Question 1

The team has reviewed several research studies regarding treatment of pancreatitis in older adult women. One intervention is found to be particularly effective, but it requires a specific piece of expensive equipment and complex provider training. In which part of the FAME framework does this intervention score poorly?

A) F
B) A
C) M
D) E

F

Accepted Answer

1. "F" stands for feasibility and determines if the evidence is immediately practicable or if it requires extensive training and resources. Some evidence is also found to be impracticable. The evidence in this scenario falls in the middle to lower range.
2. "A" stands for appropriateness. Appropriateness concerns the ethics of using the evidence or intervention. There is no information to suggest that this intervention is not ethical.
3. "M" stands for meaningfulness. The standard ranges from evidence that provides a rationale for practice development to evidence that is unlikely to make sense to practitioners. This intervention is effective and there is no evidence that the rationale for using it is not clear.
4. "E" stands for effectiveness. The standard ranges from extensive validation with limited contradictory findings to concepts that need development. There is no indication that this intervention would score poorly on this rating.

Question 2

The nurse researcher is interested in conducting research into a specific clinical problem. The research design will require that the participants be deceived about the purpose of an intervention. What should the researcher consider about this design?

A) Deception of study participants is illegal.
B) The Institutional Review Board (IRB) will likely not approve this study.
C) Deception of study participants is a common part of most research designs and is appropriate if the deception does not cause the patient to be harmed.
D) The researcher must prove to the Institutional Review Board (IRB) that this deception is critical to the study design.

Accepted Answer

1. It is not illegal to deceive study participants. The IRB must approve this design.
2. Approval from the IRB will depend upon the reason the participants are being deceived.
3. This is not a common practice, but is appropriate in some situations.
4. The IRB must approve the study and approval will rest on the researcher's ability to prove that this is a critical element of the study.

Question 3

Which patient would be considered to belong to a vulnerable population when included in research? Select all that apply.&#10;A) A healthy newborn delivered at 38-week's gestation.&#10;B) A 45-year-old woman with diagnosed bipolar disease.&#10;C) A 28-year-old woman who is 16-weeks pregnant.&#10;D) A 35-year-old man who is hospitalized with renal colic.&#10;E) A 58-year-old female inmate who was injured in a prison fight.&#10;

Accepted Answer

1. Neonates are considered a vulnerable population.
2. Persons with mental illness are considered a vulnerable population.
3. Pregnant women and fetuses are considered vulnerable populations.
4. Persons who are hospitalized are not considered part of a vulnerable population based upon the hospitalization alone.
5. Persons confined to institutions such as prisons are considered part of a vulnerable population.

Question 4

A nursing research team from a hospital would like to quickly disseminate findings from its study to the nurses in its local area. Which strategy should this team employ?&#10;A) Work to get the findings published in a research journal.&#10;B) Apply to present the findings as a poster presentation in a national conference.&#10;C) Organize a research day at the hospital.&#10;D) Get the findings published in a practice journal.&#10;

Accepted Answer

1. This is a very good method of disseminating the findings to a national forum, but takes time and would not be the best plan for these nurses.
2. This is a good forum for dissemination of findings, but locating a conference that is local and will be held quickly is difficult. The planner of such a conference generally chooses the poster presentations through a selection process that takes time and is held several weeks prior to the date of the conference.
3. This is the best way for these results to be disseminated. This event could be co-sponsored by the hospital and any nursing programs in the area. These events do take planning, but are not as planning intensive as national events.
4. When practice journals describe research findings, it is generally done as part of a secondary article. While some staff nurses are more likely to read about findings in a practice journal, the entire study would not be published. Also, having an article accepted for inclusion in a journal is a time consuming process.

Question 5

The nurse is overwhelmed with the amount of information concerning vitamin D supplementation in post-menopausal women. Which strategy would be the most appropriate for this nurse to use to find the best practice information on this topic?

A) Use any popular Internet search engine to initiate a search of the topic.
B) Read as many nursing journal articles about the topic as possible.
C) Read about the topic on a site such as Joanna Briggs.
D) Search for the topic on the World Health Organization (WHO) website.

