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Chapter 1. Primary Care inthe Twenty-First Century: A Circle of Caring
1. A nurse has conducted a literature review in an effort to identify the effect of
handwashing on the incidence of nosocomial (hospital-acquired) infections in acute care
settings. An article presented findings at a level of significance of <0.01. This indicates
that
A) thecontrol group and the experimental groupweremore than99% similar.
pzpz
B) thefindings ofthe studyhave lessthan 1%chance ofbeing attributable to chance.
C) the effects ofthe intervention werenearlyzero.
pzpz pz
D) theclinical significance ofthefindings was lessthan 1:100. pz
Ans: B
Feedback: Thelevelofsignificance isthelevel atwhich theresearcher believes thatthestudyresults most
pz pz pz
likelyrepresent a nonchance event. A level of significance of <0.01 indicates that there is less than
1% probability that the result is due to chance.
pz
2. Anursehasreadaqualitativeresearchstudyin ordertounderstandthelivedexperienceofparents
pz pz pz pz
who have a neonatal loss. Which of the following questions should the nurse prioritize
pz
when appraising the results of this study?
A) Howwell didthe authorscapture thepersonalexperiencesofthese parents? pz
B) Howwell didthe authorscontrolfor confoundingvariables thatmay have affected thefindings?
C) Did the authorsusestatisticalmeasures that were appropriate tothephenomenon in question?
pzpz pzpz pz
D) Weretheinstrumentsthatthe researchers usedstatisticallyvalid and reliable?
pz pz pz pzpz
Ans: A
Feedback: Qualitative studies are judged on the basis of how well they capture and
convey the subjective experiences of individuals. Statistical measures and variables are
not dimensions of a qualitative methodology.
3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
pz pz pz pz
nursing research has little relevance to practice. How can the nurses colleague best
defend the importance of nursing research?
,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
pz pz pz pz pz pzz pz pzz pz
something that didnt use to be the case.
B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatly
pz pz pz pz
increased the credibility of the profession.
C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan
pz pz pz pz pz
simply as a trade or a skill.
D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
pz pz pz pz pz
outcomes.
Ans: D
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
pz
ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education pz pz pz pz pz
programs, grant funding, or the public view of the profession.
4. Tracyisanursewithabaccalaureate degree who works in the labor and deliveryunit of a pzpz pz
busy urbanhospital.Shehasnoticedthatmanynewmothers abandon breast- pz
feedingtheirbabieswhen they experience early challenges and wonders what could be
done to encourage more women to continue breast-feeding. What role is Tracy most pz
likely to play in a research project that tests an intervention aimed at promoting
breast-feeding?
A) Applyingforgrant funding fortheresearch project
B) Posing the clinical problemtoone ormore nursing researchers
pzpz pz
C) Planningthemethodology oftheresearch project
pz
D) Carryingouttheinterventionand submittingtheresultsforpublication
pzpz pzpz pz pz
Ans: B
Feedback: A major role for staff nurses is to identify questions or problems for
research. Grant applications, methodological planning, and publication submission are
normally carried out by nurses who have advanced degrees in nursing. pz
5. A patient signed the informed consent form for a drug trial that was explained to
patient bya research assistant. Later, the patient admitted to his nurse that he did
pz pz pz pz
not understand the research assistantsexplanation orhis own rolein the study. pzz
Howshould this patients nurse respond to this revelation?
A) Explainthe researchprocessto thepatient ingreater detail.
pz pz pz
B) Describethedetails ofa randomized controlledtrial forthe patient. pz pz
,C) Informthe research assistant that the patients consent islikelyinvalid. pz pzpz pz
D) Explaintothe patientthat hiswritten consent is nowlegallybinding.
pz pz pzpz
Ans: C
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is
not responsible for research consent. If patients who have agreed to participate exhibit pz
ambivalence or uncertaintyabout participating, do not tryto convince them to participate. Ask
the person from the
researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
pz pz pzpz pz pzpz pzpz pz pz
patient has signed the consent forms. pz
MultipleSelection
6. A nurse leader is attempting to increase the awareness of evidence-based practice
(EBP) among
thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing?(Selectall that
pz pz pzpz pzz pzpz pz pzz
apply.)
