Exam 4 PQ (Chpt 7, 14, 20)

1. Funding has been secured to test the efficacy of a new antidepressant. Participants who have been diagnosed withdepression have been recruited and randomly assigned to experimental and control groups. Members of bothgroups have had the severity of their depression gauged by a reliable and valid instrument. Over the next severalweeks, the experimental group has been administered the new drug while the control group received standardtreatment. At the completion of the study, the same instrument was used to measure depressive symptoms. Whichof the following study designs has the research team utilized? A) Two-group RCT with pretest/posttest B) Two-group RCT with true control group C) Two-group RCT with long-term repeated measures D) Two-group RCT with posttest design only

A

1. Nurses have written a proposal for a quasi-experimental study that tests the effect of web-based teaching on nursingstudents' psychomotor skills. Which of the following is a characteristic of quasi-experimental design? A) Participants are assigned to groups by a method other than random assignment. B) The design includes a posttest but does not apply a pretest. C) The results of the study provide description but do not identify association. D) The effects of an intervention are identified by examining characteristics of participants' histories.

A

A nurse who is utilizing the Stetler model for the implementation of evidence-based practice would recognize thatthe model provides a method for conducting which of the following processes? A) Critical thinking B) Evaluation of individual research studies C) Dissemination of findings D) Interpreting clinical experiences

A

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. Narrativesare 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

A

Pediatric nurses are using the Johns Hopkins Nursing Evidence-Based Practice model to integrate more evidenceinto their child abuse screening protocol. Which of the following information sources would the nurses consider asan external factor of influence? A) Legislation that addresses child abuse B) The staffing levels that are typical on the unit C) Supplies and equipment that child abuse screening may require D) Research that addresses the clinical question

A

The Advancing Research and Clinical practice through close Collaboration (ARCC) model is beingimplemented as a hospital system seeks to improve the care of patients' skeletal pin sites. Which of thefollowing groups will play the primary role in guiding the implementation of the ARCC model? A) Evidence-based practice mentors B) Academic experts in nursing and change theory C) Staff nurses D) Nursing leadership and administration

A

The Promoting Action on Research Implementation in Health Services (PARIHS) framework is beingimplemented in an effort to identify an evidence base for nurses' pain management practices. The appointedfacilitator will primarily perform which of the following roles? A) Making the implementation of evidence easier for nurses B) Identifying research that is relevant to the clinical question C) Ensuring that the change process follows ethical guidelines D) Evaluating and disseminating the results of the change in practice

A

The nursing leadership of a university hospital wishes to implement evidence-based practice around theprevention of Clostridium difficile infection among inpatients. The team will be following the Model forEvidence-Based Practice Change. Which of the team's activities is beyond the scope of the model? A) Dissemination of the success or failure of the practice change B) Engaging stakeholders in the early stages of the practice change C) Conducting a literature review D) Implementing a pilot study

A

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.

A

1. A nurse wishes to identify the possible effect of an innovative mattress on the incidence of pressure ulcers amongthe hospitalized elderly and is planning to conduct a true experiment. Which of the following is most important tothe integrity of this study design? A) A sufficiently large number of independent variables B) Random assignment of study participants to groups C) A correlation between the variable and the outcome D) A sufficiently large number of participants

B

1. A nurse's doctoral dissertation addresses the effect that a support program may have on patients with pulmonaryhypertension. Given that pulmonary hypertension has a very low incidence and prevalence, which of thefollowing sampling strategies is applicable to the nurse's research needs? A) Heterogeneity sampling B) Snowball sampling C) Modal instance sampling D) Stratified sampling

B

1. A researcher wishes to test the effect that a specific childhood nutritional supplement will have on participants'incidence of dementia later in life. Which of the following aspects of the study question is likely lacking? A) Relevance B) Feasibility C) Ethics D) Interest

B

1. In retrospect, a team of nurse researchers believes that they had too few participants in a true experiment that testedthe effectiveness of a new type of ostomy appliance in preventing stomal leakage. Which of the following may bea consequence of a sample that is too small? A) The researchers may have concluded that the appliance is an improvement on existing types when, infact, it is not. B) The team could have underestimated the effectiveness of the new device. C) The nurses may have committed a type one error. D) The construct validity of the study may be lacking.

B

A chart audit suggests the need for evidence-based practice in an effort to prevent central-line-associated bloodinfections. In an effort to bring about this change, the leadership team has opted to use the Advancing Researchand Clinical practice through close Collaboration (ARCC) model. The team will begin the process by A) consulting experts to guide the change process. B) assessing the readiness of the workplace culture. C) identifying and reviewing the nursing and multidisciplinary literature that addresses line sepsis. D) exploring the problems that have triggered the need for change.

