Medical Surgical Nursing Ignatavicius 7th Edition – Test Bank

Medical Surgical Nursing Ignatavicius 7th Edition – Test Bank

Chapter 7: Evidence-Based Practice in Medical-Surgical Nursing
Test Bank

MULTIPLE CHOICE

1. The cardiac nurse wants to know about the best practices to prevent pneumonia after open-heart surgery. What does the nurse do first?
a. Critically appraise relevant evidence.
b. Implement acceptable recommendations.
c. Ask clinical experts for their opinions.
d. Search for evidence to answer the question.

ANS: D
The process of evidence-based practice (EBP) is systematic and consists of several steps. After asking “burning” clinical questions, the next step is to find the very best evidence to try to answer the question.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Evaluation)

2. The nurse is identifying clinical practice problems on a cardiac unit. What question is a foreground question?
a. “What is the pathophysiology of congestive heart failure?”
b. “How does smoking affect the internal lumens of arteries?
c. “What is the best treatment for a myocardial infarction?
d. “How are a client’s vital signs affected by anxiety?”

ANS: C
A foreground question asks a question of relationship and may be controversial (best treatment). All other questions are background questions, which ask for a fact.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Planning)

3. The nursing student asks, “What is the difference between qualitative and quantitative clinical questions?” What is the nurse’s best response?
a. “Qualitative questions utilize a strict statistical analysis of information.”
b. “Quantitative questions identify relationships between measurable concepts.”
c. “Qualitative questions ask about associations among defined phenomena.”
d. “Quantitative questions analyze the content of what a person says or does.”

ANS: B
Quantitative questions ask about the relationship between or among defined, measurable phenomena and include statistical analysis of information that is collected to answer a question. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people and usually analyze the content of what a person says during an interview or what a researcher observes.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Teaching/Learning

4. The nurse is assessing the following PICO(T) question: In a 60-year-old woman with osteoarthritis, can a COX-2 inhibitor decrease the risk of gastrointestinal bleeding compared with other NSAIDs? What is the comparison component in this question?
a. Osteoarthritis
b. COX-2 inhibitor
c. NSAIDs
d. Gastrointestinal bleeding

ANS: C
The comparison component of the clinical question may be the standard or the current treatment, or may be another intervention against which the innovative practice is compared. In this question, the standard or current practice is other NSAIDs. The innovative practice (COX-2 inhibitor) is compared against this standard.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Planning)

5. The nurse is looking for the best interventions for postoperative pain control. When are the facility’s policies and procedures an appropriate source of evidence?
a. When policies are based on high-quality clinical practice guidelines
b. When evidence is derived from a valid and reliable quantitative research study
c. When procedures originated from opinions of the facility’s chief surgeon
d. When evidence is founded on recommendations from experienced nurses

ANS: A
Facility policies and procedures can be used as evidence of specific nursing practice in the clinical setting if the policies are based on high-quality evidence. Clinical practice guidelines are based on systematic reviews, which provide the highest level of evidence. Policies based on quantitative research, opinions, and experience should not be used because they are not founded on evidence of highest quality.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 81
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Assessment)

6. The nurse researcher is evaluating clinical questions. Which is a qualitative question?
a. What factors affect clients’ responses to postoperative pain?
b. Do wound vacuum systems improve surgical wound healing time?
c. What are the effects of hourly rounding on client fall rates?
d. Do chlorhexidine swabs decrease central line site infections?

ANS: A
A qualitative question focuses on the participant’s interpretations of or responses to an experience. Understanding factors that influence a client’s response to a situation would be a qualitative evaluation. The other questions focus on quantitative or numeric indicators, instead of on the meaning or interpretation of an event. These questions would be quantitative questions.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Teaching/Learning

7. The nurse is searching for evidence related to a PICOT question. What source provides the best evidence?
a. Medline database
b. Cochrane library
c. CINAHL database
d. Library of Congress

ANS: B
The top level of evidence consists of systematic reviews. The major purpose of systematic reviews is to provide high-quality evidence to busy clinicians who do not have the time to spend finding original studies and then reviewing, critiquing, and synthesizing evidence from each study. These reviews can be found in the Cochrane library; the Medline and CINAHL databases provide single studies that are not reviewed, critiqued, or synthesized for the clinician. The Library of Congress houses the world’s largest collection of historical and cultural references; it does not provide best evidence related to health care PICOT questions.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 82
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Assessment)

8. A hospice nurse routinely uses Therapeutic Touch to promote comfort. A current client demonstrates anxiety when this intervention is offered. What is the nurse’s best response?
a. Provide pain medication to manage the client’s comfort and pain.
b. Continue with the intervention because it has worked with other clients.
c. Search for alternative interventions to better meet the client’s needs.
d. Share research that supports Therapeutic Touch with the client.

ANS: C
Evidence-based practice integrates best evidence with the clinician’s experience and client preferences. If a client is not receptive to an intervention, the best nursing response is to search for an alternative evidence-based intervention that is congruent with the client’s preferences.

DIF: Cognitive Level: Application/Applying or higher REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Planning)

9. The health care facility is implementing a new evidence-based nursing protocol. What is necessary to ensure successful implementation?
a. Tools to evaluate the protocol are valid and reliable.
b. Support from the nurses implementing the protocol is present.
c. Recommendations for the protocol are obtained from senior administrators.
d. The evidence-based protocol is cost-effective for the facility.

ANS: B
Complete buy-in from the people who will be involved in implementing the new protocol is essential for the success of implementation.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 83
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Planning)

MULTIPLE RESPONSE

1. The nurse is developing a clinical question in a PICOT format. What components are included in the question? (Select all that apply.)
a. Population
b. Comparison
c. Observation
d. Intervention
e. Technique

ANS: A, B, D
The major components of a PICOT question are population, intervention, comparison, and outcome, with an added time component when appropriate.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Teaching/Learning

2. The intervention component of an evidence-based question pertains to the therapeutic effectiveness of a treatment. Which are possible types of interventions? (Select all that apply.)
a. Exposure to disease
b. A high-risk behavior
c. Age, gender, or ethnicity
d. A prognostic factor
e. A client response

ANS: A, B, D
The intervention component pertains to the therapeutic effectiveness of a new treatment and may include the following: 1) exposure to disease or harm, 2) a prognostic factor, or 3) a risk behavior or factor.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Intervention)

3. A nurse who wants to incorporate evidence-based practices into client care on a medical unit is meeting resistance. What barriers prevent nurses from engaging in evidence-based practices? (Select all that apply.)
a. Difficulty accessing research materials
b. Difficulty understanding client needs
c. Lack of value for research in practice
d. Lack of value for client preferences
e. Inadequate available time
f. Inadequate nurse-client ratios

ANS: A, C, E
Major barriers that prevent nurses from engaging in evidence-based practice include lack of time, lack of value for research in practice, lack of understanding of organization or structure of electronic databases, difficulty accessing research materials, lack of computer skills, and difficulty understanding research articles.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 81
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical Practice) MSC: Integrated Process: Nursing Process (Planning)