TEST BANK
Evidence-Based Practice in Nursing & Healthcare: A Guide to
Best Practice
Bernadette Mazurek Melnyk, and Ellen Fineout-Overholt
5th Edition
,Table of Contents
Chapter 01 Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry 1
Chapter 02 Asking Compelling Clinical Questions 11
Chapter 03 Finding Relevant Evidence to Answer Clinical Questions 21
Chapter 04 Critically Appraising Knowledge for Clinical Decision Making 32
Chapter 05 Clinician Expertise and Patient-Valued Preferences as Context for Critical
Appraisal for Evidence-Based Decision Maki 42
Chapter 06 Critically Appraising Quantitative Evidence for Clinical Decision Making 53
Chapter 07 Critically Appraising Qualitative and Mixed Methods Evidence for Clinical
Decision Making 65
Chapter 08 Advancing Optimal Care With Robust Clinical Practice Guidelines 75
Chapter 09 Key Strategies for Implementing Evidence in RealWorld Clinical Settings 85
Chapter 10 The Role of Quality Improvement and Evidence-Based Quality Improvement in
Practice Changes 95
Chapter 11 Implementing the EvidenceBased Practice Competencies in Clinical and
Academic Settings to Enhance Healthcare Quality 105
Chapter 12 Leadership Strategies for Creating and Sustaining EvidenceBased Practice
Organizations 115
Chapter 13 Innovation and Evidence: A Partnership in Advancing Best Practice and High-
Quality Care 124
Chapter 14 Models to Guide Implementation and Sustainability of EvidenceBased Practice 134
Chapter 15 Implementation Science to Clinical Practice Settings: Accelerating the Uptake
of Evidence Into Practice for Best Out 143
Chapter 16 EvidenceBased Practice Mentors: The Key to Sustaining EvidenceBased
Practice in Clinical and Educational Settings 153
Chapter 17 Creating a Vision and Motivating a Change to Evidence-Based Practice in
Individuals, Teams, and Organizations 163
Chapter 18 Teaching Evidence-Based Practice in Academic Settings 173
Chapter 19 Teaching Evidence-Based Practice in Clinical Settings 183
Chapter 20 Using Evidence to Influence Health and Organizational Policy 193
Chapter 21 Disseminating Evidence Through Presentations, Publications, Health Policy
Briefs, and the Media 203
Chapter 22 Generating Evidence Through Quantitative and Qualitative Research 212
Chapter 23 Writing a Successful Grant Proposal to Fund Research and EvidenceBased
Practice Implementation Projects 221
Chapter 24 Ethical Considerations for Evidence Implementation and Evidence Generation 231
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
Chapter 1, Making the Case for Evidence-Based Practice and Cultivating a Spirit of
Inquiry
1. The EBP paradigm is composed of components that are integrated into the seven-step EBP
process. What are the key components of evidence-based practice?
A) A quality-focused culture, patient outcomes, and cost/benefit
B) Relevant best evidence, clinician expertise, and patient preferences and values
C) Relevant best evidence, quality outcomes, and patient voice
D) A quality-focused culture, clinical expertise, and patient preferences and values
ANS: B
Feedback:
The EBP paradigm includes the systematic search for and critical appraisal of the most
relevant and best research (external evidence) to answer a clinical question; clinical expertise
includes the integration of internal evidence from various sources (practice, outcomes
management, patient assessment, and outcomes, etc.) to achieve desired patient outcomes; and
patient/family values and preferences. Together these inform evidence-based decision making.
PTS: 1 DIF: Moderate
REF: Header: Differences Among EBP, Research, Quality Improvement, and Evidence-Based
Quality Improvement | Page: 9 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
2. Nurses on the postsurgical unit are wondering if the time of first patient ambulation after
surgery was impacting the length of stay, and if so, what could they do to reduce the length of
stay. They plan to complete a retrospective chart review for this baseline information. Which
component of EBP would this describe?
A) Integrating organizational priorities
B) Integrating patient preference
C) Integrating internal evidence
D) Integrating external evidence
ANS: C
Feedback:
The nurses are questioning their practice and want to know if there are ways to improve the
outcomes—Spirit of Inquiry. As part of this Step 0, internal evidence from chart reviews can
identify baseline information to support inquiry and best practice change.
PTS: 1 DIF: Moderate
REF: Header: Definition and Evolution of Evidence-Based Practice | Page: 8
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An experienced nurse working in a memory care home observed that reorienting residents
with dementia as frequently as possible seemed to minimize their agitation in the evening. The
nurse wonders if this is the best practice. As the EBP expert, what would you recommend?
