Test Bank For Evidence-Based Practice in Nursing and Healthcare, 4th Edition

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Page 11.A nurse who provides care on a renal unit has posed a number of clinical questions in aneffort to implement EBP. Which of the following questions could those nurses bestanswer by consulting a textbook?A)“What effect does a diagnosis of renal failure have on type 2 diabetics' glucosemonitoring behavior?”B)“What factors influence clinicians' decisions to recommend peritoneal dialysis overhemodialysis?”C)“What are the anatomical characteristics and physiological functions of thekidneys?”D)“What is the relationship between dosing of erythropoietin therapy and hemoglobinlevels in patients with chronic renal failure?”2.A nurse has heard from a colleague about a new approach to providing nursing care forconfused patients who have been diagnosed with hepatic encephalopathy. In which ofthe following sources is this information most likely to appear first?A)A newspaper articleB)A systematic reviewC)A conference presentationD)A journal article3.After reading an online news article about the surprising role that chewing gum mayplay in facilitating healing after bowel surgery, a nurse has “googled” the subject. Howshould 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 continenceamong older adults with dementia. Which of the following sources is most likely toprovide the nurse with specific interventions and practices to achieve this goal?A)Cumulative Index to Nursing and Allied Health Literature (CINAHL)B)National Guideline ClearinghouseC)PsycINFOD)MEDLINE

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Page 25.A hospital educator has been commissioned with identifying evidence to inform arevision of the hospital's policy on the use of physical restraints. During the search, whatparameters should the nurse establish for the dates of articles and other informationsources?A)Articles should be ranked according to publication date, with the most recentarticles being prioritized.B)The nurse should attempt to identify collaborative evidence for any source that ismore 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 overits date of publication.6.While searching an online database for information on the use of drugs to treathypertension, the nurse is unsatisfied with the quantity and quality of results aftersearching “beta blockers.” How should the nurse proceed?A)Identify the appropriate MeSH termB)Search for clinical guidelines in the Cochrane LibraryC)Consult the reference lists in articles that appeared during the searchD)Search the trade names of specific beta-blocking drugs7.In light of the large number of gall bladder patients recently admitted to the unit, a nurseis searching PubMed for literature relating to cholecystitis, cholecystectomy,cholelithiasis, and cholecystography. Which of the following terms should the nurseenter 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 needsduring their care. Which of the following searches related to nutrition promotion amongpatients with dementia or delirium is most likely to yield the greatest number of relevantresults?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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Page 39.In the interest of efficiency, a nurse has limited a search of an electronic database toonly those articles containing full text. What effect is this action likely to have on theresults 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 maintainingthe safety of a patient who is experiencing acute alcohol withdrawal. Which of thefollowing components of the Cochrane Library is most likely to provide the nurse withthe most reliable, evidence-based interventions?A)CochraneDatabase of Systematic Reviews (CDSR)B)Cochrane Central Register of Controlled Trials (CENTRAL)C)Cochrane Methodology RegisterD)Health Technology Assessment (HTA) Database11.A nurse has conducted a search of PubMed to answer the question, What factorsinfluence older adults' decisions to seek care from the emergency department rather thantheir primary care provider when experiencing fatigue? The nurse is currently reviewingthe results of the search in the order that they appear. What factor determines the orderof the results in a search of PubMed?A)Date of publicationB)Number of times the article has been citedC)Ranking by peer reviewD)Date the article was added to the database12.A nurse is working on a literature review using a laptop computer while in a café thatprovides wireless Internet access but will not allow for connection to the hospitallibrary's server that provides the nurse's normal access to database subscriptions. Whichof the following resources is likely to be unavailable to the nurse through this publicInternet connection?A)PubMedB)Cochrane LibraryC)MEDLINED)EMBASE

