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Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring pzpz pzpz p z p z pzp z pzpz p zp z pzpz pzpz pzpz pzpz pzpz
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
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incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
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findings at a level of significance of <0.01. This indicates that
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A) the control group andthe experimental groupwere more than 99% similar.
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B) the findings ofthe study have lessthan 1% chance ofbeing attributable to chance.
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C) theeffects ofthe intervention were nearly zero.
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D) theclinical significance ofthefindings was less than 1:100.
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Ans: B pzp z
Feedback: The level ofsignificance is the level atwhich the researcher believes that the studyresults most
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likely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
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probability that the result is due to chance.
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2. Anursehasreadaqualitativeresearch studyin ordertounderstandthelivedexperienceofparents who
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have a neonatal loss. Which of the following questions should the nurse prioritize when appraising
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the results of this study?
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A) Howwell did the authors capture the personal experiences ofthese parents?
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B) Howwell did the authors controlfor confounding variables that may have affected the findings?
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C) Didthe authorsusestatisticalmeasures thatwere appropriate tothephenomenon in question?
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D) Weretheinstruments that the researchers usedstatisticallyvalid andreliable?
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Ans: A pzp z
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the pzp z p zp z pzpz p zpz p zp z p zp z pzpz pzp z p zp z p zp z pzpz pzpz p zp z pzp z pzpz
subjective experiences of individuals. Statistical measures and variables are not dimensions of a
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qualitative methodology.
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3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
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nursing research has little relevance to practice. How can the nurses colleague best defend the
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importance of nursing research?
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,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
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something that didnt use to be the case.
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B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatly pz pz pz pz pz z
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increased the credibility of the profession.
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C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan simply
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as a trade or a skill.
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D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
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outcomes.
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Ans: D pzp z
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
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ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
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programs, grant funding, or the public view of the profession.
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4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy
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urban hospital. She has noticedthatmanynew mothers abandon breast-feeding theirbabies when they
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experience early challenges and wonders what could be done to encourage more women to
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continue breast-feeding. What role is Tracy most likely to play in a research project that tests an
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intervention aimed at promoting breast-feeding?
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A) Applying for grant funding for the research project pzpz pzpz p zp z pzpz pzpz pzpz p zpz
B) Posingthe clinical problemto one or more nursing researchers pz p zp z p zp z pz pzpz pzpz pzpz pzpz pzpz
C) Planningthe methodology ofthe research project pz pzpz pzpz pz pzpz pzpz
D) Carryingouttheinterventionand submittingtheresultsforpublication pz pz pz pz tx pz z
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Feedback: A major role for staff nurses is to identify questions or problems for research. Grant pzp z ppzz pzp z pzpz p zp z pzpz pzpz pzpz z
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applications, methodological planning, and publication submission are normally carried out by
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nurses who have advanced degrees in nursing.
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5. A patient signed the informed consent form for a drug trial that was explained to patient by a
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research assistant. Later, the patient admitted to his nurse that he did not understand the research
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assistantsexplanation orhis own rolein the study. Howshould this patients nurse respond to this
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revelation?
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A) Explain the researchprocessto the patient ingreater detail. pzpz pzpz pz ppzz p zp z pzpz pzpz z
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B) Describethe details ofa randomized controlledtrial for the patient. pz pzpz pzpz pz pzpz pzpz pzpz pzpz pzpz pzpz
,C) Informthe research assistantthat the patientsconsent islikely invalid. pz pzpz p zp z ppzz pzpz pzpz zp
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D) Explaintothe patientthat hiswritten consentis nowlegally binding. pz pz p zp z pz pzpz pzpz pzpz pzpz pzpz z
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Ans: C pzp z
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not p zp z pzpz pzpz pzpz pzp z pzp z p zp z pzpz p zp z pzp z p zpz p zp z p zp z p zp z pzpz p zp z
responsible for research consent. If patients who have agreed to participate exhibit ambivalence or
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uncertainty about participating, do not try to convince them to participate. Ask the person from the
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researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
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patient has signed the consent forms.
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MultipleSelection pzpz
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among
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thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing? (Selectall that
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apply.)
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A) Interdisciplinary consensus p z p z
B) Nursingtradition pz
C) Researchstudies pz
D) Patientpreferencesandvalues pz pz pz
E) Clinicalexpertise
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving p zp z pzp z p zp z pzp z pzp z pzp z p zpz pzpz p zp z p zp z
approach to the delivery of healthcare that integrates the best evidence from studies and patient care data
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with clinician expertise and patient preferences and values.
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MultipleChoice pzpz
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to
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heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working with
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Mrs.Mayes appliesevidence-based practice(EBP) wheneverpossible and has proposedthe use of maggot
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therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and
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adamantlyopposes this treatment despite thesizable bodyofevidencesupportingit. Howshould the
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nurse reconcile Mrs. Mayes views with the principles of EBP?