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
A) Conduct a research study on reorienting compared to not reorienting residents with
dementia in memory care homes
B) Pull a team together to create a policy so that all residents have decreased agitation
while in the memory care home
C) Identify a team to explore the external evidence, clinician expertise/experiences,
and preferences of the residents/families
D) Call the Quality Department to help with a PDSA project for the reorientation of
patients
ANS: C
Feedback:
The EBP paradigm includes the integration of evidence, clinical expertise, and patient
preferences to make best practice clinical decisions about care. An EBP initiative would
identify if the nurse’s practice is the best practice.
PTS: 1 DIF: Moderate
REF: Header: Components of Evidence-Based Practice | Page: 11 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
4. An EBP mentor is leading a team in the critical care department to implement the central
line-associated bloodstream infections (CLABSI) bundle across all critical care units in the
system. Which outcomes would indicate the effectiveness of this EBP implementation?
A) System-wide improvement of patient quality and safety outcomes for patients with
central lines
B) Provider satisfaction in trauma critical care
C) Consistency in care across the healthcare system in pain management
D) Cost reduction in supplies for all systems departments
ANS: A
Feedback:
EBP leads to the highest quality and safety of care and the best patient outcomes while
reducing costs. EBP implementation of best practice bundles in critical care can reduce
complications and improve care for this patient population. It is important to evaluate the
effectiveness of EBP practice change initiatives on patient outcomes.
PTS: 1 DIF: Easy
REF: Header: Why Evidence-Based Practice? | Page: 13 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. The Institute of Medicine’s Roundtable on Evidence-based Medicine set a landmark goal that
by 2020, 90% of clinical decisions would be supported by accurate, timely, and up-to-date
information based on the best available evidence. The EBP Council has been asked to assist
the organization to meet this goal by identifying best practice evidence to guide policies,
procedures, and patient care practices. Which of the goals of the IOM Roundtable would not
apply to the Council’s charge?
A) Generating evidence to support which healthcare strategies are most effective and
produce the greatest value
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
B) Accelerating the progress toward a learning healthcare system, in which evidenceis
applied and developed as a product of patient care
C) Comparing the implementation of EBP in the United States with that of other
developed countries
D) Improving public awareness and understanding of the nature of evidence and its
importance for their healthcare
ANS: C
Feedback:
The IOM Roundtable was charged with accelerating the progress toward a learning healthcare
system, generating new evidence to support which healthcare strategies are most effective,
and improving public awareness and understanding of EBP. Comparison with other countries’
EBP implementation was not the focus of the IOM Roundtable recommendations.
PTS: 1 DIF: Moderate
REF: Header: The Institute of Medicine’s Roundtable on Evidence-Based Medicine | Page: 15
OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
6. Nurses working in a trauma unit have noticed that many of their patients on enteral feedings
are required to be NPO at midnight before each scheduled procedure. For many of the
patients, this has greatly extended their length of stay and resulted in weight loss. The nurses
were wondering “What can we do to assure the patient receives the nutrition that they need
while reducing the risks of aspiration during procedures?” This is an example of what step in
EBP?
A) Formulating the clinical search question/PICOT
B) Systematically searching for the best most relevant evidence
C) Cultivating a Spirit of Inquiry and curiosity
D) Evaluation and sustainability of practice
ANS: C
Feedback:
Step 0 in the EBP process—Spirit of Inquiry, occurs when there is curiosity and questioning
of “Why do we do it this way”? This step starts the EBP process by identifying a clinical issue
using internal evidence and inquiry.
PTS: 1 DIF: Easy
REF: Header: Step 0: Cultivate a Spirit of Inquiry Within an EBP Culture and Environment | Page:
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. New graduate nurses in a residency program are asked to identify best practices in the
evidence and need to create a PICOT question. Which of the following is a PICOT question?
A) What effect does parents' smoking have on the smoking habits of their children
aged 13 to 16 years?
B) In clients aged 8 to 12 years, is the effectiveness of a pain scale using faces
superior to a numeric rating scale in the emergency room context?
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
C) How do parents who raise children with fetal alcohol spectrum disorders (FASD)
cope and develop resilience?
D) In cancer patients, how does meditation compared to benzodiazepines affect
anxiety during radiation treatments?
ANS: D
Feedback:
The PICOT question will include population or problem, intervention or issue of interest,
comparison intervention or group, outcome, and time frame. Only the question about cancer
patients is written as a PICOT question. The other questions are background or research
questions.
