Fundamentals of Nursing Ch 2: Theory, Research, and Evidence-Based Practice

The registered nurse is teaching a community health class about illness prevention. Which of the following statements reflects understanding of this concept?

"It is important to enroll in a smoking cessation class."

Nurse H. graduated several years ago from a 2-year nursing program that he took at a community college near his home city. Recently, Nurse H. has considered moving from providing direct client care into an administrative role, but he recognizes the need to further his education in order to be considered for such a position. Nurse H. most likely possesses which nursing qualification?

Associate degree

Which of the following is the best example of a nurse attending an inservice program?

Attending a hospital program on how to use a new IV pump

Who is considered to be the first nursing researcher?

Florence Nightingale Florence Nightingale conceptualized the nurse's role as manipulating the environment to facilitate and encourage the reparative process. This would be accomplished by attending to ventilation, warmth, light, diet, cleanliness, and noise.

A nurse caring for patients in a hospital setting focuses on ill patients as the center of all nursing activities performed daily. The nurse also provides care based on helping patients to adapt to the hospital environment. This nurse is following the principles of:

Myra E. Levine

There are four common concepts in nursing theory. While all concepts are important, the focus of nursing is always on which of the following?

Person

During the Christian era, nursing care excluded which area?

Psychiatric services

The nurse researcher would like to gather data about the attitudes of young adults on spirituality and health care. What is the most effective form of research on this topic?

Qualitative research

Following the identification of a researchable problem, what must the nurse do?

Select literature relevant to the problem.

A nurse practitioner considering going back to school to obtain a Doctor of Nursing Practice degree (DNP) anticipates that the main focus of the curriculum will be on which of the following?

Clinical practice

Who of the following is considered to be the first nursing theorist who conceptualized nursing in terms of manipulating the environment?

Florence Nightingale

Which nursing intervention would be most appropriate for a new mother that calls the nursery for help with breastfeeding?

Refer the mother for a home care visit.

Which of the following is the best example of client-centered approach to care?

The nurse asks the client about his health goals

Which statement best explains the importance of theoretic frameworks?

Theoretic frameworks Theoretic frameworks are important to the advancement of nursing knowledge and professional practice.

During the Reformation, what factor influenced the decline of nursing?

Women's subordination to men

The RN is working with hospital administration to transform care at their facility. Which of the following nursing competencies will be critical for the nurse to utilize?

Work effectively in interdisciplinary teams

One of the primary focuses of nursing research is to:

generate knowledge to guide practice One of the major reasons for conducting research is to expand a profession's knowledge base.

A student nurse understands that the primary aim of the Healthy People 2020 initiatives is

health promotion.

In what time period did nursing care as we now know it begin?

18th to 19th century

The nurse is evaluating client health. Which of the following clients should the nurse determine to be exhibiting the most signs of health?

A client with a leg amputation that performs activities of daily living with a prothesis

The nurse caring for a client with a new diagnosis of cancer allows the client to verbalize fears relating to how to tell the children. The nurse's intervention reflects which aspect of nursing?

Art of nursing

Which of the following actions should the nurse implement when working with a medically homeless client?

Encourage client to utilize the free healthcare clinic.

A nursing theorist examines a hospital environment by studying each ward and how it works individually, then relates this information to the hospital as a whole working entity. This is an example of the use of which theory?

General systems theory

Which of the following are the best examples of the role of the nurse as a communicator? Select all that apply.

• Telling a client their blood pressure • Calling a physician about a client's blood pressure • Informing the physical therapist that client's therapy was discontinued

The nurse is conducting a community education class on the 2011 Institute of Medicine Report on the role of nursing in transforming healthcare. Which of the following statements should the nurse include?

• Nurse practitioners should be allowed to practice independently. • Barriers to diploma nurses achieving a BSN should be removed.

A nurse manager is attempting to switch the medical records in an orthopedic office to a computerized format. The nurse asks questions about the accuracy and efficiency of the current record keeping system by using the PICO format. Which statements illustrate the components of this process? Select all that apply.

• P: The nurse chooses the population involved (orthopedic clients). • I: The nurse considers interventions to make the plan work. • C: The nurse compares the written records to the computerized records.

