Test Bank For Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice 4th Edition

1. A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement EBP. Which of the following questions could those nurses best answer by consulting a textbook? A) “What effect does a diagnosis of renal failure have on type 2 diabetics' glucose monitoring behavior?” B) “What factors influence clinicians' decisions to recommend peritoneal dialysis over hemodialysis?” C) “What are the anatomical characteristics and physiological functions of the kidneys?” D) “What is the relationship between dosing of erythropoietin therapy and hemoglobin levels in patients with chronic renal failure?” 2. A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first? A) A newspaper article B) A systematic review C) A conference presentation D) A journal article 3. After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has “googled” the subject. How should the nurse best interpret the results of this search? A) The nurse must carefully evaluate the results of this search. B) The results of searching sites such as Google and Yahoo are not clinically useful. C) The search is likely to yield inaccurate or biased results. D) The search is a time-efficient substitute for searching online health databases. 4. A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most likely to provide the nurse with specific interventions and practices to achieve this goal? A) Cumulative Index to Nursing and Allied Health Literature (CINAHL) B) National Guideline Clearinghouse C) PsycINFO D) MEDLINE 5. A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital's policy on the use of physical restraints. During the search, what parameters should the nurse establish for the dates of articles and other information sources? A) Articles should be ranked according to publication date, with the most recent articles being prioritized. B) The nurse should attempt to identify collaborative evidence for any source that is more than 3 years old. C) The nurse should establish a cutoff for sources more than 5 years old. D) The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication. 6. While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching “beta blockers.” How should the nurse proceed? A) Identify the appropriate MeSH term B) Search for clinical guidelines in the Cochrane Library C) Consult the reference lists in articles that appeared during the search D) Search the trade names of specific beta-blocking drugs 7. In light of the large number of gall bladder patients recently admitted to the unit, a nurse is searching PubMed for literature relating to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field? A) “chole*” B) “cholecystitis or cholecystectomy or cholelithiasis or cholecystography” C) “gall bladder” D) “chole-” 8. A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results? A) “nutrition OR (delirium OR dementia)” B) “(delirium OR dementia) AND nutrition” C) “delirium dementia nutrition” D) “delirium AND dementia AND nutrition” 9. In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search? A) Only noncopyrighted resources will be available to the nurse. B) The nurse will be guaranteed that each result will be from a peer-reviewed source. C) The nurse will be unable to conduct a valid or useful search. D) Articles that are relevant may be excluded from consideration. 10. A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions? A) Cochrane Database of Systematic Reviews (CDSR) B) Cochrane Central Register of Controlled Trials (CENTRAL) C) Cochrane Methodology Register D) Health Technology Assessment (HTA) Database 11. A nurse has conducted a search of PubMed to answer the question, What factors influence older adults' decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue? The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed? A) Date of publication B) Number of times the article has been cited C) Ranking by peer review D) Date the article was added to the database 12. A nurse is working on a literature review using a laptop computer while in a café that provides wireless Internet access but will not allow for connection to the hospital library's server that provides the nurse's normal access to database subscriptions. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection? A) PubMed B) Cochrane Library C) MEDLINE D) EMBASE 13. Management of a county hospital has been resistant to providing time, facilities, and subscriptions to allow nurses to conduct online searches near the point of care. Which of the following arguments can the nurses present to strengthen their case for these tools? A) “Online access at or near the point of care has been mandated by law.” B) “Providing for literature searches has been shown to save money and shorten patient stays.” C) “It is unethical for nurses to provide care that is not rooted in a recent literature search.” D) “The increased confidence that nurses gain from accessing knowledge is linked to improved patient outcomes.” 14. Which of the following sources would best provide critical appraisal during a nurse's search for evidence on which to base practice? A) A journal that provides assessments of notable articles recently published in other journals B) The expert opinion of qualified and experienced nurse clinicians C) A careful examination of the methodology of a study D) The insight of a trusted hospital librarian 15. Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy? A) Organize a small-scale clinical trial to test current practices on the unit. B) Elicit the views of the most senior nurses and those nurses who exemplify EBP. C) Formulate a question and conduct a thorough search of the existing evidence. D) Seek input from physicians with expertise in the area of VAP. 1. A nurse is preparing a research proposal in an effort to answer a clinical question. Which of the following measures is most likely to reduce the potential for bias in the study? A) Replicating the research methodology of an existing study that addresses the clinical question B) Ensuring the number of participants is sufficiently high C) Randomly assigning the participants to groups D) Ensuring the clinical question reflects phenomena identified in relevant qualitative research 2. A nurse researcher is investigating the effectiveness of a new, school-based smoking prevention program. Which of the following should the nurse consider as a potential confounding historical factor? A) Students' existing attitudes toward tobacco use B) The relationship between tobacco use and alcohol use C) Students' respiratory health status at the commencement of the program D) Antismoking messages already present in the media 3. While reviewing a study that appears to favorably recommend the use of an innovative mattress for the prevention of pressure ulcers, the nurse notes that the sum of the experimental group and the control group is significantly less than the total sample. How should the nurse best interpret this fact? A) This represents a potential threat to the reliability of the study. B) A significant number of participants did not develop pressure ulcers. C) The results of the study have most likely been manipulated. D) A confounding variable was present that the authors did not account for. 4. The historical incidence of deep vein thrombosis in medical patients at a university hospital was 2.5%. This figure dropped to 2% among an experimental group during the implementation of a new prophylaxis regimen. What is the nurse's most accurate interpretation of this finding? A) The relative risk of DVT among medical patients is 2/100. B) The regimen results in a 20% relative risk reduction. C) The absolute risk of DVT among the control group is 2.5%. D) The results of the intervention are valid and reliable. 5. The number needed to treat (NNT) for an experimental vaccine is 775. This means A) 775 individuals will be prevented from developing the disease in question. B) the relative risk reduction of the disease is -775 among those who were vaccinated. C) 775 individuals must be vaccinated to prevent one case of the disease. D) vaccinated individuals have a 1-in-775 chance of developing the disease. 6. The findings of a study indicate that the chance of the effect being attributable to chance is 1 in 25. How would this fact be expressed in the study? A) RR = 4% B) AR = 24 C) p = 0.04 D) NNT = 25 7. While reviewing the findings of a study addressing the nursing management of gestational diabetes, the nurse notes that the study fails to address the findings of the existing literature on the subject in a detailed or specific manner. How should this influence the nurse's view of the study? A) The findings of the study likely represent a notable advance in gestational diabetes management. B) This omission should be addressed in the statistical analysis of the study. C) This is acceptable in a qualitative, but not quantitative, study. D) The authors should have addressed the existing body of knowledge around the subject. 8. A nurse has presented a published case study to other nurses on the unit that relates the case of a patient who experienced respiratory arrest and sudden death following the infusion of total parenteral nutrition (TPN). How should the nurses respond to the findings of this case study? A) Modify unit practice around TPN administration B) Avoid administering TPN until more is known about the subject C) Take note of the phenomenon and do further research before implementing practice changes D) Disregard the findings of the case study due to the low level of evidence provided by a case study 9. A cohort study has investigated the effect of an asthma care support program for asthma patients under 18 years old on participants' frequency of emergency department visits. Which of the following aspects of the study raises questions about the validity or reliability of the study? A) The study included 310 pediatric asthma patients. B) The program was initiated over 7 years ago and was evaluated by reviewing medical records. C) The participants received various types of pharmacological treatment and psychosocial support for their asthma. D) The study was conducted without the presence of a control group. 