Chapter 01: Using Evidence in Nursing Practice
Perry et al.: Nursing Interventions & Clinical Skills, 7th Edition
MULTIPLE CHOICE s
1. A nursing educator is explaining how the best clinical practices are determined. Which stat
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ement best explains the purpose of evidence-based practice?
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a. It ensures that all patients receive holistic care.
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b. It provides a definite reason for providing care in a specific manner.
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c. It prevents errors when care is being delivered.
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d. It guarantees that care delivered is based on research.
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ANS: B s
Evidence-
based practice is the use of the current best evidence in making patient care decisions. It applies to
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all types of health care professionals. Currently there is no method that can ensure that all patients
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receive holistic care, that all errors can be prevented, or that a guarantee exists that care given is ba
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sed on research.s s
DIF: Cognitive Level: Understanding s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
2. Which question is a problem-focused trigger for initiating the evidence-
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based practice method in nursing care?
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a. What is known about reduction of urinary tract infections in the older adult with dia
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betes?
b. How can chronic pain best be described when the patient is nonverbal?
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c. How long can an IV catheter remain in place in a patient with obesity?
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d. What measures can the nurse take to reduce the rising incidence of urinary tract infe
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ctions on the older adult care unit? s s s s s s
ANS: D s
Evidence-
based practice (EBP) questions tend to arise from two sources: recurrent problems or new knowle
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dge. In the correct option, the increase in urinary tract infections indicates a trend or recurring pro
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blem in a specific group of patients. The other questions are general information questions, not ba
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sed on what is happening in a specific area or to a group of specific patients in an area or relating to
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an observed trend.
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DIF: Cognitive Level: Applying s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
3. What does the “I” indicate in a “PICO” question?
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a. Intervention of interest s s
b. Incorporation of concepts s s
c. Implementation by nursing s s
d. Interest of personnel s s
ANS: A s
The “I” stands for intervention of interest, meaning what the nurse hopes to use in practice and bel
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ieves is worthwhile or valuable. This could be a treatment for a specific type of wound or an approa
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ch on how to teach food preparation for a patient with impaired sight.
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DIF: Cognitive Level: Remembering s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
4. Who will the clinical research nurse contact to search relevant databases in preparation for an upc
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oming study? s
a. The physician whose patients may be involved in the study
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b. The medical librarian s s
c. The nurse manager of the unit where the study will be conducted
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d. The director of nursing of the facility
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ANS: B s
The medical librarian is most knowledgeable regarding databases relevant to a study. The other in
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dividuals do not have the knowledge regarding relevant databases.
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DIF: Cognitive Level: Understanding s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
5. Which database contains summaries of clinical guidelines and their development?
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a. MEDLINE
b. CINAHL
c. Cochrane Database of Systematic Reviews s s s s
d. The National Guideline Clearinghouse
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ANS: D s
The National Guideline Clearinghouse is a database supported by the Agency for Healthcare Res
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earch and Quality. It contains summaries of clinical guidelines for practice. MEDLINE is a datab
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ase for studies in mediciNne, nursing, dentistry, psychiatry, veterinary medicine, and
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allied health. CINAHL (Cumulative Index of Nursing and Allied Health Literature) includes
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studies in nursing, allied health, and biomedicine. The Cochrane Database Full text of regularly u
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pdated systematic reviews prepared by the Cochrane Collaboration includes completed reviews a
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nd protocols.
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DIF: Cognitive Level: Remembering s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
6. Which does the nurse researcher identify as the strongest type of research?
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a. Randomized controlled trials s s
b. A qualitative study s s
c. A descriptive study s s
d. A case controlled study
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ANS: A s
Individual randomized controlled trials are close to the top of the research pyramid. Only systema
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tic reviews and meta-
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analyses are higher. This type of study tests an intervention against the usual standard of care. The
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other types of studies are useful but do not give the same type of information as a randomized contr
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olled trial provides.