B

A group of nurses is attending the Clinical Scholar program as part of their ongoing professional education. Theprogram will equip the nurses for which of the following tasks? A) Conducting research B) Being familiar with the language of research C) Monitoring adherence to evidence-based practice

B

A nurse paged the attending physician because a postmastectomy patient became somewhat agitated andtachypneic 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, whichwas largely ineffective. Due to the nurse's persistence, diagnostics were performed, leading to a diagnosis ofpulmonary embolism. Which of the following did the nurse exhibit? A) Evidence-based practice B) Clinical grasp C) Patient-centered care D) Best practice

B

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 publishedarticles.

B

Knowing that the patient was admitted with a diagnosis of sepsis, the nurse has limited the most recent bedsideassessment to an oral temperature followed by a review of the patient's white cell count. This limited-scopeassessment will most directly affect the nurse's ability to A) engage in experiential learning. B) see the unexpected. C) individualize care. D) provide empathy.

B

Nurse L provides care on a busy medical unit of an inner-city hospital. Which of the nurse's actions bestexemplifies 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.

B

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 ofsurgery." D) "The patient will transition from dangling to assisted standing for the first time following surgery with theassistance of the physical therapist."

B

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 emergencydepartment 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 retentionamong new nursing graduates?

B

1. A group of nurse researchers wishes to identify potential predictor variables that may be present in adults with skincancer and absent in those who do not have skin cancer. Which of the following designs should the researcherschoose? A) Quasi-experimental B) Descriptive C) Case control D) Randomized controlled trial (RCT)

C

1. A longitudinal study is tracking the effects of a program aimed at improving the health-related decision-makingskills of teenagers over the course of their high school years. The researchers have had to account for maturation effects in the methodology of the study. Maturationwould have which of the following effects on the study participants? A) A decrease in the effectiveness of the intervention with passing time B) An accumulation of the effects of the intervention over time that exaggerates its effectiveness C) Developmental changes in the participants that are not related to the intervention D) An increase in the sophistication and effectiveness of the intervention with repeated applications

C

1. A published study has drawn the conclusion that an online clinical decision-making module has significantlyimproved the decision-making abilities of the nurses who completed the program. On critical appraisal, however,a nurse reader suspects that the effect was a result of the experimental group's clinical context, rather than theefficacy of the educational module. This study primarily demonstrates a deficit in which of the following areas? A) External validity B) Generalizability C) Internal validity D) Conceptualization

C

1. A research team is writing a proposal for a quantitative study that will test the efficacy of an online prenataleducation module. The team recognizes the need to control for extraneous variables. Which of the followingstrategies will best accomplish this goal? A) Pairing each member of the experimental group with a member of the control group who shares similarcharacteristics B) Utilizing multiple control groups C) Randomly assigning participants to either the experimental group or the control group D) Performing the assignment to groups after all participants have completed a pretest

C

A nurse has praised the recent efforts on a medical unit to utilize research in an effort to improve the quality ofnursing care of patients with dyspnea. The nurse educator on the unit, however, has characterized the initiative asan example of evidence-based practice rather than research utilization. This distinction suggests that A) the change was based on expert opinion rather than journal articles and textbooks. B) the effects of the practice change will be evaluated formally and the change will be revisited if outcomes areunsatisfactory. C) internal evidence was considered during the practice change. D) there was multidisciplinary input during the planning and implementation of the change.

C

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

C

A nurse is providing care for a 3-year-old girl who has been admitted to the pediatric intensive care unit with asuspected brain injury following a choking episode. Which of the following aspects of the nurse's care bestdemonstrates 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 neurologicalpathophysiology. C) The nurse recognizes that there are numerous patient and family variables at play. D) The nurse demonstrates empathy when caring for the patient.

C

In preparation for an evidence-based practice initiative that will address the spiritual care that is provided topatients and families, a group of nurses is collecting information on the evidence related to the clinical question,the context in which it will be implemented, and the way in which the process will be facilitated. The nurses aremost likely utilizing which of the following models for evidence-based practice implementation? A) Iowa model B) Advancing Research and Clinical practice through close Collaboration (ARCC) model C) Promoting Action on Research Implementation in Health Services (PARIHS) framework D) Johns Hopkins Nursing Evidence-Based Practice model

C

Nurse M makes a conscious effort to think beyond the rigidly-defined signs and symptoms of illnesses andrecognizes that context has a highly significant impact on illness situations. This thinking facilitates which ofthe following? A) Engaging in detective work B) Phronesis C) Making qualitative distinctions D) Techne

