Test Bank for Evidence-Based Geriatric Nursing Protocols for Best Practice, 7th Edition by Marie Boltz | Answers With Rationales

EVIDENCE-BASED GERIATRIC NURSING
PROTOCOLS FOR BEST PRACTICE

Seventh Edition



Marie Boltz




Elizabeth A. Capezuti




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,Contents
CHAPTER 1: Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach Error! Bookmark
not defined.
CHAPTER 2: Measuring Performance and Improving Quality Error! Bookmark not defined.
CHAPTER 3: Informational Technology: Embedding Geriatric Clinical Practice Guidelines Error! Bookmark not
defined.
CHAPTER 4: Organizational Approaches to Promote Person-Centered Care Error! Bookmark not defined.
CHAPTER 5: Incorporating Principles of Diversity, Equity, Inclusion, and Access Into Practice Error! Bookmark
not defined.
CHAPTER 6: Supporting Empowered Work Environments Error! Bookmark not defined.
CHAPTER 7: Environmental Approaches to Support Aging-Friendly Care Error! Bookmark not defined.
CHAPTER 8: Age-Related Changes in Health Error! Bookmark not defined.
CHAPTER 9: Healthcare Decision-Making and Advance Care Planning Error! Bookmark not defined.
CHAPTER 10: Assessing Cognitive Function in the Older Adult Error! Bookmark not defined.
CHAPTER 11: Assessing Physical Function and Promoting Safe Mobility in the Older Adult Error! Bookmark
not defined.
CHAPTER 12: Promotion of Optimal Nutrition in the Older Adult Error! Bookmark not defined.
CHAPTER 13: Assessment and Management of Mealtime Behaviors, Function, and Nutrition in
Older Adults Living With Dementia Error! Bookmark not defined.
CHAPTER 14: Family Caregiving for the Older Adult Error! Bookmark not defined.
CHAPTER 15: Elder Mistreatment Detection Error! Bookmark not defined.
CHAPTER 16: LGBTQ Perspectives for Older Adult Care Error! Bookmark not defined.
CHAPTER 17: HIV Prevention and Care in the Older Adult Error! Bookmark not defined.
CHAPTER 18: Pain Management in the Older Adult Error! Bookmark not defined.
CHAPTER 19: Medication Management in the Older Adult Across Care Settings Error! Bookmark not defined.
CHAPTER 20: Dementia Error! Bookmark not defined.
CHAPTER 21: Delirium Error! Bookmark not defined.
CHAPTER 22: Depression Error! Bookmark not defined.
CHAPTER 23: Care and Management of Diabetes in Older Adults Error! Bookmark not defined.
CHAPTER 24: Urinary Incontinence Error! Bookmark not defined.
CHAPTER 25: Catheter-Associated Urinary Tract Infection Error! Bookmark not defined.



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,CHAPTER 26: Oral Healthcare Error! Bookmark not defined.
CHAPTER 27: Fluid Overload: Identifying and Managing Heart Failure Patients at Risk for Hospital
Readmission Error! Bookmark not defined.
CHAPTER 28: Care of the Older Adult with Fragility Hip Fracture Error! Bookmark not defined.
CHAPTER 29: Respiratory Care Error! Bookmark not defined.
CHAPTER 30: Pressure Injuries and Skin Tears Error! Bookmark not defined.
CHAPTER 31: Disorders of Sleep Error! Bookmark not defined.
CHAPTER 32: Alcohol and Substance Use in the Older Adult Error! Bookmark not defined.
CHAPTER 33: Serious Mental Illness in the Older Adult: Care and Treatment Error! Bookmark not defined.
CHAPTER 34: Comprehensive Assessment and Management of the Critically Ill Older Adult Error! Bookmark
not defined.
CHAPTER 35: Comprehensive Assessment to Preserve Resilience in Older Adults with Cancer Error!
Bookmark not defined.
CHAPTER 36: Perioperative Care of the Older Adult Error! Bookmark not defined.
CHAPTER 37: General Surgical Care of the Older Adult Error! Bookmark not defined.
CHAPTER 38: Care and Comfort at the End of Life Error! Bookmark not defined.
CHAPTER 39: Acute Care Models Error! Bookmark not defined.
CHAPTER 40: Transitional Care Models Error! Bookmark not defined.
CHAPTER 41: Palliative Care Models Error! Bookmark not defined.
CHAPTER 42: Care of the Older Adult in the Emergency Department Error! Bookmark not defined.
CHAPTER 43: Long-Term Care Models Error! Bookmark not defined.
CHAPTER 44: Community-Based and Primary Care Models Error! Bookmark not defined.
CHAPTER 45: Age-Friendly Health Systems Error! Bookmark not defined.