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Page 413.Management of a county hospital has been resistant to providing time, facilities, andsubscriptions to allow nurses to conduct online searches near the point of care. Which ofthe following arguments can the nurses present to strengthen their case for these tools?A)“Online access at or near the point of care has been mandated by law.”B)“Providing for literature searches has been shown to save money and shortenpatient stays.”C)“It is unethical for nurses to provide care that is not rooted in a recent literaturesearch.”D)“The increased confidence that nurses gain from accessing knowledge is linked toimproved patient outcomes.”14.Which of the following sources would best provide critical appraisal during a nurse'ssearch for evidence on which to base practice?A)A journal that provides assessments of notable articles recently published in otherjournalsB)The expert opinion of qualified and experienced nurse cliniciansC)A careful examination of the methodology of a studyD)The insight of a trusted hospital librarian15.Controversy exists on an intensive care unit regarding the best ways to preventventilator-associated pneumonia (VAP). What action should the nurse first take inresponse to this controversy?A)Organize a small-scale clinical trial to test current practices on the unit.B)Elicit the views of the most senior nurses and those nurses who exemplify EBP.C)Formulate a question and conduct a thorough search of the existing evidence.D)Seek input from physicians with expertise in the area of VAP.

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Page 5Answer Key1.C2.D3.A4.B5.D6.A7.A8.B9.D10.A11.D12.D13.B14.A15.C

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Page 11.The nurses on a medical unit recently acknowledged that their efforts to introduce anevidence-based pain management regimen have failed. Which of the following factors ismost likely to have contributed to the failure of the EBP initiative?A)Differences between the educational levels of staff nurses and those promoting thechangeB)Contradictions in the body of literature around the assessment and management ofpainC)Failure to integrate principles of the psychology of changeD)The sufficiency of the existing protocols and policies of pain management on theunit2.A nurse has recognized the need to change the practice on an obstetrical unit so thatmore women choose to breastfeed their babies after discharge. Which of the followingfactors is most important in determining the success or failure of the subsequentevidence-based practice change?A)The positive effects of breastfeeding in neonatal health and developmentB)The strength and specificity of the nurse's vision for changeC)The depth and breadth of the nurse's experience baseD)The credibility that the nurse holds on the unit3.How should a group of nurses best address the need for goals at the outset of anevidence-based practice change at their workplace?A)The team should identify a set of common goals and write them down.B)The team should allow individual nurses the autonomy to choose their own goals.C)The team should identify goals from within the literature and disseminate them.D)The team should allow the project goals to evolve as the initiative progresses.4.An initiative to improve the quality of care that stroke patients receive is beingconsidered in a county hospital. Which of the following questions should theimplementation team ask as part of a SCOT analysis?A)“Who are the stakeholders that would be affected by a change in our practice?”B)“How will we define success during this initiative?”C)“What are the costs that might be incurred if we attempt to change practice?”D)“What are the challenges in our workplace that we need to address?”

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Page 25.A change in practice is being considered on a hospital unit that is producing anunacceptably high number of incident reports. Which of the following characteristics ofthe unit best exemplifies the first stage of Duck's Change Curve model?A)A directive to change has been received but ignored.B)The nurses on the unit lack knowledge and experience.C)Relationships between staff and disciplines on the unit are antagonistic.D)The leadership and culture of the unit are stagnant.6.Nursing leaders are utilizing Kotter and Cohen's Model of Change to guide a change inpressure ulcer assessment and prevention. What task should the leaders first perform?A)Assess nurses' willingness to changeB)Cultivate a sense of urgencyC)Mobilize evidence-based practice mentorsD)Communicate the proposed vision for change7.Kotter and Cohen's Model of Change has been implemented successfully, resulting in anevidence-based change in pressure ulcer assessment and prevention on a unit. What isthe final step in this change process?A)Disseminating the results of the change in practiceB)Sending out mentors to stimulate similar change on other units and in otherhospitalsC)Nourishing the change to ensure the new practice is sustainedD)Monitoring nurses' compliance with the new practice8.According to Rogers' theory of diffusion of innovations, which of the following groupsof nurses is primarily responsible for initiating evidence-based change?A)InnovatorsB)MentorsC)CatalystsD)Leaders9.The clinical nurse educator on a palliative care unit perceives that many of the staffnurses are in the precontemplative and contemplative stages of readiness to adopt a new,evidence-based approach to pain assessment and management. Which of the followingstrategies should the educator adopt?A)Presenting the findings from the literature that support the change in practiceB)Making connections with staff and fostering their readiness to changeC)Implementing the initial changes in practice that are necessaryD)Identifying and addressing those staff members who are resistant to change