A) Interdisciplinary consensus
B) Nursingtradition pzpz
C) Researchstudies pz
D) Patientpreferencesandvalues
pz pz
E) Clinicalexpertise
Ans: C, D, E
Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-
solving
approachtothedeliveryofhealthcarethatintegratesthebestevidencefromstudiesandpatientcare data
with clinician expertise and patient preferences and values. pz
MultipleChoice
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been pz pz pz
extremelyslow to heal and which now poses a threat of osteomyelitis. The wound care pz
nurse who has been working with Mrs.Mayesappliesevidence-based pz
practice(EBP)wheneverpossibleandhasproposedtheuse of maggot therapy to debride necrotic pzp pzpz
tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantlyopposes this
treatment despite thesizable bodyofevidencesupportingit. Howshould the nurse reconcile Mrs.
pz pzz pzpz pz
Mayes views with the principles of EBP?
A) Thenurseshould explainthatreliable andvalid research evidenceoverrides the patients opinion.
pz pzpz pz pz
B) Thenurse should explain the evidencetothe patient ingreater detail. pzpz
, C) The nurse shouldintegratethe patientspreferences intotheplan of care.
pzpz pzpz
D) Thenurseshould involvethe patientsfamilymembersin the decision-making process.
pz pzpz
Ans: C
Feedback: Patient preferences should be integrated into EBP and considered alongside pz
research evidenceandthe nursesclinical expertise; evidence does nottrumpthe patients
preferences. The familyshould be involved, but thisisnot an explicit dimension ofEBP. pz
Similarly, explaining the evidence in more detail is not a demonstration of EBP. pz
8. The administrators of a long-term care facility are considered the use of specialized, pz
pressure-
reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
pz pz pz pz
sought input from the nurses on the unit, all of whom are aware of the need to
implement the principles of evidence-based practice (EBP) in this decision. Which of
the following evidence sources should the nurses prioritize?
pz
A) Aqualitative studythat exploresthe experienceoflivingwith apressure ulcer
B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittooktoreducepressure
pz pz pz pzpz
ulcers among patients
C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthemattressinquestion pz pz pz
D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
pz pz pz pz pz pz pz
mattresses
Ans: D
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
pz pz pz pz
opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice (EBP)
in their
attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
pz pz pz pz pz pz pz pz pz pz
different units, a project that will consider many types of evidence. Which of the pz pz
following information sources should the administrators prioritize?
A) Asystematicreviewabout communication in nursing contexts pz p
B) Nursesideasaboutcommunication methods
pz pz
C) The resultsof a chart review
D) Thehospitalsaccreditationstatus
Ans: A
Chapter 1. Primary Care inthe Twenty-First Century: A Circle of Caring
1. A nurse has conducted a literature review in an effort to identify the effect of
handwashing on the incidence of nosocomial (hospital-acquired) infections in acute care
settings. An article presented findings at a level of significance of <0.01. This indicates
that
A) thecontrol group and the experimental groupweremore than99% similar.
pzpz
B) thefindings ofthe studyhave lessthan 1%chance ofbeing attributable to chance.
C) the effects ofthe intervention werenearlyzero.
pzpz pz
D) theclinical significance ofthefindings was lessthan 1:100. pz
Ans: B
Feedback: Thelevelofsignificance isthelevel atwhich theresearcher believes thatthestudyresults most
pz pz pz
likelyrepresent a nonchance event. A level of significance of <0.01 indicates that there is less than
1% probability that the result is due to chance.
pz
2. Anursehasreadaqualitativeresearchstudyin ordertounderstandthelivedexperienceofparents
pz pz pz pz
who have a neonatal loss. Which of the following questions should the nurse prioritize
pz
when appraising the results of this study?
A) Howwell didthe authorscapture thepersonalexperiencesofthese parents? pz
B) Howwell didthe authorscontrolfor confoundingvariables thatmay have affected thefindings?
C) Did the authorsusestatisticalmeasures that were appropriate tothephenomenon in question?
pzpz pzpz pz
D) Weretheinstrumentsthatthe researchers usedstatisticallyvalid and reliable?
pz pz pz pzpz
Ans: A
Feedback: Qualitative studies are judged on the basis of how well they capture and
convey the subjective experiences of individuals. Statistical measures and variables are
not dimensions of a qualitative methodology.
3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
pz pz pz pz
nursing research has little relevance to practice. How can the nurses colleague best
defend the importance of nursing research?
,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
pz pz pz pz pz pzz pz pzz pz
something that didnt use to be the case.
B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatly
pz pz pz pz
increased the credibility of the profession.
C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan
pz pz pz pz pz
simply as a trade or a skill.
D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
pz pz pz pz pz
outcomes.
Ans: D
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
pz
ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education pz pz pz pz pz
programs, grant funding, or the public view of the profession.