Accepted Answer

1. While the nurse might learn a great deal from this search, the number of "hits" on a general search engine would be daunting. It is also not likely that all of the information retrieved would be scientifically- or evidence-based. Identifying the evidence-based recommendations would be very time consuming.
2. In order to read enough information, the nurse would have to search the journals for appropriate articles and then find the journals, either in print or online full text. This would be a time-consuming endeavor.
3. Sites such as Joanna Briggs have already reviewed the evidence and have used the hierarchy of evidence levels to categorize the information. This would be the quickest method to find reputable evidence.
4. The information on the WHO site is not only for healthcare professionals, but is also for the general public. It is likely that very good information is available, but locating it in this huge site might be time consuming.

Question 6

The nurse researcher is developing a PICO question for a study. Which consideration should be made when writing the &#34;O&#34; section of this question?&#10;A) What happened to the study group?&#10;B) What treatment is being studied?&#10;C) Were any other treatments done?&#10;D) Who is being studied?&#10;

Accepted Answer

1. "O" is the outcome, such as risk of disease, a complication or a side effect, or an adverse outcome.
2. This is section "I." The "I" can be related to prognostic factors, risk behaviors, exposure to disease, clinical intervention, or treatment.
3. This is section "C." The "C" can be related to another treatment or no treatment.
4. This is the "P" section, the group that is being studied, written is specific terms.

Question 7

Which example of best practice review would likely be assigned a Level I?&#10;A) Information from the only existing study of an intervention.&#10;B) Information from review of several randomized controlled trials of an intervention.&#10;C) Information from the opinion of a person widely recognized as an expert in the use of the intervention.&#10;D) Information from a non-randomized well-designed controlled trial of the intervention.&#10;

Accepted Answer

1. This is considered as level VI evidence.
2. Level I evidence is the highest or best level. It is evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence based clinical practice guidelines based on systematic reviews of RCTs.
3. Expert opinion is level VII evidence.
4. This type of evidence is categorized as level III.

Question 8

The high school student is very interested in healthcare research and is trying to decide which healthcare profession to enter. What should this student consider when examining leadership roles in research that nurses can assume? Select all that apply.

A) Nurses guide their own research.
B) Nurses participate in interprofessional studies.
C) Nurses manage clinical trials.
D) Nurses guide patients who are considering clinical trial participation.
E) Nurses are not generally leaders in healthcare research.

Accepted Answer

1. Nurses act as designers and principle investigators in their own research.
2. Participating in interprofessional studies and trials is a common role for the nurse.
3. Depending upon educational level, nurses do manage clinical trials.
4. Nurses of many different educational levels serve as patient advocates in decisions about clinical trial participation.
5. The nurse serves in many roles in healthcare research, including leadership roles. This high school student should consider advanced education in nursing beyond a basic degree.

Question 9

Over the last six months, patient satisfaction surveys have begun to mention that the facility is not as clean as expected. How should an administrator using evidence-based management (EBM) strategies deal with this information?

A) Recall that the hospital has been running at full capacity for over one year.
B) Recall that the manager of the housekeeping department was on vacation for a month during this time.
C) Accept this information as accurate and work to reverse the trend.
D) Forward the information to the housekeeping manager and demand an explanation.

Accepted Answer

1. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.
2. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.
3. EBM encourages the manager or administrator to "face the hard facts" and not to make excuses for evidence. The administrator should treat the organization as a work in progress and use this information to encourage housekeeping workers to improve.
4. Demanding an answer to the situation is not an EBM principle. The administrator should see the organization as a work in progress. Something has occurred to impact the hospital's cleanliness. That issue should be addressed and rectified, but it is not necessary to be demanding and accusatory.

Question 10

The nurse executive wishes to encourage the use of evidence-based practice (EBP) in the clinical areas of the hospital. When talking to nurse managers about this decision what benefits of EBP should the nurse executive emphasize? Select all that apply.

A) EBP helps to control the cost of healthcare.
B) EBP takes decision making out of planning patient care.
C) EBP improves healthcare quality.
D) EBP makes care more patient-centered.
E) EBP encourages third party payer involvement in healthcare decisions.

Accepted Answer

1. This is a very important aspect of EBP to the nurse executive and to nursing managers.
2. Individual decision making about healthcare is still an important facet of care when using EBP.
3. Improvement of healthcare quality is a fact about EBP that should appeal to nurse managers and to staff nurses.
4. EBP does make care more patient-centered. This should be appealing to nurse managers and staff nurses.
5. There is no evidence that EBP increases involvement of third party payers in healthcare decisions.