10. Which of the following measures is most likely to ensure baseline equivalency in a randomized controlled trial that will test the efficacy of a new bandaging system for chronic venous leg ulcers? A) Ensuring that clinicians are unaware of whether the bandage they are applying is the experimental or control product B) Randomly assigning participants to the “new bandage” group and the “old bandage” group C) Rigorously screening potential participants to ensure they have as many characteristics in common as possible D) Setting strict criteria around the character and severity of ulcers that will be treated 11. A gerontological nurse is reviewing the findings of a study that tested the efficacy of donepezil in the treatment of Alzheimer's disease. Assignment to groups in the study included the fact that the researchers distributed participants with early Alzheimer's and advanced Alzheimer's evenly among the control group and the experimental group. The nurse would recognize that the researchers implemented which of the following? A) A quasi-experiment B) Cluster randomization C) A cohort study D) Stratified randomization 12. A nurse who provides care in a psychiatric care facility is reviewing the literature on the use of quetiapine for the treatment of schizophrenia. When reviewing a randomized control trial (RCT) testing the efficacy of the drug, which of the following measures should the nurse look for to best minimize the potential for bias? A) The participants and clinicians did not know if they were receiving or administering a placebo or the drug. B) The clinicians were able to select which participants were assigned to the control group or the experimental group. C) The participants did not know if they were receiving quetiapine or a placebo pill. D) Participants were selected to the control group or experimental group based on the severity of their symptoms. 13. A nurse is reviewing a study comparing a new alcohol screening instrument to an existing instrument in predicting patients' withdrawal symptoms during hospital admissions. The nurse notes that the confidence interval of the study includes a relative risk (RR) of 1. What are the implications of this fact? A) The screening instruments are unable to predict patients' risks for alcohol withdrawal. B) Using the new instrument will result in more unanticipated cases of withdrawal. C) The new instrument is a modest improvement on the existing instrument. D) The new instrument may be no better than the existing one in predicting withdrawal. 14. In an effort to update the unit protocol for the nursing management of hypoglycemic episodes, a nurse educator has consulted a systematic review that is available on the subject. Which of the following criteria should the nurse prioritize when assessing a systematic review? A) Ensuring the inclusion criteria limited the review to studies published within the past 5 years B) Checking to see that both studies that were included and those that were excluded are specified C) Ensuring that unpublished studies were excluded from the systematic review D) Confirming that all of the studies that were included in the review were statistically analyzed as one data set 15. When reviewing the studies that were included in a systematic review, a nurse is aware of the potential for publication bias. What is an implication of this phenomenon? A) Studies with no demonstrated effect may not appear in the literature. B) Studies that challenge accepted practice are often rejected for publication. C) The fact that a study has been published constitutes a form of bias. D) Biased publications often form the basis of accepted practice. 1. As a starting point for an initiative to integrate more evidence into the nursing practice at a community hospital, the nursing leadership has begun by holding meetings and focus groups aimed at developing a shared mental framework. What will this framework encompass? A) A statement of the goals for practice at a designated point in the near future B) An action plan for implementing EBP C) The values and ideals of nurses that can inspire change D) A brief document that outlines the mission of the organization and the nurses 2. Caregivers and leaders of a university medical center are pleased that their facility has recently been granted Magnet recognition by the American Nurses Credentialing Center (ANCC). What does this designation indicate about the hospital? A) The hospital has met specific outcomes for which EBP forms the foundation. B) The hospital has demonstrated positive patient outcomes and attracted practitioners from outside the geographic region. C) The hospital has proven to be a site where new research is conducted and new evidence is generated. D) The hospital has demonstrated the presence of a cohort of staff committed to providing EBP. 3. Two recent nursing graduates have resolved to champion EBP on the hospital unit where they provide care. They should begin this initiative by A) identifying research that relates to their practice setting and patient population. B) creating a shared understanding of the type of practice environment they envision. C) identifying a list of achievable goals for practice. D) enlisting the help of expert nurses who have experience in producing and implementing research. 