NU371 PrepU Week 1
At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. Which explanation by the charge nurse is most appropriate? a) "Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." b) "Cost is not a driver in quality health care delivery." c) "Using evidence-based practice is the trend in providing quality care and may expose the client to better care implementation. None of our care methods are associated with cost." d) "Because our clients are considered consumers of care, they often understand the need to use specific methods based on research, and they want the best care for the lowest cost."
a) "Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." - Evidenced-based practice improves client outcomes, thereby increasing the quality of care; quality care leads to decreased cost. Cost is a driver in quality health care delivery. Evidenced-based practice is not just a trend in care; it is an expectation in health care delivery. Clients are consumers of care, but they often do not understand evidenced-based care or the cost associated with care. Today's greater focus on quality makes it less likely that clients will suffer unnecessary or harmful treatment, reduces waste, and increases safety.
A certified nurse practitioner (CNP) working in the emergency department (ED) provides advanced cardiac life support (ACLS) to a client experiencing asystole. What care planning tool will the CNP use in this situation in order to care for the client based on response to treatment? a) Algorithm b) Nursing care plan c) Care map d) Bundles
a) Algorithm - Algorithms are used in acute situations to determine treatment based on patient information or response to treatment. Nursing care plans use the nursing process (assessment, analysis, planning, implementation, and evaluation) to direct nursing care. Care maps, along with clinical guidelines and multidisciplinary action plans (MAPs), facilitate coordination of care and education throughout hospitalization and after discharge. Bundles are sets of three to five evidence-based practices used to improve patient outcomes.
Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? a) Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. b) Gather evidence over the next several weeks in order to determine if the practice is indeed happening. c) Arrange for the newer nurses to organize the client assignment for a trial period. d) Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients.
a) Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. - Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that currently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the client assignment may perpetuate selfish practices and does not resolve animosity between the two camps.
A nurse working in the intensive care unit refers to the Institute for Healthcare Improvement (IHI) Ventilator Bundle before planning patient care. The nurse realizes nursing interventions outlined in the bundle will improve clients' outcomes. Which statement best describes how nursing interventions established by the IHI should be included in each bundle? a) Best practices derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles b) Hospitals, physicians, and nurses worked collaboratively to design patient care activities included in IHI bundles c) Nurse case managers serving as patient advocates recommended nursing interventions to be included in the IHI bundles based on patient preference d) Nursing interventions found within the IHI bundles were selected based on the ability to provide optimal time management for the nurse
a) Best practices derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles - Bundles include evidence-based practices. Hospitals, physicians, and nurses work collaboratively to provide care directed by bundles. Nurses advocate on behalf of the patient. Effective time management is a key element in the provision of care, however; IHI-based bundles on evidence-based practice.
A nurse is reading a journal article about nursing research and evidence-based practice. Part of the article addresses the areas identified by the American Nurses Association (ANA) as relevant to quality outcomes for client care. Which areas would the nurse most likely find identified when reading the article? Select all that apply. a) Client safety b) Nursing efficiency c) Population health d) Workforce mix d) Medication protocols
a) Client safety b) Nursing efficiency c) Population health d) Workforce mix - Evidence areas identified by ANA as relevant to quality outcomes for client care include client safety, improvements in nursing efficiency, population health, and workforce mix to meet the needs of the population. Medication protocols are not addressed by the ANA.
The nurse working in research correctly identifies which of the following to be mandatory for the ethical conduction of research in a hospital setting? a) Clients must grant informed consent if they are to participate. b) All interventions must benefit all clients. c) The client must directly and personally benefit from the research. d) Descriptive studies are more ethical than experimental studies.
a) Clients must grant informed consent if they are to participate. - Informed consent is an absolute prerequisite for clients who are asked to participate as subjects in a research study. Not all interventions will benefit all (or even any) clients. The risks and benefits of research are considered carefully in light of ethical principles, but this does not necessarily mean that every participant in a study stands to benefit from it. Ethical standards are applicable and achievable in every type of research, and descriptive studies are not necessarily more ethical than experiments.
