NR-449 – Evidence-Based Practice Project
Capstone Project Study Guide, Research
Application, Quality Improvement, Clinical
Practice, and Nursing Success Review
Q1. A nurse is initiating an evidence-based practice (EBP) project on the unit.
Which of the following best defines evidence-based practice?
A) Using clinical judgment without research evidence
B) Integrating the best research evidence, clinical expertise, and patient
preferences
C) Following hospital policies without question
D) Using only randomized controlled trials to guide practice
Answer: B — Integrating the best research evidence, clinical expertise, and
patient preferences
Rationale: Evidence-based practice (EBP) is the integration of the best research
evidence, clinical expertise, and patient preferences and values. It is a problem-
solving approach to clinical decision-making that uses current, best evidence in
combination with clinical judgment and patient values. EBP improves patient
outcomes, reduces variability in care, and enhances the quality of healthcare
delivery. It is a core competency for all healthcare professionals.
Q2. A nurse is formulating a clinical question for an EBP project. Which of the
following is the correct format for a PICOT question?
A) Problem, Intervention, Comparison, Outcome, Time
B) Population, Intervention, Comparison, Outcome, Time
C) Patient, Indicator, Control, Outcome, Time
D) Problem, Indicator, Clinical Outcome, Time
Answer: B — Population, Intervention, Comparison, Outcome, Time
,Rationale: A PICOT question is a structured clinical question used to guide
evidence-based practice. The components are: P (Population/Patient
problem), I (Intervention), C (Comparison/Control intervention), O (Outcome),
and T (Time frame). The PICOT format helps focus the question and guide the
search for evidence. A well-formed PICOT question is essential for a successful
EBP project.
Q3. A nurse is reviewing levels of evidence for an EBP project. Which of the
following represents the highest level of evidence?
A) Expert opinion
B) Systematic review of randomized controlled trials (RCTs)
C) Cohort study
D) Case-control study
Answer: B — Systematic review of randomized controlled trials (RCTs)
Rationale: The highest level of evidence is a systematic review or meta-analysis
of multiple randomized controlled trials (RCTs) . These studies provide the
strongest evidence because they synthesize data from multiple high-quality studies,
increasing statistical power and generalizability. The evidence hierarchy, from
highest to lowest, is: systematic reviews/meta-analyses, RCTs, controlled trials,
cohort studies, case-control studies, case series, expert opinion.
Q4. A nurse is conducting a literature search for an EBP project. Which of the
following databases is most appropriate for nursing research?
A) PubMed
B) CINAHL
C) Google Scholar
D) PsycINFO
Answer: B — CINAHL
Rationale: CINAHL (Cumulative Index to Nursing and Allied Health
Literature) is the most comprehensive database for nursing and allied health
research. It indexes nursing journals, evidence-based care sheets, and research
articles. PubMed is a biomedical database that also contains nursing
,research. Google Scholar is a broad search engine that may include gray literature
but is less focused. PsycINFO is focused on psychology and behavioral sciences.
Q5. A nurse is appraising a research article for an EBP project. Which of the
following is a key criterion for evaluating the validity of a study?
A) The study was published in a prestigious journal
B) The study used a rigorous research design and appropriate statistical
analysis
C) The study was conducted by a well-known researcher
D) The study had a large sample size
Answer: B — The study used a rigorous research design and appropriate
statistical analysis
Rationale: When appraising a research article for evidence-based practice, the
nurse should evaluate the validity of the study: whether the research design was
rigorous, whether appropriate statistical analysis was used, and whether the
findings are credible. A large sample size is important but not sufficient.
Publication in a prestigious journal and the reputation of the researcher do not
guarantee validity. Critical appraisal involves assessing the study's methodology,
results, and applicability to practice.
Q6. A nurse is implementing a quality improvement (QI) project on a medical-
surgical unit. Which of the following best describes the difference between QI and
EBP?
