Chapter 2. Evidence-Based Practice

MULTIPLE CHOICE

	1.	The nurse working in a radiation oncology department wants to reduce the incidence of skin breakdown in patients who receive beam radiation. Which question should the nurse use to guide a literature search about this topic?
1.	How often do patients with beam radiation experience skin breakdown?	
2.	Why do patients who get radiation beam therapy have skin breakdown?	
3.	What nursing interventions minimize the occurrence of skin breakdown in patients receiving beam radiation?	
4.	How does our rate of skin breakdown in patients receiving beam radiation compare to other institutions in the city?	

ANS:	3
Chapter: Chapter 2 Evidence-Based Practice 
Objective: 4. Describe the EBP process.
Page: 10
Heading: Step 1: Ask the Burning Question
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: PHYS: Reduction of Risk Potential 
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice 
Difficulty: Moderate

	Feedback	
1	The frequency of skin breakdown and why patients develop skin breakdown does not help identify ways to prevent skin breakdown.	
2	The frequency of skin breakdown and why patients develop skin breakdown does not help identify ways to prevent skin breakdown.	
3	Asking a burning clinical question is the first step in the evidence-based practice (EBP) process. It is important to include related factors in the question and to focus on nursing interventions and care. In this situation, the nurse should focus on nursing care that may reduce the occurrence of skin breakdown for the specific patient population of interest.	
4	Information on statistics from other organizations will not help the nurse identify ways to prevent skin breakdown.	

PTS:	1	CON:	Evidence-Based Practice

	2.	A licensed practical nurse (LPN) working on the pediatric floor is interested in improving patient outcomes for children with asthma. Which clinical question would best guide the nurse’s next steps?
1.	How many patients with asthma have a pet dog or cat?	
2.	What is the monthly admission rate of patients with asthma to the unit?	
3.	What patient education materials are available to address effective management of asthma in pediatric patients?	
4.	How has the occurrence rate of asthma in children under the age of 5 changed since the hospital instituted a no smoking policy for the hospital grounds?	

ANS:	3
Chapter: Chapter 2 Evidence-Based Practice
Objective: 4. Describe the EBP process.
Page: 11
Heading: Step 1: Ask the Burning Question
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Information about pets, admission rates of patients with asthma, and asthma occurrence since the implementation of a no smoking policy will not help improve patient outcomes for children with asthma.	
2	Information about pets, admission rates of patients with asthma, an asthma occurrence since the implementation of a no smoking policy will not help improve patient outcomes for children with asthma.	
3	Asking a burning clinical question is the first step in the EBP process. It is important to include related factors in the question and to focus on nursing interventions and care. For this scenario, the nurse would focus on nursing care that affects patient outcomes for the specific patient population of interest. Patient education is a critical component of nursing care.	
4	Information about pets, admission rates of patients with asthma, and asthma occurrence since the implementation of a no smoking policy will not help improve patient outcomes for children with asthma.	

PTS:	1	CON:	Evidence-Based Practice

	3.	The nurse is preparing to give oral care to a patient receiving tube feedings. Which approach should the nurse use to provide care that is based on EBP?
1.	Use a soft toothbrush and toothpaste to brush the teeth.	
2.	Have the patient use swish-and-swallow Nystatin twice a day.	
3.	Increase oral suctioning to every 2 hours using toothette suction devices.	
4.	Use mouthwash and toothettes to swab the teeth and mouth three times a day.	

ANS:	1
Chapter: Chapter 2 Evidence-Based Practice
Objective: 3. Explain how to identify nursing evidence that should be put into practice.
Page: 12
Heading: Step 3: Think Critically
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: PHYS: Basic Care and Comfort
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Evidence-based information shows the use of toothbrushes for oral care is much more effective than foam swabs in removing plaque from the teeth.	
2	Swish-and-swallow Nystatin is a medication that treats oral thrush and is not routinely used to provide oral care.	
3	Oral suctioning is not an approach to provide oral care.	
4	Toothettes are not an effective mechanism for providing oral care.	

PTS:	1	CON:	Evidence-Based Practice

	4.	The nurse is reviewing four articles for research and notes the evidence presented in one article is weaker than the others. Which level of research is the nurse most likely reviewing?
1.	Level I	
2.	Level II	
3.	Level III	
4.	Level IV	

ANS:	4
Chapter: Chapter 2 Evidence-Based Practice
Objective: 3. Explain how to identify nursing evidence that should be put into practice.
Page: 11
Heading: Identifying Nursing Evidence
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordination of Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Easy

	Feedback	
1	The rating scale used to level the quality of evidence ranges form level I (strongest) to level IV (weakest). 	
2	 The rating scale used to level the quality of evidence ranges form level I (strongest) to level IV (weakest).	
3	 The rating scale used to level the quality of evidence ranges form level I (strongest) to level IV (weakest). 	
4	 The rating scale used to level the quality of evidence ranges form level I (strongest) to level IV (weakest).	