PTS: 1 DIF: Difficult
REF: Header: Step 1: Formulate the Clinical PICOT Question OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
8. After developing a PICOT to guide the search, what strategies should be used for searching
for the best external evidence?
A) Start with each word/phrase in the PICOT and conduct a search, then combine the
searches to limit to the articles that answer your search
B) Start with GOOGLE to see if there are articles on the topic, then go to the
organization’s library to find full-text articles
C) Search MEDLINE or CINAHL only because they have the most nursing articles to
address the question
D) Search GOOGLE SCHOLAR to locate systematic reviews and systematic review
meta-analysis or metasynthesis
ANS: A
Feedback:
The PICOT will guide the search. Use each element of the PICOT separately, and then
combine elements to help find evidence that addresses the question. For a comprehensive,
systematic search, use multiple databases from nursing and other applicable disciplines.
PTS: 1 DIF: Easy
REF: Header: Step 2: Systematically Search for and Collect the Most Relevant Best Evidence |
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
9. An EBP team has completed a search of the evidence to identify the best pharmacologic
interventions to manage hypertension in obese patients. When searching for the evidence what
type of study would provide the strongest level of evidence?
A) A qualitative study describing the feelings of obese individuals with hypertension
B) A randomized control trial comparing beta-blockers to calcium channel blockers
for hypertension
C) An integrative review of studies on the management of obese hypertensive adults
D) A systematic review meta-analysis of randomized control trials on
pharmacological management of hypertension
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
ANS: D
Feedback:
The highest level of evidence is a systematic review meta-analysis of randomized control
trials—Level I. The other studies may contribute to the body of evidence but are lower levels
of evidence: qualitative—Level VI, single randomized control trial—Level II, and integrative
review—Level VI.
PTS: 1 DIF: Moderate
REF: Header: Box 1.3 Rating System for the Hierarchy of Evidence for Intervention/Treatment
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
10. An EBP team in the post-anesthesia care unit is evaluating current practices for ambulatory
surgery patients. They identify studies that address recovery management of short-stay
patients. Based on the titles from the search which article would they want to review in full
text?
A) Randomized Control Trial on End-tidal Carbon Dioxide Monitoring in Critical
Care
B) Legal and Accreditation Recommendations for Ambulatory Settings: Systematic
Review
C) Chronic Orthopedic Pain in Adults: Qualitative Review
D) Clinical Practice Guidelines for Postoperative Management
ANS: D
Feedback:
Evidence-based clinical practice guidelines are unique sources of information comprised of
multiple, specific practice recommendations that are grouped on a specific topic. They can
address multiple questions such as the management of the postoperative patient in ambulatory
settings.
PTS: 1 DIF: Moderate
REF: Header: Step 3: Critical Appraisal of Evidence | Page: 22 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
11. A nurse is conducting a literature review on the evidence regarding the use of vacuum
dressings on pressure ulcers. After locating a recent study that appears to be relevant, which
question provides key considerations when critically appraising the study?
A) “Are the findings of this study cost-effective in our clinical context?”
B) “Are the findings valid, reliable, and applicable to my population?”
C) “Are the findings of the study significantly different from what we are currently
doing on the unit?”
D) “Are the patients in the study similar to the population?”
ANS: B
Feedback:
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
The critical appraisal looks at the validity of the study results (best research methods for the
question), the reliability of the results (statistically significant and/or clinically meaningful),
and the applicability of the results (apply to the PICOT population). Cost-effectiveness is part
of the implementation of the initiative. Significance is only one piece of the appraisal, as is the
similarity of the population.
PTS: 1 DIF: Moderate
REF: Header: Step 3: Critical Appraisal of Evidence | Page: 22 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
12. The healthcare provider of a 49-year-old male client has briefly explained the best practice
evidence that supports beginning regular digital rectal examinations as part of the annual
physical assessment. Which factor would justify not performing a digital rectal examination
today in the clinic?
A) The client states that he does not want to have a digital rectal examination today.
B) The best practice clinical guidelines for prostate care do not address men under the
age of 60.
C) The clinician has previously waited until clients are over 55 for this exam.
D) The clinician is basing the practice recommendation on one large RCT.
ANS: A
Feedback:
Client preference, such as opposition to a particular assessment or intervention, should be
implemented in clinical decision making. Prostate issues are most common in older men but
can occur in men earlier than age 60. The providers’ previous practices may not apply to this
client. Practice should not be based on one RCT.
