Test Bank For Evidence-Based Practice in Nursing & Healthcare A
Guide to Best Practice 5th Edition
by Bernadette Mazurek Melnyk, Ellen Fineout-Overholt
Chapter 1 - 23 Complete
,Chapter 1 Making the Case for Evidence-Based Practice
and Cultivating a Spirit of Inquiry
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.
,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
, 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.
,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
,Answer Key
1. B
2. D
3. A
4. D
5. B
6. C
7. B
8. A
9. C
10. D
11. C
12. A
13. B
14. D
15. B
,Chapter 2 Asking Compelling Clinical Questions
,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)
,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
, 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
