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Test Bank For Evidence-Based Practice in Nursing and Healthcare, 4th Edition

  • Nursing
  • 121 pages
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    Page 1 1. A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement EBP. Which of the following questions could those nurses best answer by consulting a textbook? A) “What effect does a diagnosis of renal failure have on type 2 diabetics' glucose monitoring behavior?” B) “What factors influence clinicians' decisions to recommend peritoneal dialysis over hemodialysis?” C) “What are the anatomical characteristics and physiological functions of the kidneys?” D) “What is the relationship between dosing of erythropoietin therapy and hemoglobin levels in patients with chronic renal failure?” 2. A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first? A) A newspaper article B) A systematic review C) A conference presentation D) A journal article 3. After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has “googled” the subject. How should the nurse best interpret the results of this search? A) The nurse must carefully evaluate the results of this search. B) The results of searching sites such as Google and Yahoo are not clinically useful. C) The search is likely to yield inaccurate or biased results. D) The search is a time-efficient substitute for searching online health databases. 4. A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most likely to provide the nurse with specific interventions and practices to achieve this goal? A) Cumulative Index to Nursing and Allied Health Literature (CINAHL) B) National Guideline Clearinghouse C) PsycINFO D) MEDLINE

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    Page 2 5. A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital's policy on the use of physical restraints. During the search, what parameters should the nurse establish for the dates of articles and other information sources? A) Articles should be ranked according to publication date, with the most recent articles being prioritized. B) The nurse should attempt to identify collaborative evidence for any source that is more than 3 years old. C) The nurse should establish a cutoff for sources more than 5 years old. D) The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication. 6. While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching “beta blockers.” How should the nurse proceed? A) Identify the appropriate MeSH term B) Search for clinical guidelines in the Cochrane Library C) Consult the reference lists in articles that appeared during the search D) Search the trade names of specific beta-blocking drugs 7. In light of the large number of gall bladder patients recently admitted to the unit, a nurse is searching PubMed for literature relating to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field? A) “chole*” B) “cholecystitis or cholecystectomy or cholelithiasis or cholecystography” C) “gall bladder” D) “chole-” 8. A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results? A) “nutrition OR (delirium OR dementia)” B) “(delirium OR dementia) AND nutrition” C) “delirium dementia nutrition” D) “delirium AND dementia AND nutrition”

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    Page 3 9. In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search? A) Only noncopyrighted resources will be available to the nurse. B) The nurse will be guaranteed that each result will be from a peer-reviewed source. C) The nurse will be unable to conduct a valid or useful search. D) Articles that are relevant may be excluded from consideration. 10. A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions? A) Cochrane Database of Systematic Reviews (CDSR) B) Cochrane Central Register of Controlled Trials (CENTRAL) C) Cochrane Methodology Register D) Health Technology Assessment (HTA) Database 11. A nurse has conducted a search of PubMed to answer the question, What factors influence older adults' decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue? The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed? A) Date of publication B) Number of times the article has been cited C) Ranking by peer review D) Date the article was added to the database 12. A nurse is working on a literature review using a laptop computer while in a café that provides wireless Internet access but will not allow for connection to the hospital library's server that provides the nurse's normal access to database subscriptions. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection? A) PubMed B) Cochrane Library C) MEDLINE D) EMBASE

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    Page 4 13. Management of a county hospital has been resistant to providing time, facilities, and subscriptions to allow nurses to conduct online searches near the point of care. Which of the following arguments can the nurses present to strengthen their case for these tools? A) “Online access at or near the point of care has been mandated by law.” B) “Providing for literature searches has been shown to save money and shorten patient stays.” C) “It is unethical for nurses to provide care that is not rooted in a recent literature search.” D) “The increased confidence that nurses gain from accessing knowledge is linked to improved patient outcomes.” 14. Which of the following sources would best provide critical appraisal during a nurse's search for evidence on which to base practice? A) A journal that provides assessments of notable articles recently published in other journals B) The expert opinion of qualified and experienced nurse clinicians C) A careful examination of the methodology of a study D) The insight of a trusted hospital librarian 15. Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy? A) Organize a small-scale clinical trial to test current practices on the unit. B) Elicit the views of the most senior nurses and those nurses who exemplify EBP. C) Formulate a question and conduct a thorough search of the existing evidence. D) Seek input from physicians with expertise in the area of VAP.

