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Chapter 02: Models and Evidence
LoBiondo-wood: Evidence-Based Practice for Nursing and Health Care Quality
Improvement, 1st Edition
MULTIPLE CHOICE
1. Which of the following is an example of a problem-focused trigger?
a. How often should a patient ambulate after abdominal surgery to prevent
pneumonia?
b. How often should blood glucose monitoring be recorded for a non-diabetic patient
receiving total parenteral nutrition?
c. How long should a patient be maintained on nothing by mouth status after
endotracheal extubation?
d. Should patients with acute coronary syndrome wear sequential compression hose
to prevent deep vein thrombosis?
ANS: D
Problem-focused triggers are those identified by staff through quality improvement, risk
surveillance, benchmarking and financial data, or recurrent clinical problems.
Knowledge-focused triggers arise when health providers hear scientific presentations, read
research articles, or published evidence-based practice guidelines and question practice.
2. Which of the following are clinical questions derived from the problem?
a. Therapy
b. Harm
c. Diagnosis
d. Prognosis
e. Meaning
f. All of the above
ANS: F
There are five types of clinical questions derived from the problem: therapy—question
focuses on determining the effect of an intervention(s) on patient outcomes; harm—question
focuses on the potential harm of a symptom or group of symptoms, disorder, treatment, or
intervention; diagnosis—question focuses on the establishment of the power of a test to
differentiate between those with the disease or problem and those who do not experience the
problem; prognosis—question focuses on a patient’s likely course for a disease state or factors
that may alter a prognosis; meaning—question focuses on the situation or processes related to
how people experience, cope or adapt to conditions, illnesses, or circumstances.
3. Which of the following questions should be considered when identifying key stakeholders for
an evidence-based practice team?
a. Who is likely to lead and champion implementation of the practice?
b. Who can influence the decision to proceed with implementation of the practice,
either positively or negatively?
c. What type of cooperation is needed from stakeholders for the practice change to be
successful?
d. All of the above
ANS: D
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Questions to consider in identification of key stakeholders include: How are decisions made in
the area where the evidence-based practice will be implemented; What types of unit or system
changes will be needed; Who is involved in decision-making; Who is likely to lead and
champion implementation of the practice; Who can influence the decision to proceed with
implementation of the practice, either positively or negatively; What type of cooperation is
needed from stakeholders for the practice change to be successful?
4. Which of the following is not a component of the PICO Model?
a. Population
b. Intervention
c. Cash flow
d. Outcome
ANS: C
Components of the PICO Model include P—patient, population, problem; I—intervention,
prognostic factor, exposure; C—comparison or intervention; and O—outcome you would like
to measure or achieve.
5. In most evidence hierarchies, which of the following study types is considered to be the top of
the pyramid and to be more rigorous and hence more likely to minimize the effect of bias on
the results of the study?
a. Expert opinion
b. Systematic reviews
c. Randomized controlled trials
d. Case controlled studies
ANS: B
Systematic reviews are considered to be at the top of the pyramid in most evidence hierarchies
and are a more rigorous methodology and hence more likely to minimize the effect of bias on
the results of the study. The order then follows randomized controlled studies, case controlled
studies, and expert opinion.
6. Before critically appraising research, it is suggested to read/critique which types of the
following articles first?
a. Clinical and theory articles to understand the state of the practice and theoretical
perspectives and concepts that may be encountered in critiquing studies
b. Meta-analyses, systematic and integrative reviews to understand the state of the
science
c. Evidence-based practice guidelines and evidence reports
d. Research articles
ANS: A
It is helpful to read/critique articles in the following order: (1) clinical and theory articles to
understand the state of the practice and theoretical perspectives and concepts that may be
encountered in critiquing studies; (2) meta-analyses, systematic and integrative reviews to
understand the state of the science; (3) evidence-based practice guidelines and evidence
reports; (4) research articles.
7. A group approach to critical appraisal is recommended because
a. the leader assumes most of the workload.
b. those responsible for implementing the changes have an opportunity to understand
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