A) QI focuses on individual patient care; EBP focuses on systems
B) QI focuses on improving processes at the local level; EBP focuses on using
best evidence to guide practice
C) QI is only for nurses; EBP is for physicians
D) QI and EBP are the same
Answer: B — QI focuses on improving processes at the local level; EBP
focuses on using best evidence to guide practice
Rationale: Quality improvement (QI) focuses on improving processes and
outcomes at the local level (e.g., a specific unit or organization) using data to drive
, change. Evidence-based practice (EBP) focuses on using the best available
research evidence to guide clinical decision-making and improve patient
outcomes. While they are related, QI is often more localized and process-focused,
while EBP is broader and evidence-focused. Both are essential for improving
patient care.
Q7. A nurse is developing an evidence-based protocol for fall prevention. Which
of the following steps should the nurse take first?
A) Implement the protocol on the unit
B) Formulate a PICOT question
C) Search the literature for evidence
D) Evaluate the outcomes
Answer: B — Formulate a PICOT question
Rationale: The first step in developing an evidence-based protocol is to formulate
a PICOT question to clearly define the clinical problem. This guides the literature
search and evidence appraisal. The steps of EBP are: Ask (PICOT question),
Acquire (search for evidence), Appraise (critically appraise the evidence), Apply
(implement the evidence), and Assess (evaluate outcomes). Formulating the
question is the foundation of the process.
Q8. A nurse is reviewing the hierarchy of evidence for a systematic review.
Which level of evidence is a cohort study ?
A) Level I
B) Level II
C) Level III or IV
D) Level V
Answer: C — Level III or IV
Rationale: The hierarchy of evidence from highest to lowest: Level I (systematic
reviews/meta-analyses of RCTs), Level II (randomized controlled trials), Level III
(controlled trials without randomization), Level IV (cohort and case-control
studies), Level V (systematic reviews of descriptive/qualitative studies), Level VI
(single descriptive/qualitative studies), Level VII (expert opinion). A cohort study
Capstone Project Study Guide, Research
Application, Quality Improvement, Clinical
Practice, and Nursing Success Review
Q1. A nurse is initiating an evidence-based practice (EBP) project on the unit.
Which of the following best defines evidence-based practice?
A) Using clinical judgment without research evidence
B) Integrating the best research evidence, clinical expertise, and patient
preferences
C) Following hospital policies without question
D) Using only randomized controlled trials to guide practice
Answer: B — Integrating the best research evidence, clinical expertise, and
patient preferences
Rationale: Evidence-based practice (EBP) is the integration of the best research
evidence, clinical expertise, and patient preferences and values. It is a problem-
solving approach to clinical decision-making that uses current, best evidence in
combination with clinical judgment and patient values. EBP improves patient
outcomes, reduces variability in care, and enhances the quality of healthcare
delivery. It is a core competency for all healthcare professionals.
Q2. A nurse is formulating a clinical question for an EBP project. Which of the
following is the correct format for a PICOT question?
A) Problem, Intervention, Comparison, Outcome, Time
B) Population, Intervention, Comparison, Outcome, Time
C) Patient, Indicator, Control, Outcome, Time
D) Problem, Indicator, Clinical Outcome, Time
Answer: B — Population, Intervention, Comparison, Outcome, Time
,Rationale: A PICOT question is a structured clinical question used to guide
evidence-based practice. The components are: P (Population/Patient
problem), I (Intervention), C (Comparison/Control intervention), O (Outcome),
and T (Time frame). The PICOT format helps focus the question and guide the
search for evidence. A well-formed PICOT question is essential for a successful
EBP project.
Q3. A nurse is reviewing levels of evidence for an EBP project. Which of the
following represents the highest level of evidence?
A) Expert opinion
B) Systematic review of randomized controlled trials (RCTs)
C) Cohort study
D) Case-control study
Answer: B — Systematic review of randomized controlled trials (RCTs)
Rationale: The highest level of evidence is a systematic review or meta-analysis
of multiple randomized controlled trials (RCTs) . These studies provide the
strongest evidence because they synthesize data from multiple high-quality studies,
increasing statistical power and generalizability. The evidence hierarchy, from
highest to lowest, is: systematic reviews/meta-analyses, RCTs, controlled trials,
cohort studies, case-control studies, case series, expert opinion.
Q4. A nurse is conducting a literature search for an EBP project. Which of the
following databases is most appropriate for nursing research?
A) PubMed
B) CINAHL
C) Google Scholar
D) PsycINFO
Answer: B — CINAHL
Rationale: CINAHL (Cumulative Index to Nursing and Allied Health
Literature) is the most comprehensive database for nursing and allied health
research. It indexes nursing journals, evidence-based care sheets, and research
articles. PubMed is a biomedical database that also contains nursing
,research. Google Scholar is a broad search engine that may include gray literature
but is less focused. PsycINFO is focused on psychology and behavioral sciences.
Q5. A nurse is appraising a research article for an EBP project. Which of the
following is a key criterion for evaluating the validity of a study?
A) The study was published in a prestigious journal
B) The study used a rigorous research design and appropriate statistical
analysis
C) The study was conducted by a well-known researcher
D) The study had a large sample size
Answer: B — The study used a rigorous research design and appropriate
statistical analysis
Rationale: When appraising a research article for evidence-based practice, the
nurse should evaluate the validity of the study: whether the research design was
rigorous, whether appropriate statistical analysis was used, and whether the
findings are credible. A large sample size is important but not sufficient.
Publication in a prestigious journal and the reputation of the researcher do not
guarantee validity. Critical appraisal involves assessing the study's methodology,
results, and applicability to practice.
Q6. A nurse is implementing a quality improvement (QI) project on a medical-
surgical unit. Which of the following best describes the difference between QI and
EBP?
A) QI focuses on individual patient care; EBP focuses on systems
B) QI focuses on improving processes at the local level; EBP focuses on using
best evidence to guide practice
C) QI is only for nurses; EBP is for physicians
D) QI and EBP are the same
Answer: B — QI focuses on improving processes at the local level; EBP
focuses on using best evidence to guide practice
Rationale: Quality improvement (QI) focuses on improving processes and
outcomes at the local level (e.g., a specific unit or organization) using data to drive
, change. Evidence-based practice (EBP) focuses on using the best available
research evidence to guide clinical decision-making and improve patient
outcomes. While they are related, QI is often more localized and process-focused,
while EBP is broader and evidence-focused. Both are essential for improving
patient care.
Q7. A nurse is developing an evidence-based protocol for fall prevention. Which
of the following steps should the nurse take first?
A) Implement the protocol on the unit
B) Formulate a PICOT question
C) Search the literature for evidence
D) Evaluate the outcomes
Answer: B — Formulate a PICOT question
Rationale: The first step in developing an evidence-based protocol is to formulate
a PICOT question to clearly define the clinical problem. This guides the literature
search and evidence appraisal. The steps of EBP are: Ask (PICOT question),
Acquire (search for evidence), Appraise (critically appraise the evidence), Apply
(implement the evidence), and Assess (evaluate outcomes). Formulating the
question is the foundation of the process.
Q8. A nurse is reviewing the hierarchy of evidence for a systematic review.
Which level of evidence is a cohort study ?
A) Level I
B) Level II
C) Level III or IV
D) Level V
Answer: C — Level III or IV
Rationale: The hierarchy of evidence from highest to lowest: Level I (systematic
reviews/meta-analyses of RCTs), Level II (randomized controlled trials), Level III
(controlled trials without randomization), Level IV (cohort and case-control
studies), Level V (systematic reviews of descriptive/qualitative studies), Level VI
(single descriptive/qualitative studies), Level VII (expert opinion). A cohort study
