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1. In the hospital where Nurse L. provides care, tradition dictates that oral temperatures be included in every set of patient vital signs, regardless of patient diagnosis or acuity. This is most likely an example of which of the following phenomena? A) The prioritization of internal evidence over external evidence B) Practice that lacks evidence to support its application C) The integration of personal expertise into nursing care D) Evidence-based practice
2. The clinical nurse educator (CNE) on a postsurgical unit has recently completed a patient chart review after the implementation of a pilot program aimed at promoting early ambulation following surgery. Which of the following components of EBP is the nurse putting into practice? A) Patient preferences B) Research utilization C) Experience D) Internal evidence
3. Nurse R. has observed that reorienting demented patients as frequently as possible tends to minimize the patients' level of agitation in the evening. The nurse has shared this observation with a colleague, who is skeptical, stating that, “It's best to stick to evidence-based practice.” How can Nurse R. best respond? A) “EBP can include clinicians' personal expertise.” B) “Personal experience is often more sound than formal evidence-based practice.” C) “Traditional practice and EBP are usually shown to be the same.” D) “My years of experience can be just as valuable as any literature review or randomized trial.”
4. Which of the following factors provides the most important rationale for the consistent implementation of EBP? A) EBP provides for the most cost-effective patient care. B) EBP is accessible to all healthcare clinicians. C) EBP provides consistency in care across healthcare settings. D) EBP improves patient outcomes.
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5. The Institute of Medicine's Roundtable on Evidence-Based Medicine has been established to address EBP. Which of the following issues is the Roundtable emphasizing? A) Ensuring that external evidence, rather than internal evidence, is integrated into care B) Fostering the level of learning that exists in the American healthcare system C) Issuing clinical guidelines to ensure best nursing practice D) Comparing the implementation of EBP in the United States with that of other Western countries
6. You have become frustrated with some aspects of patient care that you believe are outdated and ineffective at the long-term care facility where you have recently begun practicing. Consequently, you have resolved to examine some of these practices in light of evidence. Which of the following should occur first in the steps of EBP? A) Conducting an electronic search of the literature and ranking individual sources B) Creating “buy-in” from the other clinicians who provide care at the facility C) Developing an inquisitive and curious mindset D) Assessing whether the practices in question may, in fact, be evidence-based
7. Which of the following clinical questions best exemplifies the PICOT format? A) What effect does parents' smoking have on the smoking habits of their children, ages 13 to 16? B) Among cancer patients, what role does meditation, rather than benzodiazepines, have on anxiety levels during the 7 days following hospital admission? C) Among undergraduate college students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new gonorrheal and chlamydial infections reported to the campus medical center? D) In patients aged 8 to 12, is the effectiveness of a pain scale using faces superior to a numeric rating scale in the emergency room context?
8. After formulating a clinical question, a nurse has proceeded to search for evidence for ways to foster restful sleep in patients who are receiving care in the intensive care unit (ICU). The nurse has identified a relevant meta-analysis in an electronic database. What will this source of evidence consist of? A) A statistical summary of the results from several different studies B) An examination of the theoretical and conceptual underpinnings of the issue C) An interdisciplinary analysis of the clinical question D) A qualitative study of different interventions related to the clinical question
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9. The nurses on a postpartum unit have noted that many primiparous (first-time) mothers are giving up on breastfeeding within the 24 hours following delivery, and the nurses want to create uniform guidelines for promoting breastfeeding on the unit. Which of the following sources is most likely to provide the best evidence in their quest for an intervention? A) Evidence from a randomized control trial that had more than 2500 participants B) Evidence from a study that is widely regarded as a classic within the obstetrical nursing community C) Evidence from a systematic review of breastfeeding-promotion studies that one of the nurses identified in an electronic database D) The consensus opinion of the most senior nurses on the unit
10. The nurse educator on an acute medicine unit is advocating for the use of evidence-based clinical practice guidelines on wound care in order to standardize and optimize the practice of the nurses on the unit. Which of the following statements best describes clinical practice guidelines? A) The result of replication studies of existing research by an impartial third party B) A collection of authorized interventions that are required by law C) A number of interventions that are the result of a large, publically-funded RCT D) A group of practice recommendations that result from a rigorous review of the literature
11. A nurse is conducting a literature review on the evidence regarding the use of vacuum dressings on stage IV pressure ulcers. After locating a recent study that appears to be relevant, which of the following questions would the nurse consider first when critically appraising the study? A) “Are the findings of this study cost-effective in our clinical context?” B) "How would the implementation of this intervention affect our staffing needs?" C) “Were the patients in the study similar to the patients on my unit?” D) “Are the findings of the study significantly different from what we are currently doing on the unit?
12. The primary care provider of a 49-year-old male patient has examined and briefly explained the evidence that supports beginning regular digital-rectal exams. Which of the following factors would justify not performing digital-rectal examinations in this patient's care? A) The patient is vehemently opposed to undergoing a digital-rectal exam. B) Clinical practice guidelines for prostate care have not been published. C) The clinician has been unable to find any large RCTs in a literature review. D) The clinician has previously waited until patients are 55 to begin regular digital-rectal exams.