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A) Thenurse should explainthatreliable andvalid research evidenceoverrides the patients opinion.
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B) Thenurse should explainthe evidencetothe patient in greater detail.
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, C) Thenurse should integrate the patientspreferences into theplan ofcare.
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D) Thenurseshould involvethe patients family membersin thedecision-making process.
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Ans: C pzp z
Feedback: Patient preferences should be integrated into EBP and considered alongside research
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evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The
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family should be involved, but thisisnot an explicit dimension ofEBP. Similarly, explaining the
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evidence in more detail is not a demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of specialized, pressure-
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reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
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sought input from the nurses on the unit, all of whom are aware of the need to implement the
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principles of evidence-based practice (EBP) in this decision. Which of the following evidence
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sources should the nurses prioritize?
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A) Aqualitative study that exploresthe experienceof living with a pressure ulcer
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B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittook toreducepressure ulcers
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among patients
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C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthe mattress inquestion pz pz pzpz z
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D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
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mattresses
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Ans: D pzp z
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
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opinion are low on the hierarchy of evidence.
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9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their pzp z p zp z p zp z pzpz pzpz p zpz pzp z pzpz pzpz p zp z p zp z
attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
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different units, a project that will consider many types of evidence. Which of the following
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information sources should the administrators prioritize?
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A) Asystematicreviewabout communication in nursing contexts
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B) Nursesideasaboutcommunication methods pz pz pz pzpz
C) The results of a chart review
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D) Thehospitalsaccreditation status tx
Ans: A
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Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring pzpz pzpz p z p z pzp z pzpz p zp z pzpz pzpz pzpz pzpz pzpz
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
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incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
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findings at a level of significance of <0.01. This indicates that
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A) the control group andthe experimental groupwere more than 99% similar.
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B) the findings ofthe study have lessthan 1% chance ofbeing attributable to chance.
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C) theeffects ofthe intervention were nearly zero.
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D) theclinical significance ofthefindings was less than 1:100.
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Ans: B pzp z
Feedback: The level ofsignificance is the level atwhich the researcher believes that the studyresults most
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likely represent a nonchance event. A level of significance of <0.01 indicates that there is less than 1%
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probability that the result is due to chance.
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2. Anursehasreadaqualitativeresearch studyin ordertounderstandthelivedexperienceofparents who
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have a neonatal loss. Which of the following questions should the nurse prioritize when appraising
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the results of this study?
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A) Howwell did the authors capture the personal experiences ofthese parents?
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B) Howwell did the authors controlfor confounding variables that may have affected the findings?
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C) Didthe authorsusestatisticalmeasures thatwere appropriate tothephenomenon in question?
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D) Weretheinstruments that the researchers usedstatisticallyvalid andreliable?
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Ans: A pzp z
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the pzp z p zp z pzpz p zpz p zp z p zp z pzpz pzp z p zp z p zp z pzpz pzpz p zp z pzp z pzpz
subjective experiences of individuals. Statistical measures and variables are not dimensions of a
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qualitative methodology.
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3. Anursehasexpressedskepticismtoacolleagueaboutthevalueofnursingresearch,claimingthat
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nursing research has little relevance to practice. How can the nurses colleague best defend the
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importance of nursing research?
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,A) Theexistenceofnursingresearchmeansthatnursesarenowabletoaccessfederalgrantmoney,
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something that didnt use to be the case.
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B) Nursingresearchhasallowedthedevelopmentofmastersanddoctoralprogramsandhasgreatly pz pz pz pz pz z
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increased the credibility of the profession.
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C) Thegrowthofnursingresearchhascausednursingtobeviewedasatrueprofession,ratherthan simply
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as a trade or a skill.
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D) Theapplicationofnursingresearchhasthepotentialtoimprovenursingpracticeandpatient
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outcomes.
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Ans: D pzp z
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
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ultimately,toimprovepatientoutcomes.Thissupersedesthecontributionsofnursingresearchto education
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programs, grant funding, or the public view of the profession.
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4. Tracy is a nurse witha baccalaureate degree who works inthe labor and delivery unit of a busy
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p pzpz p zpz p zp z pzpz pzpz pzpz pzpz
urban hospital. She has noticedthatmanynew mothers abandon breast-feeding theirbabies when they
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experience early challenges and wonders what could be done to encourage more women to
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continue breast-feeding. What role is Tracy most likely to play in a research project that tests an
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intervention aimed at promoting breast-feeding?