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Page 310.Nursing leaders in a large, urban emergency department are aware that many nurses areskeptical of a proposed evidence-based change in the management of patients withmental health problems. How should the nursing leaders best address this skepticism?A)Bring in evidence-based practice mentors from an emergency department that hassuccessfully implemented a similar changeB)Distribute copies of a meta-analysis that encompasses the relevant research andelicit feedbackC)Present the evidence that underlies the proposed change at an open forumD)Create a venue for the nurses to express and discuss their skepticism directly11.According to Rohm's model of personality types, nurses with which of the followingpersonalities are most likely to be effective as evidence-based practice mentors?A)DB)IC)SD)C12.In light of the high incidence of nosocomial methacillin-resistantstaphylococcus aureus(MRSA), there is an apparent need for improvements in infection-control practice at acounty hospital. Which of the following goals should be established for a proposedevidence-based change in practice?A)“The incidence of nosocomial MRSA will decrease significantly within the next 60days.”B)“New cases of MRSA colonization will go down by 15% between now and 90 daysfrom now.”C)“Within the next 3 months, nosocomial MRSA colonization will be eliminated inour hospital.”D)“MRSA will decrease by a minimum of 10%.”13.A group of nurses has introduced evidence-based practice rounds to their communityhealth clinic. What purpose should be primarily accomplished by these rounds?A)Identifying the nurses' practices that are evidence-basedB)Generating and answering practice questionsC)Generating evidence to guide practiceD)Assessing the nurses' readiness to change

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Page 414.A group of registered nurses who provide care in the operating room (OR) isvehemently opposed to a role for unlicensed care providers in the OR despite theexistence of valid and reliable evidence to support such a change. How should thenursing leadership best address this resistance?A)Clearly presenting the benefits of the proposed changeB)Allowing unlicensed care providers to present their perceived attributes to the RNsC)Implementing the change and allowing the benefits to become apparentD)Listening to the concerns of the RNs and creating a dialogue15.The time frame that is necessary to fully implement an evidence-based change in thestaffing mix on a postpartum care unit is very long. What strategy should theevidence-based practice mentors implement in order to prevent nurses from becomingfatigued and disenchanted with the change process?A)Issue reminders of the benefits that will result from the changeB)Release regular updates on the progress of the changeC)Celebrate the accomplishment of smaller goals within the larger projectD)Conduct a research study parallel to the change that documents the process

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Page 5Answer Key1.C2.B3.A4.D5.D6.B7.C8.A9.B10.D11.A12.B13.B14.D15.C

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Page 11.The leadership of a large, tertiary care hospital is under pressure from various sources toimplement both evidence-based practice (EBP) and quality improvement (QI). Which ofthe following statements most accurately conveys an aspect of these philosophies?A)EBP integrates patient preferences into clinical care decisions.B)QI allows for the expertise of clinicians to be taken into account.C)QI does not account for effects on patients who will be excluded from care.D)EBP is linked to better patient outcomes than QI.2.Which of the following factors differentiates evidence-based practice (EBP)implementation from clinical research?A)Clinical research has more stringent ethical standards than EBP implementation.B)EBP implementation is often less generalizable than clinical research.C)The implementation of EBP creates new knowledge while clinical researchconfirms or disputes existing knowledge.D)EBP implementation takes place on a larger scale than clinical research.3.A leadership team is planning an evidence-based practice (EBP) initiative that willaddress the policies and protocols around wound care. Which of the followingdevelopments in the implementation may be construed as unethical?A)Evidence-based treatments may be a benefit to some patients' healing butexacerbate others.B)The implementation of evidence-based wound care may be impractical from astaffing perspective.C)The clinical practice guidelines that form the basis of the practice change may havebeen developed at a different site.D)Clinicians may find that existing routines around wound care are difficult tochange.4.Which of the following activities would most likely be categorized as evidence-basedpractice (EBP) implementation rather than clinical research?A)Testing the effectiveness of new composite dressing in promoting wound healingB)Assessing whether a school-based antismoking initiative reduces smoking ratesamong teenagersC)Determining the efficacy of an innovative antihypertensive medication in patientswho do not respond to standard therapyD)Examining whether the introduction of a clinical practice guideline around fallsprevention results in a reduction in falls

