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
j j j j j j j j j j j j j j j j j
jincidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
j j j j j j j j j j j
jfindings at a level of significance of <0.01. This indicates that
j j j j j j j j j j
A) the control group and the experimental group were more than 99% similar.
j j j j j j j j j j j
B) the findings of the study have less than 1% chance of being attributable to chance.
j j j j j j j j j j j j j j
C) the effects of the intervention were nearly zero.
j j j j j j j
D) theclinical significance of the findings was less than 1:100.
j j j j j j j j j
Ans: B j
Feedback: The level ofsignificance is the level atwhich the researcher believes that the study results most
j j j j j j j j j j j j j j j j j
jlikely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
j j j j j j j j j j j j j j j j j
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
j j j j j j j j j j j j j j j j j
jhave a neonatal loss. Which of the following questions should the nurse prioritize when appraising the
j j j j j j j j j j j j j j j
jresults of this study? j j j
A) Howwell did the authors capture the personal experiences of these parents?
j j j j j j j j j j j
B) Howwell did the authors control for confounding variables that may have affected the findings?
j j j j j j j j j j j j j j
C) Didthe authors use statistical measures that were appropriate to the phenomenon in question?
j j j j j j j j j j j j j
D) Werethe instruments that the researchers used statisticallyvalid and reliable?
j j j j j j j j j j
Ans: A j
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
j j j j j j j j j j j j j j j
jsubjective experiences of individuals. Statistical measures and variables are not dimensions of a
j j j j j j j j j j j j
jqualitative methodology. j
3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch, claimingthat
j j j j j j j j j j j j j j j
jnursing research has little relevance to practice. How can the nurses colleague best defend the
j j j j j j j j j j j j j j
jimportance of nursing research? j j j
,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrant money,
j j j j j j j j j j j j j j j
something that didnt use to be the case.
j j j j j j j j
B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprograms andhasgreatly
j j j j j j j j j j j j j
increased the credibility of the profession.
j j j j j j
C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession, ratherthan simply
j j j j j j j j j j j j j j j j j
as a trade or a skill.
j j j j j j
D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
j j j j j j j j j j j j j
outcomes.
j
Ans: D j
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
j j j j j j j j j j j j j j
ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
j j j j j j j j j j j j j j
programs, grant funding, or the public view of the profession.
j j j j j j j j j j
4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy urban
j j j j j j j j j j j j j j j j j j j
hospital. She has noticed thatmany new mothers abandon breast-feeding their babies when they
j j j j j j j j j j j j j j
experience early challenges and wonders what could be done to encourage more women to continue
j j j j j j j j j j j j j j j
breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention
j j j j j j j j j j j j j j j j j
aimed at promoting breast-feeding?
j j j j
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
j j j j j j j j j
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
j j j j j j j j j j j j j j j
applications, methodological planning, and publication submission are normally carried out by
j j j j j j j j j j j
nurses who have advanced degrees in nursing.
j j j j j j j
5. A patient signed the informed consent form for a drug trial that was explained to patient by a
j j j j j j j j j j j j j j j j j
research assistant. Later, the patient admitted to his nurse that he did not understand the research
j j j j j j j j j j j j j j j j
assistants explanation orhis own rolein the study. How should this patients nurse respond to this
j j j j j j j j j j j j j j j j j
revelation?
j
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.
j j j j j j j j j j
D) Explainto the patient that his written consent is nowlegally binding.
j j j j j j j j j j j
Ans: C j
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible
j j j j j j j j j j j j j j j j j
jfor research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty
j j j j j j j j j j j j j
jabout participating, do not try to convince them to participate. Ask the person from the research
j j j j j j j j j j j j j j j
teamwhois managingconsents tospeakwithconcerned patientsabout thestudy, evenafter a patient has
j j j j j j j j j j j j j j j j j j
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
j j j j j j j j j j j j j j
jnurses on a unit. Anurse who is implementing EBP integrates whichofthe following? (Select all that
j j j j j j j j j j j j j j j j j
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
j j j j
Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
j j j j j j j j j j
japproach to the delivery of healthcare that integrates the best evidence from studies and patient care data
j j j j j j j j j j j j j j j j
jwith clinician expertise and patient preferences and values.
j j j j j j j
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
j j j j j j j j j j j j j j j j j j
jand which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs.
j j j j j j j j j j j j j j j j j
jMayes applies evidence-based practice (EBP) whenever possible and has proposed the use of maggot
j j j j j j j j j j j j j
jtherapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
j j j j j j j j j j j j j
jopposes this treatment despite thesizable bodyof evidencesupportingit. Howshould the nurse reconcile
j j j j j j j j j j j j j j j
jMrs. Mayes views with the principles of EBP?
j j j j j j j
A) Thenurse should explainthat reliable and valid research evidence overrides the patients opinion.