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A) Applying for grant funding for the research project pzpz pzpz p zp z pzpz pzpz pzpz p zpz
B) Posingthe clinical problemto one or more nursing researchers pz p zp z p zp z pz pzpz pzpz pzpz pzpz pzpz
C) Planningthe methodology ofthe research project pz pzpz pzpz pz pzpz pzpz
D) Carryingouttheinterventionand submittingtheresultsforpublication pz pz pz pz tx pz z
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Feedback: A major role for staff nurses is to identify questions or problems for research. Grant pzp z ppzz pzp z pzpz p zp z pzpz pzpz pzpz z
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applications, methodological planning, and publication submission are normally carried out by
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nurses who have advanced degrees in nursing.
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5. A patient signed the informed consent form for a drug trial that was explained to patient by a
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research assistant. Later, the patient admitted to his nurse that he did not understand the research
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assistantsexplanation orhis own rolein the study. Howshould this patients nurse respond to this
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revelation?
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A) Explain the researchprocessto the patient ingreater detail. pzpz pzpz pz ppzz p zp z pzpz pzpz z
p p zp z
B) Describethe details ofa randomized controlledtrial for the patient. pz pzpz pzpz pz pzpz pzpz pzpz pzpz pzpz pzpz
,C) Informthe research assistantthat the patientsconsent islikely invalid. pz pzpz p zp z ppzz pzpz pzpz zp
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D) Explaintothe patientthat hiswritten consentis nowlegally binding. pz pz p zp z pz pzpz pzpz pzpz pzpz pzpz z
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Ans: C pzp z
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not p zp z pzpz pzpz pzpz pzp z pzp z p zp z pzpz p zp z pzp z p zpz p zp z p zp z p zp z pzpz p zp z
responsible for research consent. If patients who have agreed to participate exhibit ambivalence or
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uncertainty about participating, do not try to convince them to participate. Ask the person from the
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researchteamwhoismanagingconsentstospeakwithconcernedpatientsaboutthestudy,evenafter a
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patient has signed the consent forms.
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MultipleSelection pzpz
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among
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thenursesonaunit.AnursewhoisimplementingEBPintegrateswhichofthefollowing? (Selectall that
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apply.)
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A) Interdisciplinary consensus p z p z
B) Nursingtradition pz
C) Researchstudies pz
D) Patientpreferencesandvalues pz pz pz
E) Clinicalexpertise
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving p zp z pzp z p zp z pzp z pzp z pzp z p zpz pzpz p zp z p zp z
approach to the delivery of healthcare that integrates the best evidence from studies and patient care data
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with clinician expertise and patient preferences and values.
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MultipleChoice pzpz
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to
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heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working with
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Mrs.Mayes appliesevidence-based practice(EBP) wheneverpossible and has proposedthe use of maggot
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therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and
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adamantlyopposes this treatment despite thesizable bodyofevidencesupportingit. Howshould the
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nurse reconcile Mrs. Mayes views with the principles of EBP?
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A) Thenurse should explainthatreliable andvalid research evidenceoverrides the patients opinion.
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B) Thenurse should explainthe evidencetothe patient in greater detail.
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, C) Thenurse should integrate the patientspreferences into theplan ofcare.
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D) Thenurseshould involvethe patients family membersin thedecision-making process.
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Ans: C pzp z
Feedback: Patient preferences should be integrated into EBP and considered alongside research
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evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The
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family should be involved, but thisisnot an explicit dimension ofEBP. Similarly, explaining the
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p pzp z pzpz pzpz pzpz z
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evidence in more detail is not a demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of specialized, pressure-
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reducingmattressesinordertoreducetheincidenceofpressureulcersamongresidents.Theyhave
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sought input from the nurses on the unit, all of whom are aware of the need to implement the
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principles of evidence-based practice (EBP) in this decision. Which of the following evidence
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sources should the nurses prioritize?
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A) Aqualitative study that exploresthe experienceof living with a pressure ulcer
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B) Acasestudythatdescribesthemeasuresthat nursesonageriatricunittook toreducepressure ulcers
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p tx p zp z z
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among patients
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C) Testimonialsfromexperienced cliniciansabout theeffectiveness ofthe mattress inquestion pz pz pzpz z
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p
D) Arandomizedcontrolledtrialthatcomparedthepressure-reducingmattresswithstandard
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mattresses
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Ans: D pzp z
Feedback:ThemostreliableevidenceisconsideredRCTs.Qualitativestudies,casestudies,and expert
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opinion are low on the hierarchy of evidence.
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9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their pzp z p zp z p zp z pzpz pzpz p zpz pzp z pzpz pzpz p zp z p zp z
attempttoascertainthemostefficientandeffectivewaytocommunicatebetweennurseswhoareon
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different units, a project that will consider many types of evidence. Which of the following
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information sources should the administrators prioritize?
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A) Asystematicreviewabout communication in nursing contexts
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B) Nursesideasaboutcommunication methods pz pz pz pzpz
C) The results of a chart review
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D) Thehospitalsaccreditation status tx
Ans: A
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