PTS: 1 DIF: Moderate
REF: Header: Step 4: Integrate the Evidence with Clinical Expertise and Patient/Family Preferences
to Make the Best Clinical Decision | Page: 25 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
13. A group of nurses on the postsurgical unit has completed the implementation and evaluation
of daily CHG baths for all postoperative patients to reduce infections. Which action would the
nurses initiate as the final step of the EBP initiative?
A) Calculating the return on investment of the initiative to determine if the initiative
was cost-effective
B) Developing a sustainability plan to monitor and report adherence to the leadership
team
C) Sharing the effectiveness of the EBP initiative with other healthcare providers in
the organization
D) Conducting a secondary search of the literature to determine if there is any new
evidence on this issue
ANS: C
Feedback:
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
The final step in the EBP process is the dissemination of outcomes/effectiveness of the
practice change. Dissemination should be done internally to the organization, and externally
through presentations and publications if possible.
PTS: 1 DIF: Moderate
REF: Header: Step 6: Disseminate the Outcomes of the Evidence-Based Practice Change | Page: 26
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter, KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
14. A nurse manager wants staff to apply the EBP process to improve patient outcomes. Which
action by the nurse would be important to overcome barriers and sustain a culture of EBP?
A) Recruit baccalaureate-level or higher nurses to participate in EBP initiatives in the
organization
B) Increase accountability for patient outcomes in the annual evaluations and unit
score cards
C) Seek funding to support EBP initiatives from the hospital or organizational
foundation
D) Get stakeholder buy-in from the staff, providers, practice leaders, and
administration
ANS: D
Feedback:
Stakeholder buy-in and support from staff, providers, practice leaders, and administration can
facilitate a culture of readiness for EBP implementation and sustainability of practice changes.
Having baccalaureate-educated or higher staff nurses, increased accountability for patient
outcomes in the annual evaluation, and increased funding are not noted to increase the
implementation of EBP.
PTS: 1 DIF: Moderate
REF: Header: Facilitators of Evidence-Based Practice | Page: 28 OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
15. A team of nurses in the pediatric department has been asked to revise policies, procedures,
and guidelines to reflect evidence-based practice. What is the best approach to identify the
best evidence to support this activity?
A) Bring together the most experienced staff to serve as practice experts
B) Work with the librarian to identify evidence from databases of peer-reviewed
journals such as Cochrane, PubMed, CINAHL
C) Ask the nurse educator/professional development specialist for assistance
D) Look for lay publications on Google before searching in peer-reviewed journals
ANS: B
Feedback:
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
Working with the librarian to search databases such as the Cochrane Library, PubMed,
CINAHL, and the Emergency Care Research Institute (ECRI) can provide nurses with quick,
easily retrievable, systematic reviews, quantitative and qualitative studies, and evidence-based
clinical practice guidelines to inform their practices. Expert staff and educators can address
clinician expertise but not best practice without searching the evidence. Lay publications do
not address best-practice evidence.
PTS: 1 DIF: Moderate REF: Header: Correcting Misperceptions | Page: 30
OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
16. A new administrator wants to implement EBP due to concerns that the internal evidence
shows that the organization is not meeting benchmarks for key outcomes. Some staff and
providers do not believe that EBP can make a difference. How would the administrator
address these concerns?
A) Wait 6 months to assess the culture and to see if the outcomes improve with
current practice
B) Provide an overview of EBP methods/steps and examples of EBP initiatives
including outcomes and return on investments
C) Identify a small group to explore if EBP would work in the organization to
improve outcomes
D) Create a provider expert panel to decide what should be done to improve
Outcomes
ANS: B
Feedback:
Providers and staff who are hesitant about implementing EBP need to be educated on the steps
of EBP and how the methodology can be used to guide best practice change. Presenting
examples of EBP initiatives that show the effectiveness of the EBP practice change including
return on investment can engage nurses, staff, and providers to implement EBP. Waiting to
see if outcomes will improve is not acceptable. For an organizational change, a small group or
provider expert panel is not adequate.
PTS: 1 DIF: Moderate
REF: Header: Overcoming Barriers to Evidence-Based Practice | Page: 29
OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
17. A nurse in a bariatric clinic is searching for best practice evidence on maintaining weight loss
after bariatric surgery. For a rapid critical appraisal of a clinical trial, which question would be
the best to determine validity?
A) Did the control group match my population?
B) Was the follow-up time frame adequate for the study design?
C) Were the subjects randomly assigned to groups?
D) Were the outcomes statistically significant?