Question 11

The experienced staff nurse complains that use of evidence-based practice (EBP) guidelines has &#34;reduced nursing to a cookbook profession.&#34; What is meant by this comment?&#10;A) Some people believe that the guidelines are too easy to follow and take the challenge out of nursing.&#10;B) Some people believe that the guidelines are written so that they could be followed by anyone, despite their educational level.&#10;C) Some people believe that EBP guidelines are too proscriptive and do not allow for consideration of individual needs.&#10;D) Some people believe that too many factors are left to the interpretation of the person who is reading the guidelines.&#10;

Accepted Answer

The answer of The experienced staff nurse complains that use...

Question 12

Arrange the five steps of the evidence-based practice process in order of their use. &#10;A) Evaluate practice decisions. &#10;B) Collect best evidence. &#10;C) Integrate the evidence. &#10;D) Appraise the evidence. &#10;E) Write a PICO question.&#10;

Accepted Answer

The answer of Arrange the five steps of the evidence-based...

Question 13

Place the steps of the evidence-based management (EBM) process in correct order. &#10;A) Formulate the question. &#10;B) Assess the evidence. &#10;C) Acquire research evidence. &#10;D) Apply the evidence. &#10;E) Present the evidence.&#10;

Accepted Answer

The answer of Place the steps of the evidence-based management...

Question 14

Which option best fulfills the &#34;P&#34; portion of a PICO question?&#10;A) Middle-aged Caucasian men who have been treated for Type I Diabetes Mellitus for over 1 year&#10;B) Infants who are breast-fed&#10;C) Women who are breast cancer survivors&#10;D) African American women who are poor and who have lived in the western United States for some time&#10;

Accepted Answer

The answer of Which option best fulfills the &#34;P&#34; portion...

Question 15

The nurse executive has instituted a very effective program that encourages nursing staff involvement in research. Nurses are suggesting research topics, helping to collect data, and have assisted with data analysis. What should be the nurse executive's next goal for these nurses?

A) Getting the nurses to seek funding for research projects.
B) Helping the nurses consider additional study topics.
C) Involving the nurses in efforts to seek resources and time to conduct more research.
D) Encouraging the nurses to find ways to disseminate the findings of completed studies.

Accepted Answer

The answer of The nurse executive has instituted a very...

Question 16

The staff nurse has long wondered if some common nursing interventions are helpful to patient outcomes. Where would this nurse find evidence-based practice information to help solve this dilemma? Select all that apply.

A) Research journals
B) Expert nursing opinion
C) Established nursing theories
D) Tradition
E) Clinical expertise

Accepted Answer

The answer of The staff nurse has long wondered if...

Question 17

The nurse is involved in basic research. Which study topic would the nurse most likely research?&#10;A) The antiseptic that provides the cleanest environment for intravenous access.&#10;B) The efficacy of diuretic use for pregnancy induced edema.&#10;C) The historic significance of feminism in nursing.&#10;D) The use of nursing self-scheduling in a unit.&#10;

Accepted Answer

The answer of The nurse is involved in basic research....

Question 18

Which research topics would likely be included in the National Institute of Nursing Research (NINR) Intramural program? Select all that apply.&#10;A) Use of a specific intervention to reduce shortness of breath in patients with congestive heart failure&#10;B) How referred pain is associated with pathology&#10;C) What is the best way to disseminate research training&#10;D) Use of knowledge management theory in a free-standing dialysis unit&#10;E) Cost of an education program on prevention of sudden infant death syndrome&#10;

Accepted Answer

The answer of Which research topics would likely be included...

Question 19

The newly licensed nurse is concerned about the rapidity with which nursing care information changes. What characteristic would be best to help manage this concern?&#10;A) Ability to use general Internet search engines to obtain information.&#10;B) Knowledge of where and how to find the best possible sources of evidence.&#10;C) Ability to use library print resources to find good information.&#10;D) A good working relationship with experienced nurses.&#10;

Accepted Answer

The answer of The newly licensed nurse is concerned about...

Question 20

What are the advantages of using systematic reviews to learn about evidence-based practice issues? Select all that apply.&#10;A) Any inconsistencies in the material are explored.&#10;B) The review increases the strength of cause and effect relationships.&#10;C) Helps to increase efficiency in time between research and clinical implementation.&#10;D) This review proves this intervention is the best one available.&#10;E) There is a decrease in bias from researcher error.&#10;

Accepted Answer

The answer of What are the advantages of using systematic...

Question 21

The nurse executive suspects that the nurse managers see evidence-based management (EBM) as another management suggestion that will "blow-over" with time. What is the best way for the nurse executive to be assured that EBM strategies are being used in the facility?

