Test Bank for Clinical Nursing Skills and Techniques 9th Edition by Perry

Test Bank for Clinical Nursing Skills and Techniques 9th Edition by Perry

Chapter 01: Using Evidence in Practice

MULTIPLE CHOICE

1. Evidence-based practice is a problem-solving approach to making decisions about patient care that is grounded in:

ANS:   B

The best evidence comes from well-designed, systematically conducted research studies described in scientific journals. Portions of a textbook often become outdated by the time it is published. Many health care settings do not have a process to help staff adopt new evidence in practice, and nurses in practice settings lack easy access to risk-management data, relying instead on tradition or convenience. Some sources of evidence do not originate from research. These include quality improvement and risk-management data; infection control data; retrospective or concurrent chart reviews; and clinicians’ expertise. Although non–research-based evidence is often very valuable, it is important that you learn to rely more on research-based evidence.

DIF:    Cognitive Level: Comprehension       REF:    Text reference: p. 2

OBJ:    Discuss the benefits of evidence-based practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

2. When evidence-based practice is used, patient care will be:

ANS:   C

Using your clinical expertise and considering patients’ cultures, values, and preferences ensures that you will apply available evidence in practice ethically and appropriately. Even when you use the best evidence available, application and outcomes will differ; as a nurse, you will develop critical thinking skills to determine whether evidence is relevant and appropriate.

DIF:    Cognitive Level: Application             REF:    Text reference: p. 2

OBJ:    Discuss the benefits of evidence-based practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

3. When a PICOT question is developed, the letter that corresponds with the usual standard of care is:

ANS:   C

C = Comparison of interest. What standard of care or current intervention do you usually use now in practice?

P = Patient population of interest. Identify your patient by age, gender, ethnicity, disease, or health problem.

I = Intervention of interest. What intervention (e.g., treatment, diagnostic test, and prognostic factor) do you think is worthwhile to use in practice?

O = Outcome. What result (e.g., change in patient’s behavior, physical finding, and change in patient’s perception) do you wish to achieve or observe as the result of an intervention?

DIF:    Cognitive Level: Knowledge             REF:    Text reference: p. 3

OBJ:    Develop a PICO question.                 TOP:    PICO

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

4. A well-developed PICOT question helps the nurse:

ANS:   A

The more focused a question that you ask is, the easier it is to search for evidence in the scientific literature. A well-designed PICOT question does not have to include all five elements, nor does it have to follow the PICOT sequence. Do not be satisfied with clinical routines. Always question and use critical thinking to consider better ways to provide patient care.

DIF:    Cognitive Level: Analysis                  REF:    Text reference: p. 3

OBJ:    Describe the six steps of evidence-based practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

5. The nurse is not sure that the procedure the patient requires is the best possible for the situation. Utilizing which of the following resources would be the quickest way to review research on the topic?

ANS:   D

The Cochrane Community Database of Systematic Reviews is a valuable source of synthesized evidence (i.e., pre-appraised evidence). The Cochrane Database includes the full text of regularly updated systematic reviews and protocols for reviews currently happening. MEDLINE, CINAHL, and PubMed are among the most comprehensive databases and represent the scientific knowledge base of health care.

DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 4

OBJ:    Describe the six steps of evidence-based practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

6. The nurse is getting ready to develop a plan of care for a patient who has a specific need. The best source for developing this plan of care would probably be:

ANS:   C

The National Guidelines Clearinghouse (NGC) is a database supported by the Agency for Healthcare Research and Quality (AHRQ). It contains clinical guidelines—systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population. The NGC is a valuable source when you want to develop a plan of care for a patient. The Cochrane Community Database of Systematic Reviews, MEDLINE, and CINAHL are all valuable sources of synthesized evidence (i.e., pre-appraised evidence).

DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 4

OBJ:    Describe the six steps of evidence-based practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

7. The nurse has done a literature search and found 25 possible articles on the topic that she is studying. To determine which of those 25 best fit her inquiry, the nurse first should look at:

ANS:   A

An abstract is a brief summary of an article that quickly tells you whether the article is research based or clinically based. An abstract summarizes the purpose of the study or clinical query, the major themes or findings, and the implications for nursing practice. The literature review usually gives you a good idea of how past research led to the researcher’s question. The “Methods” or “Design” section explains how a research study is organized and conducted to answer the research question or to test the hypothesis. The narrative of a manuscript differs according to the type of evidence-based article—clinical or research.

DIF:    Cognitive Level: Application             REF:    Text reference: p. 7

OBJ:    Discuss elements to review when critiquing the scientific literature.

TOP:    Randomized Controlled Trials           KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

8. The nurse wants to determine the effects of cardiac rehabilitation program attendance on the level of postmyocardial depression for individuals who have had a myocardial infarction. The type of study that would best capture this information would be a:

ANS:   B

Qualitative studies examine individuals’ experiences with health problems and the contexts in which these experiences occur. A qualitative study is best in this case of an individual nurse who wants to examine the effectiveness of a local program. Randomized controlled trials involve close monitoring of control groups and treatment groups to test an intervention against the usual standard of care. Case control studies typically compare one group of subjects with a certain condition against another group without the condition, to look for associations between the condition and predictor variables. Descriptive studies focus mainly on describing the concepts under study.

DIF:    Cognitive Level: Synthesis                REF:    Text reference: p. 6

OBJ:    Discuss ways to apply evidence in nursing practice.

TOP:    Randomized Controlled Trials           KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe and Effective Care Environment (management of care)

9. Six months after an early mobility protocol was implemented, the incidence of deep vein thrombosis in patients was decreased. This is an example of what stage in the EBP process?

ANS:   C

After implementing a practice change, your next step is to evaluate the effect. You do this by analyzing the outcomes data that you collected during the pilot project. Outcomes evaluation tells you whether your practice change improved conditions, created no change, or worsened conditions.

DIF:    Cognitive Level: Application             REF:    Text reference: p. 9

OBJ:    Discuss ways to apply evidence in nursing practice.

TOP:    Evidence-Based Practice                   KEY:   Nursing Process Step: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment (safety and infection control)

MULTIPLE RESPONSE

1. To use evidence-based practice appropriately, you need to collect the most relevant and best evidence and to critically appraise the evidence you gather. This process also includes: (Select all that apply.)

ANS:   A, B, C, D