Evidence-Based Practice in Nursing & Healthcare
5th Edition by Melnyk, Chapters 1 – 23
TEST BANK
,Contents
CHAPTER 1 MAKING THE CASE FOR EVIDENCE-BASED PRACTICE AND CULTIVATING A SPIRIT OF
INQUIRY........................................................................................................................................... 3
CHAPTER 2: ASKING COMPELLING CLINICAL QUESTIONS .................................................................. 8
CHAPTER 3: FINDING RELEVANT EVIDENCE TO ANSWER CLINICAL QUESTIONS............................... 14
CHAPTER 4: CRITICALLY APPRAISING KNOWLEDGE FOR CLINICAL DECISION MAKING ..................... 19
CHAPTER 5: CRITICALLY APPRAISING QUANTITATIVE EVIDENCE ...................................................... 24
CHAPTER 6: CRITICALLY APPRAISING QUALITATIVE EVIDENCE ......................................................... 29
CHAPTER 7: INTEGRATION OF PATIENT PREFERENCES, VALUES, AND CLINICIAN EXPERTISE ............ 34
CHAPTER 8: ADVANCING OPTIMAL CARE WITH ROBUST CLINICAL PRACTICE GUIDELINES .............. 39
CHAPTER 9: IMPLEMENTING EVIDENCE IN CLINICAL SETTINGS....................................................... 44
CHAPTER 10: THE ROLE OF OUTCOMES AND EVIDENCE-BASED QUALITY IMPROVEMENT............... 49
CHAPTER 11: IMPLEMENTING EVIDENCE-BASED PRACTICE COMPETENCIES IN CLINICAL AND
ACADEMIC SETTINGS ..................................................................................................................... 54
CHAPTER 12: LEADERSHIP STRATEGIES FOR CREATING AND SUSTAINING EVIDENCE-BASED PRACTICE
ORGANIZATIONS ............................................................................................................................ 59
CHAPTER 13: INNOVATION AND EVIDENCE — A PARTNERSHIP IN ADVANCING BEST PRACTICE AND
HIGH-QUALITY CARE ...................................................................................................................... 65
CHAPTER 14: MODELS TO GUIDE IMPLEMENTATION AND SUSTAINABILITY OF EBP ......................... 72
CHAPTER 15: CREATING A VISION AND MOTIVATING A CHANGE TO EVIDENCE-BASED PRACTICE.... 77
CHAPTER 16: TEACHING EVIDENCE-BASED PRACTICE IN ACADEMIC SETTINGS ............................... 82
CHAPTER 17 TEACHING EVIDENCE-BASED PRACTICE IN CLINICAL SETTINGS ................................... 87
CHAPTER 18 ARCC EVIDENCE-BASED PRACTICE MENTORS: THE KEY TO SUSTAINING EBP ............... 92
CHAPTER 19 USING EVIDENCE TO INFLUENCE HEALTH AND ORGANIZATIONAL POLICY................... 97
CHAPTER 20: DISSEMINATING EVIDENCE THROUGH PRESENTATIONS, PUBLICATIONS, HEALTH
POLICY BRIEFS, AND THE MEDIA .................................................................................................. 102
CHAPTER 21: GENERATING EVIDENCE THROUGH QUANTITATIVE AND QUALITATIVE RESEARCH .... 107
CHAPTER 22: WRITING A SUCCESSFUL GRANT PROPOSAL TO FUND RESEARCH AND EBP
IMPLEMENTATION ....................................................................................................................... 112
CHAPTER 23: ETHICAL CONSIDERATIONS FOR EBP IMPLEMENTATION AND EVIDENCE GENERATION
.................................................................................................................................................... 117
,CHAPTER 1 MAKING THE CASE FOR EVIDENCE-BASED PRACTICE AND CULTIVATING
A SPIRIT OF INQUIRY
───────────────────────────────────────────────
1. In the hospital where Nurse L. works, tradi:on dictates that oral temperatures be included in
every set of pa:ent vital signs, regardless of pa:ent diagnosis or acuity. This is most likely an
example of which phenomenon?