The nurse is attempting to provide anticipatory guidance for the parents of an eighteen-month-old boy. Which of the following would be the best statement for the nurse to make?

"Keep all medications in a locked cabinet." Correct

A nurse identifies a patient's health care needs and devises a plan of care to meet those needs. Which guideline is being followed in this case?

Nursing process

The nursing instructor asks a group of students to identify a theory that describes, explains, predicts, and controls outcomes in nursing practice. One student correctly identifies this theory as what?

Nursing theory

A nurse applies for membership in a professional nursing organization that is operating in the United States. To which organizations might this nurse apply? Select all that apply.

• ICN • AACN • ANA

A nurse observes that the past five patients referred from a certain community clinic have been treated for drug and/or alcohol overdose. Based on this information, the nurse assumes that the clinic specializes in the treatment of substance abuse. This is an example of what type of reasoning?

Inductive reasoning

Christine Grady is a nurse ethicist that proposed a framework for evaluating ethics. Grady suggested that a independent review is needed for ethical research. This principle is correctly defined as:

Informed consent means that "individuals should be informed about the research and provide their voluntary consent."

Which skill is foundational for a nursing student's participation in the evidence-based practice process?

Read and understand a research article.

The nurse is using the nursing process to care for a client and is in the process of making a nursing diagnosis for the client. Which of the following best reflects a nursing diagnosis?

Risk for falls

The registered nurse communicates with the physical therapist that a client is now on strict bed rest due to bradycardia. Which statement best explains the standard exemplified by the nurse?

The RN coordinates care delivery

Christine Grady is a nurse ethicist that proposed a framework for evaluating ethics. She suggested that a fair subject selection is needed for ethical research. This principle is correctly defined as:

"Scientific objectives, not vulnerability or privilege, and the potential for and distraction of risk and benefits, should determine communities selected as study sites and the inclusion criteria for individual subject." Fair subject selection suggests that scientific objectives, not vulnerability or privilege, and the potential for and distraction of risk and benefits, should determine communities selected as study sites and the inclusion criteria for individual subject. Scientific validity suggests that "the research must be methodologically rigorous." Value suggests that enhancements of health or knowledge must be derived from the research. Favorable risk-benefit ratio is correctly defined as "within the context of standard clinical practice and the research protocol, risks must be minimized, potential benefits enhanced, and the potential benefits to individuals and knowledge gained for society must outweigh the risks." Fair subject selection suggests that scientific objectives, not vulnerability or privilege, and the potential for and distraction of risk and benefits, should determine communities selected as study sites and the inclusion criterial for individual subject. Independent review suggests that unaffiliated individuals must review the research and approve, amend, or terminate the research.

A nurse conducting an inservice on the early history of the education of nurses should include which of the following statements?

"The focus was on students providing direct care to clients without pay."

A nurse is using the quantitative research process to study the cause of healthcare-associated infections (HIA) and how to prevent them. Which actions are examples of the components of this process? Select all that apply.

• The nurse collects data from subjects in the study. • The nurse formulates a hypothesis and variables in the study.

The nurse is describing the role of the nurse entrepreneur. Which of the following statements best describe this role?

A nurse who manages a health-related business

A nurse is completing a family assessment on a routine home health visit. The parents have a child with a severe peanut allergy. The mother states that she does not purchase any foods with peanut or peanut oil for her family. The other children are allowed to have foods containing peanuts while they are at school and visiting with friends and family. The nurse would conclude that which of the following theories would most like be the basis for this family's functioning?

Adaptation Theory Adaptation theory is based on an understanding of humans and their interaction with the environment. In this situation the mother is manipulating the physical environment for the child with allergies, as well as the needs and/or desires of the other children. Systems theory is described as studying relationships between a whole and identifying how parts interact and behave. Developmental theory is based on growth and maturation of humans. Maslow's theory is based on a pyramid of human needs related to the most primitive needs moving toward higher level needs, such as self-actualization.

A nurse is preparing to conduct a research study and uses the PICO format to develop the foreground question which is: "In adults, does reducing salt intake, compared to no change in salt intake, lower blood pressure?" The nurse identifies the "P" as:

Adults Using the PICO format, "P" refers to the population, which in this case is adults. "I" refers to the intervention, which is reducing salt intake. "C" refers to comparison, which is no change in salt intake. "O" refers to the outcome, which would be lower blood pressure.