4. Tracyisanursewithabaccalaureate degree who works in the labor and deliveryunit of a pzpz pz
busy urbanhospital.Shehasnoticedthatmanynewmothers abandon breast- pz
feedingtheirbabieswhen they experience early challenges and wonders what could be
done to encourage more women to continue breast-feeding. What role is Tracy most pz
likely to play in a research project that tests an intervention aimed at promoting
breast-feeding?
A) Applyingforgrant funding fortheresearch project
B) Posing the clinical problemtoone ormore nursing researchers
pzpz pz
C) Planningthemethodology oftheresearch project
pz
D) Carryingouttheinterventionand submittingtheresultsforpublication
pzpz pzpz pz pz
Ans: B
Feedback: A major role for staff nurses is to identify questions or problems for
research. Grant applications, methodological planning, and publication submission are
normally carried out by nurses who have advanced degrees in nursing. pz
5. A patient signed the informed consent form for a drug trial that was explained to
patient bya research assistant. Later, the patient admitted to his nurse that he did
pz pz pz pz
not understand the research assistantsexplanation orhis own rolein the study. pzz
Howshould this patients nurse respond to this revelation?
A) Explainthe researchprocessto thepatient ingreater detail.
pz pz pz
B) Describethedetails ofa randomized controlledtrial forthe patient. pz pz
,C) Informthe research assistant that the patients consent islikelyinvalid. pz pzpz pz
D) Explaintothe patientthat hiswritten consent is nowlegallybinding.
pz pz pzpz
Ans: C
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is
not responsible for research consent. If patients who have agreed to participate exhibit pz
ambivalence or uncertaintyabout participating, do not tryto convince them to participate. Ask
the person from the
researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
pz pz pzpz pz pzpz pzpz pz pz
patient has signed the consent forms. pz
MultipleSelection
6. A nurse leader is attempting to increase the awareness of evidence-based practice
(EBP) among
thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing?(Selectall that
pz pz pzpz pzz pzpz pz pzz
apply.)
A) Interdisciplinary consensus
B) Nursingtradition pzpz
C) Researchstudies pz
D) Patientpreferencesandvalues
pz pz
E) Clinicalexpertise
Ans: C, D, E
Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-
solving
approachtothedeliveryofhealthcarethatintegratesthebestevidencefromstudiesandpatientcare data
with clinician expertise and patient preferences and values. pz
MultipleChoice
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been pz pz pz
extremelyslow to heal and which now poses a threat of osteomyelitis. The wound care pz
nurse who has been working with Mrs.Mayesappliesevidence-based pz
practice(EBP)wheneverpossibleandhasproposedtheuse of maggot therapy to debride necrotic pzp pzpz
tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantlyopposes this
treatment despite thesizable bodyofevidencesupportingit. Howshould the nurse reconcile Mrs.
pz pzz pzpz pz
Mayes views with the principles of EBP?
A) Thenurseshould explainthatreliable andvalid research evidenceoverrides the patients opinion.
pz pzpz pz pz
B) Thenurse should explain the evidencetothe patient ingreater detail. pzpz
, C) The nurse shouldintegratethe patientspreferences intotheplan of care.
pzpz pzpz
D) Thenurseshould involvethe patientsfamilymembersin the decision-making process.
pz pzpz
Ans: C
Feedback: Patient preferences should be integrated into EBP and considered alongside pz
research evidenceandthe nursesclinical expertise; evidence does nottrumpthe patients
preferences. The familyshould be involved, but thisisnot an explicit dimension ofEBP. pz
Similarly, explaining the evidence in more detail is not a demonstration of EBP. pz
8. The administrators of a long-term care facility are considered the use of specialized, pz
pressure-
reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
pz pz pz pz
sought input from the nurses on the unit, all of whom are aware of the need to
implement the principles of evidence-based practice (EBP) in this decision. Which of
the following evidence sources should the nurses prioritize?
pz
A) Aqualitative studythat exploresthe experienceoflivingwith apressure ulcer
B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittooktoreducepressure
pz pz pz pzpz
ulcers among patients
C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthemattressinquestion pz pz pz
D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
pz pz pz pz pz pz pz
mattresses
Ans: D
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
pz pz pz pz
opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice (EBP)
in their
attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
pz pz pz pz pz pz pz pz pz pz
different units, a project that will consider many types of evidence. Which of the pz pz
following information sources should the administrators prioritize?
A) Asystematicreviewabout communication in nursing contexts pz p
B) Nursesideasaboutcommunication methods
pz pz
C) The resultsof a chart review
D) Thehospitalsaccreditationstatus
Ans: A