4. In an effort to create an environment that exemplifies EBP, the nursing leadership has made a concerted effort to include as many caregivers as possible, from numerous levels, in the process. What is the most likely rationale for this aspect of the change process? A) Promoting engagement B) Identifying and removing barriers C) Identifying goals D) Prioritizing clinical issues 5. A group of nurses has encountered difficulties at many points in their efforts to integrate EBP on the medical unit where they provide care. Which of the following barriers is likely to present the greatest challenge? A) The difficulty of identifying research that relates directly to their patient population B) Apathy and resistance on the part of a cohort of nurses on the unit C) Unfamiliarity of some nurses with the concept of EBP D) The lack of a common vision for change among the nurses who are advocating EBP 6. In the course of narrowing their focus in a campaign to implement EBP in their workplace, a group of nurses is currently choosing which nursing areas to address. The nurses should prioritize which of the following? A) Nursing activities that are most familiar to the educators on the unit B) Areas that relate to the outcomes necessary for Magnet recognition C) Nursing actions that are addressed in the most detail in the literature D) Interventions that nurses perform most often during their care 7. Which of the following principles should guide the choice of leadership when implementing EBP? A) Staff nurses should be mentored into familiarity with EBP by experts. B) Nurses should independently guide the EBP process in order to facilitate their experiential knowledge. C) Experts from academic settings should be brought in to carry out the process. D) Hospital leaders and administrators, assisted by nurses, should guide the EBP process. 8. How can an EBP implementation team best build engagement and buy-in among nurses? A) By emphasizing the pride and sense of accomplishment that can come from implementing EBP B) By emphasizing the positive outcomes that can be brought about by the change C) By identifying the relationship between EBP and the American Nurses Association's Nursing Standards D) By explaining the role of EBP in Magnet recognition 9. The nurses on a pediatric unit have identified a need for changes to their assessment practices to minimize sleep disruption to patients. Which of the following strategies should the EBP implementation team use in an effort to disseminate the evidence that forms the foundation of EBP? A) Distributing new clinical practice guidelines that are reflective of EBP B) Combining information on relevant changes with stories of the effects of change C) Increasing nurses' access to online databases and journals D) Offering teaching sessions from an expert nurse during scheduled break times 10. The nurses who provide care in the cardiac catheterization clinic of a large hospital are currently engaged in an EBP initiative. Which of the following factors will have the greatest effect on the success or failure of the initiative? A) Ensuring that practice guidelines are widely-distributed, clear, and well-understood B) Providing opportunities for staff to see EBP in action at other hospitals and care facilities C) Restructuring the flow and organization of work to allow EBP to be implemented D) Ensuring that examples of traditional practice that are not evidence-based are identified and addressed 11. The staff of a medical unit has agreed to pilot test a new, evidence-based educational initiative that addresses the learning needs of adults who have been recently diagnosed with type 2 diabetes. A pilot test is likely to accomplish which of the following? A) Determine whether the existing research on diabetes education is valid and reliable. B) Reduce the incidence of type 2 diabetes among local adults. C) Gauge whether nurses are qualified to perform patient and family teaching related to diabetes. D) Indicate whether the initiative is feasible to implement and applicable to the population. 12. Nurses on a labor-and-delivery unit are in the early stages of planning an evidence-based initiative aimed at establishing evidence-based practice around fetal monitoring during labor. Which of the following guidelines should the nurses follow when planning the timeline of this EBP initiative? A) The nurses should be aware that if the initiative spans more than 3 months, it is very difficult to sustain momentum. B) Constraining the initiative to a written timeline compromises the success of the initiative. C) The nurses should identify the multiple variables that could affect the project and create a timeline accordingly. D) Most complex EBP initiatives can be implemented in 8 to 10 weeks. 13. During the planning stages of an evidence-based falls-prevention initiative, the nurses at a convalescent facility are organizing the way that the initiative will be evaluated. When should the nurses plan to audit the incidence of falls at the facility? A) Immediately following the completion of the initiative B) One to 2 months after the project has been completed C) Before and immediately after the project D) Before and right after the project as well as several weeks or months after the change 14. Use of a new, evidence-based method of securing intravenous catheters and tubing has resulted in 31% fewer incidents of accidental or intentional IV removal on a pediatric unit. This statistic is an example of what type of evaluation indicator? A) Risk reductions B) Environmental changes C) Efficiency of processes D) Outcome measures 15. Which of the following phenomena would signal that an EBP initiative has resulted in environmental change? A) Hypo- and hyperglycemia are being addressed more quickly than before an EBP initiative. B) Nurses are consulting and implementing the unit policy and procedures manual more often than before an initiative. C) Staff compliance with hand washing and hand sanitizing increased 26% over the course of an initiative. D) Sick calls and other forms of absenteeism have been reduced following the completion of an EBP initiative.