Test Bank Understanding Medical Surgical Nursing 5th Edition Williams Hopper

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== SAMPLE ==

Chapter 2. Evidence-Based Practice

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse working in a radiation oncology department wants to reduce the incidence of skin breakdown in patients who receive beam radiation. Which question should the nurse use to guide a literature search about this topic?
a. How often do patients with beam radiation experience skin breakdown?
b. Why do patients who get radiation beam therapy have skin breakdown?
c. What nursing interventions minimize the occurrence of skin breakdown in patients receiving beam radiation?
d. How does our rate of skin breakdown in patients receiving beam radiation compare to other institutions in the city?

____ 2. The nurse who works on a medical-surgical unit reads an article about a research study regarding nursing care in the intensive care unit (ICU) and decreased nosocomial infections. Which action should the nurse take in exploring this research topic?’
a. Institute a pilot study utilizing the outlined nursing care.
b. Discuss the research with the chief of nursing at the institution.
c. Do a journal search and look for similar studies related to non-ICU patients.
d. Take the article to the nurse manger in the ICU and suggest a new policy be developed.

____ 3. A licensed practical nurse (LPN) working on the pediatric floor is interested in improving patient outcomes for children with asthma. Which clinical question would best guide the nurse’s next steps?
a. How many patients with asthma have a pet dog or cat?
b. What is the monthly admission rate of patients with asthma to the unit?
c. What patient education materials are available to address effective management of asthma in pediatric patients?
d. How has the occurrence rate of asthma in children under the age of 5 changed since the hospital instituted a no smoking policy for the hospital grounds?

____ 4. The nurse is preparing to give oral care to a patient receiving tube feedings. Which approach should the nurse use to provide care that is based on EBP?
a. Use a soft toothbrush and toothpaste to brush the teeth.
b. Have the patient use swish-and-swallow Nystatin twice a day.
c. Increase oral suctioning to every 2 hours using toothette suction devices.
d. Use mouthwash and toothettes to swab the teeth and mouth three times a day.

____ 5. The nurse is planning to review a research article for applicability to EBP. Which acronym should the nurse use to guide this review?
a. RIGHT
b. MYWAY
c. ASKMME
d. ASKWHY

____ 6. The nurse working on the burn unit is interested in understanding the rate of renal compromise with a burn. Which step should the nurse take first?
a. Complete a literature review.
b. Work with a medical librarian to identify key words.
c. Develop a clinical question that can guide further research.
d. Join the policy and procedure committee to evaluate care in the hospital.

____ 7. A nursing committee developed an evidence-based intervention that it would like to initiate institute-wide. Which step should the committee take to implement the intervention?
a. Conduct a small pilot study involving the proposed change.
b. Ask the charge nurse to propose the change to administration.
c. Poll the nursing staff to determine its attitude toward change.
d. Invite nursing experts in the city to review the proposed change.

____ 8. The nurse is researching evidence to address a clinical problem. Which evidence should the nurse focus as being the highest level supporting practice?
a. Evidence obtained from quasi-experimental research studies
b. Evidence from a systematic review of all relevant randomized clinical trials
c. Evidence from the opinion of authorities and/or reports of expert committees
d. Evidence obtained from at least one well-designed randomized controlled trial

____ 9. A nursing student asks the registered nurse (RN) preceptor why EBP is important. How should the nurse respond to the student?
a. “EBP makes nursing more professional.”
b. “EBP helps ensure we can demand more pay.”
c. “EBP helps validate the difference nurses really make.”
d. “EBP guides nursing decisions to optimize effective care.”

____ 10. The nurse is reviewing a proposal for changing the type of needleless systems currently used to administer intravenous (IV) medications in the hospital. Which part of the proposal most effectively supports the proposed change?
a. A pilot study is planned.
b. Two cases of staff injury related to needle sticks have occurred in the past 3 years.
c. A single randomized clinical trial is cited as evidence to support the new policy.
d. The supporting evidence includes research conducted at an outpatient hematology center.