A. The priori:za:on of internal evidence over external evidence
B. Prac:ce that lacks evidence to support its applica:on
C. The integra:on of personal exper:se into nursing care
D. Evidence-based prac:ce
Correct Answer: B
Ra onale: Performing a rou:ne vital sign measure that may not be supported by best prac:ce
guidelines or current research suggests a tradi:on-based prac:ce rather than evidence-based
care.
───────────────────────────────────────────────
2. The clinical nurse educator (CNE) on a postsurgical unit has completed a pa:ent chart review
aGer pilo:ng an early ambula:on program. Which component of EBP is the nurse puHng into
prac:ce?
A. Pa:ent preferences
B. Research u:liza:on
C. Experience
D. Internal evidence
Correct Answer: D
Ra onale: Chart reviews and outcome data from a local seHng cons:tute internal evidence, a
key element in deciding whether to adopt an EBP change.
───────────────────────────────────────────────
3. Nurse R. observes that frequent reorienta:on of pa:ents with demen:a reduces evening
agita:on. A colleague says, “It's best to s:ck to evidence-based prac:ce.” How should Nurse R.
best respond?
,A. “EBP can include clinicians’ personal exper:se.”
B. “Personal experience is oGen more sound than formal EBP.”
C. “Tradi:onal prac:ce and EBP are usually the same.”
D. “My years of experience can be just as valuable as a literature review.”
Correct Answer: A
Ra onale: EBP integrates the best external evidence, pa:ent preferences, and clinicians’
exper:se. Clinicians’ observa:ons and knowledge are part of EBP’s founda:onal elements.
───────────────────────────────────────────────
4. Which factor provides the most important ra:onale for the consistent implementa:on of
evidence-based prac:ce?
A. EBP provides for the most cost-effec:ve pa:ent care.
B. EBP is widely accessible to healthcare clinicians.
C. EBP creates consistency in care across healthcare seHngs.
D. EBP improves pa:ent outcomes.
Correct Answer: D
Ra onale: The primary goal of EBP is to promote quality care and pa:ent safety, resul:ng in
improved overall health outcomes.
───────────────────────────────────────────────
5. The Ins:tute of Medicine's Roundtable on Evidence-Based Medicine has been established to
address EBP. Which of the following issues does the Roundtable emphasize?
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 strict clinical guidelines to ensure legal compliance
D. Comparing EBP implementa:on in the United States with other Western countries
Correct Answer: B
Ra onale: The Roundtable aims to enhance the capacity of the healthcare system to con:nually
learn from and apply the best evidence, fostering con:nuous improvement and innova:on.
───────────────────────────────────────────────
,6. You have become frustrated with prac:ces in a long-term care facility that you suspect are
outdated and ineffec:ve. You have decided to examine some of these prac:ces in light of
evidence. Which step should happen first?
A. Conduct an electronic search of the literature and rank sources
B. Obtain “buy-in” from other clinicians at the facility
C. Develop an inquisi:ve and curious mindset
D. Assess whether the prac:ces in ques:on might actually be evidence-based
Correct Answer: C
Ra onale: Cul:va:ng a spirit of inquiry (i.e., curiosity and openness to change) is the
founda:onal first step in the EBP process. This mindset propels thoughQul ques:oning and
subsequent steps.
───────────────────────────────────────────────
7. Which clinical ques:on 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 pa:ents, what role does medita:on, rather than benzodiazepines, have on
anxiety levels during the 7 days following hospital admission?
C. Among undergraduate students, what is the effec:veness of a sexual health campaign during
the first 4 weeks of the semester as measured by incidence of gonorrhea and chlamydia?
D. In pa:ents aged 8 to 12, is the effec:veness of a pain scale using faces superior to a numeric
ra:ng scale in the ER?
Correct Answer: B
Ra onale: Op:on B clearly ar:culates each element: Popula:on (cancer pa:ents), Interven:on
(medita:on), Comparison (benzodiazepines), Outcome (anxiety levels), Time (7 days
postadmission).
───────────────────────────────────────────────
8. AGer formula:ng a clinical ques:on on fostering resQul sleep in ICU pa:ents, a nurse finds a
relevant meta-analysis. What does a meta-analysis typically consist of?
