EVIDENCE-BASED PRACTICE
& QUALITY IMPROVEMENT
Original Practice Question Bank
PICO • Evidence Hierarchy • Appraisal • Implementation • QI Tools
Original Self-Study Material with Answers & Rationales
Contents Introduction to EBP • Research designs & levels of evidence • Searching & appraisal • Implementation models • QI
methods & tools • Ethics, outcomes & translation
How to use Cover the green answer box, answer each question, then review the rationale. Focus on applying concepts to clinical
and improvement scenarios.
Disclaimer Original educational material for self-study only. Not a publisher test bank. Not affiliated with LoBiondo-Wood, Haber,
Titler, Elsevier, or any textbook publisher.
Original Nursing EBP & QI Practice Series
,Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
Unit 1: Introduction to Evidence-Based Practice
1. Evidence-based practice (EBP) is best defined as the integration of:
A. Only expert opinion
B. Best research evidence, clinical expertise, and patient values/preferences
C. Only randomized trials
D. Tradition and authority
Answer: B
Rationale: EBP integrates best evidence, clinical expertise, and patient preferences/values.
2. The first step in the EBP process is typically:
A. Implementing a change
B. Asking a clinical question (often in PICO format)
C. Publishing a paper
D. Ignoring patient preference
Answer: B
Rationale: EBP begins by asking a focused, answerable clinical question.
3. PICO stands for:
A. Patient, Intervention, Comparison, Outcome
B. Place, Intervention, Cost, Outcome
C. Patient, Intuition, Comparison, Opinion
D. Protocol, Intervention, Control, Output
Answer: A
Rationale: PICO: Patient/Population, Intervention, Comparison, Outcome (sometimes Time is added).
4. Which component is essential in a foreground clinical question?
A. Only the disease name
B. Specific comparison of interventions or exposures and outcomes
C. A yes/no historical fact
D. A dictionary definition
Answer: B
Rationale: Foreground questions compare interventions/exposures and outcomes to guide decisions.
5. Background questions are best answered by:
A. Only meta-analyses
B. Textbooks, review articles, and reliable summaries
C. Single case reports exclusively
D. Social media
Answer: B
Rationale: Background questions address general knowledge and are suited to textbooks and reviews.
6. A key reason nurses use EBP is to:
A. Increase tradition-based care
B. Improve patient outcomes and provide high-quality care
C. Eliminate clinical expertise
D. Avoid all change
Answer: B
Rationale: EBP aims to improve outcomes and quality through best available evidence.
7. Which is an example of a PICO intervention element?
A. Adults with type 2 diabetes
B. Daily foot inspection education
C. Standard care
D. Reduction in ulcer rates
Answer: B
Rationale: The intervention is the treatment or action being considered.
Educational Use Only Page 2 Not a Publisher Test Bank
,Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
8. Patient preferences in EBP refer to:
A. What the physician prefers only
B. The patient's values, concerns, and choices regarding care
C. Hospital policy only
D. Insurance requirements exclusively
Answer: B
Rationale: Patient values and preferences are a core pillar of EBP.
9. Clinical expertise in EBP includes:
A. Ignoring research
B. The clinician's education, experience, and skills applied to the individual patient
C. Only years of seniority
D. Memorizing guidelines without judgment
Answer: B
Rationale: Expertise helps tailor evidence to the specific patient and context.
10. Which statement about EBP is accurate?
A. It replaces clinical judgment
B. It supports clinical judgment with external evidence
C. It is only for researchers
D. It requires no critical appraisal
Answer: B
Rationale: EBP informs—not replaces—clinical judgment.
Unit 2: Research Designs & Levels of Evidence
11. Which design is generally considered the highest level of evidence for intervention questions (single studies)?
A. Case report
B. Randomized controlled trial (RCT)
C. Expert opinion
D. Editorial
Answer: B
Rationale: Well-conducted RCTs provide strong evidence for intervention effectiveness.
12. A systematic review of RCTs is typically ranked:
A. Lower than a single case study
B. At or near the top of evidence hierarchies for intervention questions
C. As the lowest form of evidence
D. Equal to expert opinion only
Answer: B
Rationale: Systematic reviews/meta-analyses of high-quality studies sit at the top of many hierarchies.
13. Qualitative research is most appropriate for answering questions about:
A. Drug dosage only
B. Lived experience, meaning, and perspectives
C. Blood pressure averages exclusively
D. Cost-effectiveness only
Answer: B
Rationale: Qualitative methods explore experiences, meanings, and social processes.