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    Page 5 Answer Key 1. C 2. D 3. A 4. B 5. D 6. A 7. A 8. B 9. D 10. A 11. D 12. D 13. B 14. A 15. C

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    Page 1 1. The nurses on a medical unit recently acknowledged that their efforts to introduce an evidence-based pain management regimen have failed. Which of the following factors is most likely to have contributed to the failure of the EBP initiative? A) Differences between the educational levels of staff nurses and those promoting the change B) Contradictions in the body of literature around the assessment and management of pain C) Failure to integrate principles of the psychology of change D) The sufficiency of the existing protocols and policies of pain management on the unit 2. A nurse has recognized the need to change the practice on an obstetrical unit so that more women choose to breastfeed their babies after discharge. Which of the following factors is most important in determining the success or failure of the subsequent evidence-based practice change? A) The positive effects of breastfeeding in neonatal health and development B) The strength and specificity of the nurse's vision for change C) The depth and breadth of the nurse's experience base D) The credibility that the nurse holds on the unit 3. How should a group of nurses best address the need for goals at the outset of an evidence-based practice change at their workplace? A) The team should identify a set of common goals and write them down. B) The team should allow individual nurses the autonomy to choose their own goals. C) The team should identify goals from within the literature and disseminate them. D) The team should allow the project goals to evolve as the initiative progresses. 4. An initiative to improve the quality of care that stroke patients receive is being considered in a county hospital. Which of the following questions should the implementation team ask as part of a SCOT analysis? A) “Who are the stakeholders that would be affected by a change in our practice?” B) “How will we define success during this initiative?” C) “What are the costs that might be incurred if we attempt to change practice?” D) “What are the challenges in our workplace that we need to address?”

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    Page 2 5. A change in practice is being considered on a hospital unit that is producing an unacceptably high number of incident reports. Which of the following characteristics of the unit best exemplifies the first stage of Duck's Change Curve model? A) A directive to change has been received but ignored. B) The nurses on the unit lack knowledge and experience. C) Relationships between staff and disciplines on the unit are antagonistic. D) The leadership and culture of the unit are stagnant. 6. Nursing leaders are utilizing Kotter and Cohen's Model of Change to guide a change in pressure ulcer assessment and prevention. What task should the leaders first perform? A) Assess nurses' willingness to change B) Cultivate a sense of urgency C) Mobilize evidence-based practice mentors D) Communicate the proposed vision for change 7. Kotter and Cohen's Model of Change has been implemented successfully, resulting in an evidence-based change in pressure ulcer assessment and prevention on a unit. What is the final step in this change process? A) Disseminating the results of the change in practice B) Sending out mentors to stimulate similar change on other units and in other hospitals C) Nourishing the change to ensure the new practice is sustained D) Monitoring nurses' compliance with the new practice 8. According to Rogers' theory of diffusion of innovations, which of the following groups of nurses is primarily responsible for initiating evidence-based change? A) Innovators B) Mentors C) Catalysts D) Leaders 9. The clinical nurse educator on a palliative care unit perceives that many of the staff nurses are in the precontemplative and contemplative stages of readiness to adopt a new, evidence-based approach to pain assessment and management. Which of the following strategies should the educator adopt? A) Presenting the findings from the literature that support the change in practice B) Making connections with staff and fostering their readiness to change C) Implementing the initial changes in practice that are necessary D) Identifying and addressing those staff members who are resistant to change