A. A sta:s:cal summary of results from several different studies
B. An examina:on of theore:cal underpinnings of the issue
C. An interdisciplinary analysis of the clinical ques:on
,D. A qualita:ve study of various interven:ons
Correct Answer: A
Ra onale: A meta-analysis uses sta:s:cal methods to synthesize findings from mul:ple studies,
providing high-level evidence.
───────────────────────────────────────────────
9. Nurses on a postpartum unit no:ce many first-:me mothers discon:nue breasQeeding within
24 hours. They want to create uniform breasQeeding-promo:on guidelines. Which source is
most likely to provide the best evidence?
A. A randomized controlled trial that had more than 2500 par:cipants
B. A study widely regarded as a classic in obstetrical nursing
C. A systema:c review of breasQeeding-promo:on studies from an electronic database
D. The consensus among the most senior nurses on the unit
Correct Answer: C
Ra onale: A systema:c review summarizes and evaluates findings from mul:ple high-quality
studies on a topic, typically offering strong evidence to guide prac:ce.
───────────────────────────────────────────────
10. A nurse educator advocates for clinical prac:ce guidelines on wound care to op:mize and
standardize care. Which statement best describes clinical prac:ce guidelines?
A. Replica:on studies of exis:ng research by an impar:al third party
B. A collec:on of legally mandated interven:ons
C. Interven:ons derived solely from a large, publicly-funded RCT
D. Recommenda:ons that result from a rigorous review of the literature
Correct Answer: D
Ra onale: Clinical guidelines are systema:cally constructed recommenda:ons based on
comprehensive reviews of the best available evidence.
───────────────────────────────────────────────
11. A nurse reviews a recent study about vacuum dressings for stage IV pressure ulcers. When
cri:cally appraising this study, which ques:on should be asked first?
A. “Are these findings cost-effec:ve in our clinical context?”
,B. “How would implemen:ng this interven:on affect staffing?”
C. “Were the pa:ents in the study similar to those on my unit?”
D. “Are these findings substan:ally different from our current approach?”
Correct Answer: C
Ra onale: Determining the study sample’s similarity to one’s own pa:ent popula:on is a
fundamental step in assessing external validity and applicability.
───────────────────────────────────────────────
12. A primary care provider explains to a 49-year-old male the evidence suppor:ng regular
digital-rectal exams. Which factor would jus:fy choosing not to perform them?
A. The pa:ent refuses the procedure.
B. No clinical prac:ce guidelines exist for prostate care.
C. There are no large randomized controlled trials on the topic.
D. The provider has historically waited un:l 55 to ini:ate rectal exams.
Correct Answer: A
Ra onale: Pa:ent preference and values are integral to EBP. If a fully informed pa:ent refuses a
recommended interven:on, providers typically respect that decision.
───────────────────────────────────────────────
13. A new infec:on-control regimen in a community hospital has cut nosocomial infec:ons
significantly. What is the final step in the nurses’ EBP process?
A. Calcula:ng the cost savings realized by the new guidelines
B. Sharing their experience with other healthcare professionals
C. Implemen:ng enforcement measures to ensure compliance
D. Conduc:ng a meta-analysis of other infec:on-control measures
Correct Answer: B
Ra onale: AGer successful implementa:on and evalua:on, dissemina:ng findings to peers
helps build broader evidence and encourages prac:ce improvements in other seHngs.
───────────────────────────────────────────────
14. A community health nurse wants to iden:fy evidence-based interven:ons for newly
diagnosed type 2 diabetes pa:ents. Which factor is most likely to promote EBP use?
,A. Hiring more nurses educated at the baccalaureate level
B. Making nurses more accountable for pa:ent outcomes
C. Increased funding for the facility
D. Support from the prac:ce leaders and administra:on
Correct Answer: D
Ra onale: Administra:ve and leadership support fosters a culture that enables the :me,
resources, and mo:va:on needed to implement EBP effec:vely.
───────────────────────────────────────────────
15. While advoca:ng for EBP guidelines around intracranial pressure management, a nurse
faces staff skep:cism about searching large numbers of journals. Which resource might the
nurse recommend first?
A. Engaging in self-reflec:on about current prac:ces
B. Accessing the Cochrane Library
C. Contac:ng the clinical nurse educator
D. Reviewing lay publica:ons before peer-reviewed journals
Correct Answer: B
Ra onale: The Cochrane Library provides systema:c reviews and high-quality summaries of
current research, oGen serving as a star:ng point for evidence-based inquiries.