PTS:	1	CON:	Evidence-Based Practice

	5.	The nurse working on an oncology unit wants to know if it is best practice to clean a central line in a circular motion or a back-and-forth motion. What action should the nurse take first?
1.	Ask the physicians what they think is best.	
2.	Ask the patient what their preference is.	
3.	Develop a research question to guide a literature search.	
4.	Continue performing the procedure per hospital policy.	

ANS:	3
Chapter: Chapter 2 Evidence-Based Practice
Objective: 4. Describe the EBP process.
Page: 11
Heading: Step 1: Ask the Burning Question
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Physicians do not determine best practice.	
2	The patient’s preference may not be reflective of what is best practice.	
3	The nurse should formulate a question to guide a literature search to determine the best practice for cleaning a central line.	
4	The nurse should not take no action—the current practice may not be the best practice.	

PTS:	1	CON:	Evidence-Based Practice

	6.	A group of nurses conducted a pilot study about implementing a team to turn patients every hour to prevent skin breakdown. The results proved the intervention to be a success. What step should the nurses take next to implement the turn team hospital wide?
1.	Educate individuals in the facility about implementing the change hospital wide.	
2.	Collect evidence to support implementation of a turn team.	
3.	Plan a pilot study to determine if implementing a turn team will reduce skin breakdown.	
4.	Propose the change to a policy and procedure committee.	

ANS:	1
Chapter: Chapter 2 Evidence-Based Practice
Objective: 4. Describe the EBP process.
Page: 13
Heading: Step 5: Make It Happen
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: PHYS: Reduction of Risk Potential 
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice 
Difficulty: Moderate

	Feedback	
1	Since turning a patient is an independent nursing intervention, a literature review has been conducted, and a pilot study has been implemented where results have been proved to be successful, the next step is to educate other nurses in the facility about how to implement the turn team. 	
2	A literature review has already been done. 	
3	A pilot study has already been conducted.	
4	Since turning patients is an independent nursing intervention, it is not required to go to a committee for policy and procedure change.	

PTS:	1	CON:	Evidence-Based Practice

	7.	A nursing student asks the registered nurse (RN) preceptor why EBP is important. How should the nurse respond to the student?
1.	“EBP makes nursing more professional.”	
2.	“EBP helps ensure we can demand more pay.”	
3.	“EBP helps validate the difference nurses really make.”	
4.	“EBP guides nursing decisions to optimize effective care.”	

ANS:	4
Chapter: Chapter 2 Evidence-Based Practice
Objective: 2. Discuss why EBP should be used. 
Page: 11
Heading: Reasons For Using EBP
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	EBP is not used to support professionalism in nursing or as a mechanism to increase nurses’ salaries.	
2	EBP is not used to support professionalism in nursing or as a mechanism to increase nurses’ salaries.	
3	EBP is not used to validate the importance of nursing care.	
4	Evidence-based nursing practice is much more than just evaluating research studies to determine what results to apply to nursing practice. Evidence-based nursing practice is a systematic process that utilizes current evidence to make decisions about the care of patients, including evaluation of quality and applicability of existing research, patient preferences, costs, clinical expertise, and clinical settings.	

PTS:	1	CON:	Evidence-Based Practice

	8.	The nurse is reviewing a proposal for changing the type of needleless systems currently used to administer IV medications in the hospital. Which part of the proposal most effectively supports the proposed change?
1.	A pilot study is planned.	
2.	Two cases of staff injury related to needle sticks have occurred in the past 3 years.	
3.	A single randomized clinical trial is cited as evidence to support the new policy.	
4.	The supporting evidence includes research conducted at an outpatient hematology center.	

ANS:	1
Chapter: Chapter 2 Evidence-Based Practice
Objective: 5. List the six steps of EBP.
Page: 12
Heading: Step 4: Measure Outcomes Before and After Change
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Difficult

	Feedback	
1	A small pilot study is typically done before an institute-wide change is made. 	
2	This would not be a statistically significant number to support the need for change.	
3	More evidence or evidence of a higher level would better support the proposed change.	
4	It is important to consider the context in which the evidence will be used, and research involving a population similar to that of the nurse’s institution is helpful.	