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    Page 3 10. Nursing leaders in a large, urban emergency department are aware that many nurses are skeptical of a proposed evidence-based change in the management of patients with mental health problems. How should the nursing leaders best address this skepticism? A) Bring in evidence-based practice mentors from an emergency department that has successfully implemented a similar change B) Distribute copies of a meta-analysis that encompasses the relevant research and elicit feedback C) Present the evidence that underlies the proposed change at an open forum D) Create a venue for the nurses to express and discuss their skepticism directly 11. According to Rohm's model of personality types, nurses with which of the following personalities are most likely to be effective as evidence-based practice mentors? A) D B) I C) S D) C 12. In light of the high incidence of nosocomial methacillin-resistant staphylococcus aureus (MRSA), there is an apparent need for improvements in infection-control practice at a county hospital. Which of the following goals should be established for a proposed evidence-based change in practice? A) “The incidence of nosocomial MRSA will decrease significantly within the next 60 days.” B) “New cases of MRSA colonization will go down by 15% between now and 90 days from now.” C) “Within the next 3 months, nosocomial MRSA colonization will be eliminated in our hospital.” D) “MRSA will decrease by a minimum of 10%.” 13. A group of nurses has introduced evidence-based practice rounds to their community health clinic. What purpose should be primarily accomplished by these rounds? A) Identifying the nurses' practices that are evidence-based B) Generating and answering practice questions C) Generating evidence to guide practice D) Assessing the nurses' readiness to change

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    Page 4 14. A group of registered nurses who provide care in the operating room (OR) is vehemently opposed to a role for unlicensed care providers in the OR despite the existence of valid and reliable evidence to support such a change. How should the nursing leadership best address this resistance? A) Clearly presenting the benefits of the proposed change B) Allowing unlicensed care providers to present their perceived attributes to the RNs C) Implementing the change and allowing the benefits to become apparent D) Listening to the concerns of the RNs and creating a dialogue 15. The time frame that is necessary to fully implement an evidence-based change in the staffing mix on a postpartum care unit is very long. What strategy should the evidence-based practice mentors implement in order to prevent nurses from becoming fatigued and disenchanted with the change process? A) Issue reminders of the benefits that will result from the change B) Release regular updates on the progress of the change C) Celebrate the accomplishment of smaller goals within the larger project D) Conduct a research study parallel to the change that documents the process

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    Page 5 Answer Key 1. C 2. B 3. A 4. D 5. D 6. B 7. C 8. A 9. B 10. D 11. A 12. B 13. B 14. D 15. C

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    Page 1 1. The leadership of a large, tertiary care hospital is under pressure from various sources to implement both evidence-based practice (EBP) and quality improvement (QI). Which of the following statements most accurately conveys an aspect of these philosophies? A) EBP integrates patient preferences into clinical care decisions. B) QI allows for the expertise of clinicians to be taken into account. C) QI does not account for effects on patients who will be excluded from care. D) EBP is linked to better patient outcomes than QI. 2. Which of the following factors differentiates evidence-based practice (EBP) implementation from clinical research? A) Clinical research has more stringent ethical standards than EBP implementation. B) EBP implementation is often less generalizable than clinical research. C) The implementation of EBP creates new knowledge while clinical research confirms or disputes existing knowledge. D) EBP implementation takes place on a larger scale than clinical research. 3. A leadership team is planning an evidence-based practice (EBP) initiative that will address the policies and protocols around wound care. Which of the following developments in the implementation may be construed as unethical? A) Evidence-based treatments may be a benefit to some patients' healing but exacerbate others. B) The implementation of evidence-based wound care may be impractical from a staffing perspective. C) The clinical practice guidelines that form the basis of the practice change may have been developed at a different site. D) Clinicians may find that existing routines around wound care are difficult to change. 4. Which of the following activities would most likely be categorized as evidence-based practice (EBP) implementation rather than clinical research? A) Testing the effectiveness of new composite dressing in promoting wound healing B) Assessing whether a school-based antismoking initiative reduces smoking rates among teenagers C) Determining the efficacy of an innovative antihypertensive medication in patients who do not respond to standard therapy D) Examining whether the introduction of a clinical practice guideline around falls prevention results in a reduction in falls

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    Page 2 5. Which of the following beliefs underlies many of the ethical debates surrounding evidence-based practice (EBP) implementation? A) It is sometimes claimed that ethics approval for the implementation of others' research should be obtained by the person who originally conducted that research. B) Some believe that the implementation of existing research does not require ethical approval. C) Some nurses state that considering patient preferences and integrating these into practice is an adequate form of ethics approval. D) It is sometimes claimed that EBP is inherently ethical, negating the need for further ethics approval. 6. In preparation for a credentialing process, a county hospital will be conducting an audit. What is the primary focus of this activity? A) Evaluating whether ethical principles are being integrated into bedside care B) Determining caregivers' knowledge base around evidence-based practice (EBP) C) Determining whether patient outcomes at the hospital align with patient expectations D) Evaluating whether current practice is based on the best available evidence 7. Which of the following activities most clearly requires ethical approval? A) Implementation of a new clinical practice guideline B) Recruitment for a case-control study C) Modification of hospital policy and procedures D) Modification of a nurse's practice habits 8. Which of the following factors should be prioritized in the decision of whether to seek ethical approval for a project involving a change in practice? A) The project's classification as either quality improvement (QI) or clinical research B) The stated values and mission statement of the site where it will be implemented C) The question of whether the implementation represents a risk to participants D) The stance of the agency or foundation that is funding the implementation