───────────────────────────────────────────────
────────────────────────────────────────────────────────
CHAPTER 2: ASKING COMPELLING CLINICAL QUESTIONS
────────────────────────────────────────────────────────
1. Which of the following components of a clinical ques:on represents the “P” in the PICOT
format for asking clinical ques:ons?
A) The nurse’s prepara:on for pa:ent teaching prior to surgery
B) Early ambula:on versus aggressive an:coagulant therapy
C) Individuals who require peritoneal dialysis
D) Deep vein thrombosis
, Answer: C) Individuals who require peritoneal dialysis
Ra onale: “P” stands for Popula:on or Pa:ent in the PICOT format. In this ques:on,
“individuals who require peritoneal dialysis” is clearly the pa:ent popula:on (Melnyk &
Fineout-Overholt, 5th ed., on forming a PICOT ques:on).
2. An unacceptably high number of pa:ents on a geriatric, subacute medicine unit have
developed pressure ulcers. The nurses 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?
A) O
B) P
C) I
D) C
Answer: A) O
Ra onale: “O” is for Outcome. In this scenario, the specific outcome is the aim of reducing
pressure ulcers by 50% in 10 weeks (Melnyk & Fineout-Overholt, 5th ed., components of PICOT).
3. Which of the following scenarios represents the most common obstacle nurses encounter
when aVemp:ng to gain the knowledge necessary for EBP?
A) Iden:fying several relevant ar:cles, but each having significant methodological flaws
B) Becoming overwhelmed by the number of database search results
C) Finding that no relevant studies exist on the topic
D) Discovering that the only exis:ng research is from a medical rather than a nursing
perspec:ve
Answer: B) Becoming overwhelmed by the number of database search results
Ra onale: Nurses oGen become discouraged when an electronic search yields too many
cita:ons or when they feel uncertain about efficiently naviga:ng databases (Melnyk & Fineout-
Overholt, 5th ed., discussing barriers to finding evidence).
4. A nurse has tried to implement EBP in the area of falls preven:on but is overwhelmed by the
number of publica:ons. Which strategy should the nurse implement?
A) Narrow the scope of the clinical ques:on
B) Restrict the informa:on search to publica:ons from the past 24 months
, C) Seek recommenda:ons for informa:on sources from trusted colleagues
D) Limit the search to ar:cles that relate only to randomized control trials (RCTs)
Answer: A) Narrow the scope of the clinical ques:on
Ra onale: When a search becomes unmanageable, refining or narrowing the PICOT ques:on
can help yield more focused results (Melnyk & Fineout-Overholt, 5th ed.).
5. A pediatric nurse cares for many pa:ents who present with asthma. Which of the following is
a background ques:on?
A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers
(MDIs)?
B) What pa:ent popula:ons respond best to nebulized bronchodilators?
C) How effec:ve are nebulizers compared to metered-dose inhalers at reducing
bronchospasm?
D) Are nebulizers provided to pa:ents in the ED more oGen than metered-dose inhalers?
Answer: D) Are nebulizers provided to pa:ents in the ED more oGen than metered-dose
inhalers?
Ra onale: Background ques:ons are broad and oGen ask about general knowledge (the “who,
what, when, why”) rather than specific interven:onal comparisons. This ques:on simply
addresses what is happening in a specific seHng (Melnyk & Fineout-Overholt, 5th ed.).
6. Which of the following statements is true of foreground ques:ons?
A) They focus on issues that can be addressed by applying scien:fic evidence.
B) They have a broad, rather than narrow, scope.
C) They can be answered by examining electronic sources instead of print sources.
D) They are rooted in the current prac:ces of a nurse’s clinical seHng.
Answer: A) They focus on issues that can be addressed by applying scien:fic evidence.
Ra onale: Foreground ques:ons target specific pa:ent/popula:on, interven:on, comparison,
and outcome details that can be answered with current scien:fic research. They are narrower
and more specific than background ques:ons (Melnyk & Fineout-Overholt, 5th ed.).
