EBP exam 1

How can a nurse manager best support staff nurses in their enthusiasm for evidence-based change?

Listen to the nurse, inquire about their EBP knowledge, and connect them with a resource on the unit.

Please rank the following strength-of-evidence levels from strongest study results to weakest study results.

1)Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) 2)Evidence obtained from well-designed controlled trials without randomization 3)Evidence from systematic reviews of descriptive and qualitative studies 4)Evidence from the opinion of authorities and/or reports of expert committees

Please rank the following study types from highest (Level 1) to lowest (Level 7) in the evidence pyramid.

1)Randomized controlled trial 2)Cohort study 3)Qualitative study 4)Clinical practice guideline

¢Which signs/symptoms are indicators of an asthma attack? Select all that apply. 1. Audible wheeze, especially on exhalation 2. Muscle retraction between the ribs 3. Decreased forced expiratory volume in the first second (FEV1) on flowmeter 4. Eosinophils in the sputum 5. Increased, then decreased arterial carbon dioxide (PaCO2) level

1, 2, 3, 4

The nurse has assisted a health care provider (HCP) with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water-seal chamber after the tube is inserted. Based on this assessment, which action is most appropriate? 1. Inform the HCP. 2. Continue to monitor the client. 3. Reinforce the occlusive dressing. 4. Encourage the client to deep breathe.

2

Level 7

Lowest level of evidence Option or reports of experts Guidelines, background information, textbooks

Which statements are correct regarding the drug management of asthma? Select all that apply. 1. Long-acting beta agonists are indicated to relieve acute attack symptoms. 2. Control therapy medications are used to prevent asthma attacks from occurring. 3. Control therapy medications are used to reduce airway responsiveness. 4. Reliever medications are used to stop an asthma attack once it has started. 5. Anti-inflammatory medications are used to cause bronchodilation.

2, 3, 4

A nurse is caring for a client with a chest tube drainage system. While the client is being assisted to sit up in bed in preparation for ambulation, the chest drainage system accidentally disconnects. Which is the initial nursing action? 1. Call a respiratory therapist. 2. Contact the health care provider (HCP). 3. Encourage the client to perform the Valsalva maneuver. 4. Place the end of the chest tube in a container of sterile water.

4

The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? 1. Exhale slowly. 2. Stay very still. 3. Inhale and exhale quickly. 4. Perform the Valsalva maneuver.

4

What is a facilitator to the implementation of EBP? Poor attitudes toward EBP Adequate access to resources Resistance to change Lack of time and money

Adequate access to resources

Why are background questions useful before formulating a PICOT question? Select all that apply.

Background questions are broad and help lead to a PICOT question. Background questions serve as the foundation for asking a PICOT question.

Which healthcare role is best trained to have the most expertise in the steps of EBP?

Clinical Nurse Specialist

An adult presenting with a high fever, dizziness and aching joints who has been on an Appalachian trek for a month asks whether Lyme disease is a possible cause of the symptoms they are now experiencing. The provider wonders if running an enzyme immunoassay would get the patient back on the trail sooner than running an immunofluorescence assay. Which question template would the provider use?

Diagnosis/diagnostic test PICOT template

Which statements are true about evidence-based practice (EBP)? Select all that apply.

EBP allows clinicians to translate evidence into clinical decision-making., EBP is the integration of best available evidence with clinical expertise and client preferences.

Level 6

Evidence from descriptive or qualitative studies Descriptive, grounded theory, historical, philosophical inquiry, ethnography

Level 1

Evidence from systematic review or meta-analysis of well-designed randomized controlled trials

Level 5

Evidence from systematic review or meta-synthesis of descriptive and qualitative studies

Level 2

Evidence from well designed RCT

Level 4

Evidence from well designed case control and cohort studies Correlational, experimental, pre and post test, descriptive, methodological and quasi-experimental

Level 3

Evidence from well designed controlled trials without randomization

Health care organizations can best show support for evidence-based practice by hiring external consultants to perform research and informing nurses within the organization about changes that will be made based on evidence.

False

If there isn't a systematic review in the literature I've identified,

I'll try and locate a guideline that answers my clinical question., I'll need to read the studies from other levels of evidence I've found.

How many types of templates are there to handle clinical questions?

Five

What is the next step a nurse would take to move forward an EBP initiative after attending a professional conference and speaking with key stakeholders?

Formulate a PICOT question

A charge nurse and team of nurses lack the motivation required to implement EBP. Which solution may help address this barrier?

Gain authorization to offer continuing education credits for attending training workshops and include staff use of EBP in the annual evaluation.

To facilitate EBP in a hospital setting, which activity would provide recognition for staff who recently completed EBP projects as part of a nurse residency program?

Hold a poster presentation session in the lobby featuring staff's EBP projects.

5After returning from a conference with an example of best evidence that is not current practice in one's organization, what is the first step toward making a change in that organization?

Meeting with a manager and continuing to read the literature.

Which is higher meta analysis or systematic review?

Meta-analysis

Which statements are potential barriers for evidence-based practice? Select all that apply

Nurses do not understand research., Nurses do not have the skills to access research evidence., Nurses do not value research.

Why is it important to generate a good PICOT question? Select all that apply.

PICOT questions avoid directing the search for evidence in one direction. Well-formulated PICOT questions ensure the clinical issue is well defined. Good PICOT questions will ensure the search is likely to be successful.

Which studies use a control group? Select all that apply.

Randomized controlled trials Controlled trials

Levels of evidence are used for which reasons? Select all that apply.

Ranking secondary sources of evidence Ranking primary sources of evidence Ranking expert opinion Ranking websites

What types of clinical issues might guide a prognosis question? Select all that apply.

Patient choice concerning therapy, Future outcomes regarding therapy

Which process produces results that are valid only in the setting in which it took place?

Quality improvement

Which statements are true about research? Select all that apply.

Research can be considered to be external evidence., Research creates new knowledge or validates existing knowledge., Research is a systematic investigation that uses scientific methods to answer clinical questions

A nursing team doesn't have enough funding to properly implement evidence-based practice (EBP). What would be an appropriate way to address this barrier?

Seek out funding sources through local organizations and specialty organizations.

Levels of evidence are important for which reasons? Select all that apply.

They act as a hierarchy to prioritize which studies to read first when looking at a body of evidence They help to rank the potential amount of bias of individual studies They offer a way for clinicians to recognize the soundness of an individual study's design

Why are journal clubs especially practical as facilitators of EBP?

They are participatory, actively involving all levels of staff in discussion.

Consider the following clinical scenario: Are fair-skinned children who have prolonged unprotected UV exposure compared to darker-skinned children without prolonged unprotected UV exposure at increased risk of melanoma? Which question template would you use?

This clinical scenario would use an etiology template, as this template addresses potential causality and harm.

What is the best reason for attending a professional conference in order to advance evidence-based practice (EBP)?

To network and share

All of the following statements represent nursing activities used in promoting evidence-based practice: participate in interdisciplinary evidence-based projects; join a journal club; and attend professional conferences.

True