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    Page 3 9. An evidence-based quality improvement (EBQI) initiative will soon be commenced at a university hospital. Which of the following characteristics of the project cause it to be categorized as EBQI? A) The project is aimed at changing practice to improve outcomes so that they are more evidence based. B) The project is being spearheaded by individuals who possess knowledge and experience in evidence-based practice (EBP). C) The implementation of the project is based on valid research and does not represent a risk to participants. D) The project has dual goals of improving outcomes while producing new knowledge that is generalizable. 10. Which of the following characteristics of a practice change is most closely associated with evidence-based quality improvement (EBQI)? A) The change is implemented by the individuals who provide patient care. B) The funding source for the practice change is an organization external to the clinical site. C) The ultimate goal of the project is to generate new evidence that can be applied universally. D) The individuals who carry out the change are brought in from outside the organization. 11. The nurses at a long-term care facility have recently completed an evidence-based quality improvement (EBQI) project that aimed to improve the outcomes of residents with dementia. Which of the following principles should guide the decision of whether to publish the results of the initiative? A) The results of the project should be submitted for publication if they have produced new knowledge. B) The results should be considered for publication if they are thought to be applicable to other settings. C) Publication should be considered if it was an explicit goal of the project and if participants have granted consent for publication. D) The nurses are obligated to disseminate their results as part of the evidence-based practice (EBP) process.

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    Page 4 12. The nursing leaders at a county hospital are aware of the need for rigor during the implementation of an EBQI project that will address emergency department triage. How should the leaders apply rigor to this project? A) By ensuring that instruments for measuring effectiveness have face and content validity B) By justifying their choice of methodology in terms of the clinical question and the characteristics of the site C) By seeking ethical approval and patient consent prior to beginning the project D) By ensuring that resources will not be wasted and patients will not be placed at risk 13. An evidence-based quality improvement (EBQI) project has been proposed that will increase the number of school-aged children who receive an annual influenza vaccination. The project will be implemented in an affluent suburban community despite the fact that vaccination rates are much lower in poorer neighborhoods. The implementation of this project may be in violation of which of the following ethical principles? A) Respect for potential and enrolled subjects B) Social or scientific value C) Scientific validity D) Fair subject selection 14. Members of the nursing leadership at a hospital disagree about the need for informed consent from patients who are participating in an evidence-based quality improvement (EBQI) project. Which of the following principles should guide the team's decision of whether to seek informed consent from patients? A) The decision should be deferred to the ethical review board of the hospital. B) EBQI is a part of normal clinical care and likely does not require written consent. C) Proceeding with EBQI without informed consent violates patient autonomy. D) Participation in clinical research is a tacit understanding of seeking hospital care. 15. A group of nurses is taking measures to ensure that an evidence-based quality improvement (EBQI) initiative is conducted ethically. Which of the following actions most clearly demonstrates appropriate selection of subjects? A) Distributing risks and benefits fairly B) Maximizing the number of participants in the sample C) Randomly assigning patients to receive or not receive the changed practice D) Sampling selectively to ensure equivalence between groups

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    Page 5 Answer Key 1. A 2. B 3. A 4. D 5. B 6. D 7. B 8. C 9. A 10. A 11. B 12. D 13. D 14. B 15. A