7. An oncology nurse wants to increase EBP quality on the cancer unit. Which of the following
ques:ons is an adequate foreground ques:on?
5th Edition by Melnyk, Chapters 1 – 23
TEST BANK
,Contents
CHAPTER 1 MAKING THE CASE FOR EVIDENCE-BASED PRACTICE AND CULTIVATING A SPIRIT OF
INQUIRY........................................................................................................................................... 3
CHAPTER 2: ASKING COMPELLING CLINICAL QUESTIONS .................................................................. 8
CHAPTER 3: FINDING RELEVANT EVIDENCE TO ANSWER CLINICAL QUESTIONS............................... 14
CHAPTER 4: CRITICALLY APPRAISING KNOWLEDGE FOR CLINICAL DECISION MAKING ..................... 19
CHAPTER 5: CRITICALLY APPRAISING QUANTITATIVE EVIDENCE ...................................................... 24
CHAPTER 6: CRITICALLY APPRAISING QUALITATIVE EVIDENCE ......................................................... 29
CHAPTER 7: INTEGRATION OF PATIENT PREFERENCES, VALUES, AND CLINICIAN EXPERTISE ............ 34
CHAPTER 8: ADVANCING OPTIMAL CARE WITH ROBUST CLINICAL PRACTICE GUIDELINES .............. 39
CHAPTER 9: IMPLEMENTING EVIDENCE IN CLINICAL SETTINGS....................................................... 44
CHAPTER 10: THE ROLE OF OUTCOMES AND EVIDENCE-BASED QUALITY IMPROVEMENT............... 49
CHAPTER 11: IMPLEMENTING EVIDENCE-BASED PRACTICE COMPETENCIES IN CLINICAL AND
ACADEMIC SETTINGS ..................................................................................................................... 54
CHAPTER 12: LEADERSHIP STRATEGIES FOR CREATING AND SUSTAINING EVIDENCE-BASED PRACTICE
ORGANIZATIONS ............................................................................................................................ 59
CHAPTER 13: INNOVATION AND EVIDENCE — A PARTNERSHIP IN ADVANCING BEST PRACTICE AND
HIGH-QUALITY CARE ...................................................................................................................... 65
CHAPTER 14: MODELS TO GUIDE IMPLEMENTATION AND SUSTAINABILITY OF EBP ......................... 72
CHAPTER 15: CREATING A VISION AND MOTIVATING A CHANGE TO EVIDENCE-BASED PRACTICE.... 77
CHAPTER 16: TEACHING EVIDENCE-BASED PRACTICE IN ACADEMIC SETTINGS ............................... 82
CHAPTER 17 TEACHING EVIDENCE-BASED PRACTICE IN CLINICAL SETTINGS ................................... 87
CHAPTER 18 ARCC EVIDENCE-BASED PRACTICE MENTORS: THE KEY TO SUSTAINING EBP ............... 92
CHAPTER 19 USING EVIDENCE TO INFLUENCE HEALTH AND ORGANIZATIONAL POLICY................... 97
CHAPTER 20: DISSEMINATING EVIDENCE THROUGH PRESENTATIONS, PUBLICATIONS, HEALTH
POLICY BRIEFS, AND THE MEDIA .................................................................................................. 102
CHAPTER 21: GENERATING EVIDENCE THROUGH QUANTITATIVE AND QUALITATIVE RESEARCH .... 107
CHAPTER 22: WRITING A SUCCESSFUL GRANT PROPOSAL TO FUND RESEARCH AND EBP
IMPLEMENTATION ....................................................................................................................... 112
CHAPTER 23: ETHICAL CONSIDERATIONS FOR EBP IMPLEMENTATION AND EVIDENCE GENERATION
.................................................................................................................................................... 117
,CHAPTER 1 MAKING THE CASE FOR EVIDENCE-BASED PRACTICE AND CULTIVATING
A SPIRIT OF INQUIRY
───────────────────────────────────────────────
1. In the hospital where Nurse L. works, tradi:on dictates that oral temperatures be included in
every set of pa:ent vital signs, regardless of pa:ent diagnosis or acuity. This is most likely an
example of which phenomenon?