What are the steps of evidence-based practice, in the correct order?
a) Design a question related to a clinical area of interest. b) Collect the most relevant and best evidence available. c) Critically evaluate the collected evidence. d) Integrate the evidence with clinical expertise, client preferences, and values as the decision is made to make a change. e) Evaluate the decision or change.
When looking at a model for evidence-based practice, what is the final step of the process? a) Evaluating practice change b) Searching the literature c) Appraising evidence d) Formulating a clinical question
a) Evaluating practice change - The fifth and final step in the process of implementing evidence-based practice is to evaluate and critically appraise the change in practice. Formulating a clinical question and searching and appraising the literature precede this step.
Research has demonstrated that a common source of hospital-acquired infections in clients with intravenous (IV) infusions is the hub on the IV tubing. Which nursing practice competency is displayed when health care institutions recommend that health care providers always wash hands and wear gloves when accessing the hubs of IV tubing? a) Evidence-based practice b) Informatics c) Person-centered care d) Teamwork and collaboration
a) Evidence-based practice - Evidence-based practice as defined by Quality and Safety Education for Nurses (QSEN) indicates the need to value evidence-based practice findings to ensure that the best clinical practice is provided for clients. When health care institutions change their policies based on research, this reflects the significance of this QSEN competency. Informatics is the use of technology to gather and use data to improve client health. Person-centered care is a model of patient care based on holistic roots in which the nurse or other caregiver uses every clinical encounter to assess how the person is doing and to communicate respect, compassion, and care. Teamwork and collaboration are values in nursing that emphasize the benefits of health care team members working together to meet clients' needs rather than just individually.
Which attribute is a benefit of health care providers using an evidence-based practice guideline? a) It directs research into forming a diagnosis and treatment for a certain condition. b) Once a practice guideline is well developed, it does not require modification. c) It uses one research method for delivery of care. d) With continued use, it will decrease healing time for clients.
a) It directs research into forming a diagnosis and treatment for a certain condition. - Evidence-based practice guidelines often use methods to combine evidence from different studies to produce a more precise estimate of the accuracy of a diagnostic method or the effects of an intervention method. Practice guidelines require continuous updates as new research is conducted and supported. Practice guidelines are developed on numerous research studies. Not all research is directed toward healing time.
What is the ultimate goal of expanding nursing knowledge through nursing research? a) Learn improved ways to promote and maintain health b) Develop technology to provide hands-on nursing care c) Apply knowledge to become independent practitioners d) Become full-fledged partners with other care providers
a) Learn improved ways to promote and maintain health - The ultimate goal of expanding nursing's body of knowledge through nursing research is to learn improved ways to promote and maintain health. Ongoing practice-based research reflects the nursing profession's commitment to meet the ever-changing demands of health care consumers. While doing research also facilitates the development of technology, helps produce independent practitioners, and provides partnerships with other providers of care, those are not the ultimate goals of nursing research.
Which is the best example of evidence-based nursing practice? a) Recommending ginger to alleviate nausea and vomiting in obstetric clients based on a literature review b) Using central line dressing kits to reduce infection rates in clients based on 10 years of experience working in the ICU c) Continuing to prescribe an antibiotic that is no longer recommended in the literature based on 20 years of personal success in treating clients using this antibiotic d) Consulting with a prescribing health care provider about a client on the cardiac floor who does not take daily aspirin, a practice recommended in a nursing journal article for people 50 years and older
a) Recommending ginger to alleviate nausea and vomiting in obstetric clients based on a literature review - Identifying a client problem (nausea and vomiting), performing a literature review to learn about solutions to this problem that have been studied (use of ginger), and applying the information gained to clients in one's practice (recommending ginger to obstetrical clients with nausea and vomiting) are a great example of evidence-based nursing practice. Basing interventions on personal experience, personal observation, and personal success in treating clients - despite the length of that experience - are not examples of evidence-based practice. Evidence from a single article in a nursing journal for use of an intervention with a single client who may or may not be a part of the population studied is not the best example of evidence-based nursing practice.