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    Page 1 1. Which of the following components of a clinical question represents the “P” in the PICOT format for asking clinical questions? A) The nurse's preparation for patient teaching prior to surgery B) Early ambulation versus aggressive anticoagulant therapy C) Individuals who require peritoneal dialysis D) Deep vein thrombosis 2. An unacceptably high number of patients on a geriatric, subacute medicine unit have developed pressure ulcers during their period of care. The nurses on the unit have agreed on a goal of reducing the incidence of these wounds by 50% over the next 10 weeks. This goal represents which component of the PICOT format for asking clinical questions? A) O B) P C) I D) C 3. Which of the following scenarios represents the most common obstacle that nurses encounter when attempting to gain the knowledge necessary for EBP? A) A nurse identifies several articles relevant to a clinical question, but the methodology of each is significantly flawed. B) A nurse is overwhelmed by the number of hits during a CINAHL search. C) Current research that relates to the nurse's clinical question does not exist. D) The research that the nurse locates is rooted in a medical, not nursing, perspective. 4. A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem? A) Narrow the scope of the clinical question B) Restrict the information search to publications from the past 24 months C) Seek recommendations for information sources from trusted colleagues D) Limit the search to articles that relate the findings of randomized control trials (RCTs)

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    Page 2 5. A pediatric nurse provides care for many children who present to the emergency department (ED) with signs and symptoms of asthma. Which of the following questions is a background question that the nurse can utilize in the process of providing EBP? A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers (MDIs)? B) What patient populations respond best to nebulized bronchodilators? C) How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm? D) Are nebulizers provided to patients in the ED more often than metered-dose inhalers? 6. Which of the following statements is true of foreground questions? A) They focus on issues that can be addressed by applying scientific evidence. B) They have a broad, rather than narrow, scope. C) They can be answered by examining electronic information sources instead of print sources. D) They are rooted in the current practices of a nurse's clinical setting. 7. An oncology nurse is engaged in increasing the quality of EBP that is provided on the cancer unit of the local hospital. Which of the following questions would the nurse consider to be an adequate and useful foreground question? A) “Are benzodiazepines and analgesics provided before patients have a bone marrow biopsy?” B) “What is the clinical rationale for using bone marrow biopsy to gauge and predict the course of a patient's cancer?” C) “Does guided imagery reduce the anxiety of patients who undergo bone marrow biopsy?” D) “How often is bone marrow biopsy performed on the unit?” 8. Which of the following clinical questions would be most justified in lacking a comparison? A) An examination of the antipyretic qualities of cool bed-bathing B) A study on the perceived meaning of hope among palliative patients C) A study on the influence of prenatal care on preventing perineal tearing during delivery D) An examination of the effect of rehydration using lactated Ringer's on patients' energy levels

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    Page 3 9. Which of the following clinical questions would be considered to be a “meaning” question? A) “What factors underlie parents' decisions to refuse immunizations for their children aged 3 months to 24 months?” B) “What factors, apart from asbestos exposure, may contribute to ex-miners' diagnoses of mesothelioma?” C) “How do pregnant women with high-risk pregnancies who have been prescribed bed-rest perceive their situations?” D) “Are cigarette warning labels an effective deterrent to cigarette smoking among females aged 11 to 15 years?” 10. Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question? A) The patient population should be as narrow a range as possible. B) The population in the clinical question should closely match the demographics of the nurse's geographic region. C) A specific and defensible rationale should exist for the choice of patient population. D) The patient population in the clinical question should mirror the populations in prominent studies related to the issue. 11. In the context of the PICOT format for formulating clinical questions, which of the following may be considered to be an intervention? A) Levels of patient hygiene in an assisted-living facility B) The incidence and prevalence of stomach cancer among low-income males aged 65 to 85 C) The prevalence of wound dehiscence among postmastectomy patients D) Occupational exposure to airborne silicon dust 12. Which of the following symptoms could be best clustered into a single outcome for the purposes of crafting a concise clinical question? A) Increased anxiety, increased serum cholesterol, and low rating of overall well-being B) Hypotension, tachycardia, and decreased level of consciousness C) Increased temperature, decreased mobility, and confusion D) Increased neonatal bilirubin levels and the mother's choice to feed with formula rather than breastfeed