A community health nurse has been visiting a diabetic client whose morning fasting glucose levels are constantly elevated. Upon further assessment, the nurse determines that the client's spouse does not understand how to prepare meals following the prescribed diabetic diet. Using Dorothea Orem Self Care Theory, how can the nurse help meet the needs of this client?

Arrange an evaluation appointment with a dietician. According to Dorothea Orem's theory, arranging an evaluation appointment with a dietician the nurse is facilitating self-care to sustain life and health, to recover from disease or injury, or to cope with its effects. The nurse is providing a service that assists the client and spouse to progressively maximize their self-care potential. People learn behaviors that they perform on their own behalf to maintain life, health, and well-being. The other options are providing care for the client, not facilitating self-care.

A nursing student understands which of the following is true of concepts?

Concepts describe objects, properties, and events and relationships among them Concepts describe objects, properties, and events and the relationships among them. Theories are derived through deductive and inductive reasoning and provide a mechanism by which knowledge can be tested, and nursing theory differentiates nursing from other disciplines.

Which is not a focus of nursing research?

Cytochrome P450 Cytochrome P450 are required for metabolism of medications. Nursing research is defined as a systematic inquiry into the problems encountered in nursing practice and into the modalities of client care such as health appraisal, prevention of trauma, promotion of recovery, and coordination of health care (Gortner, 1975).

The nursing instructor asks the students to place the steps of implementing evidence-based practice in order. The correct order is:

Design a question related to a clinical area of interest. Collect the most relevant and best evidence available. Critically evaluate the collected evidence. Integrate the evidence with clinical expertise, client preferences, and values as the decision is made to make a change. Evaluate the decision or change.

A nurse is completing a family assessment on a routine home health visit. There is a mother, father, and three children ages 2, 4, and 6 years of age. She watches the children individually as they play and interact with one another. She compares each child with the norms established for the age groups and determines and they are all within normal limits for their ages. The nurse would be utilizing which of the following theories as the basis for this part of the family assessment?

Developmental Theory Developmental theory is based on growth and maturation of humans. In this situation the nurse is assessing what the child is doing with regard to norms for the specific age child. Adaptation theory is based on an understanding of humans and their interaction with the environment. Systems theory is described as studying relationships between a whole and identifying how parts interact and behave. Maslow's theory is based on a pyramid of human needs related to the most primitive needs, moving toward higher level needs, such as self-actualization.

The nursing instructor asks a group of students to identify a theory that describes the maturation of humans through stages. One student correctly identifies this theory as what?

Developmental theory Developmental theory describes maturation of humans through stages. Nursing theory describes, explains, predicts, and controls outcomes in nursing practice. Systems theory describes how parts interact together. Adaptation theory describes adjustment of living things to other living things and the environment.

A nurse who works in a pediatric practice assesses the developmental level of children of various ages to determine their psychosocial development. These assessments are based on the work of:

Erikson Erik Erikson based his theory of psychosocial development on the process of socialization, emphasizing how individuals learn to interact with the world. Erikson recognized the role of social, biologic, and environmental factors in development, and defined specific tasks or conflicts that people accomplish or overcome during what he defined as the eight stages of life, based on chronological age. Abraham Maslow developed his theory of human needs in terms of physical and psychosocial needs considered essential to human life, rather than by chronologic age as Erikson did. Maslow defined five levels of need in a hierarchy, with different needs existing simultaneously. Jean Watson is a nursing theorist who is known for her focus on caring. The central theme of her work is that nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. Caring is universal and is practiced through interpersonal relationships. Martha Rogers is a nursing theorist who is known for her theory focus of the individual client being central to the discipline of nursing. Nursing interventions are directed toward repatterning human environment fields or assisting in mobilizing inner resources.

When looking at a model for evidence-based practice, what is the final step of the process?

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.

The nursing student studying research exhibits an understanding when informing the instructor that which of the following is the bridge between theory and practice?

Evidence-based research Evidence-based research is translational research that forms the bridge between theory and practice.