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DIF: Cognitive Level: Remembering s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Assessment
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7. What is the nurse attempting to determine when critiquing the evidence related to a PICOT que
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stion?
a. The ethical conduct of the research the nurse read
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b. The strength of the evidence found in the literature
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c. If there are any experts in the clinical question needing to be researched
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d. If the study demonstrates cost-effectiveness if a change in practice occurs
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ANS: B s
Once a literature search is complete and data are gathered about the question, it is time to critique t
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he evidence. Critiquing the evidence involves a systematic approach to looking at the strength of th
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e work reviewed and its relevance. The other questions are not applicable to critiquing the evidenc
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e.
DIF: Cognitive Level: Understanding s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
8. A nurse finds a cohort study comparing one group taking hormone treatment with another group
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not taking hormone treatment to determine the incidence of changes in bone density of the lower s
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pine. What can the nurse imply from this study?
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a. Low level of strength makes the study limited in value.
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b. Moderate level of strength makes the study probably useful. s s s s s s s s
c. Opinions of the individuals in the cohort are not research. s s s s s s s s s
d. This could be the basis for a Quality Improvement project.
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ANS: B s
A cohort study is Level 4 evidence as it is a single, non-
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experimental study. This moderate level of evidence makes the study probably useful but the nurs
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e should strive to find stronger
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evidence. N
DIF: Cognitive Level: Applying s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Evaluation
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9. Which question would be the best example of a knowledge-
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focused trigger for conducting an evidence-based practice project?
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a. What is the best method for treatment of leg swelling when a patient is taking gab
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apentin (Neurontin)? s
b. How can we decrease the incidence of skin cancer in adults over the age of 65?
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c. What is the current evidence for improving oral intake for cancer patients with sto
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matitis?
d. What is the maximal length of time our hospital allows irrigation kits to be used?
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ANS: C s
Evidence-
based practice (EBP) questions tend to arise from two sources: recurrent problems or new knowle
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dge. In this example, the new knowledge that drives the question is the one looking at current evid
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ence. The other questions do not look at the newest knowledge to form a question to research.
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DIF: Cognitive Level: Analyzing s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
MULTIPLE RESPONSE s
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1. When planning to implement an evidence-
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based practice strategy, what factors are most important for the nurse to consider and includ
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e? (Select all that apply.)
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a. Time required to perform the strategy s s s s s
b. Patient preferences and values s s s
c. Clinical expertise s
d. Scientific knowledge s
e. Historical practices s
ANS: B, C, D s s s
When implementing evidence- s s
based practice, the nurse considers and includes clinical expertise and patient preferences and val
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ues in addition to the scientific knowledge. Time required to perform the new strategy and custom
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ary practices are not vital to this approach. In fact, EBP seeks to ensure practices are based on evid
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ence and not just historical practice.
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DIF: Cognitive Level: Remembering s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
2. A new nurse wants to ensure practice is based on the best knowledge available. What actions are b
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est for this nurse to be involved in evidence-based practice? (Select all that apply.)
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a. Design and conduct a study based on interest. s s s s s s s
b. Join the hospital’s policy review committee.
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c. Remain vigilant for recurring problems. s s s s
d. Maintain a spirit of inquiry. s s s s
e. Read current literature appropriate to practice area.
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ANS: B, C, D, E s s s s
This novice nurse would best mNaintain an evidence-
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based nursing practice by joining policy review committees, watching for and taking note of recur
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ring problems in the practice area, maintaining a spirit of inquiry, and staying current in the literat
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ure. The nurse would not need to design and conduct a study.
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DIF: Cognitive Level: Applying s s
OBJ: NCLEX: Safe and Effective Care Environment TOP: Nursing Process: Implementatio
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n
3. When explaining the value of evidence-
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based practice, what benefits does the nurse include? (Select all that apply.)
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a. Improves quality of care. s s s
b. Improves patient outcomes. s s
c. Improves stakeholder satisfaction. s s
d. Incorporates near real-time data in practice. s s s s s
e. Helps nurses remain current in practice. s s s s s
ANS: A, B, D, E s s s s
There are five ways that EBP adds value to the health care system: helps clinicians remain current
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on standardized, evidence-based protocols; uses near real-
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time scientific data to make care decisions; improves transparency, accountability, and value (e.g
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. safe care); improves quality of care; and improves outcomes. One would hope all stakeholders w
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ould be more satisfied with this method of determining care but that is not one of the specific bene
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fits.
DIF: Cognitive Level: Remembering s s
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