A. The priori:za:on of internal evidence over external evidence
B. Prac:ce that lacks evidence to support its applica:on
C. The integra:on of personal exper:se into nursing care
D. Evidence-based prac:ce
Correct Answer: B
Ra onale: Performing a rou:ne vital sign measure that may not be supported by best prac:ce
guidelines or current research suggests a tradi:on-based prac:ce rather than evidence-based
care.
───────────────────────────────────────────────
2. The clinical nurse educator (CNE) on a postsurgical unit has completed a pa:ent chart review
aGer pilo:ng an early ambula:on program. Which component of EBP is the nurse puHng into
prac:ce?
A. Pa:ent preferences
B. Research u:liza:on
C. Experience
D. Internal evidence
Correct Answer: D
Ra onale: Chart reviews and outcome data from a local seHng cons:tute internal evidence, a
key element in deciding whether to adopt an EBP change.
───────────────────────────────────────────────
3. Nurse R. observes that frequent reorienta:on of pa:ents with demen:a reduces evening
agita:on. A colleague says, “It's best to s:ck to evidence-based prac:ce.” How should Nurse R.
best respond?
,A. “EBP can include clinicians’ personal exper:se.”
B. “Personal experience is oGen more sound than formal EBP.”
C. “Tradi:onal prac:ce and EBP are usually the same.”
D. “My years of experience can be just as valuable as a literature review.”
Correct Answer: A
Ra onale: EBP integrates the best external evidence, pa:ent preferences, and clinicians’
exper:se. Clinicians’ observa:ons and knowledge are part of EBP’s founda:onal elements.
───────────────────────────────────────────────
4. Which factor provides the most important ra:onale for the consistent implementa:on of
evidence-based prac:ce?
A. EBP provides for the most cost-effec:ve pa:ent care.
B. EBP is widely accessible to healthcare clinicians.
C. EBP creates consistency in care across healthcare seHngs.
D. EBP improves pa:ent outcomes.
Correct Answer: D
Ra onale: The primary goal of EBP is to promote quality care and pa:ent safety, resul:ng in
improved overall health outcomes.
───────────────────────────────────────────────
5. The Ins:tute of Medicine's Roundtable on Evidence-Based Medicine has been established to
address EBP. Which of the following issues does the Roundtable emphasize?
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 strict clinical guidelines to ensure legal compliance
D. Comparing EBP implementa:on in the United States with other Western countries
Correct Answer: B
Ra onale: The Roundtable aims to enhance the capacity of the healthcare system to con:nually
learn from and apply the best evidence, fostering con:nuous improvement and innova:on.
───────────────────────────────────────────────
,6. You have become frustrated with prac:ces in a long-term care facility that you suspect are
outdated and ineffec:ve. You have decided to examine some of these prac:ces in light of
evidence. Which step should happen first?
A. Conduct an electronic search of the literature and rank sources
B. Obtain “buy-in” from other clinicians at the facility
C. Develop an inquisi:ve and curious mindset
D. Assess whether the prac:ces in ques:on might actually be evidence-based
Correct Answer: C
Ra onale: Cul:va:ng a spirit of inquiry (i.e., curiosity and openness to change) is the
founda:onal first step in the EBP process. This mindset propels thoughQul ques:oning and
subsequent steps.
───────────────────────────────────────────────
7. Which clinical ques:on 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 pa:ents, what role does medita:on, rather than benzodiazepines, have on
anxiety levels during the 7 days following hospital admission?
C. Among undergraduate students, what is the effec:veness of a sexual health campaign during
the first 4 weeks of the semester as measured by incidence of gonorrhea and chlamydia?
D. In pa:ents aged 8 to 12, is the effec:veness of a pain scale using faces superior to a numeric
ra:ng scale in the ER?
Correct Answer: B
Ra onale: Op:on B clearly ar:culates each element: Popula:on (cancer pa:ents), Interven:on
(medita:on), Comparison (benzodiazepines), Outcome (anxiety levels), Time (7 days
postadmission).
───────────────────────────────────────────────
8. AGer formula:ng a clinical ques:on on fostering resQul sleep in ICU pa:ents, a nurse finds a
relevant meta-analysis. What does a meta-analysis typically consist of?