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    Page 4 13. Which of the following clinical questions can be best addressed by a meta-synthesis of qualitative studies? A) “What is the meaning of spiritual support in hospice patients who are younger than 50?” B) “What is the effectiveness of physical activity compared with beta-blockers in reducing the blood pressure of adult, African-American men?” C) “Is the use of a stroke team in the emergency department, rather than standard assessment and treatment, associated with improved outcomes among patients diagnosed with stroke?” D) “Are single-occupancy hospital rooms, rather than shared rooms, associated with increased patient satisfaction reports?” 14. Which of the following principles can help a nurse rank levels of evidence when answering clinical questions of all types and scopes? A) Quantitative research supersedes qualitative research. B) Randomized control trials must be included when answering clinical questions. C) Sources of evidence must be peer-reviewed. D) Syntheses are the highest level of evidence. 15. Which of the following groups would most likely be considered a self-selected cohort? A) Obese, Hispanic females B) Cigarette smokers C) Patients with hypertension who take diuretics D) Teenage females

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    Page 5 Answer Key 1. C 2. A 3. B 4. A 5. D 6. A 7. C 8. B 9. C 10. C 11. D 12. B 13. A 14. D 15. B

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    Page 1 1. A qualitative research study would be considered to be level one evidence in a nurse's attempt to answer which of the following clinical questions? A) “What is the meaning of hope among patients undergoing treatment with burn injuries?” B) “What factors contribute to diabetic patients' decisions to infrequently monitor their blood glucose levels?” C) “How does an exercise program compared with dietary control affect weight loss in obese patients?” D) “How does partial assistance with feeding compared with total assistance affect the nutritional outcomes of stroke patients younger than 70?” 2. A nurse has recognized a need to understand the ways in which women with fibromyalgia adjust their lifestyles to accommodate the effects of their diagnosis. Which of the following domains of research is most likely to provide evidence for the nurse? A) Randomized controlled trials B) Qualitative studies C) Case control studies D) Cohort studies 3. A nurse is searching for evidence in an effort to answer a series of clinical questions related to childhood asthma. In which of the following areas is qualitative research likely to be most valuable? A) Identifying if nebulized delivery of bronchodilators is superior to the use of metered-dose inhalers B) Identifying which environmental exposures are most closely linked to the incidence of bronchospasm C) Identifying how a family's accessibility to primary care affects the course of a child's asthma D) Identifying values that determine children's choices of where and when to use their metered-dose inhalers 4. A nurse is seeking to understand the processes of adjustment and coping that parents go through in the year after giving birth to a child with a neural tube defect. Which of the following qualitative traditions is most likely to inform the nurse? A) Ethnography B) Phenomenology C) Grounded theory D) Hermeneutics

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    Page 2 5. A nurse researcher is conducting a phenomenological study among men who have been diagnosed with prostate cancer. Which of the following focuses is most indicative of the nurse's chosen methodology? A) Identifying what support programs best meet men's emotional needs following diagnosis B) Identifying the role that culture plays in men's sense-making of their diagnoses C) Identifying the process that men go through as they suspect, receive, and then live with their diagnoses D) Identifying and examining the meanings of the lived experiences that the men associate with their diagnoses 6. In the course of gathering and analyzing data for a qualitative study that examines the effect that a child's chronic illness has on his or her siblings, a nurse has produced fieldnotes. What is the purpose of the nurse's fieldnotes? A) Making a record of the nurse's observations and interactions that occur during data gathering B) Producing a written record through which other researchers may follow the research process C) Recording the analytic conclusions of the data D) Relating the changes in the phenomenon that occur over time 7. While conducting a qualitative research study on patients' responses to having a colostomy, the nurse is at the stage of doing content analysis. What activities characterize this component of the qualitative research process? A) Identifying practical applications of the research findings B) Reflecting on the nurse's own response to the informants' experiences C) Breaking down data and reconstituting them in some other form D) Gathering data from participants in the form of interviews and focus groups 8. A nurse is writing a research proposal for a grounded theory study that will address the experiences and transitions of women in the months following spontaneous abortion. Which of the following guidelines should the nurse follow when choosing a sampling strategy? A) Random sampling should be the nurse's goal with participant self-selection if this is not practicable. B) The nurse should identify a minimum of 10 informants or 15 informants if purposeful sampling is utilized. C) The nurse should have a sample small enough to allow depth of inquiry but large enough to include a variety of voices. D) The nurse should seek as large a sample as possible in order to facilitate thick description and the validity of findings.