C

The nurse educator on a gerontological unit has recognized the need to implement evidence-based practicearound the prevention of wandering. The nurse will be implementing the Iowa model of evidence-basedpractice. According to the model, which of the following is a "problem-focused trigger" that most likelyprompted the nurse's desire for changes in practice? A) The emergence of new and innovative research around the prevention and management of wandering B) The release of new standards by the administration of the hospital C) The fact that wandering patients have recently fallen or gone missing from the unit D) Increases in patient acuity of the past several months with no commensurate increase in staffing levels

C

The nurses who provide care on an obstetrical unit of a busy, urban hospital have resolved to amend their practicearound the facilitation of breastfeeding for preterm infants. The nurses will be utilizing the Stetler model and will,consequently, conduct a review of relevant studies they have located in which of the following phases of themodel? A) Translation B) Preparation C) Validation D) Comparative evaluation

C

While helping a colleague reposition a patient who is in moderate respiratory distress, the nurse has a sense that itwould be appropriate to ensure the bag-valve mask (Ambu bag) is readily accessible and to confirm the patient'scode status. Which of the following qualities does this exemplify? A) Engaging in detective work B) Evidence-based practice C) Future think

C

1. A community health nurse is disturbed by the apparently high incidence of postpartum depression among womenwho have recently given birth. As a result, the nurse has formulated an idea for a research study addressingpostpartum depression. What should the nurse do after formulating an idea for research? A) Investigate funding options B) Create a research team C) Recruit participants D) Search for systematic reviews

D

1. During the early conceptualization of a study that will assess the influence of cognitive behavioral therapy on thesmoking behavior of teenage girls, the researchers have addressed the need to prevent attrition during the courseof the study. How can this best be accomplished? A) Inform potential participants that they will be reimbursed according the quality of the data they provide B) Assign more participants to the control group than the experimental group C) Create disincentives for leaving the study before completion D) Maintain frequent contact with participants throughout the study

D

1. Which of the following study questions should be answered within a nonexperimental study design? A) "How will a peer-counseling program influence the glycemic monitoring behaviors of newly diagnoseddiabetics?" B) "How does oral administration of ginseng affect humoral immune function?" C) "What effect does regular physical exercise have on the self-esteem of obese children?" "Whateffectdohigh-risk

D

A nurse who provides care on a geriatric subacute medicine unit is aware that elderly patients often exhibit signsand 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.

D

Implementation of a new evidence-based practice guideline aimed at reducing urinary incontinence amonghospitalized elders has proven difficult because of increased demands on nursing staff. Nurses on the unit statethat the guideline requires them to spend more time and effort assessing for precursors to incontinence andtoileting patients. Implementation of the practice guideline is being challenged by which of the followingfactors? A) Patient preferences and actions B) Patients' clinical states C) Clinical expertise D) Healthcare resources

D

Nurses are applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework inorder to guide their implementation of evidence-based diabetes education in the hospital. Which of the followingconsiderations will the team examine under the dimension of "context"? A) The similarities between sites where research was conducted and the site where it will be implemented B) The significance that a new diagnosis of diabetes has for patients and families C) The existing evidence-based practice that is demonstrated in other clinical situations at the hospital D) The character and quality of leadership that exists in the hospital

D

Nurses at a county hospital are using the Advancing Research and Clinical practice through close Collaboration(ARCC) model to foster evidence-based practice in their screening for delirium, depression, and dementiaamong older adult patients. Which of the following data sources will be prioritized and combined with researchevidence in order to guide practice? A) Input from an interdisciplinary panel B) The experiences of other institutions that have undertaken similar initiatives C) The results of a cost analysis around implementing a change in practice D) Preferences of patients and families

D

Which of the following activities by the nurse most directly fosters phronesis in the care of geriatric patients in along-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.

D

Which of the following nurses is most likely to have success in following and implementing the Stetlermodel of research utilization to facilitate evidence-based practice? A) A practitioner who is an outside consultant and, thus, possesses objectivity B) A practitioner who has direct leadership experience C) A practitioner with experience among a large variety of patient populations D) A practitioner with a graduate-level nursing education

D

Which of the following statements provides the clearest rationale for the use of narratives inunderstanding 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 oftenoverlap. D) The trajectory of illness and the human experience of it can be complex and highly individualized.

D

1. A master's-educated nurse has been recruited to conduct a pilot study prior to the commencement of a large,multisite quantitative research project. A pilot study is used primarily to inform which of the followingparameters of a larger study? A) Feasibility B) Relevance C) Ethics D) Generalizability

A

1. A study that is examining healthcare workers' adherence to standard infection-control precautions began shortlybefore an outbreak of Clostridium difficile. This outbreak of C. diff constitutes what type of threat to the internal validity of the study? A) History B) Testing C) Externality D) Construct

A