j j j j j j j j j j j j j
B) Thenurse should explain the evidence tothe patient in greater detail.
j j j j j j j j j j j
, C) Thenurse should integrate the patients preferences into the plan of care.
j j j j j j j j j j j
D) Thenurse should involve the patients family members in the decision-making process.
j j j j j j j j j j j
Ans: C
j
Feedback: Patient preferences should be integrated into EBP and considered alongside research
j j j j j j j j j j j
jevidence and the nurses clinical expertise; evidence does not trump the patients preferences. The family
j j j j j j j j j j j j j j
jshould be involved, but this is not an explicit dimension ofEBP. Similarly, explaining the evidence in
j j j j j j j j j j j j j tx j j j
jmore detail is not a demonstration of EBP.
j j j j j j j
8. The administrators of a long-term care facility are considered the use of specialized, pressure-
j j j j j j j j j j j j j
jreducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
j j j j j j j j j j j j j j
jsought input from the nurses on the unit, all of whom are aware of the need to implement the
j j j j j j j j j j j j j j j j j j
jprinciples of evidence-based practice (EBP) in this decision. Which of the following evidence
j j j j j j j j j j j j
jsources should the nurses prioritize?
j j j j
A) Aqualitative study that explores the experience of living with a pressure ulcer
j j j j j j j j j j j j
B) Acase studythat describes the measures that nurses on a geriatric unit took toreduce pressure
j j j j j j j tx j j j j j j j j j
ulcers among patients
j j j
C) Testimonialsfromexperienced clinicians about the effectiveness ofthe mattress inquestion j j j j j j j j j j j
D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
j j j j j j j j j j
mattresses
j
Ans: D
j
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
j j j j j j j j j j j j j
jopinion are low on the hierarchy of evidence.
j j j j j j j
9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
j j j j j j j j j j j
jattempttoascertainthemostefficientandeffectivewaytocommunicatebetween nurseswhoareon
j j j j j j j j j j j j j j j
jdifferent units, a project that will consider many types of evidence. Which of the following
j j j j j j j j j j j j j j
jinformation sources should the administrators prioritize? j j j j j
A) Asystematic review about communication in nursing contexts
j j j j j j j
B) Nurses ideas about communication methods j j j j
C) The results of a chart review
j j j j j
D) Thehospitalsaccreditation status tx
Ans: A
j j
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
j j j j j j j j j j j j j j j j j
jincidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
j j j j j j j j j j j
jfindings at a level of significance of <0.01. This indicates that
j j j j j j j j j j
A) the control group and the experimental group were more than 99% similar.
j j j j j j j j j j j
B) the findings of the study have less than 1% chance of being attributable to chance.
j j j j j j j j j j j j j j
C) the effects of the intervention were nearly zero.
j j j j j j j
D) theclinical significance of the findings was less than 1:100.
j j j j j j j j j
Ans: B j
Feedback: The level ofsignificance is the level atwhich the researcher believes that the study results most
j j j j j j j j j j j j j j j j j
jlikely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
j j j j j j j j j j j j j j j j j
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
j j j j j j j j j j j j j j j j j
jhave a neonatal loss. Which of the following questions should the nurse prioritize when appraising the
j j j j j j j j j j j j j j j
jresults of this study? j j j
A) Howwell did the authors capture the personal experiences of these parents?
j j j j j j j j j j j
B) Howwell did the authors control for confounding variables that may have affected the findings?
j j j j j j j j j j j j j j
C) Didthe authors use statistical measures that were appropriate to the phenomenon in question?
j j j j j j j j j j j j j
D) Werethe instruments that the researchers used statisticallyvalid and reliable?
j j j j j j j j j j
Ans: A j
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
j j j j j j j j j j j j j j j
jsubjective experiences of individuals. Statistical measures and variables are not dimensions of a
j j j j j j j j j j j j
jqualitative methodology. j
3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch, claimingthat
j j j j j j j j j j j j j j j
jnursing research has little relevance to practice. How can the nurses colleague best defend the
j j j j j j j j j j j j j j
jimportance of nursing research? j j j
,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrant money,
j j j j j j j j j j j j j j j
something that didnt use to be the case.
j j j j j j j j
B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprograms andhasgreatly
j j j j j j j j j j j j j
increased the credibility of the profession.
j j j j j j
C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession, ratherthan simply
j j j j j j j j j j j j j j j j j
as a trade or a skill.
j j j j j j
D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
j j j j j j j j j j j j j
outcomes.
j
Ans: D j
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
j j j j j j j j j j j j j j
ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
j j j j j j j j j j j j j j
programs, grant funding, or the public view of the profession.