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13. The implementation of a new, evidence-based infection-control regimen in a community hospital has resulted in a significant reduction in the incidence of nosocomial (hospital-acquired) infections. What should constitute the final step in the nurses' evidence-based practice? A) Calculating the cost-savings that will be realized by using the new regimen B) Sharing their experience with other healthcare professionals C) Implementing enforcement measures to ensure compliance with the new regimen D) Conducting a meta-analysis of other infection-control measures
14. Frustrated by the lack of follow-up provided to patients who are newly diagnosed with type 2 diabetes, a community health nurse has begun the process of identifying evidence for the best interventions for this patient population. Which of the following factors is most likely to promote the use of EBP in this nurse's workplace? A) Bringing in nurses who have been educated at a baccalaureate (bachelor's degree) level B) Increasing nurses' accountability for patient outcomes C) Increased funding D) Support from the practice leaders and administration
15. In the process of advocating for EBP in the unit guidelines around the management of increased intracranial pressure, a nurse has met with skepticism from other members of the nursing staff, with several stating, “Evidence-based practice is good in theory, but it's almost impossible to actually search hundreds of journals and find the evidence.” What could the nurse recommend? A) Self-reflection on the nurses' current practices B) Accessing the Cochrane Library C) Contacting the clinical nurse educator on the unit D) Beginning with lay publications before progressing to peer-reviewed journals
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Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
B D A D B C B A C D C A B D B
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1. Which of the following components of a clinical question represents the “P” in the PICOT format for asking clinical questions? A) The nurse's preparation for patient teaching prior to surgery B) Early ambulation versus aggressive anticoagulant therapy C) Individuals who require peritoneal dialysis D) Deep vein thrombosis
2. An unacceptably high number of patients on a geriatric, subacute medicine unit have developed pressure ulcers during their period of care. The nurses on the unit have agreed on a goal of reducing the incidence of these wounds by 50% over the next 10 weeks. This goal represents which component of the PICOT format for asking clinical questions? A) O B) P C) I D) C
3. Which of the following scenarios represents the most common obstacle that nurses encounter when attempting to gain the knowledge necessary for EBP? A) A nurse identifies several articles relevant to a clinical question, but the methodology of each is significantly flawed. B) A nurse is overwhelmed by the number of hits during a CINAHL search. C) Current research that relates to the nurse's clinical question does not exist. D) The research that the nurse locates is rooted in a medical, not nursing, perspective.
4. A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem? A) Narrow the scope of the clinical question B) Restrict the information search to publications from the past 24 months C) Seek recommendations for information sources from trusted colleagues D) Limit the search to articles that relate the findings of randomized control trials (RCTs)
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5. A pediatric nurse provides care for many children who present to the emergency department (ED) with signs and symptoms of asthma. Which of the following questions is a background question that the nurse can utilize in the process of providing EBP? A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers (MDIs)? B) What patient populations respond best to nebulized bronchodilators? C) How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm? D) Are nebulizers provided to patients in the ED more often than metered-dose inhalers?
6. Which of the following statements is true of foreground questions? A) They focus on issues that can be addressed by applying scientific evidence. B) They have a broad, rather than narrow, scope. C) They can be answered by examining electronic information sources instead of print sources. D) They are rooted in the current practices of a nurse's clinical setting.
7. An oncology nurse is engaged in increasing the quality of EBP that is provided on the cancer unit of the local hospital. Which of the following questions would the nurse consider to be an adequate and useful foreground question? A) “Are benzodiazepines and analgesics provided before patients have a bone marrow biopsy?” B) “What is the clinical rationale for using bone marrow biopsy to gauge and predict the course of a patient's cancer?” C) “Does guided imagery reduce the anxiety of patients who undergo bone marrow biopsy?” D) “How often is bone marrow biopsy performed on the unit?”
8. Which of the following clinical questions would be most justified in lacking a comparison? A) An examination of the antipyretic qualities of cool bed-bathing B) A study on the perceived meaning of hope among palliative patients C) A study on the influence of prenatal care on preventing perineal tearing during delivery D) An examination of the effect of rehydration using lactated Ringer's on patients' energy levels
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9. Which of the following clinical questions would be considered to be a “meaning” question? A) “What factors underlie parents' decisions to refuse immunizations for their children aged 3 months to 24 months?” B) “What factors, apart from asbestos exposure, may contribute to ex-miners' diagnoses of mesothelioma?” C) “How do pregnant women with high-risk pregnancies who have been prescribed bed-rest perceive their situations?” D) “Are cigarette warning labels an effective deterrent to cigarette smoking among females aged 11 to 15 years?”
10. Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question? A) The patient population should be as narrow a range as possible. B) The population in the clinical question should closely match the demographics of the nurse's geographic region. C) A specific and defensible rationale should exist for the choice of patient population. D) The patient population in the clinical question should mirror the populations in prominent studies related to the issue.
