Chapter 01: Using Evidence in Nursing Practice
Perry et al.: Nursing Interventions & Clinical Skills, 6th Edition

MULTIPLE CHOICE

	1.	A nursing educator is explaining how the best clinical practices are determined. Which statement best explains the purpose of evidence-based practice?
a.	It ensures that all patients receive holistic care.	
b.	It provides a definite reason for providing care in a specific manner.	
c.	It prevents errors when care is being delivered.	
d.	It guarantees that care delivered is based on research.	

ANS:	B
Evidence-based practice is the use of the current best evidence in making patient care decisions. It applies to all types of health care professionals. Currently there is no method that can ensure that all patients receive holistic care, that all errors can be prevented, or that a guarantee exists that care given is based on research.

DIF:	Cognitive Level: Remember	REF:	Page 1	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	2.	Which question is a problem-focused trigger?
a.	What is known about reduction of urinary tract infections in the older adult with diabetes?	
b.	How can chronic pain best be described when the patient is nonverbal?	
c.	How long can an intravenous catheter remain in place in an obese patient?	
d.	What measures can the nurse take to reduce the rising incidence of urinary tract infections on the elder care unit?	

ANS:	D
A problem-focused trigger is a question faced when caring for a patient or a trend seen in a practice setting. In this example there is a problem (urinary tract infections) and a trend (on the elder care unit). The other questions are general information questions, not based on what is happening in a specific area or to a group of specific patients in an area or relating to an observed trend.

DIF:	Cognitive Level: Apply	REF:	Page 3	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	3.	What does the “I” indicate in a “PICO” question?
a.	Intervention of interest	
b.	Incorporation of concepts	
c.	Implementation by nursing	
d.	Interest of personnel	

ANS:	A
The “I” stands for intervention of interest, meaning what the nurse hopes to use in practice and believes is worthwhile or valuable. This could be a treatment for a specific type of wound or an approach on how to teach food preparation for a patient with impaired sight.

DIF:	Cognitive Level: Remember	REF:	Page 4, Box 1-2	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	4.	The nurse is conducting clinical research and needs to obtain relevant databases. Whom should the nurse contact?
a.	The physician whose patients may be involved in the study	
b.	The medical librarian	
c.	The nurse manager of the unit where the study will be conducted	
d.	The director of nursing of the facility	

ANS:	B
The medical librarian is most knowledgeable regarding databases relevant to a study. The other individuals will know about the study but do not have the knowledge regarding relevant databases.

DIF:	Cognitive Level: Remember	REF:	Page 4	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	5.	Which database contains clinical guidelines systematically developed for a specific set of circumstances involving a specific patient population?
a.	MEDLINE	
b.	CINAHL	
c.	Cochrane Data of Systematic Reviews	
d.	The National Guideline Clearinghouse	

ANS:	D
The National Guideline Clearinghouse is a database supported by the Agency for Healthcare Research and Quality. It contains clinical guidelines systematically developed about a plan of care for a specific set of clinical circumstances involving a specific patient population. The others are not as specific and have broader application and references.

DIF:	Cognitive Level: Remember	REF:	Page 5	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	6.	The nurse researcher is trying to determine the strongest type of research. Which type of research would the nurse choose?
a.	Randomized controlled trials	
b.	A qualitative study	
c.	A descriptive study	
d.	A case-controlled study	

ANS:	A
Individual randomized controlled trials are close to the top of the research pyramid. Only systematic reviews and meta-analyses are higher. This type of study tests an intervention against the usual standard of care. The other types of studies are useful but do not give the same type of information as a randomized controlled trial provides.

DIF:	Cognitive Level: Remember	REF:	Page 5-6	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	7.	What is the nurse attempting to determine when critiquing the evidence?
a.	If the potential study is ethical to conduct	
b.	If there is enough evidence to ask a PICO question and change practice	
c.	If there are any experts in the clinical area to be researched	
d.	If the study is cost-effective if a change in practice occurs	

ANS:	B
Once a literature search is complete and data are gathered about the question, it is time to critique the evidence. The critique tells the nurse if there is enough evidence to answer the PICO question and change practice. The other questions are important to consider when doing the study but are not applicable to critiquing the evidence.

DIF:	Cognitive Level: Understand	REF:	Page 7	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	8.	Why is piloting a practice change after conducting a study the best approach to change?
a.	It ensures that all of the patients involved will benefit from the change.	
b.	It helps identify any issues with implementation on a limited basis.	
c.	It facilitates communication among all of the participants.	
d.	It provides better acceptance by personnel reluctant to change.	

ANS:	B
Piloting a practice change involves implementing the change for a small group of patients over a limited period of time. This allows identification of issues with the implementation of the practice change(s) to determine if the change(s) result in beneficial patient outcomes. If the pilot is successful, it is easier to make the changes on a larger scale because the issues have been identified. It does not ensure that all patients involved will benefit, nor does it facilitate communication among participants. Difficulty making and accepting change may be experienced by some staff members, no matter how successful the pilot is.