14. A cohort study follows:
A. Only one patient
B. A group over time to examine associations between exposures and outcomes
C. Only laboratory samples
D. Random assignment always
Answer: B
Rationale: Cohort studies track groups longitudinally based on exposure status.
Educational Use Only Page 3 Not a Publisher Test Bank
, Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
15. In an RCT, randomization is used primarily to:
A. Increase sample size only
B. Reduce selection bias and balance known/unknown confounders
C. Guarantee external validity
D. Eliminate all ethical concerns
Answer: B
Rationale: Randomization helps create comparable groups and reduce confounding.
16. A case-control study starts with:
A. The intervention
B. People with and without the outcome, then looks back at exposures
C. Only healthy volunteers
D. Random assignment to treatment
Answer: B
Rationale: Case-control designs sample on outcome status and compare prior exposures.
17. Level of evidence hierarchies help clinicians:
A. Ignore study quality
B. Quickly gauge the relative strength of evidence types for a question
C. Replace appraisal entirely
D. Choose the cheapest study
Answer: B
Rationale: Hierarchies provide a starting framework; appraisal of quality remains essential.
18. Meta-analysis is:
A. A single qualitative interview
B. A statistical combination of results from multiple studies
C. Always biased
D. Only used in qualitative research
Answer: B
Rationale: Meta-analysis pools quantitative results across studies.
19. Which threat is reduced by blinding in an RCT?
A. Sample size calculation
B. Performance and detection bias
C. External validity only
D. Cost
Answer: B
Rationale: Blinding reduces bias in treatment delivery and outcome assessment.
20. External validity refers to:
A. Internal consistency of a scale only
B. Generalizability of findings to other settings/populations
C. Whether randomization worked
D. Statistical significance only
Answer: B
Rationale: External validity is about applicability beyond the study sample.
Unit 3: Searching for & Appraising Evidence
21. A well-built clinical question improves searching by:
A. Making searches broader and unfocused
B. Clarifying key concepts and synonyms for efficient database queries
C. Eliminating the need for databases
D. Replacing Boolean operators
Answer: B
Rationale: PICO elements map to search terms and improve precision.
Educational Use Only Page 4 Not a Publisher Test Bank
& QUALITY IMPROVEMENT
Original Practice Question Bank
PICO • Evidence Hierarchy • Appraisal • Implementation • QI Tools
Original Self-Study Material with Answers & Rationales
Contents Introduction to EBP • Research designs & levels of evidence • Searching & appraisal • Implementation models • QI
methods & tools • Ethics, outcomes & translation
How to use Cover the green answer box, answer each question, then review the rationale. Focus on applying concepts to clinical
and improvement scenarios.
Disclaimer Original educational material for self-study only. Not a publisher test bank. Not affiliated with LoBiondo-Wood, Haber,
Titler, Elsevier, or any textbook publisher.
Original Nursing EBP & QI Practice Series
,Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
Unit 1: Introduction to Evidence-Based Practice
1. Evidence-based practice (EBP) is best defined as the integration of:
A. Only expert opinion
B. Best research evidence, clinical expertise, and patient values/preferences
C. Only randomized trials
D. Tradition and authority
Answer: B
Rationale: EBP integrates best evidence, clinical expertise, and patient preferences/values.
2. The first step in the EBP process is typically:
A. Implementing a change
B. Asking a clinical question (often in PICO format)
C. Publishing a paper
D. Ignoring patient preference
Answer: B
Rationale: EBP begins by asking a focused, answerable clinical question.
3. PICO stands for:
A. Patient, Intervention, Comparison, Outcome
B. Place, Intervention, Cost, Outcome
C. Patient, Intuition, Comparison, Opinion
D. Protocol, Intervention, Control, Output
Answer: A
Rationale: PICO: Patient/Population, Intervention, Comparison, Outcome (sometimes Time is added).
4. Which component is essential in a foreground clinical question?
A. Only the disease name
B. Specific comparison of interventions or exposures and outcomes
C. A yes/no historical fact
D. A dictionary definition
Answer: B
Rationale: Foreground questions compare interventions/exposures and outcomes to guide decisions.
5. Background questions are best answered by:
A. Only meta-analyses
B. Textbooks, review articles, and reliable summaries
C. Single case reports exclusively
D. Social media
Answer: B
Rationale: Background questions address general knowledge and are suited to textbooks and reviews.