____ 11. The staff development instructor is preparing a presentation on EBP for the nursing staff. Which should the instructor include as being the most important reason for using EBP?
a. Saves money
b. Optimizes care
c. Reduces staff error
d. Improves access to care

____ 12. The nurse is researching articles prior to determining the best practice for providing an aspect of patient care. On what type of article should the nurse focus when researching best practice?
a. Expert opinion
b. Systematic review
c. Traditional practice
d. Quasi-experimental studies

____ 13. The nurse wants to find research studies on infection rates as they relate to specific hand washing products. Where should the nurse search for these articles?
a. Medline
b. PubMed
c. CINAHL
d. Cochrane Reviews

____ 14. The nurse researcher is designing a study using the quasi-experimental approach. What type of data will the nurse obtain from this study design?
a. Uncontrolled results
b. Outcome tracking over 10 years
c. Controlled comorbid conditions
d. Modifiable and non-modifiable risk factors

____ 15. The nurse is planning to evaluate care provided to a patient. Which step should the nurse take to learn if the best possible care is being provided?
a. Measure outcomes.
b. Review the literature.
c. Construct a burning clinical question.
d. Determine the validity of clinical research.

____ 16. After completing all of the steps in the research process, the nurse identifies a positive response to a new intervention for foot ulcer care. Which step in EBP should the nurse perform now?
a. Publish and share the results of the study.
b. Complete a cost-benefit analysis of the results.
c. Evaluate the validity of related research studies.
d. Conduct a pilot project using the proposed intervention.

____ 17. The nurse is using Level II research when planning best practices for skin care. Which type of evidence is the nurse using?
a. Cochrane Review
b. A quasi-experimental study
c. Joanna Briggs Best Practice Review
d. A randomized controlled trial (RCT)

____ 18. While reviewing a patient care assignment with unlicensed assistive personnel (UAP), the nurse explains the reason for turning and repositioning a patient every 2 hours. Why did the nursing include this information?
a. Ensures that evidence-based care is provided
b. Guarantees that the patient will receive morning care
c. Helps UAP focus on the action being performed
d. Helps UAP with time management of tasks to complete

____ 19. Prior to administering a prescribed medication to a patient, the nurse talks with the health care provider (HCP) regarding expected effects and then contacts the pharmacist to review the guidelines for administration. Which Quality and Safety Education for Nurses (QSEN) focus is the nurse demonstrating?
a. Informatics
b. Patient-centered care
c. Quality improvement
d. Teamwork and collaboration

____ 20. The nurse identifies an intervention that has been proven to enhance patient safety. What should the nurse do before implementing this intervention?
a. Analyze the intervention to determine if it is appropriate for the patient.
b. Ask the charge nurse if the intervention can be implemented.
c. Find out if the patient wants the intervention to be performed.
d. Conduct a pilot study to see if the intervention works on the care area.

Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 21. The nurse is implementing dependent interventions when providing patient care. Which actions are dependent nursing interventions? (Select all that apply.)
a. Low sodium soft diet
b. Music therapy as desired
c. Bathroom privileges as tolerated
d. Give Tylenol 650 mg orally every 4 hours prn pain
e. Wet-to-moist dressing changes every 6 hours while awake

____ 22. The nurse is planning a quasi-experimental study. Which criteria support the nurse’s approach? (Select all that apply.)
a. 28 volunteer patients who agree to try a new type of mouthwash
b. An experimental group and a control group each with 225 patients
c. 14 individuals on a medical unit who complete the same questionnaire
d. Tracking of pneumonia rates for all patients receiving artificial tube feedings
e. Identification of oral flora in nursing home patients who receive artificial feedings

____ 23. The nurse is working with a committee to determine EBP approaches for patient care. Which steps will the committee members include when determining EBP? (Select all that apply.)
a. Evaluate the change.
b. Measure the outcome.
c. Ask the nursing experts.
d. Manipulate current practice.
e. Search for the best available evidence.

____ 24. The nurse is considering the importance of safety when providing patient care. At which times should the nurse be particularly alert for safety hazards? (Select all that apply.)
a. When providing patient medications
b. When identifying a patient for a treatment
c. When washing hands after providing care
d. When stocking the supply room with linens
e. When raising the side rails on a patient’s bed

____ 25. The nurse is implementing the QSEN focus of patient-centered care. Which nursing actions support this focus? (Select all that apply.)
a. Individualize interventions.
b. Schedule interventions to meet the patient’s needs.
c. Evaluate interventions for applicability to the patient.
d. Scan prescribed medications using the bar-coding system.
e. Document responses to treatment in the electronic medical record.