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Page 25.Which of the following beliefs underlies many of the ethical debates surroundingevidence-based practice (EBP) implementation?A)It is sometimes claimed that ethics approval for the implementation of others'research should be obtained by the person who originally conducted that research.B)Some believe that the implementation of existing research does not require ethicalapproval.C)Some nurses state that considering patient preferences and integrating these intopractice is an adequate form of ethics approval.D)It is sometimes claimed that EBP is inherently ethical, negating the need for furtherethics approval.6.In preparation for a credentialing process, a county hospital will be conducting an audit.What is the primary focus of this activity?A)Evaluating whether ethical principles are being integrated into bedside careB)Determining caregivers' knowledge base around evidence-based practice (EBP)C)Determining whether patient outcomes at the hospital align with patientexpectationsD)Evaluating whether current practice is based on the best available evidence7.Which of the following activities most clearly requires ethical approval?A)Implementation of a new clinical practice guidelineB)Recruitment for a case-control studyC)Modification of hospital policy and proceduresD)Modification of a nurse's practice habits8.Which of the following factors should be prioritized in the decision of whether to seekethical approval for a project involving a change in practice?A)The project's classification as either quality improvement (QI) or clinical researchB)The stated values and mission statement of the site where it will be implementedC)The question of whether the implementation represents a risk to participantsD)The stance of the agency or foundation that is funding the implementation

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Page 39.An evidence-based quality improvement (EBQI) initiative will soon be commenced at auniversity hospital. Which of the following characteristics of the project cause it to becategorized as EBQI?A)The project is aimed at changing practice to improve outcomes so that they aremore evidence based.B)The project is being spearheaded by individuals who possess knowledge andexperience in evidence-based practice (EBP).C)The implementation of the project is based on valid research and does not representa risk to participants.D)The project has dual goals of improving outcomes while producing new knowledgethat is generalizable.10.Which of the following characteristics of a practice change is most closely associatedwith evidence-based quality improvement (EBQI)?A)The change is implemented by the individuals who provide patient care.B)The funding source for the practice change is an organization external to theclinical site.C)The ultimate goal of the project is to generate new evidence that can be applieduniversally.D)The individuals who carry out the change are brought in from outside theorganization.11.The nurses at a long-term care facility have recently completed an evidence-basedquality improvement (EBQI) project that aimed to improve the outcomes of residentswith dementia. Which of the following principles should guide the decision of whetherto publish the results of the initiative?A)The results of the project should be submitted for publication if they have producednew knowledge.B)The results should be considered for publication if they are thought to be applicableto other settings.C)Publication should be considered if it was an explicit goal of the project and ifparticipants have granted consent for publication.D)The nurses are obligated to disseminate their results as part of the evidence-basedpractice (EBP) process.

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Page 412.The nursing leaders at a county hospital are aware of the need for rigor during theimplementation of an EBQI project that will address emergency department triage. Howshould the leaders apply rigor to this project?A)By ensuring that instruments for measuring effectiveness have face and contentvalidityB)By justifying their choice of methodology in terms of the clinical question and thecharacteristics of the siteC)By seeking ethical approval and patient consent prior to beginning the projectD)By ensuring that resources will not be wasted and patients will not be placed at risk13.An evidence-based quality improvement (EBQI) project has been proposed that willincrease the number of school-aged children who receive an annual influenzavaccination. The project will be implemented in an affluent suburban communitydespite the fact that vaccination rates are much lower in poorer neighborhoods. Theimplementation of this project may be in violation of which of the following ethicalprinciples?A)Respect for potential and enrolled subjectsB)Social or scientific valueC)Scientific validityD)Fair subject selection14.Members of the nursing leadership at a hospital disagree about the need for informedconsent from patients who are participating in an evidence-based quality improvement(EBQI) project. Which of the following principles should guide the team's decision ofwhether to seek informed consent from patients?A)The decision should be deferred to the ethical review board of the hospital.B)EBQI is a part of normal clinical care and likely does not require written consent.C)Proceeding with EBQI without informed consent violates patient autonomy.D)Participation in clinical research is a tacit understanding of seeking hospital care.15.A group of nurses is taking measures to ensure that an evidence-based qualityimprovement (EBQI) initiative is conducted ethically. Which of the following actionsmost clearly demonstrates appropriate selection of subjects?A)Distributing risks and benefits fairlyB)Maximizing the number of participants in the sampleC)Randomly assigning patients to receive or not receive the changed practiceD)Sampling selectively to ensure equivalence between groups