In nursing class the instructor asks the students about the nursing research process. The student identifies the first nurse to collect data on clients as which of the following?

Florence Nightingale

The registered nurse is performing a nutritional assessment to ensure that the client's diet is optimal for wound healing. The nurse's intervention can be traced back to which of nursing's key people's contributions to nursing?

Florence Nightingale

Who established the first public health service for the sick and poor?

Lillian Wald

What is the central theme of Florence Nightingale's nursing theory?

Meeting the personal needs of the client within the environment.

A nurse is planning to conduct a nursing research study and is seeking federal funding. Which institution would be most helpful for the nurse to contact funding?

National Institute of Nursing Research The nurse would most likely contact the National Institute of Nursing Research, which was established under the National Institutes of Health in response to a 1983 study by the Institute of Medicine. The institute's purpose was to place nursing securely in the sphere of scientific investigation and to support research and training in client care, health promotion, and disease prevention, as well as the mitigation of effects of acute and chronic disabilities. The NINR has continued to fund and support nursing research and is instrumental in the support and dissemination of seminal work in nursing. The ANA Cabinet on Nursing Research was responsible for establishing priorities for nursing research.

The nursing instructor asks a group of students to identify a theory that describes, explains, predicts, and controls outcomes in nursing practice. One student correctly identifies this theory as what?

Nursing theory Nursing theory describes, explains, predicts, and controls outcomes in nursing practice. Systems theory describes how parts interact together. Adaptation theory describes adjustment of living things to other living things and the environment. Developmental theory describes maturation of humans through stages.

A nurse is developing a foreground question for nursing research using the PICO model. Which component would be represented by the statement, "a 45-year-old male with coronary heart disease and atrial fibrillation"?

P When using PICO, the "P" stands for the patient or problem and its delineation. The "I" signifies the intervention considered; "C" denotes comparison if appropriate, or it may be optional; and "O" represents the outcome of interest or relevant outcomes.

The second step in implementation of evidence-based practice includes systematic review. In order to complete a systematic review of the literature the nurse must do which of the following?

Summarize findings from multiple studies that are related to a particular nursing practice.

A nurse researcher develops a foreground question in preparation for conducting a research study. The question is: "In clients with intravenous catheters, how does replacing administration sets every 72 hours (h) compared to other frequent intervals (24h, 48h, or 96h) decrease infection rates?" Applying the PICO framework, which part of the statement reflects the "O"?

decrease infection The "O" of PICO indicates the outcome, which in this instance is "decrease infection." The "P" refers to patients with intravenous catheter; "I" refers to replacing administration set every 72 hours; "C" refers to replacing it at other frequencies.

A group of nurses is planning to investigate the effectiveness of turning immobilized stroke clients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which of the following will the "O" in the team's PICO question refer to?

preventing skin breakdown Within the PICO question framework, the "O" denotes the outcome of interest. In this case, the desired outcome is the prevention of skin breakdown. Stroke clients are the "P," or population of interest, while turning clients more frequently is the "I," or intervention. The current turning schedule is the "C," referring to the comparison of interest.

A nurse has received a doctoral degree from a research oriented educational program. Which activities would this nurse be able to perform? Select all that apply.

uses analytic and empirical methods to modify existing scientific knowledge so that the knowledge is relevant to nursing develops methods for scientific inquiry of phenomena related to nursing A nurse prepared at the doctoral level from a research-oriented program would be able to use analytic and empirical methods to discover ways to modify or extend existing scientific knowledge so it is relevant to nursing, and would also be able to develop methods for scientific inquiry of phenomena relevant to nursing. A nurse prepared at the doctoral level from a practice-oriented program would be able to provide leadership for the integration of scientific knowledge with other sources of knowledge for the advancement of practice, and also would be able to conduct investigations to evaluate the contribution of nursing activities to the well-being of clients. A nurse prepared at the master's level would conduct investigations for the purpose of monitoring the quality of the practice of nursing in a clinical setting.

In today's healthcare environment nurses use theories to guide all stages of the nursing process. Which of the following are examples of ways that a nurse can utilize theories to guide client care? (Select all that apply.)

• Collect client data. • Organize client information. • Classify client data. • Analyze client situations.