Chapter 2. Evidence-Based Practice
Answer Section

MULTIPLE CHOICE

1. ANS: C
Asking a burning clinical question is the first step in the evidence-based practice (EBP) process. It is important to include related factors in the question and to focus on nursing interventions and care. In this situation, the nurse should focus on nursing care that may reduce the occurrence of skin breakdown for the specific patient population of interest. A. B. The frequency of skin breakdown and why patients develop skin breakdown does not help identify ways to prevent skin breakdown. D. Information on statistics from other organizations will not help the nurse identify ways to prevent skin breakdown.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

2. ANS: C
Clinical reality can be very different from research situations. It could be unsafe to apply research findings in an environment that differs from the one in the study, so the next step would be to identify current research related to the current population. A. A pilot study would be premature. B. Discussing the research with the chief of nursing would not help explore the topic. D. Taking the article to the head nurse in the ICU would not help with the issue of nosocomial infections on the medical-surgical unit.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

3. ANS: C
Asking a burning clinical question is the first step in the EBP process. It is important to include related factors in the question and to focus on nursing interventions and care. For this scenario, the nurse would focus on nursing care that affects patient outcomes for the specific patient population of interest. Patient education is a critical component of nursing care. A. B. D. Information about pets, admission rates of patients with asthma, and asthma occurrence since the implementation of a no smoking policy will not help improve patient outcomes for children with asthma.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

4. ANS: D
Evidence-based information shows the use of toothbrushes for oral care is much more effective than foam swabs in removing plaque from the teeth. B. Swish-and swallow Nystatin is a medication that treats oral thrush and is not routinely used to provide oral care. C. Oral suctioning is not an approach to provide oral care. D. Toothettes are not an effective mechanism for providing oral care.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Application

5. ANS: C
An acronym that can be used to recall the steps of the evidence-based process is ASKMME: Ask, Search, Think, Measure, Make It Happen, and Evaluate. A. B. D. RIGHT, MYWAY, and ASKWHY are not acronyms used to recall the steps of the evidence-based process.

PTS: 1 DIF: Easy
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

6. ANS: C
Asking a burning clinical question is the first step in the EBP process. A. B. Conducting a literature search and working with a medical librarian to identify key words would be done after the clinical question is formulated. D. Evaluating the impact of care or changes in care is the last step in the EBP process.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

7. ANS: A
Usually a small pilot study within the institution is done before any institute-wide change in practice is made. B. The charge nurse will not have the evidence needed to propose the change to administration. C. Polling the nursing staff is not going to help with implementing the change. D. Nursing experts might not have the information needed to determine if the change is appropriate within the organization.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

8. ANS: B
Level I is the best evidence and is an analysis of many well-conducted, randomized, controlled trials. It is a systematic review of studies. D. Level II evidence is obtained from at least one well-designed randomized controlled trial. A. Level III is evidence obtained from quasi-experimental research studies. C. Level IV is evidence from the opinion of authorities and/or reports of expert committees.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

9. ANS: D
Evidence-based nursing practice is much more than just evaluating research studies to determine what results to apply to nursing practice. Evidence-based nursing practice is a systematic process that utilizes current evidence to make decisions about the care of patients, including evaluation of quality and applicability of existing research, patient preferences, costs, clinical expertise, and clinical settings. A. B. EBP is not used to support professionalism in nursing or as a mechanism to increase nurses’ salaries. C. EBP also is not used to validate the importance of nursing care.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

10. ANS: A
A small pilot study is typically done before an institute-wide change is made. B. This would not be a statistically significant number to support the need for change. C. More evidence or evidence of a higher level would better support the proposed change. D. It is important to consider the context in which the evidence will be used, and research involving a population similar to that of the nurse’s institution is helpful.