j j j j j j j j j j
4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy urban
j j j j j j j j j j j j j j j j j j j
hospital. She has noticed thatmany new mothers abandon breast-feeding their babies when they
j j j j j j j j j j j j j j
experience early challenges and wonders what could be done to encourage more women to continue
j j j j j j j j j j j j j j j
breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention
j j j j j j j j j j j j j j j j j
aimed at promoting breast-feeding?
j j j j
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
j j j j j j j j j
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
j j j j j j j j j j j j j j j
applications, methodological planning, and publication submission are normally carried out by
j j j j j j j j j j j
nurses who have advanced degrees in nursing.
j j j j j j j
5. A patient signed the informed consent form for a drug trial that was explained to patient by a
j j j j j j j j j j j j j j j j j
research assistant. Later, the patient admitted to his nurse that he did not understand the research
j j j j j j j j j j j j j j j j
assistants explanation orhis own rolein the study. How should this patients nurse respond to this
j j j j j j j j j j j j j j j j j
revelation?
j
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.
j j j j j j j j j j
D) Explainto the patient that his written consent is nowlegally binding.
j j j j j j j j j j j
Ans: C j
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible
j j j j j j j j j j j j j j j j j
jfor research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty
j j j j j j j j j j j j j
jabout participating, do not try to convince them to participate. Ask the person from the research
j j j j j j j j j j j j j j j
teamwhois managingconsents tospeakwithconcerned patientsabout thestudy, evenafter a patient has
j j j j j j j j j j j j j j j j j j
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
j j j j j j j j j j j j j j
jnurses on a unit. Anurse who is implementing EBP integrates whichofthe following? (Select all that
j j j j j j j j j j j j j j j j j
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
j j j j
Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
j j j j j j j j j j
japproach to the delivery of healthcare that integrates the best evidence from studies and patient care data
j j j j j j j j j j j j j j j j
jwith clinician expertise and patient preferences and values.
j j j j j j j
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
j j j j j j j j j j j j j j j j j j
jand which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs.
j j j j j j j j j j j j j j j j j
jMayes applies evidence-based practice (EBP) whenever possible and has proposed the use of maggot
j j j j j j j j j j j j j
jtherapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
j j j j j j j j j j j j j
jopposes this treatment despite thesizable bodyof evidencesupportingit. Howshould the nurse reconcile
j j j j j j j j j j j j j j j
jMrs. Mayes views with the principles of EBP?
j j j j j j j
A) Thenurse should explainthat reliable and valid research evidence overrides the patients opinion.
j j j j j j j j j j j j j
B) Thenurse should explain the evidence tothe patient in greater detail.
j j j j j j j j j j j
, C) Thenurse should integrate the patients preferences into the plan of care.
j j j j j j j j j j j
D) Thenurse should involve the patients family members in the decision-making process.
j j j j j j j j j j j
Ans: C
j
Feedback: Patient preferences should be integrated into EBP and considered alongside research
j j j j j j j j j j j
jevidence and the nurses clinical expertise; evidence does not trump the patients preferences. The family
j j j j j j j j j j j j j j
jshould be involved, but this is not an explicit dimension ofEBP. Similarly, explaining the evidence in
j j j j j j j j j j j j j tx j j j
jmore detail is not a demonstration of EBP.
j j j j j j j
8. The administrators of a long-term care facility are considered the use of specialized, pressure-
j j j j j j j j j j j j j
jreducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
j j j j j j j j j j j j j j
jsought input from the nurses on the unit, all of whom are aware of the need to implement the
j j j j j j j j j j j j j j j j j j
jprinciples of evidence-based practice (EBP) in this decision. Which of the following evidence
j j j j j j j j j j j j
jsources should the nurses prioritize?
j j j j
A) Aqualitative study that explores the experience of living with a pressure ulcer
j j j j j j j j j j j j
B) Acase studythat describes the measures that nurses on a geriatric unit took toreduce pressure
j j j j j j j tx j j j j j j j j j
ulcers among patients
j j j
C) Testimonialsfromexperienced clinicians about the effectiveness ofthe mattress inquestion j j j j j j j j j j j
D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
j j j j j j j j j j
mattresses
j
Ans: D
j
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
j j j j j j j j j j j j j
jopinion are low on the hierarchy of evidence.
j j j j j j j
9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
j j j j j j j j j j j
jattempttoascertainthemostefficientandeffectivewaytocommunicatebetween nurseswhoareon
j j j j j j j j j j j j j j j
jdifferent units, a project that will consider many types of evidence. Which of the following
j j j j j j j j j j j j j j
jinformation sources should the administrators prioritize? j j j j j
A) Asystematic review about communication in nursing contexts
j j j j j j j
B) Nurses ideas about communication methods j j j j
C) The results of a chart review
j j j j j
D) Thehospitalsaccreditation status tx
Ans: A
j j