A. A sta:s:cal summary of results from several different studies
B. An examina:on of theore:cal underpinnings of the issue
C. An interdisciplinary analysis of the clinical ques:on
,D. A qualita:ve study of various interven:ons
Correct Answer: A
Ra onale: A meta-analysis uses sta:s:cal methods to synthesize findings from mul:ple studies,
providing high-level evidence.
───────────────────────────────────────────────
9. Nurses on a postpartum unit no:ce many first-:me mothers discon:nue breasQeeding within
24 hours. They want to create uniform breasQeeding-promo:on guidelines. Which source is
most likely to provide the best evidence?
A. A randomized controlled trial that had more than 2500 par:cipants
B. A study widely regarded as a classic in obstetrical nursing
C. A systema:c review of breasQeeding-promo:on studies from an electronic database
D. The consensus among the most senior nurses on the unit
Correct Answer: C
Ra onale: A systema:c review summarizes and evaluates findings from mul:ple high-quality
studies on a topic, typically offering strong evidence to guide prac:ce.
───────────────────────────────────────────────
10. A nurse educator advocates for clinical prac:ce guidelines on wound care to op:mize and
standardize care. Which statement best describes clinical prac:ce guidelines?
A. Replica:on studies of exis:ng research by an impar:al third party
B. A collec:on of legally mandated interven:ons
C. Interven:ons derived solely from a large, publicly-funded RCT
D. Recommenda:ons that result from a rigorous review of the literature
Correct Answer: D
Ra onale: Clinical guidelines are systema:cally constructed recommenda:ons based on
comprehensive reviews of the best available evidence.
───────────────────────────────────────────────
11. A nurse reviews a recent study about vacuum dressings for stage IV pressure ulcers. When
cri:cally appraising this study, which ques:on should be asked first?
A. “Are these findings cost-effec:ve in our clinical context?”
,B. “How would implemen:ng this interven:on affect staffing?”
C. “Were the pa:ents in the study similar to those on my unit?”
D. “Are these findings substan:ally different from our current approach?”
Correct Answer: C
Ra onale: Determining the study sample’s similarity to one’s own pa:ent popula:on is a
fundamental step in assessing external validity and applicability.
───────────────────────────────────────────────
12. A primary care provider explains to a 49-year-old male the evidence suppor:ng regular
digital-rectal exams. Which factor would jus:fy choosing not to perform them?
A. The pa:ent refuses the procedure.
B. No clinical prac:ce guidelines exist for prostate care.
C. There are no large randomized controlled trials on the topic.
D. The provider has historically waited un:l 55 to ini:ate rectal exams.
Correct Answer: A
Ra onale: Pa:ent preference and values are integral to EBP. If a fully informed pa:ent refuses a
recommended interven:on, providers typically respect that decision.
───────────────────────────────────────────────
13. A new infec:on-control regimen in a community hospital has cut nosocomial infec:ons
significantly. What is the final step in the nurses’ EBP process?
A. Calcula:ng the cost savings realized by the new guidelines
B. Sharing their experience with other healthcare professionals
C. Implemen:ng enforcement measures to ensure compliance
D. Conduc:ng a meta-analysis of other infec:on-control measures
Correct Answer: B
Ra onale: AGer successful implementa:on and evalua:on, dissemina:ng findings to peers
helps build broader evidence and encourages prac:ce improvements in other seHngs.
───────────────────────────────────────────────
14. A community health nurse wants to iden:fy evidence-based interven:ons for newly
diagnosed type 2 diabetes pa:ents. Which factor is most likely to promote EBP use?
,A. Hiring more nurses educated at the baccalaureate level
B. Making nurses more accountable for pa:ent outcomes
C. Increased funding for the facility
D. Support from the prac:ce leaders and administra:on
Correct Answer: D
Ra onale: Administra:ve and leadership support fosters a culture that enables the :me,
resources, and mo:va:on needed to implement EBP effec:vely.
───────────────────────────────────────────────
15. While advoca:ng for EBP guidelines around intracranial pressure management, a nurse
faces staff skep:cism about searching large numbers of journals. Which resource might the
nurse recommend first?
A. Engaging in self-reflec:on about current prac:ces
B. Accessing the Cochrane Library
C. Contac:ng the clinical nurse educator
D. Reviewing lay publica:ons before peer-reviewed journals
Correct Answer: B
Ra onale: The Cochrane Library provides systema:c reviews and high-quality summaries of
current research, oGen serving as a star:ng point for evidence-based inquiries.
