Test Bank for Primary Care, Art and Science of Advanced Practice Nursing, 6th Edition by Lynne M. Dunphy.

82|LATEST

Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring j j j j j j j j j j j




1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
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jincidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
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jfindings at a level of significance of <0.01. This indicates that
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A) the control group and the experimental group were more than 99% similar.
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B) the findings of the study have less than 1% chance of being attributable to chance.
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C) the effects of the intervention were nearly zero.
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D) theclinical significance of the findings was less than 1:100.
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Ans: B j




Feedback: The level ofsignificance is the level atwhich the researcher believes that the study results most
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jlikely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
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jprobability that the result is due to chance. j j j j j j j




2. Anursehas reada qualitative research studyin order to understandthe livedexperience of parents who
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jhave a neonatal loss. Which of the following questions should the nurse prioritize when appraising the
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jresults of this study? j j j




A) Howwell did the authors capture the personal experiences of these parents?
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B) Howwell did the authors control for confounding variables that may have affected the findings?
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C) Didthe authors use statistical measures that were appropriate to the phenomenon in question?
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D) Werethe instruments that the researchers used statisticallyvalid and reliable?
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Ans: A j




Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
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jsubjective experiences of individuals. Statistical measures and variables are not dimensions of a
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jqualitative methodology. j




3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch, claimingthat
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jnursing research has little relevance to practice. How can the nurses colleague best defend the
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jimportance of nursing research? j j j

,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrant money,
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something that didnt use to be the case.
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B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprograms andhasgreatly
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increased the credibility of the profession.
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C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession, ratherthan simply
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as a trade or a skill.
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D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
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outcomes.
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Ans: D j




Feedback: The greatest value of nursing research lies in the potential to improve practice and,
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ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
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programs, grant funding, or the public view of the profession.
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4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy urban
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hospital. She has noticed thatmany new mothers abandon breast-feeding their babies when they
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experience early challenges and wonders what could be done to encourage more women to continue
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breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention
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aimed at promoting breast-feeding?
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A) Applying for grant funding for the research project j j j j j j j




B) Posingthe clinical problem to one or more nursing researchers
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C) Planningthe methodology of the research project j j j j j j




D) Carryingouttheinterventionand submittingtheresultsforpublication j j j j tx j j j j




j Ans: B j




Feedback: A major role for staff nurses is to identify questions or problems for research. Grant
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applications, methodological planning, and publication submission are normally carried out by
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nurses who have advanced degrees in nursing.
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5. A patient signed the informed consent form for a drug trial that was explained to patient by a
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research assistant. Later, the patient admitted to his nurse that he did not understand the research
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assistants explanation orhis own rolein the study. How should this patients nurse respond to this
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revelation?
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A) Explain the research process to the patient ingreater detail. j j j j j j j j j




B) Describe the details of a randomized controlled trial for the patient. j j j j j j j j j j

,C) Informthe research assistant that the patients consent is likely invalid.
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D) Explainto the patient that his written consent is nowlegally binding.
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Ans: C j




Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible
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jfor research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty
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jabout participating, do not try to convince them to participate. Ask the person from the research
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teamwhois managingconsents tospeakwithconcerned patientsabout thestudy, evenafter a patient has
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jsigned the consent forms. j j j




Multiple Selection j




6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among the
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jnurses on a unit. Anurse who is implementing EBP integrates whichofthe following? (Select all that
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japply.)

A) Interdisciplinary consensus j




B) Nursing tradition j




C) Research studies j




D) Patient preferences andvalues j j j




E) Clinicalexpertise

Ans: C, D, E
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
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japproach to the delivery of healthcare that integrates the best evidence from studies and patient care data
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jwith clinician expertise and patient preferences and values.
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Multiple Choice j




7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to heal
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jand which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs.
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jMayes applies evidence-based practice (EBP) whenever possible and has proposed the use of maggot
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jtherapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
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jopposes this treatment despite thesizable bodyof evidencesupportingit. Howshould the nurse reconcile
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jMrs. Mayes views with the principles of EBP?
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A) Thenurse should explainthat reliable and valid research evidence overrides the patients opinion.
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B) Thenurse should explain the evidence tothe patient in greater detail.
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, C) Thenurse should integrate the patients preferences into the plan of care.
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D) Thenurse should involve the patients family members in the decision-making process.
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Ans: C
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Feedback: Patient preferences should be integrated into EBP and considered alongside research
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jevidence and the nurses clinical expertise; evidence does not trump the patients preferences. The family
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jshould be involved, but this is not an explicit dimension ofEBP. Similarly, explaining the evidence in
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jmore detail is not a demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of specialized, pressure-
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jreducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
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jsought input from the nurses on the unit, all of whom are aware of the need to implement the
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jprinciples of evidence-based practice (EBP) in this decision. Which of the following evidence
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jsources should the nurses prioritize?
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A) Aqualitative study that explores the experience of living with a pressure ulcer
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B) Acase studythat describes the measures that nurses on a geriatric unit took toreduce pressure
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ulcers among patients
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C) Testimonialsfromexperienced clinicians about the effectiveness ofthe mattress inquestion j j j j j j j j j j j




D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
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mattresses
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Ans: D
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Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
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jopinion are low on the hierarchy of evidence.
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9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
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jattempttoascertainthemostefficientandeffectivewaytocommunicatebetween nurseswhoareon
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jdifferent units, a project that will consider many types of evidence. Which of the following
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jinformation sources should the administrators prioritize? j j j j j




A) Asystematic review about communication in nursing contexts
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B) Nurses ideas about communication methods j j j j




C) The results of a chart review
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D) Thehospitalsaccreditation status tx




Ans: A
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