11. In the context of the PICOT format for formulating clinical questions, which of the following may be considered to be an intervention? A) Levels of patient hygiene in an assisted-living facility B) The incidence and prevalence of stomach cancer among low-income males aged 65 to 85 C) The prevalence of wound dehiscence among postmastectomy patients D) Occupational exposure to airborne silicon dust
12. Which of the following symptoms could be best clustered into a single outcome for the purposes of crafting a concise clinical question? A) Increased anxiety, increased serum cholesterol, and low rating of overall well-being B) Hypotension, tachycardia, and decreased level of consciousness C) Increased temperature, decreased mobility, and confusion D) Increased neonatal bilirubin levels and the mother's choice to feed with formula rather than breastfeed
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13. Which of the following clinical questions can be best addressed by a meta-synthesis of qualitative studies? A) “What is the meaning of spiritual support in hospice patients who are younger than 50?” B) “What is the effectiveness of physical activity compared with beta-blockers in reducing the blood pressure of adult, African-American men?” C) “Is the use of a stroke team in the emergency department, rather than standard assessment and treatment, associated with improved outcomes among patients diagnosed with stroke?” D) “Are single-occupancy hospital rooms, rather than shared rooms, associated with increased patient satisfaction reports?”
14. Which of the following principles can help a nurse rank levels of evidence when answering clinical questions of all types and scopes? A) Quantitative research supersedes qualitative research. B) Randomized control trials must be included when answering clinical questions. C) Sources of evidence must be peer-reviewed. D) Syntheses are the highest level of evidence.
15. Which of the following groups would most likely be considered a self-selected cohort? A) Obese, Hispanic females B) Cigarette smokers C) Patients with hypertension who take diuretics D) Teenage females
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Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
C A B A D A C B C C D B A D B
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1. A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement EBP. Which of the following questions could those nurses best answer by consulting a textbook? A) “What effect does a diagnosis of renal failure have on type 2 diabetics' glucose monitoring behavior?” B) “What factors influence clinicians' decisions to recommend peritoneal dialysis over hemodialysis?” C) “What are the anatomical characteristics and physiological functions of the kidneys?” D) “What is the relationship between dosing of erythropoietin therapy and hemoglobin levels in patients with chronic renal failure?”
2. A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first? A) A newspaper article B) A systematic review C) A conference presentation D) A journal article
3. After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has “googled” the subject. How should the nurse best interpret the results of this search? A) The nurse must carefully evaluate the results of this search. B) The results of searching sites such as Google and Yahoo are not clinically useful. C) The search is likely to yield inaccurate or biased results. D) The search is a time-efficient substitute for searching online health databases.
4. A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most likely to provide the nurse with specific interventions and practices to achieve this goal? A) Cumulative Index to Nursing and Allied Health Literature (CINAHL) B) National Guideline Clearinghouse C) PsycINFO D) MEDLINE
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5. A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital's policy on the use of physical restraints. During the search, what parameters should the nurse establish for the dates of articles and other information sources? A) Articles should be ranked according to publication date, with the most recent articles being prioritized. B) The nurse should attempt to identify collaborative evidence for any source that is more than 3 years old. C) The nurse should establish a cutoff for sources more than 5 years old. D) The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication.
6. While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching “beta blockers.” How should the nurse proceed? A) Identify the appropriate MeSH term B) Search for clinical guidelines in the Cochrane Library C) Consult the reference lists in articles that appeared during the search D) Search the trade names of specific beta-blocking drugs
7. In light of the large number of gall bladder patients recently admitted to the unit, a nurse is searching PubMed for literature relating to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field? A) “chole*” B) “cholecystitis or cholecystectomy or cholelithiasis or cholecystography” C) “gall bladder” D) “chole-”
8. A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results? A) “nutrition OR (delirium OR dementia)” B) “(delirium OR dementia) AND nutrition” C) “delirium dementia nutrition” D) “delirium AND dementia AND nutrition”
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9. In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search? A) Only noncopyrighted resources will be available to the nurse. B) The nurse will be guaranteed that each result will be from a peer-reviewed source. C) The nurse will be unable to conduct a valid or useful search. D) Articles that are relevant may be excluded from consideration.
10. A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions? A) Cochrane Database of Systematic Reviews (CDSR) B) Cochrane Central Register of Controlled Trials (CENTRAL) C) Cochrane Methodology Register D) Health Technology Assessment (HTA) Database
11. A nurse has conducted a search of PubMed to answer the question, What factors influence older adults' decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue? The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed? A) Date of publication B) Number of times the article has been cited C) Ranking by peer review D) Date the article was added to the database
12. A nurse is working on a literature review using a laptop computer while in a café that provides wireless Internet access but will not allow for connection to the hospital library's server that provides the nurse's normal access to database subscriptions. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection? A) PubMed B) Cochrane Library C) MEDLINE D) EMBASE
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Evidence-Based Practice in Nursing and Healthcare 4th Edition Melnyk Test Bank Full ACCESS Test Bank From Link Below https://nursylab.com/products/evidence-based-practice-in-nur sing-and-healthcare-4th-edition-melnyk-test-bank/ TestBank Directly From The publisher, 100% Verified Answers. COVERS ALL CHAPTERS. Download Immediately
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