researcher want to limit or eliminate extraneous variables in a study? a. More research questions would be required to account for extraneous variables. b. Extensive statistical analysis would be required to justify the presence of extraneous variables. c. Extraneous variables compete with the independent variables as explanations of the study's outcome. d. Manipulation of the extraneous variables increases the risk of researcher bias in the study's outcomes. Rationale: The correct answer is C. Extraneous or mediating variables interfere with analyzing the effect of the independent variables on the dependent variable. 11. When should a nurse researcher include an extraneous variable as part of a study's design? a. When excluding the variable would limit the study's generalizability b. When the variable is an important consideration for the study's outcome c. When the researcher is limited by time or monetary constraints d. When it would not make a difference in the overall study outcome Rationale: The correct answer is B. If the researcher believes that an extraneous variable is important to the outcome, it should be included in the design. 12. A study is examining the effect of a new antilipemic drug, compared with placebo, on lipoprotein levels in postmenopausal women. Which of these actions represents the researcher's attempt at consistency in data collection to control extraneous variables? a. Drawing the serum lipoprotein levels of all subjects at the same time of day b. Having the same phlebotomist draw serum lipoprotein levels of all subjects c. Using the same room for drawing blood for lipoprotein levels of all subjects d. Ensuring that all subjects are postmenopausal women taking lipid-lowering medication Rationale: The correct answer is A. Constancy in data collection (e.g., identical timing of collecting blood samples) helps maintain control in the research design because lipid levels may fluctuate throughout the day. 13. A nurse researcher assigns half a study sample to an experimental group and the other half to a control group. What does this action represent? a. Instrumentation of the independent variable b. Manipulation of the mediating variable c. Elimination of the mediating variable d. Manipulation of the independent variable Rationale: The correct answer is D. Administration of a treatment or intervention to an experimental (treatment) group and a control group represents manipulation of the independent variable. 14. For which of these reasons would a nurse researcher choose to assign subjects randomly to groups in a study? a. To help ensure that all groups within a study are representative of the larger population b. To increase the chance that the study groups will be different from each other with regard to extraneous variables c. To help ensure that current events do not influence the outcomes of the study d. To eliminate the need for establishing specific study criteria and subject eligibility Rationale: The correct answer is A. The purpose of randomization is to help ensure that subjects in the study's groups represent the larger population. 15. A nurse researcher assigns subjects to experimental and control groups in such a manner that each subject in a population has an equal chance of being selected. What is the researcher using? a. Selection bias b. Convenience sampling c. Randomization d. Internal validity Rationale: The correct answer is C. Randomization is the process of obtaining subjects so that each has an equal chance of being selected for experimental or control groups. 16. The issue of control would be less important in a quantitative study with which type of research design? a. Exploratory b. Experimental c. Correlational d. Randomized clinical trial Rationale: The correct answer is A. Control is less important in exploratory studies because the researcher is investigating an area in which little literature exists. 17. Which situation represents a threat to internal validity in an experimental study measuring the effect of a videotape of discharge instructions for patients who underwent coronary artery bypass graft (CABG) surgery? a. Both men and women undergoing CABG surgery were included as subjects in the study. b. Two new surgeons began performing CABG surgery during the study period. c. Patients in the experimental group discussed aspects of the videotape with patients in the control group. d. Data collection for the videotape and control groups took 1 year. Rationale: The correct answer is C. Sharing aspects of the videotape with control group members interferes with interpretation of the true effect of the independent variable on the dependent variable(s). 18. The nurse researcher designed a study examining anxiety among elementary school children. If a widely publicized murder of a child occurred in the city during the time frame of the study, what type of threat to internal validity would the murder represent? a. Maturation b. Instrumentation c. Selection bias d. Historical Rationale: The correct answer is D. The murder would represent a historical event threatening internal validity. 19. A nurse researcher should consider mortality a threat to the study's internal validity for which of these reasons? a. There is concern that the intervention may have harmful effects on subjects. b. Those who dropped out of the study may be different than those who remained in the study. c. Those who participated in the study may have died as a result of being in the study. d. There is concern that the design is inappropriate for the study question if a large number of participants drop out of a study. Rationale: The correct answer is B. Subjects who drop out or who are otherwise lost from a study may differ in some important way from remaining subjects and therefore threaten internal validity. 20. A nurse researcher can control for selection bias in a study by taking which of these actions? a. Allow subjects to self-select into an experimental or a control group b. Handpick the subjects for group assignment c. Use defined selection criteria for approaching potential subjects d. Have someone other than the researcher selects the subjects for the study Rationale: The correct answer is C. Selection criteria (inclusive and exclusive) that are consistently applied help obtain a representative sample and decrease the risk of selection bias. 21. External validity refers to which of these issues? a. The relationship existing between the independent variable and the study outcomes b. The influence of a specific event on the independent variable c. The degree to which extraneous or mediating variables interfere with the study outcomes d. The degree to which findings are generalizable to populations beyond those studied Rationale: The correct answer is D. External validity deals with possible problems of generalizability of the investigation's findings to other populations or environments. 