PTS:	1	CON:	Evidence-Based Practice

	9.	The nurse is planning a Quality and Safety Education for Nurses (QSEN) project to focus on informatics. Which would the nurse include in this project?
1.	Collecting data on repeat admissions	
2.	Implementing a medication barcode system	
3.	Collaborating with a pharmacist about medication reconciliation	
4.	Including the patient in a care plan meeting	

ANS:	2
Chapter: Chapter 2 Evidence-Based Practice
Objective: 8. Describe how the Quality and Safety Education for Nurses (QSEN) project can promote safe patient care.
Page: 12
Heading: Quality and Safety Education for Nurses Project
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordination of Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Collecting data on repeat admissions is an example of quality improvement.	
2	Implementing a medication barcode system is an example of informatics.	
3	Collaborating with a pharmacist about medication reconciliation is an example of teamwork and collaboration.	
4	Including a patient in a care plan meeting demonstrates patient-centered care.	

PTS:	1	CON:	Evidence-Based Practice

	10.	The nurse is teaching a group of students about implementing EBP to control pain. Which statement best describes understanding of evidence?
1.	“I saw a commercial for pain medication that works well.”	
2.	“The patient has chronic pain and will need more medication.”	
3.	“We could give this patient Morphine every 4 hours. It works for the other patient.”	
4.	“There are studies that prove nonpharmacological methods can relieve pain.”	

ANS:	4
Chapter: Chapter 2 Evidence-Based Practice
Objective: 1. Define evidence-based practice (EBP) and evidence-informed practice.
Page: 12
Heading: Reasons For Using EBP
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Watching a commercial does not demonstrate an understanding of evidence.	
2	Not all patients who experience chronic pain need more medication; this statement does not demonstrate an understanding of evidence.	
3	Just because a drug regimen works for one patient does not mean it will work for another. This statement does not demonstrate evidence. 	
4	Basing care on studies demonstrates an understanding of evidence. 	

PTS:	1	CON:	Evidence-Based Practice

	11.	A licensed practical nurse/licensed vocational nurse (LPN/LVN) is preparing to insert an indwelling urinary catheter. The policy states to test the balloon before inserting the catheter, although evidence supports not testing the balloon. Which action should the nurse take?
1.	Continue to test the balloon per hospital policy.	
2.	Refuse to insert the catheter until policy is changed.	
3.	Conduct a literature search and present the literature to the policy committee.	
4.	Begin the practice of not testing the balloon when inserting urinary catheters.	

ANS:	3
Chapter: Chapter 2 Evidence-Based Practice 
Objective: 4. Describe the EBP process.
Page: 12
Heading: Step 2: Search for and Collect the Most Relevant and Best Evidence Available
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Safety and Infection Control
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Difficult

	Feedback	
1	The nurse is not practicing using evidence if he or she does nothing and continues to follow policy.	
2	The patient needs an indwelling urinary catheter, so refusing to complete the procedure is not beneficial to the patient.	
3	The nurse should review the literature and present the literature to the policy review committee for an update to the current policy.	
4	The nurse still needs to follow policy and should first present information to the policy committee.	

PTS:	1	CON:	Evidence-Based Practice

	12.	The nurse is providing diabetic education to a patient with a low literacy level. Which statement best promotes health literacy?
1.	“You will frequently rotate sites when administering insulin.”	
2.	“You will need to self-administer insulin subcutaneously.”	
3.	“If you experience hypoglycemia, consume 15 grams of carbohydrates.”	
4.	“You will need to call your doctor if your blood sugar is over 300.”	

ANS:	4
Chapter: Chapter 2 Evidence-Based Practice 
Objective: 7. Explain health literacy.
Page: 14
Heading: Health Literacy
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	This statement has big words and may not be understood by a patient with low health literacy.	
2	This statement has medical terminology that may not be understood by a patient with low health literacy.	
3	This statement has medical terminology that may not be understood by a patient with low health literacy.	
4	This statement uses smaller words, avoids medical jargon, and is most likely to be understood by a patient with low health literacy.	

PTS:	1	CON:	Evidence-Based Practice

	13.	The nurse wants to conduct a pilot study on frequency of readmission for patients with heart failure. Which question should the nurse use to guide a literature review?
1.	“What can nurses do to improve hospital readmission rates for patients with heart failure?”	
2.	“What causes patients with heart failure to have repeat admissions?”	
3.	“Why do patients with heart failure have a high incidence of readmission?”	
4.	“How often are patients with heart failure readmitted?”	

ANS:	4
Chapter: Chapter 2 Evidence-Based Practice
Objective: 4. Describe the EBP process.
Page: 14
Heading: Step 1: Ask the Burning Question
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	The nurse is wanting to look at frequency of readmission rates for patients with heart failure. Asking what nurses can do to improve rates of readmission does not relate to frequency of readmission. 	
2	A question asking about the cause of readmission rates for patients with heart failure does not relate to frequency of readmissions.	
3	A question asking why patients have a high incidence of readmission does not relate to frequency of readmissions.	
4	A question asking how often patients with heart failure are readmitted is an appropriate question.	