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CHAPTER 2: ASKING COMPELLING CLINICAL QUESTIONS
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1. Which of the following components of a clinical ques:on represents the “P” in the PICOT
format for asking clinical ques:ons?
A) The nurse’s prepara:on for pa:ent teaching prior to surgery
B) Early ambula:on versus aggressive an:coagulant therapy
C) Individuals who require peritoneal dialysis
D) Deep vein thrombosis
, Answer: C) Individuals who require peritoneal dialysis
Ra onale: “P” stands for Popula:on or Pa:ent in the PICOT format. In this ques:on,
“individuals who require peritoneal dialysis” is clearly the pa:ent popula:on (Melnyk &
Fineout-Overholt, 5th ed., on forming a PICOT ques:on).
2. An unacceptably high number of pa:ents on a geriatric, subacute medicine unit have
developed pressure ulcers. The nurses 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?
A) O
B) P
C) I
D) C
Answer: A) O
Ra onale: “O” is for Outcome. In this scenario, the specific outcome is the aim of reducing
pressure ulcers by 50% in 10 weeks (Melnyk & Fineout-Overholt, 5th ed., components of PICOT).
3. Which of the following scenarios represents the most common obstacle nurses encounter
when aVemp:ng to gain the knowledge necessary for EBP?
A) Iden:fying several relevant ar:cles, but each having significant methodological flaws
B) Becoming overwhelmed by the number of database search results
C) Finding that no relevant studies exist on the topic
D) Discovering that the only exis:ng research is from a medical rather than a nursing
perspec:ve
Answer: B) Becoming overwhelmed by the number of database search results
Ra onale: Nurses oGen become discouraged when an electronic search yields too many
cita:ons or when they feel uncertain about efficiently naviga:ng databases (Melnyk & Fineout-
Overholt, 5th ed., discussing barriers to finding evidence).
4. A nurse has tried to implement EBP in the area of falls preven:on but is overwhelmed by the
number of publica:ons. Which strategy should the nurse implement?
A) Narrow the scope of the clinical ques:on
B) Restrict the informa:on search to publica:ons from the past 24 months
, C) Seek recommenda:ons for informa:on sources from trusted colleagues
D) Limit the search to ar:cles that relate only to randomized control trials (RCTs)
Answer: A) Narrow the scope of the clinical ques:on
Ra onale: When a search becomes unmanageable, refining or narrowing the PICOT ques:on
can help yield more focused results (Melnyk & Fineout-Overholt, 5th ed.).
5. A pediatric nurse cares for many pa:ents who present with asthma. Which of the following is
a background ques:on?
A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers
(MDIs)?
B) What pa:ent popula:ons respond best to nebulized bronchodilators?
C) How effec:ve are nebulizers compared to metered-dose inhalers at reducing
bronchospasm?
D) Are nebulizers provided to pa:ents in the ED more oGen than metered-dose inhalers?
Answer: D) Are nebulizers provided to pa:ents in the ED more oGen than metered-dose
inhalers?
Ra onale: Background ques:ons are broad and oGen ask about general knowledge (the “who,
what, when, why”) rather than specific interven:onal comparisons. This ques:on simply
addresses what is happening in a specific seHng (Melnyk & Fineout-Overholt, 5th ed.).
6. Which of the following statements is true of foreground ques:ons?
A) They focus on issues that can be addressed by applying scien:fic evidence.
B) They have a broad, rather than narrow, scope.
C) They can be answered by examining electronic sources instead of print sources.
D) They are rooted in the current prac:ces of a nurse’s clinical seHng.
Answer: A) They focus on issues that can be addressed by applying scien:fic evidence.
Ra onale: Foreground ques:ons target specific pa:ent/popula:on, interven:on, comparison,
and outcome details that can be answered with current scien:fic research. They are narrower
and more specific than background ques:ons (Melnyk & Fineout-Overholt, 5th ed.).
7. An oncology nurse wants to increase EBP quality on the cancer unit. Which of the following
ques:ons is an adequate foreground ques:on?