PTS: 1 DIF: Difficult
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

11. ANS: B
The use of EBP allows nurses to give patients the best care possible, which is the goal of all caring nurses. It is considered the gold standard for nursing care. A. C. EBP does not necessarily save money or reduce staff errors. D. EBP does not influence access to health care.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

12. ANS: B
Systematic review, or Level I evidence, is the best evidence; it is an analysis of several well-conducted, randomized, controlled trials. A. Expert opinion is Level IV evidence, which is considered the weakest evidence. C. Traditional practice is not a type of evidence for EBP analysis. D. Quasi-experimental studies are considered Level III evidence, because these studies do not control factors that could falsely change the results and are less predictive of the effectiveness of nursing care.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

13. ANS: C
The only database specific to nursing is CINAHL. CINAHL is available through school libraries and hospital libraries. A. B. Medline and PubMed are the same resource and are used for medical literature. D. Cochrane Reviews focus on reviews of nursing literature.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

14. ANS: A
Quasi-experimental research studies do not control for factors that could falsely change results and as such, are less predictive of the effectiveness of nursing care. B. Outcome tracking over 10 years is a longitudinal study design, however, does not explain the type of data that will be obtained. C. Control of comorbid conditions describes a Level II design study. D. Modifiable and non-modifiable risk factors would not be identified through a quasi-experimental approach, because the variables or factors are not controlled.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

15. ANS: A
Nurses will know from measured outcomes that they are giving the best care possible based on the evidence available at the time. B. Reviewing the literature helps with planning care. C. Constructing a burning question is used to identify the best possible practice for care. D. Determining the validity of clinical research is used to analyze research studies for best practices.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

16. ANS: A
The steps of EBP are Ask, Search, Think, Measure, Make It Happen, and Evaluate. Since the nurse completed Ask, Search, Think, and Measure, the next step is Make It Happen. B. A cost-benefit analysis should have been completed already. C. Related research studies should have been validated already. D. A pilot project should have been completed already.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Physiological Integrity | Cognitive Level: Application

17. ANS: D
A randomized controlled trial is considered Level II evidence. A. C. The Cochrane Review and Joanna Briggs Best Practices Review are considered Level I evidence. B. A quasi-experimental study is considered Level III evidence.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

18. ANS: A
Evidence-based care should be given at all times if possible and in all settings where nursing care is given. A way to ensure that evidence-based care is provided is to explain why the care should be given at the time the care is delegated. B. C. D. Explaining the reason for the care is not done to guarantee that the patient will receive morning care, help the UAP focus on actions, or help with time management.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

19. ANS: D
Discussing expected effects of a prescribed medication with an HCP and reviewing guidelines for administration of the medication with the pharmacist demonstrate teamwork and collaboration. A. Informatics is the management of patient confidential information. B. Patient-centered care is creating an individualized plan of care for a patient. C. Quality improvement is a process to improve patient care.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

20. ANS: A
It takes critical thinking to use safety interventions at the right times and in the right circumstances. Using them appropriately helps provide safer care with fewer errors. A. The nurse does not need to ask for permission to use a safety intervention. C. The patient will most likely want all safety interventions to be used. D. A pilot study does not need to be conducted before implementing a safety intervention.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

MULTIPLE RESPONSE

21. ANS: A, C, D, E
Dependent nursing interventions are those delegated by a physician. B is an independent nursing intervention that does not require a physician’s order.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Basic Care and Comfort | Cognitive Level: Analysis

22. ANS: A, C, D, E
Quasi-experimental studies do not control factors that could falsely change the results and as such, are less predictive of the effectiveness of nursing care. No control exists if there is only one group being tracked or if patients are collected on a volunteer basis. B. The use of an experimental group and a control group describes a randomized controlled trial study.

PTS: 1 DIF: Difficult
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

23. ANS: A, B
The steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. An acronym to remember these steps is ASKMME. C. D. Asking nursing experts and manipulating current practice are not steps in the EBP process.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

24. ANS: A, B, C, E
Safety goals increase awareness and understanding of patient safety. They address administering medications safely, identifying patients correctly, identifying operative sites correctly, improving communication, reducing fall injuries, and reducing the risk of infection. D. Safety goals would not be applicable while stocking a supply room with linens.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

25. ANS: A, B, C
A. When collaborating on the development of nursing care plans, it is important to individualize interventions to provide patient-centered care. B. As nursing interventions are performed, they should meet the patient’s preferred schedules. C. Nurses should always evaluate each suggested intervention to see if it fits the patient. D. E. Scanning medication using a bar-coding system and documenting in the electronic medical record are actions that support the focus of informatics.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis