Question 1

A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based practice.Which of the following actions would the nurse most likely take?

Accepted Answer

Research findings,knowledge from basic science,clinical knowledge,and expert opinion should be considered sources of evidence for EBP.The use of policies and procedures is only helpful if they have been written using EBP,and depending on when they were written there may be evidence that supports the use of a different practice.The problem with nursing textbooks is that many are not grounded in evidence-based practice,because the concept is relatively new to the United States.Scanning the Internet for ideas is helpful only if evidence-based practice sites are accessed,and most internet sites are not EBP sites.

Question 2

A nurse implements an education program that incorporates computer games to reinforce learning for a group of older adults.Although the research demonstrates evidence of improved retention of this information,the nurse experiences exactly the opposite with this group.Which of the following is the most likely cause of such poor outcomes?

Accepted Answer

EBP cannot be applied as a universal remedy without attention to client differences.When EBP is applied at the community level,best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to the community.For example,computer games may be excellent for younger groups but are often poorly suited for older Americans who may face challenges with learning new technology.Because the nurse did not consider the client differences,the intervention was unsuccessful.This does not mean that the research had poor quality,was not evaluated correctly,or was not correctly incorporated into practice.The nurse should not assume that an EBP intervention will work in a different setting or with a different population than what it has been intended.

Question 3

A school nurse is developing a primary prevention strategy for school-aged children.Which of the following interventions would the nurse most likely implement?

Accepted Answer

At the primary prevention level,campaigns to support regular exercise,greater emphasis on school-based physical education programs,and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children.Exercise programs are an example of tertiary prevention.Monitoring BMI in children is an example of secondary prevention.Notifying parents of their children's height-weight scale increases family awareness but does not meet the definition of a preventive measure.

Question 4

A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP).Which of the following actions would best achieve this goal?

Accepted Answer

A lack of computers and Internet access can create a barrier to implementation of EBP in community-based nursing agencies.If these are provided,nurses can quickly access current evidence-based findings and recommendations.Conducting market research will not change the work environment to make it more conductive to implementing EBP.Learning about nurses opinions about how it will affect workload would not impact the work environment and make it more conducive to implementing EBP.Rather the administrator would need to discuss the benefits of the use of EBP with the staff.Sending staff to a conference,although it may change staff attitudes,would not necessarily change the work environment.

Question 5

A nurse is familiar with evidence-based practice (EBP)and wants to implement it into the care of clients.Which of the following would present the biggest challenge?

Accepted Answer

The first step toward implementing evidence-based practice in nursing is recognizing the current status of one's own practice and believing that care based on the best evidence will lead to improved client outcomes.After the nurse has assessed his/her own practice,and accessed EBP resources,the next steps would be to talk with administration and implement EBP into practice.Without self-reflection first,the nurse would be ineffective in implementing EBP.The challenge for the clinician is how to access the evidence and integrate it into practice,thus moving beyond practice based solely on experience,tradition,or ritual.

Question 6

The nurse has been reading everything she can find on a particular clinical problem,using both the closest medical library and the Internet.Which of the following would be the most helpful source?

Accepted Answer

A systematic review is an approach to identifying,appraising,and synthesizing research evidence to evaluate and interpret all available research that is relevant to a particular research question.Systematic reviews can be accessed from most databases.Systematic reviews require more rigor and contain less opinion of the author than typical reviews of the literature.An entire journal devoted to research on a clinical problem may be helpful,but it is unknown what type of research is being published in that journal.A well-designed systematic review can provide stronger evidence than a single randomized controlled trial.A researcher alone does not provide the best evidence,rather one would need to look at the information that has been published by the researcher in peer-reviewed journals.

Question 7

A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP)but faces barriers because of time constraints.Which of the following actions should the nurse take first?

Accepted Answer

The first step of the seven-step EBP process is step zero,which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors.Step one requires asking questions in a "PICOT" format; this is not described in any of the topic descriptors.Step two involves searching for the best evidence to answer the question.This is done through evaluating best practices.The first step of the seven-step EBP process is step zero,which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors.Step one requires asking questions in a "PICOT" format; this is not described in any of the topic descriptors.Step two involves searching for the best evidence to answer the question.This is done through evaluating best practices.

Question 8

Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP)?

Accepted Answer

Much of the pressure to use evidence-based practice comes from third-party payers and is a response to the need to contain costs and reduce legal liability.Nurses,physicians,and adminstrators are not pressuring the use of EBP as much as insurance companies as these are not the payors of health care.

Question 9

Which of the following is the best way to increase the number of persons who come to their screening test appointments?

Accepted Answer

Client reminders and recalls via mail,telephone,or e-mail-or a combination of these strategies-are effective in increasing compliance with screening activities such as those for colorectal and breast cancer.Emphasizing the importance of screening,how it is inexpensive,and the dangers of the condition if it is not diagnosed early can all occur as clients are reminded of the screening via telephone,e-mail,or mail.Without the reminder,clients are likely to lose sight of the benefits of receiving the screening.

Question 10

A nurse has decided to increase the evidence base of current nursing practice in an agency.Which of the following describes a barrier that could be encountered by the nurse?

Accepted Answer

Barriers to evidence-based practice exist when the following are limited or lacking: time,access to journal articles,search skills,critical appraisal skills,and an understanding of research terminology.Other barriers include miscommunication about the process; inferior or unavailable research or other evidence; unwillingness of organizations to fund research or make decisions based on evidence; and concern that evidence-based practice will decrease emphasis on individual client needs or the nurse's clinical decisions.Dedication to the history and tradition of the agency may pose a barrier as this may influence the philosophy of the practice environment and the willingness to embrace EBP.The number of meta-analyses in the literature,regardless if the results are consistent or not,would not be a barrier to the practice environment when implementation is considered.

Question 11

A school health nurse plans to use evidence-based practice (EBP)to guide the development of health education programs most likely to increase retention of learning in elementary schoolchildren.Which of the following would be the best way to use EBP in this situation?

Accepted Answer

Randomized controlled trials are generally ranked as the highest level of evidence.EBP is not collected by word of mouth,rather the nurse must look in the literature to obtain the best information.There is not evidence that a series of games will assist with the retention of learning based on what is stated in this question.This may be an appropriate activity,but this information must be gathered from the literature.Searching the Internet for ideas is helpful only if evidence-based practice sites are accessed,and most Internet sites are not EBP sites.

Question 12

A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant population.Which of the following actions would be the most helpful for the nurse?

Accepted Answer

To determine whether practice is serving the needs of the population,the nurse will need to consult the population served.This means that evidence should be applied with input from the community.For example,decisions related to the services to be offered in a nurse-managed clinic should be made with input from the clinic's advisory board,which should include community leaders and consumers of the clinic's services.Information about the population needs to come from the population itself,not from cultural competency experts within the community or from the staff members.Cuban immigrant needs may not be the same as those of Hispanic immigrants from other places such as Mexico or Spain.

Question 13

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP)in the clinical setting.Which of the following would be the best strategy to accomplish this goal?

Accepted Answer

EBP demands changes.It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers.Emphasis should be on decision making using the varied sources of evidence.The environment and climate must be supportive in order to implement EBP.Rather than eliminating protocols and standards that are not evicence based,the nurse manager should make it a priority to begin to update these practices based on EBP.Self-reflection on one's own nursing practice and how EBP can be implemented would be more important than group reflection on the large ideals of nursing practice.Referring the nurses to the Internet for ideas is helpful only if evidence-based practice sites are accessed,and most Internet sites are not EBP sites.

Question 14

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control.What would be the best reference for the provider to implement evidence-based practice (EBP)in the management of this problem?

Accepted Answer

EBP in community-oriented nursing challenges nurses to integrate outcomes of the best evidence into their clinical practice.Current research findings will explicate evidence of most successful interventions.(Randomized controlled trials are the gold standard of research for EBP.)Protocols and opinions often reflect tradition rather than the most current scientific evidence.Although many nursing journals are peer reviewed,many are not and,even if peer reviewed,many are not research based or focused on scientific evidence.

Question 15

After finding several studies related to the clinical problem,a nurse knows the studies must be evaluated.Which of the following characteristics should be present in the literature?

Accepted Answer

The Agency for Healthcare Research and Quality (AHRQ)reviewed 40 systems used to evaluate the quality of studies and strength of evidence.The report identified three domains for evaluating systems that grade the strength of evidence: quality,quantity,and consistency.The quality of a study refers to the extent to which bias is minimized.Quantity refers to the number of studies,the magnitude of the effect,and the sample size.Consistency refers to studies that have similar findings,using similar and different study designs.Federally supported multiagency clinical studies,research studies completed by multidisciplinary teams in multiple settings,and controlled clinical trials do not necessarily meet the three domains for evaluating systems to grade the strength of the evidence: quality,quantity,and consistency.These are the criteria that should be used to evaluate the literature so additional information is needed about these studies in order to evaluate them.

Question 16

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature.The group has selected the interventions that seem the easiest to implement.Which of the following actions would the staff take next?

Accepted Answer

After the group has chosen the topic and evaluated the literature for approaches that seem feasible,specific interventions are chosen.The quality of the evidence must be assessed before recommending specific changes or writing a protocol to resolve the problem.Grading the strength of evidence or determining the quality,quantity,and consistency of research studies must be done before making recommendations for practice.Deciding how to orient staff and the community to the change would occur at the end of the process after the findings have been summarized and written recommendations or protocols have been developed.Elimination of nursing interventions that are not evidence based would be part of the written recommendations and proposal that happen at the end of the process.The nurse should not plan another literature search or topic to explore until after completing the process with the current issue.

Quiz 10: Evidence-Based Practice

A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based practice.Which of the following actions would the nurse most likely take?

A school nurse is developing a primary prevention strategy for school-aged children.Which of the following interventions would the nurse most likely implement?

A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP) .Which of the following actions would best achieve this goal?

A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care of clients.Which of the following would present the biggest challenge?

The nurse has been reading everything she can find on a particular clinical problem,using both the closest medical library and the Internet.Which of the following would be the most helpful source?

A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP) but faces barriers because of time constraints.Which of the following actions should the nurse take first?

Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP) ?

Which of the following is the best way to increase the number of persons who come to their screening test appointments?

A nurse has decided to increase the evidence base of current nursing practice in an agency.Which of the following describes a barrier that could be encountered by the nurse?

A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most likely to increase retention of learning in elementary schoolchildren.Which of the following would be the best way to use EBP in this situation?

A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant population.Which of the following actions would be the most helpful for the nurse?

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting.Which of the following would be the best strategy to accomplish this goal?

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control.What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem?

After finding several studies related to the clinical problem,a nurse knows the studies must be evaluated.Which of the following characteristics should be present in the literature?

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature.The group has selected the interventions that seem the easiest to implement.Which of the following actions would the staff take next?