A nurse is performing an admission assessment on a client. During the medication history portion of the assessment, what would be important to assess with herbal supplements? a) Research them for interactions with other medications. b) Discontinue them if taking prescription medications. c) Take them one hour before prescription medications. d) Take them three hours after prescription medications.
a) Research them for interactions with other medications. - Clients often neglect to mention OTC drugs or alternative therapies because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. Ask clients specifically about OTC drug or alternative therapy use. Do not tell the client to discontinue the supplements or to take them one hour before prescription medication or three hours after prescription medication.
A client has been diagnosed with a glioblastoma and the care team has determined that this brain tumor is inoperable. Which aspects of the client's subsequent care demonstrate adherence to the Quality and Safety Education for Nurses (QSEN) competencies? Select all that apply. a) The care team meets with the client and family promptly to identify their preferences for treatment. b) The care team balances the best available evidence about glioblastoma treatment with the client's preferences. c) Nurses proactively identify threats to the client's safety that may occur as treatment is provided. d) Each member of the care team uses the best available technology to organize and provide care. e) Treatments are chosen with the goal of minimizing the financial burden on the health care institution.
a) The care team meets with the client and family promptly to identify their preferences for treatment. b) The care team balances the best available evidence about glioblastoma treatment with the client's preferences. c) Nurses proactively identify threats to the client's safety that may occur as treatment is provided. d) Each member of the care team uses the best available technology to organize and provide care. - According to the ANA, there are six focus-area competencies in QSEN: 1) client-centered care, 2) evidence-based practice, 3) teamwork and collaboration, 4) safety, 5) quality improvement, and 6) informatics. Meeting with the family exemplifies client-centered care. Evidence-based practice includes research evidence as well as client preferences. Safety is a QSEN competency, as is informatics (the effective use of technology). Financial concerns of the health care institution are not included among the six QSEN competencies.
The nurse is applying evidence-based practice (EBP) during a client's wound care. Which are characteristics of EBP that the nurse is likely to demonstrate? Select all that apply. a) The nurse is using a problem-solving approach. b) The nurse uses the best evidence available. c) The nurse performs the wound care as it has always been done in the facility. d) The nurse performs care based on institutional protocols. e) The nurse blends the science and art of nursing.
a) The nurse is using a problem-solving approach. b) The nurse uses the best evidence available. e) The nurse blends the science and art of nursing. - EBP is a problem-solving approach to making clinical nursing decisions. EBP uses the best evidence available, which is collected from resources such as published research, national standards and guidelines, and reviews of targeted literature. EBP blends both the science and the art of nursing. EBP is practiced among clinical nurses by using the nursing process and reading professional journals. Institutional protocols may be based on EBP, but EBP is based on research and not institutional protocols. Doing things the way they've always been done is not EBP.
The nursing process is: a) a critical thinking method used by nurses to provide nursing care that is individualized and holistic. b) a mechanism for increasing the knowledge and skill of the nurse through programs of education. c) the promotion of health, prevention of illness, and care of ill, disabled, and dying individuals. d) an approach for identifying and analyzing the best available scientific evidence for nursing care.
a) a critical thinking method used by nurses to provide nursing care that is individualized and holistic. - The nursing process is a critical thinking method used by nurses to provide nursing care that is individualized and holistic. Continuing education and in-service education programs increase the knowledge and skill of the nurse. Evidence-based practice involves the identification and analysis of the best available scientific evidence for nursing care. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying individuals.
The nurse is caring for a client with a new diagnosis of cancer, and allows the client to verbalize fears relating to how to tell the children. The nurse's intervention reflects which aspect of nursing? a) art of nursing b) science of nursing c) evidence-based practice d) application of research
a) art of nursing - In this example, the nurse is utilizing a holistic approach to the provision of nursing care based on the knowledge of providing psychosocial interventions, such as allowing the client to verbalize feelings/fears. This application of knowledge is the art of nursing. The science of nursing is the knowledge base for the provision of care. Evidence-based practice and application of research are using research to make decisions on how to care for clients.