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Page 5Answer Key1.A2.B3.A4.D5.B6.D7.B8.C9.A10.A11.B12.D13.D14.B15.A

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Page 11.Which of the following components of a clinical question represents the “P” in thePICOT format for asking clinical questions?A)The nurse's preparation for patient teaching prior to surgeryB)Early ambulation versus aggressive anticoagulant therapyC)Individuals who require peritoneal dialysisD)Deep vein thrombosis2.An unacceptably high number of patients on a geriatric, subacute medicine unit havedeveloped pressure ulcers during their period of care. The nurses on the unit haveagreed on a goal of reducing the incidence of these wounds by 50% over the next 10weeks. This goal represents which component of the PICOT format for asking clinicalquestions?A)OB)PC)ID)C3.Which of the following scenarios represents the most common obstacle that nursesencounter when attempting to gain the knowledge necessary for EBP?A)A nurse identifies several articles relevant to a clinical question, but themethodology 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 fallsprevention but has become disillusioned by the possibility of having to read a vastnumber of publications. Which of the following strategies should the nurse implementin response to this problem?A)Narrow the scope of the clinical questionB)Restrict the information search to publications from the past 24 monthsC)Seek recommendations for information sources from trusted colleaguesD)Limit the search to articles that relate the findings of randomized control trials(RCTs)

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Page 25.A pediatric nurse provides care for many children who present to the emergencydepartment (ED) with signs and symptoms of asthma. Which of the following questionsis 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-doseinhalers (MDIs)?B)What patient populations respond best to nebulized bronchodilators?C)How effective are nebulizers compared to metered-dose inhalers at reducingbronchospasm?D)Are nebulizers provided to patients in the ED more often than metered-doseinhalers?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 printsources.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 thecancer unit of the local hospital. Which of the following questions would the nurseconsider to be an adequate and useful foreground question?A)“Are benzodiazepines and analgesics provided before patients have a bone marrowbiopsy?”B)“What is the clinical rationale for using bone marrow biopsy to gauge and predictthe course of a patient's cancer?”C)“Does guided imagery reduce the anxiety of patients who undergo bone marrowbiopsy?”D)“How often is bone marrow biopsy performed on the unit?”8.Which of the following clinical questions would be most justified in lacking acomparison?A)An examination of the antipyretic qualities of cool bed-bathingB)A study on the perceived meaning of hope among palliative patientsC)A study on the influence of prenatal care on preventing perineal tearing duringdeliveryD)An examination of the effect of rehydration using lactated Ringer's on patients'energy levels

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Page 39.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 childrenaged 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 prescribedbed-rest perceive their situations?”D)“Are cigarette warning labels an effective deterrent to cigarette smoking amongfemales aged 11 to 15 years?”10.Which of the following considerations should be prioritized when choosing a patientpopulation 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 ofthe nurse's geographic region.C)A specific and defensible rationale should exist for the choice of patientpopulation.D)The patient population in the clinical question should mirror the populations inprominent studies related to the issue.11.In the context of the PICOT format for formulating clinical questions, which of thefollowing may be considered to be an intervention?A)Levels of patient hygiene in an assisted-living facilityB)The incidence and prevalence of stomach cancer among low-income males aged 65to 85C)The prevalence of wound dehiscence among postmastectomy patientsD)Occupational exposure to airborne silicon dust12.Which of the following symptoms could be best clustered into a single outcome for thepurposes of crafting a concise clinical question?A)Increased anxiety, increased serum cholesterol, and low rating of overallwell-beingB)Hypotension, tachycardia, and decreased level of consciousnessC)Increased temperature, decreased mobility, and confusionD)Increased neonatal bilirubin levels and the mother's choice to feed with formularather than breastfeed