ANS: C
Feedback:
______________________________________________________________________________________________
8|Page
Evidence-Based Practice in Nursing & Healthcare: A Guide to
Best Practice
Bernadette Mazurek Melnyk, and Ellen Fineout-Overholt
5th Edition
,Table of Contents
Chapter 01 Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry 1
Chapter 02 Asking Compelling Clinical Questions 11
Chapter 03 Finding Relevant Evidence to Answer Clinical Questions 21
Chapter 04 Critically Appraising Knowledge for Clinical Decision Making 32
Chapter 05 Clinician Expertise and Patient-Valued Preferences as Context for Critical
Appraisal for Evidence-Based Decision Maki 42
Chapter 06 Critically Appraising Quantitative Evidence for Clinical Decision Making 53
Chapter 07 Critically Appraising Qualitative and Mixed Methods Evidence for Clinical
Decision Making 65
Chapter 08 Advancing Optimal Care With Robust Clinical Practice Guidelines 75
Chapter 09 Key Strategies for Implementing Evidence in RealWorld Clinical Settings 85
Chapter 10 The Role of Quality Improvement and Evidence-Based Quality Improvement in
Practice Changes 95
Chapter 11 Implementing the EvidenceBased Practice Competencies in Clinical and
Academic Settings to Enhance Healthcare Quality 105
Chapter 12 Leadership Strategies for Creating and Sustaining EvidenceBased Practice
Organizations 115
Chapter 13 Innovation and Evidence: A Partnership in Advancing Best Practice and High-
Quality Care 124
Chapter 14 Models to Guide Implementation and Sustainability of EvidenceBased Practice 134
Chapter 15 Implementation Science to Clinical Practice Settings: Accelerating the Uptake
of Evidence Into Practice for Best Out 143
Chapter 16 EvidenceBased Practice Mentors: The Key to Sustaining EvidenceBased
Practice in Clinical and Educational Settings 153
Chapter 17 Creating a Vision and Motivating a Change to Evidence-Based Practice in
Individuals, Teams, and Organizations 163
Chapter 18 Teaching Evidence-Based Practice in Academic Settings 173
Chapter 19 Teaching Evidence-Based Practice in Clinical Settings 183
Chapter 20 Using Evidence to Influence Health and Organizational Policy 193
Chapter 21 Disseminating Evidence Through Presentations, Publications, Health Policy
Briefs, and the Media 203
Chapter 22 Generating Evidence Through Quantitative and Qualitative Research 212
Chapter 23 Writing a Successful Grant Proposal to Fund Research and EvidenceBased
Practice Implementation Projects 221
Chapter 24 Ethical Considerations for Evidence Implementation and Evidence Generation 231
,______________________________________________________________________________________________
Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
Chapter 1, Making the Case for Evidence-Based Practice and Cultivating a Spirit of
Inquiry
1. The EBP paradigm is composed of components that are integrated into the seven-step EBP
process. What are the key components of evidence-based practice?
A) A quality-focused culture, patient outcomes, and cost/benefit
B) Relevant best evidence, clinician expertise, and patient preferences and values
C) Relevant best evidence, quality outcomes, and patient voice
D) A quality-focused culture, clinical expertise, and patient preferences and values
ANS: B
Feedback:
The EBP paradigm includes the systematic search for and critical appraisal of the most
relevant and best research (external evidence) to answer a clinical question; clinical expertise
includes the integration of internal evidence from various sources (practice, outcomes
management, patient assessment, and outcomes, etc.) to achieve desired patient outcomes; and
patient/family values and preferences. Together these inform evidence-based decision making.
PTS: 1 DIF: Moderate
REF: Header: Differences Among EBP, Research, Quality Improvement, and Evidence-Based
Quality Improvement | Page: 9 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
2. Nurses on the postsurgical unit are wondering if the time of first patient ambulation after
surgery was impacting the length of stay, and if so, what could they do to reduce the length of
stay. They plan to complete a retrospective chart review for this baseline information. Which
component of EBP would this describe?
A) Integrating organizational priorities
B) Integrating patient preference
C) Integrating internal evidence
D) Integrating external evidence
ANS: C
Feedback:
The nurses are questioning their practice and want to know if there are ways to improve the
outcomes—Spirit of Inquiry. As part of this Step 0, internal evidence from chart reviews can
identify baseline information to support inquiry and best practice change.
PTS: 1 DIF: Moderate
REF: Header: Definition and Evolution of Evidence-Based Practice | Page: 8
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. An experienced nurse working in a memory care home observed that reorienting residents
with dementia as frequently as possible seemed to minimize their agitation in the evening. The
nurse wonders if this is the best practice. As the EBP expert, what would you recommend?
______________________________________________________________________________________________
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,______________________________________________________________________________________________
Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
A) Conduct a research study on reorienting compared to not reorienting residents with
dementia in memory care homes
B) Pull a team together to create a policy so that all residents have decreased agitation
while in the memory care home
C) Identify a team to explore the external evidence, clinician expertise/experiences,
and preferences of the residents/families
D) Call the Quality Department to help with a PDSA project for the reorientation of
patients
ANS: C
Feedback:
The EBP paradigm includes the integration of evidence, clinical expertise, and patient
preferences to make best practice clinical decisions about care. An EBP initiative would
identify if the nurse’s practice is the best practice.
PTS: 1 DIF: Moderate
REF: Header: Components of Evidence-Based Practice | Page: 11 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
4. An EBP mentor is leading a team in the critical care department to implement the central
line-associated bloodstream infections (CLABSI) bundle across all critical care units in the
system. Which outcomes would indicate the effectiveness of this EBP implementation?
A) System-wide improvement of patient quality and safety outcomes for patients with
central lines
B) Provider satisfaction in trauma critical care
C) Consistency in care across the healthcare system in pain management
D) Cost reduction in supplies for all systems departments
ANS: A
Feedback:
EBP leads to the highest quality and safety of care and the best patient outcomes while
reducing costs. EBP implementation of best practice bundles in critical care can reduce
complications and improve care for this patient population. It is important to evaluate the
effectiveness of EBP practice change initiatives on patient outcomes.
PTS: 1 DIF: Easy
REF: Header: Why Evidence-Based Practice? | Page: 13 OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. The Institute of Medicine’s Roundtable on Evidence-based Medicine set a landmark goal that
by 2020, 90% of clinical decisions would be supported by accurate, timely, and up-to-date
information based on the best available evidence. The EBP Council has been asked to assist
the organization to meet this goal by identifying best practice evidence to guide policies,
procedures, and patient care practices. Which of the goals of the IOM Roundtable would not
apply to the Council’s charge?
A) Generating evidence to support which healthcare strategies are most effective and
produce the greatest value
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Test Bank - Evidence-Based Practice in Nursing and Healthcare, 5th Edition (Melnyk, 2023)
B) Accelerating the progress toward a learning healthcare system, in which evidenceis
applied and developed as a product of patient care
C) Comparing the implementation of EBP in the United States with that of other
developed countries
D) Improving public awareness and understanding of the nature of evidence and its
importance for their healthcare
ANS: C
Feedback:
The IOM Roundtable was charged with accelerating the progress toward a learning healthcare
system, generating new evidence to support which healthcare strategies are most effective,
and improving public awareness and understanding of EBP. Comparison with other countries’
EBP implementation was not the focus of the IOM Roundtable recommendations.
PTS: 1 DIF: Moderate
REF: Header: The Institute of Medicine’s Roundtable on Evidence-Based Medicine | Page: 15
OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
6. Nurses working in a trauma unit have noticed that many of their patients on enteral feedings
are required to be NPO at midnight before each scheduled procedure. For many of the
patients, this has greatly extended their length of stay and resulted in weight loss. The nurses
were wondering “What can we do to assure the patient receives the nutrition that they need
while reducing the risks of aspiration during procedures?” This is an example of what step in
EBP?
A) Formulating the clinical search question/PICOT
B) Systematically searching for the best most relevant evidence
C) Cultivating a Spirit of Inquiry and curiosity
D) Evaluation and sustainability of practice
ANS: C
Feedback:
Step 0 in the EBP process—Spirit of Inquiry, occurs when there is curiosity and questioning
of “Why do we do it this way”? This step starts the EBP process by identifying a clinical issue
using internal evidence and inquiry.
PTS: 1 DIF: Easy
REF: Header: Step 0: Cultivate a Spirit of Inquiry Within an EBP Culture and Environment | Page:
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. New graduate nurses in a residency program are asked to identify best practices in the
evidence and need to create a PICOT question. Which of the following is a PICOT question?
A) What effect does parents' smoking have on the smoking habits of their children
aged 13 to 16 years?
B) In clients aged 8 to 12 years, is the effectiveness of a pain scale using faces
superior to a numeric rating scale in the emergency room context?
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C) How do parents who raise children with fetal alcohol spectrum disorders (FASD)
cope and develop resilience?
D) In cancer patients, how does meditation compared to benzodiazepines affect
anxiety during radiation treatments?
ANS: D
Feedback:
The PICOT question will include population or problem, intervention or issue of interest,
comparison intervention or group, outcome, and time frame. Only the question about cancer
patients is written as a PICOT question. The other questions are background or research
questions.
PTS: 1 DIF: Difficult
REF: Header: Step 1: Formulate the Clinical PICOT Question OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
8. After developing a PICOT to guide the search, what strategies should be used for searching
for the best external evidence?
A) Start with each word/phrase in the PICOT and conduct a search, then combine the
searches to limit to the articles that answer your search
B) Start with GOOGLE to see if there are articles on the topic, then go to the
organization’s library to find full-text articles
C) Search MEDLINE or CINAHL only because they have the most nursing articles to
address the question
D) Search GOOGLE SCHOLAR to locate systematic reviews and systematic review
meta-analysis or metasynthesis
ANS: A
Feedback:
The PICOT will guide the search. Use each element of the PICOT separately, and then
combine elements to help find evidence that addresses the question. For a comprehensive,
systematic search, use multiple databases from nursing and other applicable disciplines.
PTS: 1 DIF: Easy
REF: Header: Step 2: Systematically Search for and Collect the Most Relevant Best Evidence |
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
9. An EBP team has completed a search of the evidence to identify the best pharmacologic
interventions to manage hypertension in obese patients. When searching for the evidence what
type of study would provide the strongest level of evidence?
A) A qualitative study describing the feelings of obese individuals with hypertension
B) A randomized control trial comparing beta-blockers to calcium channel blockers
for hypertension
C) An integrative review of studies on the management of obese hypertensive adults
D) A systematic review meta-analysis of randomized control trials on
pharmacological management of hypertension
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ANS: D
Feedback:
The highest level of evidence is a systematic review meta-analysis of randomized control
trials—Level I. The other studies may contribute to the body of evidence but are lower levels
of evidence: qualitative—Level VI, single randomized control trial—Level II, and integrative
review—Level VI.
PTS: 1 DIF: Moderate
REF: Header: Box 1.3 Rating System for the Hierarchy of Evidence for Intervention/Treatment
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
10. An EBP team in the post-anesthesia care unit is evaluating current practices for ambulatory
surgery patients. They identify studies that address recovery management of short-stay
patients. Based on the titles from the search which article would they want to review in full
text?
A) Randomized Control Trial on End-tidal Carbon Dioxide Monitoring in Critical
Care
B) Legal and Accreditation Recommendations for Ambulatory Settings: Systematic
Review
C) Chronic Orthopedic Pain in Adults: Qualitative Review
D) Clinical Practice Guidelines for Postoperative Management
ANS: D
Feedback:
Evidence-based clinical practice guidelines are unique sources of information comprised of
multiple, specific practice recommendations that are grouped on a specific topic. They can
address multiple questions such as the management of the postoperative patient in ambulatory
settings.
PTS: 1 DIF: Moderate
REF: Header: Step 3: Critical Appraisal of Evidence | Page: 22 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
11. A nurse is conducting a literature review on the evidence regarding the use of vacuum
dressings on pressure ulcers. After locating a recent study that appears to be relevant, which
question provides key considerations when critically appraising the study?
A) “Are the findings of this study cost-effective in our clinical context?”
B) “Are the findings valid, reliable, and applicable to my population?”
C) “Are the findings of the study significantly different from what we are currently
doing on the unit?”
D) “Are the patients in the study similar to the population?”
ANS: B
Feedback:
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The critical appraisal looks at the validity of the study results (best research methods for the
question), the reliability of the results (statistically significant and/or clinically meaningful),
and the applicability of the results (apply to the PICOT population). Cost-effectiveness is part
of the implementation of the initiative. Significance is only one piece of the appraisal, as is the
similarity of the population.
PTS: 1 DIF: Moderate
REF: Header: Step 3: Critical Appraisal of Evidence | Page: 22 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
12. The healthcare provider of a 49-year-old male client has briefly explained the best practice
evidence that supports beginning regular digital rectal examinations as part of the annual
physical assessment. Which factor would justify not performing a digital rectal examination
today in the clinic?
A) The client states that he does not want to have a digital rectal examination today.
B) The best practice clinical guidelines for prostate care do not address men under the
age of 60.
C) The clinician has previously waited until clients are over 55 for this exam.
D) The clinician is basing the practice recommendation on one large RCT.
ANS: A
Feedback:
Client preference, such as opposition to a particular assessment or intervention, should be
implemented in clinical decision making. Prostate issues are most common in older men but
can occur in men earlier than age 60. The providers’ previous practices may not apply to this
client. Practice should not be based on one RCT.