A) Require a weekly report on the strategies from each nurse manager.
B) Call staff nurses in and ask them about how the managers are making day-to-day decisions on the unit.
C) Make daily walking rounds with a member of upper management to check on the progress of the EBM initiative.
D) Incorporate EBM into the performance evaluation of the nurse managers.

Accepted Answer

The answer of The nurse executive suspects that the nurse...

Question 22

What would be a barrier for a nurse researcher to accomplish effective research?&#10;A) Statistical expertise&#10;B) Completed a past study&#10;C) Assuming a new administrative position&#10;D) Expansion of clinical services with more patients&#10;

Accepted Answer

The answer of What would be a barrier for a...

Question 23

Changing practice with EBP is least supported with which strategy?&#10;A) Educate staff about EBP and evaluate results.&#10;B) Develop policies and procedures that are based on best evidence.&#10;C) Incorporate assessment of EBP in performance appraisal.&#10;D) Connect EBP with QI within the healthcare organization.&#10;

Accepted Answer

The answer of Changing practice with EBP is least supported...

Question 24

Differentiate among quality improvement (QI), research, and evidence-based practice (EBP) by choosing the statement that is accurate.&#10;A) Statistical language in research is much more sophisticated than that used in QI.&#10;B) Research and EBP support clinical decision making whereas QI is a monitoring program.&#10;C) Quality improvement efforts help to generate new knowledge in the care of patients.&#10;D) Quality improvement is not dependent upon a specific theory as is research and EBP.&#10;

Accepted Answer

The answer of Differentiate among quality improvement (QI), research, and...

Question 25

The newly hired quality improvement (QI) director states, "I believe we should seek Institutional Review Board (IRB) approval before starting this new project. The medical center has never involved the IRB committee in QI proceedings. How should the medical center chief operating officer respond to this statement?

A) IRB approval is not necessary in this state.
B) Since we are a federal institution, we do not need IRB approval.
C) We can ask the IRB committee for an opinion on our plan for this project.
D) We should always get IRB approval for our QI initiatives from now on.

Accepted Answer

The answer of The newly hired quality improvement (QI) director...

Question 26

The medical center nurse executive tells the nurse managers that the nursing department will be instituting evidence-based management (EBM). The medical center has a history of bureaucratic management style. What should the managers consider about these two facts?

A) The history of centralized decision making in the bureaucratic organization will make EBM easier to implement.
B) Since EBM depends on all managers following rigid policies and procedures this transition should go quickly.
C) These two concepts have very little influence on one another.
D) The restrictions on decision making that are common in bureaucratic organizations will make use of EBM strategies difficult.

Accepted Answer

The answer of The medical center nurse executive tells the...

Question 27

Why is the Nuremberg Code important in research?&#10;A) It protects animals in research.&#10;B) It is a current listing of standards describing the research process.&#10;C) It establishes a prototype for current views of research ethics.&#10;D) The code resulted from the Willowbrook study and concerns about ethics.&#10;

Accepted Answer

The answer of Why is the Nuremberg Code important in...

Question 28

The nurse executive of a major medical center and the dean of a school of nursing have entered into an affiliation agreement. The medical center will supply clinical sites and preceptors to students and the nursing school will supply research expertise and other academic support. How will this affiliation affect the medical center's plans to implement evidence-based practice (EBP) and evidence-based management (EBM)?

A) This affiliation should have very little effect on these two initiatives.
B) The affiliation should be helpful in initiating these practice and management styles.
C) The affiliation will help with EBP, but will likely have little effect on EBM.
D) The affiliation will help with EBM, but will likely have little effect on EBP.

Accepted Answer

The answer of The nurse executive of a major medical...

Question 29

Which of the following government initiatives focuses on accelerating diffusion of research in practice?&#10;A) AHRQ&#10;B) PCORI&#10;C) ACTION&#10;D) CER&#10;

Accepted Answer

The answer of Which of the following government initiatives focuses...

Question 30

You are serving on the IRB committee. In reviewing study proposals, what are questions you might ask? Select all that apply.&#10;A) Can subjects withdraw at any time?&#10;B) How are subjects told about their role in the study?&#10;C) Is it clear whom the subjects should contact for questions?&#10;D) Will negative results be kept private?&#10;E) How will the researcher protect subject confidentiality?&#10;

Accepted Answer

The answer of You are serving on the IRB committee....

Deck 16: Evidence-Based Practice and Management