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Page 413.Which of the following clinical questions can be best addressed by a meta-synthesis ofqualitative studies?A)“What is the meaning of spiritual support in hospice patients who are younger than50?”B)“What is the effectiveness of physical activity compared with beta-blockers inreducing the blood pressure of adult, African-American men?”C)“Is the use of a stroke team in the emergency department, rather than standardassessment and treatment, associated with improved outcomes among patientsdiagnosed with stroke?”D)“Are single-occupancy hospital rooms, rather than shared rooms, associated withincreased patient satisfaction reports?”14.Which of the following principles can help a nurse rank levels of evidence whenanswering 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 femalesB)Cigarette smokersC)Patients with hypertension who take diureticsD)Teenage females

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Page 5Answer Key1.C2.A3.B4.A5.D6.A7.C8.B9.C10.C11.D12.B13.A14.D15.B

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Page 11.A qualitative research study would be considered to be level one evidence in a nurse'sattempt to answer which of the following clinical questions?A)“What is the meaning of hope among patients undergoing treatment with burninjuries?”B)“What factors contribute to diabetic patients' decisions to infrequently monitortheir blood glucose levels?”C)“How does an exercise program compared with dietary control affect weight loss inobese patients?”D)“How does partial assistance with feeding compared with total assistance affect thenutritional outcomes of stroke patients younger than 70?”2.A nurse has recognized a need to understand the ways in which women withfibromyalgia adjust their lifestyles to accommodate the effects of their diagnosis. Whichof the following domains of research is most likely to provide evidence for the nurse?A)Randomized controlled trialsB)Qualitative studiesC)Case control studiesD)Cohort studies3.A nurse is searching for evidence in an effort to answer a series of clinical questionsrelated to childhood asthma. In which of the following areas is qualitative researchlikely to be most valuable?A)Identifying if nebulized delivery of bronchodilators is superior to the use ofmetered-dose inhalersB)Identifying which environmental exposures are most closely linked to the incidenceof bronchospasmC)Identifying how a family's accessibility to primary care affects the course of achild's asthmaD)Identifying values that determine children's choices of where and when to use theirmetered-dose inhalers4.A nurse is seeking to understand the processes of adjustment and coping that parents gothrough in the year after giving birth to a child with a neural tube defect. Which of thefollowing qualitative traditions is most likely to inform the nurse?A)EthnographyB)PhenomenologyC)Grounded theoryD)Hermeneutics

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Page 25.A nurse researcher is conducting a phenomenological study among men who have beendiagnosed with prostate cancer. Which of the following focuses is most indicative of thenurse's chosen methodology?A)Identifying what support programs best meet men's emotional needs followingdiagnosisB)Identifying the role that culture plays in men's sense-making of their diagnosesC)Identifying the process that men go through as they suspect, receive, and then livewith their diagnosesD)Identifying and examining the meanings of the lived experiences that the menassociate with their diagnoses6.In the course of gathering and analyzing data for a qualitative study that examines theeffect that a child's chronic illness has on his or her siblings, a nurse has producedfieldnotes. What is the purpose of the nurse's fieldnotes?A)Making a record of the nurse's observations and interactions that occur during datagatheringB)Producing a written record through which other researchers may follow theresearch processC)Recording the analytic conclusions of the dataD)Relating the changes in the phenomenon that occur over time7.While conducting a qualitative research study on patients' responses to having acolostomy, the nurse is at the stage of doing content analysis. What activitiescharacterize this component of the qualitative research process?A)Identifying practical applications of the research findingsB)Reflecting on the nurse's own response to the informants' experiencesC)Breaking down data and reconstituting them in some other formD)Gathering data from participants in the form of interviews and focus groups8.A nurse is writing a research proposal for a grounded theory study that will address theexperiences and transitions of women in the months following spontaneous abortion.Which of the following guidelines should the nurse follow when choosing a samplingstrategy?A)Random sampling should be the nurse's goal with participant self-selection if this isnot practicable.B)The nurse should identify a minimum of 10 informants or 15 informants ifpurposeful sampling is utilized.C)The nurse should have a sample small enough to allow depth of inquiry but largeenough to include a variety of voices.D)The nurse should seek as large a sample as possible in order to facilitate thickdescription and the validity of findings.