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    Page 3 9. Which of the following facts about a qualitative study addresses the meanings of a support group for adults with type 1 diabetes that may present a potential flaw? A) The researcher provides original insights into the etiology of diabetes. B) The researcher has type 1 diabetes. C) The researcher was an open attendee of the support group meetings. D) The researcher did not do random sampling. 10. A researcher has developed and administered a survey that addresses patients' reactions and responses to being diagnosed with nosocomial (hospital-acquired) infections while inpatients. The researcher has subsequently completed and submitted a manuscript that proposes a theory around the patients' perceptions of infection control in the hospital setting. The researcher's actions most clearly represent a potential deficit in which of the following criteria? A) Veracity B) Individuality C) Transferability D) Credibility 11. A careful reading of a qualitative research study has revealed a potential lack of confirmability. Which of the following observations may have led the reader to this conclusion? A) The findings appear to be true only among the specific participants in the study. B) The links between the findings and the data are not evident. C) The sample consisted of only 8 participants. D) The researcher makes no mention of producing fieldnotes. 12. The findings of a widely-disseminated qualitative study that addresses the meaning of smoking to teenage cigarette smokers has resulted in significant changes to many of the antismoking strategies undertaken by school nurses. The study has most clearly demonstrated which of the following qualities? A) Ontological authenticity B) Credibility C) Catalytic authenticity D) Confirmability

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    Page 4 13. An oncology nurse has been exposed to numerous qualitative studies addressing the experience and meaning of cancer diagnosis and is now preparing to conduct a metasynthesis of the subject. Which of the following principles should the nurse include in the methodology of this new study? A) Reanalyzing the raw data from the studies selected for inclusion B) Performing a thematic analysis of the themes and category titles of the chosen studies C) Forming a liaison with the authors of the original studies D) Performing statistical analysis of the combined findings of the chosen studies 14. Though rooted in the voices of the 16 men who were interviewed for the study, the findings of a qualitative study into the health practices of male prison inmates is thought to be true for many members of the larger prison population. This fact about the study most clearly demonstrates A) Transferability B) Confirmability C) Dependability D) Credibility 15. Use of which of the following data-gathering techniques is most likely to represent a potential flaw in the design of a qualitative study? A) Participant observation B) Unstructured interviews C) Focus groups D) Online surveys

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    Page 5 Answer Key 1. A 2. B 3. D 4. C 5. D 6. A 7. C 8. C 9. A 10. D 11. B 12. C 13. C 14. A 15. D

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    Page 1 1. Which of the following activities most clearly indicates that a nurse is engaging in self-improving practice? A) The nurse reflects on practice in an effort to identify potential mistakes. B) The nurse seeks input from more experienced colleagues. C) The nurse attempts to get to know patients on a personal level. D) The nurse has participated in a research study being conducted on the hospital unit. 2. A nurse has recently marked 10 years of practice on a medical unit. Which of the following aspects of “experience” is most likely to result in improved practice on the part of a nurse? A) Increased years of practice in a consistent clinical environment B) Exposure to more patient interactions and conduction of more interventions C) Examination of interactions and events in the clinical context D) Engagement with a greater variety of patients and patient populations 3. Which of the following aspects of care on a postsurgical unit is the clearest example of phronesis? A) “The patient will dangle at the bedside q4h on postoperative day 1.” B) “The patient will demonstrate independent ambulation prior to discharge.” C) “The patient will perform leg exercises and deep breathing and coughing exercises twice on the day of surgery.” D) “The patient will transition from dangling to assisted standing for the first time following surgery with the assistance of the physical therapist.” 4. Which of the following activities by the nurse most directly fosters phronesis in the care of geriatric patients in a long-term care setting? A) The nurse consistently seeks out and attends continuing education offerings. B) The nurse stays abreast of current research in geriatric nursing. C) The nurse has organized a pilot study on falls prevention in the care facility. D) The nurse makes an effort to get know residents' individual needs, concerns, and goals. 5. How should a nurse best understand the concept of clinical expertise? A) Clinical expertise is even more valuable than research evidence. B) Clinical expertise is enhanced by holistically knowing patients as individuals. C) Clinical expertise is demonstrated by the formalized knowledge of nursing practice. D) Clinical expertise is central to good nursing practice, superseded only by the importance of published articles.