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, CHAPTER 1
Developing and Evaluating Clinical Practice
Guidelines: A Systematic Approach
MULTIPLE CHOICE TEST QUESTIONS

1. Models of evidence-based practice (EBP) involve which of the following steps when determining the
process of developing protocols? Select all that apply.
*a. Develop an answerable question.
b. Compare the evidence to what one feels to be true.
*c. Critically appraise the evidence.
*d. Locate the best evidence.
Rationale: Evidence-based practice (EBP) involves five steps:
1. Develop an answerable question.
2. Locate the best evidence.
3. Critically appraise the evidence.
4. Integrate evidence into practice using clinical expertise with attention to the patient’s values and
perspectives.
5. Evaluate the outcome(s).
Comparing the evidence to what one feels to be true is not a part of evidence-based practice.

2. When critically evaluating the evidence used in a study, which level of evidence is at the bottom of
the level of evidence (LOE) hierarchy pyramid?
*a. Opinions of respected authorities
b. Systematic reviews of clinical practice guidelines (CPGs)
c. Single experimental studies (randomized controlled trials)
d. Nonexperimental studies
Rationale: The level of evidence (LOE) hierarchy pyramid highlights six levels of evidence. Opinions of
respected authorities, internationally or nationally known, based on their clinical experience or the
opinions of an expert committee, including regulatory or legal opinions, form the lowest level of evidence
(i.e., Level VI, at the bottom of the LOE pyramid). The highest level of evidence, at the top of the
pyramid, comprised systematic reviews, meta-analyses, or structured integrative reviews of evidence.



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,Evidence judged to be at Level II comes from a single randomized controlled trial. Nonexperimental
studies are considered Level IV evidence.

3. Which of the following questions are based on the PICO format? Select all that apply.
*a. In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?
*b. For obese children, does the use of community recreation activities compared with educational
programs on lifestyle changes reduce the risk of diabetes mellitus?
*c. For deep vein thrombosis, is D-dimer testing or ultrasound more accurate for diagnosis?
d. Do adults who binge-drink have higher mortality rates?
Rationale: PICO stands for:
P - Population or patient problem
I - Intervention
C - Comparison group or standard practice
O - Outcomes

PICO format is used to frame the research question and facilitate literature search. Each research question
is narrowed down to clearly state the population or the patient problem, the intervention being studied, the
comparison group, and the outcome measures. In the question “In patients with osteoarthritis of the knee,
is hydrotherapy more effective than traditional physiotherapy in relieving pain?”, patients with
osteoarthritis form the population, hydrotherapy is the intervention that is being compared with traditional
physiotherapy, and pain relief is the expected outcome. In the question “For obese children, does the use
of community recreation activities compared with educational programs on lifestyle changes reduce the
risk of diabetes mellitus?”, obese children form the study population, use of community recreation
services is the intervention, being compared with educational programs on lifestyle changes, and reducing
the risk of diabetes mellitus is the expected outcome. In the question “For deep vein thrombosis, is D-
dimer testing or ultrasound more accurate for diagnosis?”, deep vein thrombosis is the patient problem,
D-dimer testing is the intervention, being compared with ultrasound for accuracy of diagnosis, which is
the expected outcome. The question “Do adults who binge-drink have higher mortality rates?” does not
follow the PICO format. In this question, adults form the population being studied, binge drinking is the
intervention, and higher mortality rate is the outcome being studied. However, the comparison group is
not defined and stated in the question.

4. Which of the following statements regarding the AGREE II instrument are true? Select all that apply.
*a. The AGREE instrument has 6 quality domains with 23 items divided among these domains.



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, *b. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to “strongly agree”
by a number of appraisers.
c. The six domain scores are aggregated into a single quality score.
d. The reliability of the AGREE instrument is decreased when each guideline is appraised by more
than one appraiser.
Rationale: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument has six
quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity and
presentation, application, and editorial independence. A total of 23 items are divided into these domains.
Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to “strongly agree” by a
number of appraisers. Appraisers evaluate how well the guideline they are assessing meets the criteria of
the six quality domains. The six domain scores are independent and should not be aggregated into a single
quality score. The reliability of the AGREE instrument is increased, not decreased, when each guideline is
appraised by more than one appraiser.

5. Four appraisers give the following scores, as shown in the table below, for domain 1 (Scope and
Purpose) in the AGREE II instrument. What will be the scaled domain score?
Item 1 Item 2 Item 3 Item 4

Appraiser 1 5 6 6 17

Appraiser 2 6 6 7 19

Appraiser 3 2 4 3 9

Appraiser 4 3 3 2 8

16 19 18 53

a. 53%
*b. 57%
c. 47%
d. 19%
Rationale:
Maximum possible score = 7 (strongly agree) × 3 (items) × 4 (appraisers) = 84
Minimum possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12
The scaled domain score will be:
Obtained score − Minimum possible score



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