PTS: 1 DIF: Moderate
REF: Header: Step 4: Integrate the Evidence with Clinical Expertise and Patient/Family Preferences
to Make the Best Clinical Decision | Page: 25 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
13. A group of nurses on the postsurgical unit has completed the implementation and evaluation
of daily CHG baths for all postoperative patients to reduce infections. Which action would the
nurses initiate as the final step of the EBP initiative?
A) Calculating the return on investment of the initiative to determine if the initiative
was cost-effective
B) Developing a sustainability plan to monitor and report adherence to the leadership
team
C) Sharing the effectiveness of the EBP initiative with other healthcare providers in
the organization
D) Conducting a secondary search of the literature to determine if there is any new
evidence on this issue
ANS: C
Feedback:
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The final step in the EBP process is the dissemination of outcomes/effectiveness of the
practice change. Dissemination should be done internally to the organization, and externally
through presentations and publications if possible.
PTS: 1 DIF: Moderate
REF: Header: Step 6: Disseminate the Outcomes of the Evidence-Based Practice Change | Page: 26
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter, KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
14. A nurse manager wants staff to apply the EBP process to improve patient outcomes. Which
action by the nurse would be important to overcome barriers and sustain a culture of EBP?
A) Recruit baccalaureate-level or higher nurses to participate in EBP initiatives in the
organization
B) Increase accountability for patient outcomes in the annual evaluations and unit
score cards
C) Seek funding to support EBP initiatives from the hospital or organizational
foundation
D) Get stakeholder buy-in from the staff, providers, practice leaders, and
administration
ANS: D
Feedback:
Stakeholder buy-in and support from staff, providers, practice leaders, and administration can
facilitate a culture of readiness for EBP implementation and sustainability of practice changes.
Having baccalaureate-educated or higher staff nurses, increased accountability for patient
outcomes in the annual evaluation, and increased funding are not noted to increase the
implementation of EBP.
PTS: 1 DIF: Moderate
REF: Header: Facilitators of Evidence-Based Practice | Page: 28 OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
15. A team of nurses in the pediatric department has been asked to revise policies, procedures,
and guidelines to reflect evidence-based practice. What is the best approach to identify the
best evidence to support this activity?
A) Bring together the most experienced staff to serve as practice experts
B) Work with the librarian to identify evidence from databases of peer-reviewed
journals such as Cochrane, PubMed, CINAHL
C) Ask the nurse educator/professional development specialist for assistance
D) Look for lay publications on Google before searching in peer-reviewed journals
ANS: B
Feedback:
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Working with the librarian to search databases such as the Cochrane Library, PubMed,
CINAHL, and the Emergency Care Research Institute (ECRI) can provide nurses with quick,
easily retrievable, systematic reviews, quantitative and qualitative studies, and evidence-based
clinical practice guidelines to inform their practices. Expert staff and educators can address
clinician expertise but not best practice without searching the evidence. Lay publications do
not address best-practice evidence.
PTS: 1 DIF: Moderate REF: Header: Correcting Misperceptions | Page: 30
OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
16. A new administrator wants to implement EBP due to concerns that the internal evidence
shows that the organization is not meeting benchmarks for key outcomes. Some staff and
providers do not believe that EBP can make a difference. How would the administrator
address these concerns?
A) Wait 6 months to assess the culture and to see if the outcomes improve with
current practice
B) Provide an overview of EBP methods/steps and examples of EBP initiatives
including outcomes and return on investments
C) Identify a small group to explore if EBP would work in the organization to
improve outcomes
D) Create a provider expert panel to decide what should be done to improve
Outcomes
ANS: B
Feedback:
Providers and staff who are hesitant about implementing EBP need to be educated on the steps
of EBP and how the methodology can be used to guide best practice change. Presenting
examples of EBP initiatives that show the effectiveness of the EBP practice change including
return on investment can engage nurses, staff, and providers to implement EBP. Waiting to
see if outcomes will improve is not acceptable. For an organizational change, a small group or
provider expert panel is not adequate.
PTS: 1 DIF: Moderate
REF: Header: Overcoming Barriers to Evidence-Based Practice | Page: 29
OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
17. A nurse in a bariatric clinic is searching for best practice evidence on maintaining weight loss
after bariatric surgery. For a rapid critical appraisal of a clinical trial, which question would be
the best to determine validity?
A) Did the control group match my population?
B) Was the follow-up time frame adequate for the study design?
C) Were the subjects randomly assigned to groups?
D) Were the outcomes statistically significant?
ANS: C
Feedback:
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