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Page 39.Which of the following facts about a qualitative study addresses the meanings of asupport group for adults with type 1 diabetes that may present a potential flaw?A)The researcher provides original insights into the etiology of diabetes.B)The researcher has type 1 diabetes.C)The researcher was an open attendee of the support group meetings.D)The researcher did not do random sampling.10.A researcher has developed and administered a survey that addresses patients' reactionsand responses to being diagnosed with nosocomial (hospital-acquired) infections whileinpatients. The researcher has subsequently completed and submitted a manuscript thatproposes a theory around the patients' perceptions of infection control in the hospitalsetting. The researcher's actions most clearly represent a potential deficit in which of thefollowing criteria?A)VeracityB)IndividualityC)TransferabilityD)Credibility11.A careful reading of a qualitative research study has revealed a potential lack ofconfirmability. Which of the following observations may have led the reader to thisconclusion?A)The findings appear to be true only among the specific participants in the study.B)The links between the findings and the data are not evident.C)The sample consisted of only 8 participants.D)The researcher makes no mention of producing fieldnotes.12.The findings of a widely-disseminated qualitative study that addresses the meaning ofsmoking to teenage cigarette smokers has resulted in significant changes to many of theantismoking strategies undertaken by school nurses. The study has most clearlydemonstrated which of the following qualities?A)Ontological authenticityB)CredibilityC)Catalytic authenticityD)Confirmability

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Page 413.An oncology nurse has been exposed to numerous qualitative studies addressing theexperience and meaning of cancer diagnosis and is now preparing to conduct ametasynthesis of the subject. Which of the following principles should the nurse includein the methodology of this new study?A)Reanalyzing the raw data from the studies selected for inclusionB)Performing a thematic analysis of the themes and category titles of the chosenstudiesC)Forming a liaison with the authors of the original studiesD)Performing statistical analysis of the combined findings of the chosen studies14.Though rooted in the voices of the 16 men who were interviewed for the study, thefindings of a qualitative study into the health practices of male prison inmates is thoughtto be true for many members of the larger prison population. This fact about the studymost clearly demonstratesA)TransferabilityB)ConfirmabilityC)DependabilityD)Credibility15.Use of which of the following data-gathering techniques is most likely to represent apotential flaw in the design of a qualitative study?A)Participant observationB)Unstructured interviewsC)Focus groupsD)Online surveys

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Page 5Answer Key1.A2.B3.D4.C5.D6.A7.C8.C9.A10.D11.B12.C13.C14.A15.D

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Page 11.Which of the following activities most clearly indicates that a nurse is engaging inself-improving practice?A)The nurse reflects on practice in an effort to identify potential mistakes.B)The nurse seeks input from more experienced colleagues.C)The nurse attempts to get to know patients on a personal level.D)The nurse has participated in a research study being conducted on the hospital unit.2.A nurse has recently marked 10 years of practice on a medical unit. Which of thefollowing aspects of “experience” is most likely to result in improved practice on thepart of a nurse?A)Increased years of practice in a consistent clinical environmentB)Exposure to more patient interactions and conduction of more interventionsC)Examination of interactions and events in the clinical contextD)Engagement with a greater variety of patients and patient populations3.Which of the following aspects of care on a postsurgical unit is the clearest example ofphronesis?A)“The patient will dangle at the bedside q4h on postoperative day 1.”B)“The patient will demonstrate independent ambulation prior to discharge.”C)“The patient will perform leg exercises and deep breathing and coughing exercisestwice on the day of surgery.”D)“The patient will transition from dangling to assisted standing for the first timefollowing surgery with the assistance of the physical therapist.”4.Which of the following activities by the nurse most directly fosters phronesis in the careof geriatric patients in a long-term care setting?A)The nurse consistently seeks out and attends continuing education offerings.B)The nurse stays abreast of current research in geriatric nursing.C)The nurse has organized a pilot study on falls prevention in the care facility.D)The nurse makes an effort to get know residents' individual needs, concerns, andgoals.5.How should a nurse best understand the concept of clinical expertise?A)Clinical expertise is even more valuable than research evidence.B)Clinical expertise is enhanced by holistically knowing patients as individuals.C)Clinical expertise is demonstrated by the formalized knowledge of nursingpractice.D)Clinical expertise is central to good nursing practice, superseded only by theimportance of published articles.