The nursing department at a hospital sponsored a poster presentation for which nurses researched a problem related to nursing care. On each poster, the nurse identified a problem, cited research findings, and presented a conclusion about best practices. Which ANA Informatics Competencies are demonstrated by the poster presentation? Select all that apply. a) education b) evidence-based research and practice c) ethics d) quality of practice e) leadership
a) education b) evidence-based research and practice d) quality of practice e) leadership - The poster presentation of nursing research is another way of presenting nursing informatics. The poster presentation supports the ANA Informatics Competencies of education (ongoing education to advance knowledge base and professional practice); evidence-based practice and research (integrates evidence and research findings into practice); quality of practice (contributes to quality and effectiveness of nursing and informatics practice); and leadership (the organization's vision, goals, and strategic plan may be promoted). Ethics refers to consumer confidentiality and legal and regulatory parameters.
Which action by the nurse is the best indication that the nurse is incorporating the quality and safety education for nursing (QSEN) competency of teamwork and collaboration in the plan of care for a client? a) including the client in the morning rounds of the health care team b) keeping up all four side rails for a confused client to prevent falls c) using a new client positioning technique described in research to prevent pressure injuries d) asking a client about his or her personal goals for rehabilitation following a stroke
a) including the client in the morning rounds of the health care team - The QSEN competencies include client-centered care, teamwork and collaboration, quality improvement, safety, evidence-based practice, and informatics. The competency of teamwork and collaboration is best indicated by including the client in the morning rounds of the health care team, which fosters open communication, mutual respect, and shared decision making among team members. Keeping the side rails up on the bed of a client who is confused is an example of the competency of safety. Using a new technique for patient care based on the latest research is an example of the competency of evidence-based practice. Gaining input from a client regarding personal goals for rehabilitation is an example of the competency of client-centered care.
A group of students are reviewing information about evidence-based practice in preparation for an exam. The students demonstrate understanding of the information when they identify which of the following as associated with evidence-based practice? a) It emphasizes personal experience over science. b) Clinical expertise is integrated with external evidence. c) It involves gaining solutions to problems. d) The purpose is to learn about a specific problem.
b) Clinical expertise is integrated with external evidence. - Evidence-based practice (EBP) is an approach to healthcare that realizes that pathophysiologic reasoning and personal experience are necessary but not sufficient for making decisions. Advocates argue that medical decisions should be based as much as possible on a firm foundation of high-grade scientific evidence, rather than on experience or opinion. Its practice involves the integrated of individual clinical expertise with the best available external evidence from systematic research. Nursing research aims to gain solutions to problems, learn about a specific problem, or to understand a situation.
The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which statement about clinical practice guidelines are accurate? Select all that apply. a) Step-by-step guidelines are usually developed and based primarily on "how it has always been done before." b) The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. c) Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. d) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. e) A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.
b) The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. d) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. e) A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. - Clinical practice guidelines are systematically developed and intended to inform practitioners in making decisions about health care for CVA clients. They should be developed using research and review by experts in the clinical content. Potential users should also participate and provide feedback prior to implementation. The purpose of the guidelines is to review EBP articles and develop new practice guidelines rather that continuing practicing primarily on "how it has always been done before." Once developed, the guidelines must be continually reviewed and changed to keep pace with new research findings. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method or the effects of an intervention method.
A client preparing to be a subject in a research study informs the nurse that the client would like to withdraw from the research study immediately. What is the best response by the nurse? a) "You have signed a consent form indicating that you will be a willing participant in the study." b) "If you don't continue with the study, there will be consequences for you, such as a lawsuit." c) "You have the right to withdraw your consent for being a research subject at any time." d) "If you will stay in the study, we will find monetary reimbursement for you."
c) "You have the right to withdraw your consent for being a research subject at any time." - It is within the client's right to consent knowledgeably to participate in the study without being coerced. The client has the right to withdraw consent at any time during the study and should be able to do so without being threatened, coerced, or even dissuaded in any manner.
Which descriptor helps to define the term criteria? a) Immeasurable qualities b) Established by authority c) Acceptable level of performance d) Evidence-based practice
c) Acceptable level of performance - Criteria are measurable qualities, attributes, or characteristics that specify skills, knowledge, or health states. They describe acceptable levels of performance by stating the expected behaviors of the nurse or the client. Standards are the levels of performance accepted and expected by the nursing staff or other health team members. They are established by authority, custom, or consent and are based on evidence-based practice.