DIF:	Cognitive Level: Understand	REF:	Page 8	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	9.	A study is being conducted comparing a group of normal-weight postmenopausal women not receiving any hormone treatment with a group of obese postmenopausal women not receiving any hormone treatment to determine the incidence of changes in bone density of the lower spine (L4 and below). Which type of study would this be?
a.	Qualitative	
b.	Case-controlled	
c.	Descriptive	
d.	Quality improvement	

ANS:	B
A case-controlled study examines one group of subjects with a certain condition at the same time as another group of subjects who do not have the condition to determine if there is an association between the condition and predictor variables. A qualitative study examines individuals’ experiences with health problems and the contexts in which the experiences occur (e.g., a group of poststroke patients and how the attitude of the therapist affected their recovery). A descriptive study looks at specific concepts such as health care workers’ perceptions of infection control practices. Quality improvement is not a study but a collection of data reflecting trends and information about clinical conditions and problems.

DIF:	Cognitive Level: Analyze	REF:	Page 6	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Evaluation

	10.	Which question would be the best example of a knowledge-focused trigger?
a.	What is the best method for treatment of leg swelling when a patient is taking gabapentin (Neurontin)?	
b.	How can we decrease the incidence of skin cancer in adults over the age of 65?	
c.	What is the current evidence for improving oral intake for cancer patients with stomatitis?	
d.	What is the maximum length of time our hospital allows irrigation kits to be used?	

ANS:	C
A knowledge-focused trigger is a question regarding new information about a topic. It does not have to be concerned with what is happening on a specific unit or with a specific group of people. The other questions are examples of problem-focused triggers in which a patient problem exists and an approach needs to be found for improving or eliminating the problem.

DIF:	Cognitive Level: Analyze	REF:	Page 3	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	11.	In which database would biomedical and pharmaceutical studies be found?
a.	EMBASE	
b.	PsycINFO	
c.	MEDLINE	
d.	CINAHL	

ANS:	A
EMBASE contains biomedical and pharmaceutical studies. PsycINFO contains psychology and related health care disciplines. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. CINAHL includes studies in nursing, allied health, and biomedicine.

DIF:	Cognitive Level: Remember	REF:	Page 5	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

MULTIPLE RESPONSE

	1.	When collecting the best evidence, what should the nurse use as external evidence? (Select all that apply.)
a.	Scientific literature	
b.	Agency policy and procedure manuals	
c.	Clinical practice guidelines	
d.	National guidelines	
e.	National benchmarks	
f.	Quality improvement data	

ANS:	A, D, E
Scientific literature such as computerized bibliographical databases, national guidelines, and national benchmarks provide external evidence. The other sources listed provide internal evidence.

DIF:	Cognitive Level: Analyze	REF:	Page 4	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

	2.	The nurse is conducting research on decreasing the incidence of pressure areas. Which parts of an evidence-based article would give the nurse enough information to determine if the article would be of help in the research? (Select all that apply.)
a.	Design of the study	
b.	Narrative	
c.	Abstract	
d.	Literature review	
e.	Results	
f.	Introduction	

ANS:	C, F
The abstract and the introduction together provide enough information to help the nurse know if the article will provide useful information for the PICO question being asked. The method or design of the study explains how the research study is organized. The narrative includes the purpose statement, methods or design, results or conclusions, and clinical implications. The literature review helps the researcher examine past research on the same topic. The results are embedded in the narrative and summarize the findings.

DIF:	Cognitive Level: Analyze	REF:	Page 7	
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation

MATCHING

Health care providers often confuse evidence-based practices, research, and performance or quality improvement activities. They each contribute to the improvement of patient care in different ways. Match the description below with the type of activity it most closely represents.
a.	The nurse implements a set of guidelines to reduce falls after an extensive review of the literature.	
b.	The nurse investigates a new falls reduction strategy and measures its ability to reduce falls.	
c.	The nurse implements a process in her unit to ensure all patients receive a falls risk evaluation upon admission.	

	1.	Performance improvement

	2.	Evidence-based practice

	3.	Research

	1.	ANS:	C	DIF:	Cognitive Level: Apply	REF:	Page 3
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation
MSC:	Performance improvement works to improve systems or processes so as to improve outcomes within a work unit or health care setting.

	2.	ANS:	A	DIF:	Cognitive Level: Apply	REF:	Page 3
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation
MSC:	Evidence-based practice applies existing evidence to change a practice (clinical, educational or managerial). It starts with a rigorous review and critique of the literature regarding current evidence-based practices.	

	3.	ANS:	B	DIF:	Cognitive Level: Apply	REF:	Page 3
OBJ:	NCLEX: Safe and Effective Care	TOP:	Nursing Process: Implementation
MSC:	Research involves generating new scientific knowledge that is generalizable to other patient populations or health care settings.