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Page 26.A nurse is providing care for a 3-year-old girl who has been admitted to the pediatricintensive care unit with a suspected brain injury following a choking episode. Which ofthe following aspects of the nurse's care best demonstrates clinical expertise?A)The nurse has previously cared for a patient in similar circumstances.B)The nurse has a sound and current knowledge base around respiratory andneurological pathophysiology.C)The nurse recognizes that there are numerous patient and family variables at play.D)The nurse demonstrates empathy when caring for the patient.7.A qualitative study addresses the cues that nurses perceive when they sense a patient'scondition is worsening. The study data are based on narratives from several nurses whoprovide care in high acuity settings. Narratives are most likely to make which of thefollowing contributions to the study?A)Insights into the nuances of nurses' understandings of complex situationsB)Indications of the depth of participants' knowledge basesC)Insights into the nurses' abilities to implement evidence-based practiceD)Indications of the depth of clinical expertise that exists among the sample8.Which of the following clinical questions is most likely to be informed by the use ofnurses' narratives?A)How do 8-hour nursing shifts compare with 12-hour shifts to affect patient safetyin an emergency department setting?B)What meaning do nurses assign to conflicts they have with patients and thefamilies of patients?C)What factors contribute to nurses' decisions to administer as-needed analgesia?D)How does a mentorship program compare with traditional orientation of new staffin affecting retention among new nursing graduates?9.Which of the following statements provides the clearest rationale for the use ofnarratives in understanding nursing knowledge and clinical expertise?A)The acuity of patients on admission to a hospital is higher than in previous decadesand continues to increase.B)The ability ofnurses to provide adequate care with ever-increasing patient loadsis poorly understood.C)As life expectancy increases, more patients are living with chronic conditionswhose symptoms often overlap.D)The trajectory of illness and the human experience of it can be complex and highlyindividualized.

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Page 310.Nurse L provides care on a busy medical unit of an inner-city hospital. Which of thenurse's actions best exemplifies clinical grasp?A)Nurse L is committed to reading and integrating the most recent, publishedevidence.B)Nurse L is able to identify subtle changes in patient condition that are often notobvious to other clinicians.C)Nurse L has responded appropriately to patients in cardiac or respiratory arrest.D)Nurse L makes a concerted effort to get to know patients' families.11.A nurse paged the attending physician because a postmastectomy patient becamesomewhat agitated and tachypneic in recent hours. Despite other nurses' assertions thatthe patient was simply experiencing some anxiety, the nurse suspected a more seriousetiology. The physician prescribed a single dose of a benzodiazepine, which was largelyineffective. Due to the nurse's persistence, diagnostics were performed, leading to adiagnosis of pulmonary embolism. Which of the following did the nurse exhibit?A)Evidence-based practiceB)Clinical graspC)Patient-centered careD)Best practice12.Nurse M makes a conscious effort to think beyond the rigidly-defined signs andsymptoms of illnesses and recognizes that context has a highly significant impact onillness situations. This thinking facilitates which of the following?A)Engaging in detective workB)PhronesisC)Making qualitative distinctionsD)Techne13.A nurse who provides care on a geriatric subacute medicine unit is aware that elderlypatients often exhibit signs and symptoms of infection that are very different from thoseof younger patients. This knowledge is an example ofA)recognizing changing clinical relevance.B)engaging in detective work.C)making qualitative distinctions.D)developing clinical knowledge about specific patient populations.

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Page 414.While helping a colleague reposition a patient who is in moderate respiratory distress,the nurse has a sense that it would be appropriate to ensure the bag-valve mask (Ambubag) is readily accessible and to confirm the patient's code status. Which of thefollowing qualities does this exemplify?A)Engaging in detective workB)Evidence-based practiceC)Future thinkD)Phronesis15.Knowing that the patient was admitted with a diagnosis of sepsis, the nurse has limitedthe most recent bedside assessment to an oral temperature followed by a review of thepatient's white cell count. This limited-scope assessment will most directly affect thenurse's ability toA)engage in experiential learning.B)see the unexpected.C)individualize care.D)provide empathy.

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