6. A key reason nurses use EBP is to:
A. Increase tradition-based care
B. Improve patient outcomes and provide high-quality care
C. Eliminate clinical expertise
D. Avoid all change
Answer: B
Rationale: EBP aims to improve outcomes and quality through best available evidence.
7. Which is an example of a PICO intervention element?
A. Adults with type 2 diabetes
B. Daily foot inspection education
C. Standard care
D. Reduction in ulcer rates
Answer: B
Rationale: The intervention is the treatment or action being considered.
Educational Use Only Page 2 Not a Publisher Test Bank
,Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
8. Patient preferences in EBP refer to:
A. What the physician prefers only
B. The patient's values, concerns, and choices regarding care
C. Hospital policy only
D. Insurance requirements exclusively
Answer: B
Rationale: Patient values and preferences are a core pillar of EBP.
9. Clinical expertise in EBP includes:
A. Ignoring research
B. The clinician's education, experience, and skills applied to the individual patient
C. Only years of seniority
D. Memorizing guidelines without judgment
Answer: B
Rationale: Expertise helps tailor evidence to the specific patient and context.
10. Which statement about EBP is accurate?
A. It replaces clinical judgment
B. It supports clinical judgment with external evidence
C. It is only for researchers
D. It requires no critical appraisal
Answer: B
Rationale: EBP informs—not replaces—clinical judgment.
Unit 2: Research Designs & Levels of Evidence
11. Which design is generally considered the highest level of evidence for intervention questions (single studies)?
A. Case report
B. Randomized controlled trial (RCT)
C. Expert opinion
D. Editorial
Answer: B
Rationale: Well-conducted RCTs provide strong evidence for intervention effectiveness.
12. A systematic review of RCTs is typically ranked:
A. Lower than a single case study
B. At or near the top of evidence hierarchies for intervention questions
C. As the lowest form of evidence
D. Equal to expert opinion only
Answer: B
Rationale: Systematic reviews/meta-analyses of high-quality studies sit at the top of many hierarchies.
13. Qualitative research is most appropriate for answering questions about:
A. Drug dosage only
B. Lived experience, meaning, and perspectives
C. Blood pressure averages exclusively
D. Cost-effectiveness only
Answer: B
Rationale: Qualitative methods explore experiences, meanings, and social processes.
14. A cohort study follows:
A. Only one patient
B. A group over time to examine associations between exposures and outcomes
C. Only laboratory samples
D. Random assignment always
Answer: B
Rationale: Cohort studies track groups longitudinally based on exposure status.
Educational Use Only Page 3 Not a Publisher Test Bank
, Evidence-Based Practice & Quality Improvement | Original Practice Bank Self-Study Material
15. In an RCT, randomization is used primarily to:
A. Increase sample size only
B. Reduce selection bias and balance known/unknown confounders
C. Guarantee external validity
D. Eliminate all ethical concerns
Answer: B
Rationale: Randomization helps create comparable groups and reduce confounding.
16. A case-control study starts with:
A. The intervention
B. People with and without the outcome, then looks back at exposures
C. Only healthy volunteers
D. Random assignment to treatment
Answer: B
Rationale: Case-control designs sample on outcome status and compare prior exposures.
17. Level of evidence hierarchies help clinicians:
A. Ignore study quality
B. Quickly gauge the relative strength of evidence types for a question
C. Replace appraisal entirely
D. Choose the cheapest study
Answer: B
Rationale: Hierarchies provide a starting framework; appraisal of quality remains essential.
18. Meta-analysis is:
A. A single qualitative interview
B. A statistical combination of results from multiple studies
C. Always biased
D. Only used in qualitative research
Answer: B
Rationale: Meta-analysis pools quantitative results across studies.
19. Which threat is reduced by blinding in an RCT?
A. Sample size calculation
B. Performance and detection bias
C. External validity only
D. Cost
Answer: B
Rationale: Blinding reduces bias in treatment delivery and outcome assessment.
20. External validity refers to:
A. Internal consistency of a scale only
B. Generalizability of findings to other settings/populations
C. Whether randomization worked
D. Statistical significance only
Answer: B
Rationale: External validity is about applicability beyond the study sample.
Unit 3: Searching for & Appraising Evidence
21. A well-built clinical question improves searching by:
A. Making searches broader and unfocused
B. Clarifying key concepts and synonyms for efficient database queries
C. Eliminating the need for databases
D. Replacing Boolean operators
Answer: B
Rationale: PICO elements map to search terms and improve precision.
Educational Use Only Page 4 Not a Publisher Test Bank