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    Page 2 6. A nurse is providing care for a 3-year-old girl who has been admitted to the pediatric intensive care unit with a suspected brain injury following a choking episode. Which of the following aspects of the nurse's care best demonstrates clinical expertise? A) The nurse has previously cared for a patient in similar circumstances. B) The nurse has a sound and current knowledge base around respiratory and neurological pathophysiology. C) The nurse recognizes that there are numerous patient and family variables at play. D) The nurse demonstrates empathy when caring for the patient. 7. A qualitative study addresses the cues that nurses perceive when they sense a patient's condition is worsening. The study data are based on narratives from several nurses who provide care in high acuity settings. Narratives are most likely to make which of the following contributions to the study? A) Insights into the nuances of nurses' understandings of complex situations B) Indications of the depth of participants' knowledge bases C) Insights into the nurses' abilities to implement evidence-based practice D) Indications of the depth of clinical expertise that exists among the sample 8. Which of the following clinical questions is most likely to be informed by the use of nurses' narratives? A) How do 8-hour nursing shifts compare with 12-hour shifts to affect patient safety in an emergency department setting? B) What meaning do nurses assign to conflicts they have with patients and the families of patients? C) What factors contribute to nurses' decisions to administer as-needed analgesia? D) How does a mentorship program compare with traditional orientation of new staff in affecting retention among new nursing graduates? 9. Which of the following statements provides the clearest rationale for the use of narratives in understanding nursing knowledge and clinical expertise? A) The acuity of patients on admission to a hospital is higher than in previous decades and continues to increase. B) The ability of nurses to provide adequate care with ever-increasing patient loads is poorly understood. C) As life expectancy increases, more patients are living with chronic conditions whose symptoms often overlap. D) The trajectory of illness and the human experience of it can be complex and highly individualized.

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    Page 3 10. Nurse L provides care on a busy medical unit of an inner-city hospital. Which of the nurse's actions best exemplifies clinical grasp? A) Nurse L is committed to reading and integrating the most recent, published evidence. B) Nurse L is able to identify subtle changes in patient condition that are often not obvious to other clinicians. C) Nurse L has responded appropriately to patients in cardiac or respiratory arrest. D) Nurse L makes a concerted effort to get to know patients' families. 11. A nurse paged the attending physician because a postmastectomy patient became somewhat agitated and tachypneic in recent hours. Despite other nurses' assertions that the patient was simply experiencing some anxiety, the nurse suspected a more serious etiology. The physician prescribed a single dose of a benzodiazepine, which was largely ineffective. Due to the nurse's persistence, diagnostics were performed, leading to a diagnosis of pulmonary embolism. Which of the following did the nurse exhibit? A) Evidence-based practice B) Clinical grasp C) Patient-centered care D) Best practice 12. Nurse M makes a conscious effort to think beyond the rigidly-defined signs and symptoms of illnesses and recognizes that context has a highly significant impact on illness situations. This thinking facilitates which of the following? A) Engaging in detective work B) Phronesis C) Making qualitative distinctions D) Techne 13. A nurse who provides care on a geriatric subacute medicine unit is aware that elderly patients often exhibit signs and symptoms of infection that are very different from those of younger patients. This knowledge is an example of A) recognizing changing clinical relevance. B) engaging in detective work. C) making qualitative distinctions. D) developing clinical knowledge about specific patient populations.

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    Page 4 14. While helping a colleague reposition a patient who is in moderate respiratory distress, the nurse has a sense that it would be appropriate to ensure the bag-valve mask (Ambu bag) is readily accessible and to confirm the patient's code status. Which of the following qualities does this exemplify? A) Engaging in detective work B) Evidence-based practice C) Future think D) Phronesis 15. Knowing that the patient was admitted with a diagnosis of sepsis, the nurse has limited the most recent bedside assessment to an oral temperature followed by a review of the patient's white cell count. This limited-scope assessment will most directly affect the nurse's ability to A) engage in experiential learning. B) see the unexpected. C) individualize care. D) provide empathy.

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    Page 5 Answer Key 1. A 2. C 3. B 4. D 5. B 6. C 7. A 8. B 9. D 10. B 11. B 12. C 13. D 14. C 15. B

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