22. Which of these situations describes a reactive (Hawthorne) effect? a. Control subjects in an intervention study to reduce anxiety also experience a reduction in anxiety. b. The subjects in an intervention support group continue the support group after the study has ended. c. Subjects become concerned after learning that they received a placebo, not the treatment, during the study. d. Study subjects want to know the outcomes of the study after it is completed. Rationale: The correct answer is A. Reactivity occurs when control subjects respond to the investigator not because of the treatment but because of the fact they were being studied. 23. A nurse researcher is investigating the effect of type of operating room mattress and surgical position on tissue interface pressures in healthy young adults. Which component of research is most affected by the choice of subjects? a. Mortality b. Instrumentation c. Internal validity d. External validity Rationale: The correct answer is D. Subject selection affects external validity (generalizability), especially because most surgical patients are not healthy young adults. 24. What action by a nurse researcher will help eliminate bias on the dependent variable? a. Establishing strict eligibility criteria for the study participants b. Ensuring that all data are collected by a single researcher c. Formulating at least two hypotheses for each research question d. Developing a strong theoretical framework for the study Rationale: The correct answer is A. Strict eligibility criteria help reduce extraneous or mediating variables that compete with the study (independent) variables for impact on the dependent variable. 1. A nurse researcher is planning to write a proposal for a research study using a quantitative design. To maintain control in the study, the nurse should include which elements? (Select all that apply.) a. Valid, reliable collection methods b. Subjects of all ages c. Trained data collectors d. Standardized data collection processes e. Analysis of data by words or text only Rationale: The correct answer is A, C, D. Control requires valid, reliable instruments. Trained research assistants help maintain standardized procedures and promote control. Data collection processes that are standardized promote control. 2. A nursing student is reviewing a research study in which researchers used a pretest/posttest design to examine the effect of an AIDS education intervention on teenagers' knowledge about the condition over a school year. What threats to internal validity could be present? (Select all that apply.) a. Maturation b. Selection effects c. Reactivity d. Hawthorne effect e. Testing Rationale: The correct answer is A, E. Maturation could be an issue because the students may learn about AIDS from other sources over the school year. Testing is a threat to internal validity because use of a pretest may affect subjects' subsequent responses to a posttest. 3. What should the nurse researcher consider when determining the feasibility of a research question? (Select all that apply.) a. Time b. Selection effects c. Reactive effects d. Measurement effects e. Subject availability f. Cost Rationale: The correct answer is A, E, F. The research question must be one that can be studied within a realistic time period. The researcher must determine whether a sufficient number of eligible subjects will be available and willing to participate in the study. Before embarking on a study, the researcher should itemize the expenses and project the total cost of the project. 4. Which factors would be considered threats to internal validity? (Select all that apply.) a. Time b. Selection effects c. History d. Testing e. Subject availability f. Cost g. Selection bias Rationale: The correct answer is C, D, G. History refers to events occurring outside the study setting that can affect the dependent variable. Testing can affect the dependent variable because the effect of taking a pretest may affect the subjects' posttest performance (the dependent variable). Selection bias occurs if precautions are not taken to obtain a representative sample. Randomly assigning subjects to groups helps to minimize selection bias. 1. The nurse is critiquing a research study that used an experimental design. How can the nurse determine if the study's results are able to infer causality? a. The relationship between independent and dependent variables must be reciprocal. b. The relationship between independent and dependent variables must not be explainable by any other variable. c. Both independent and dependent variables should be characterized by reactive effects. d. Both independent and dependent variables should change as a result of the treatment. Rationale: The correct answer is B. Critical to causality is the control of extraneous variables that may influence changes in the dependent variable. 2. The nurse is critiquing a research study that involves subjects undergoing chemotherapy for breast cancer. Which finding would meet a criterion for inferring causality between performance of exercise and adaptive behavior of the subjects receiving chemotherapy? a. Adaptive behavior began before the exercise program was initiated. b. Adaptive behavior occurred in the control group over time. c. The level of adaptive behavior increased in direct proportion to an increase in the intensity of the exercise. d. No difference in adaptive behavior was observed between subjects in the experimental group and subjects in the control group. Rationale: The correct answer is C. Causality is supported by a clear proportional change in the dependent variable (adaptive behavior) following a clear proportional change in the independent variable (exercise). 3. The experimental treatment initiated by the researcher can be described as what kind of variable? a. Independent b. Dependent