Nursing theories are important as they are all directed toward improved client care. Which of the following are goals of nursing theory? (Select all that apply.)

• Provides knowledge and a rationale for client interventions • Provides a rationale for appropriate nursing actions in a given situation • Identifies and defines concepts that are important to nursing • Increases the nursing body of knowledge

A nurse is writing an article for a nursing journal describing a study of the emergency protocols in a hospital emergency department. Which statements accurately describe elements of this process? (Select all that apply.)

• The introduction reviews the literature and states the purpose of the article. • The method section provides details of how the study was conducted. • The results are often presented in words, charts, tables, or graphs.

The nursing instructor is discussing nursing theories and concepts with a group of nursing students in a fundamentals course. In guiding the thoughts and understanding of concepts, the instructor discusses nursing concepts specifically. The purpose of concepts in nursing practice include which of the following? (Select all that apply.)

• Guide the steps of the nursing process. • Suggest appropriate nursing interventions. • Serve in the determination of what information is relevant related to a specific client issue. • Suggest appropriate nursing outcomes for a client.

Nurses in an ICU noticed that their clients required fewer interventions for pain when the ICU was quiet. They then asked a researcher to design a study about the effects of noise on the pain levels of hospitalized clients. How does this demonstrate the ultimate goal of expanding the nursing body of knowledge?

Nursing research helps improve ways to promote and maintain health.

A nurse researcher must decide on the method for conducting the research. The researcher that plans to emphasize collection of numerical data and analysis would select which method of research?

Quantitative research Quantitative research utilizes numerical values and statistical analysis of data. Basic research is utilized to generate or refine theory. Applied research is utilized for its application in clinical practice. The stem of the question did not provide information as to the application of the study. Qualitative research utilizes words or narrative for data rather than numbers.

A nurse is discussing dietary issues with a Latino client in the clinic. The client states, "My grandmother always told me that I needed to include beans in my diet so that my muscles would grow." The information that the client is expressing is known as what?

Traditional knowledge Traditional knowledge is known as knowledge that is passed down from one generation to the next. A grandmother passing information is an example of traditional knowledge. Authoritative knowledge is information that is gleaned from an expert based on their perceived experience. Scientific knowledge is derived through the scientific method. Philosophy is the study of wisdom and one perceptions of life.

A nurse manager is using the AACN PEARL tool as a resource in a hospital setting. Which statements describe examples of the chief focus of this resource? (Select all that apply.)

• The nurse uses PEARL to plan change initiatives for the unit. • The nurse uses PEARL to find tools to improve patient outcomes. • The nurse uses PEARL to share critical learning with staff.

The nursing instructor is teaching about nursing theories. Students are asked to identify facts related to nursing theory. Which of the following facts are true regarding nursing theory? (Select all that apply.)

• The ultimate outcome for nursing theory is improved client care. • Nursing theory provides a rationale for the care that nurses provide. • Nursing theories may be descriptive or prescriptive. • Nursing theory provides a focus for care that is delivered to clients. Nursing theories should be written in simple and practical language so that the information can be translated to the bedside. Therefore, nurses at all educational levels should have a basic knowledge of nursing theory. All of the other choices are true of nursing theory.

As a researcher begins to form plans for a research project the researcher must decide on the method for conducting the research. The nurse researcher that plans to emphasize collection data and the analyses for the purpose of creating a new theory would select which of the following methods of research?

Basic research Basic research is utilized to generate or refine theory. Applied research is utilized for its application in clinical practice. Qualitative research utilizes words or narrative for data rather than numbers. Quantitative research utilizes numerical values and statistical analysis of data.

The evolution of nursing research has significant markers in time. Place the following events in the correct order.

Florence Nightingale kept records while caring for victims of the Crimean War. Nursing research was deemed to be increasingly important, and research was utilized for the development of nursing practice standards. Clinical research became the emphasis of nursing research resulting in procedures for primary client care, such as vital signs and treatments. The National Institute for Nursing Research funded research for the scientific basis for client care.

A nurse's personal philosophy is developed by learning through which of the following? (Select all that apply.)

• Interpersonal relationships • Formal and informal education • Religion and culture • Environment