Which of the following is a measure taken to protect healthcare workers from being charged with battery? a) The client's signed release is obtained for presentations. b) The nurse uses initials instead of names in written reports. c) Clients sign a written consent before undergoing any kind of procedure. d) The nurse draws bedside curtains while giving personal care.
c) Clients sign a written consent before undergoing any kind of procedure. - To protect healthcare workers from being charged with battery, clients sign a general permission for care and treatment at the time of hospitalization. They also sign a written consent before undergoing special tests, procedures, or surgery. Obtaining a signed release for recognizable photographs for publications, using initials or code numbers instead of names in written reports or research papers, and drawing bedside curtains when giving personal care are essential for protecting a client's privacy.
Before developing a procedure, a nurse reviews all current research-based literature on insertion of a nasogastric tube. What type of nursing will be practiced based on this review? a) Institutional practice b) Authoritative nursing c) Evidence-based practice d) Fact-based nursing
c) Evidence-based practice - Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of research-based information in making decisions about the delivery of care. Institutional practice may or may not use EBP. Authoritative nursing and fact-based nursing are not based on EBP but on what is common and customary practice.
A client expresses confidence in his traditional healer to relieve symptoms of an illness. What is the client demonstrating? a) Hope b) Spirituality c) Faith d) Charity
c) Faith - Faith generally refers to a confident belief in something for which there is no proof or material evidence. It can involve a person, idea, or thing and is usually followed by action related to the ideals and values of the belief. A client who has faith in a health care provider is more likely to follow the plan of care, and experience benefits. Hope is an optimistic state of mind that is based on an expectation of positive outcomes with respect to events and circumstances in one's life or the world at large. Spirituality is the quality of being concerned with the human spirit or soul as opposed to material or physical things. The practice of charity means the voluntary giving of help to those in need, as a humanitarian act.
Which practice by the nurse indicates that the nurse is a professional? a) Doing things the way they have always been done b) Using intuition to make decisions about client care c) Using evidence-based practice interventions d) Submitting an article to a local newspaper
c) Using evidence-based practice interventions - When the nurse uses evidence-based practice interventions, the interventions are based on ongoing research, which is part of the defining criteria of a profession. A nurse should not use tradition (doing things the way they have always been done) or intuition to make decisions about client care; rather, a nurse should use the nursing process (assessment, diagnosis, outcome identification, intervention, and evaluation) and evidence-based practice to guide nursing care. If writing articles is to be considered a professional activity, the article should be specific to nursing and not for the general public, as in a local newspaper.
Which nursing role is the nurse exhibiting when collecting data about the number of urinary tract infections on the nursing unit? a) Advocate b) Leader c) Counselor d) Researcher
d) Researcher - Data collection is part of the research process. As an advocate, the nurse would implement actions to protect the rights of the client. Counseling involves the use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate client problem-solving and decision-making skills. A nurse leader is assertive and self-confident when providing care, effecting change, and functioning within groups.
Information is collected for analysis in both quantitative and qualitative research. What is the information called? a) Surveys b) answers c) interviews d) data
d) data - Data are information the researcher collects from subjects in the study. Data are collected through answers on instruments (such as surveys, rating scales, or biologic measurements) or verbal interviews.
A group of nurses visits selected clients individually at the beginning of each shift. What are these procedures called? a) nursing care conferences b) staff visits c) interdisciplinary referrals d) nursing care rounds
d) nursing care rounds - Nursing care rounds are procedures in which a group of nurses visits select clients individually at each client's bedside. The primary purposes are to gather information to help plan and evaluate nursing care and to provide the client with an opportunity to discuss care. Interdisciplinary referrals involve inviting other members of the health care team to assess the client including physicians and physical therapists. Nursing care conference are usually held outside or away from clients' rooms to re-educate about new products or review information or can be based on evidence-based practice. Staff visits are those ancillary personnel that visit a client at the bedside, such as housekeeping and dietary staff.