PTS:	1	CON:	Evidence-Based Practice

	14.	While reviewing a patient care assignment with an unlicensed assistive personnel (UAP), the nurse explains the reason for turning and repositioning a patient every 2 hours. Why did the nursing include this information?
1.	Ensures that evidence-based care is provided	
2.	Guarantees that the patient will receive morning care	
3.	Helps a UAP focus on the action being performed	
4.	Helps a UAP with time management of tasks to complete	

ANS:	1
Chapter: Chapter 2 Evidence-Based Practice
Objective: 2. Discuss why EBP should be used.
Page: 14
Heading: Reasons For Using EBP
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Analysis (Analyzing)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Evidence-based care should be given at all times, if possible, and in all settings where nursing care is given. A way to ensure that evidence-based care is provided is to explain why the care should be given at the time the care is delegated.	
2	Explaining the reason for the care is not done to guarantee that the patient will receive morning care, help the UAP focus on actions, or help with time management.	
3	Explaining the reason for the care is not done to guarantee that the patient will receive morning care, help the UAP focus on actions, or help with time management.	
4	Explaining the reason for the care is not done to guarantee that the patient will receive morning care, help the UAP focus on actions, or help with time management.	

PTS:	1	CON:	Evidence-Based Practice

	15.	A low health literacy level can lead to which outcome?
1.	Improved self-esteem	
2.	Poor health outcome	
3.	Low health care cost	
4.	Decrease in hospitalizations	

ANS:	2
Chapter: Chapter 2 Evidence-Based Practice
Objective: 7. Explain health literacy.
Page: 14
Heading: Health Literacy 
Integrated Process: Teaching/Learning
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application (Applying)
Concept: Communication
Difficulty: Moderate

	Feedback	
1	The patient will experience a decrease in self-esteem, not an increase.	
2	Poor health outcomes are common in patients with low health literacy.	
3	A patient with low health literacy will experience an increase in health care cost.	
4	A patient with low health literacy will experience an increase in hospitalizations.	

PTS:	1	CON:	Communication		

	16.	The nurse is working on ensuring all care plans are individualized to meet each patient’s specific needs. This focuses on which area of QSEN?
1.	Evidence-Based Practice	
2.	Safety	
3.	Patient-Centered Care	
4.	Informatics	

ANS:	3
Chapter: Chapter 2 Evidence-Based Practice
Objective: 8. Describe how the Quality and Safety Education for Nurses (QSEN) project can promote safe patient care. 
Page: 14
Heading: Quality and Safety Education for Nurses Project
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1	Evidence-based practice is not specific to providing individualized patient care.	
2	Safety is not specific to providing individualized patient care.	
3	Patient-centered care is ensuring the care plan is individualized to meet the patient’s needs and schedules rather than those of the institution or caregiver.	
4	Informatics is not specific to providing individualized patient care.	

PTS:	1	CON:	Evidence-Based Practice

MULTIPLE RESPONSE

	1.	The nurse works in a clinic where many of the patients did not attend school beyond elementary level. What interventions can the nurse implement to promote health literacy for this particular group? (Select all that apply.)
1.	Ask an interpreter to explain the material.	
2.	Provide easy-to-understand written materials.	
3.	Use video or computer for learning purposes.	
4.	Encourage the patient to attend speech therapy.	
5.	Provide brochures with pictured instructions.	

ANS:	2, 3, 5
Chapter: Chapter 2 Evidence-Based Practice
Objective: 7. Explain health literacy.
Page: 14
Heading: HEALTH LITERACY
Integrated Process: Teaching/Learning
Client Need: Health Promotion and Maintenance 
Cognitive Level: Analysis (Analyzing)
Concept: Communication 
Difficulty: Difficult

	Feedback	
1.	The patients read at a low level; an interpreter will not resolve this issue. 	
2.	Providing easy-to-understand written materials will promote health literacy.	
3. 	Use of a video or computer to provide teaching is a technique to promote health literacy.	
4.	Speech therapy is not a method used to promote health literacy. 	
5.	Providing brochures with pictures may be effective since the patients may read at a low level.	

PTS:	1	CON:	Communication		

	2.	The nurse is working with a committee to determine EBP approaches for patient care. Which steps will the committee members include when determining EBP? (Select all that apply.)
1.	Evaluate the change.	
2.	Measure the outcome.	
3.	Ask the nursing experts.	
4.	Manipulate current practice.	
5.	Search for the best available evidence.	

ANS:	1, 2, 5
Chapter: Chapter 2 Evidence-Based Practice
Objective: 5. List the six steps of EBP.
Page: 14
Heading: The EBP Process
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1.	The steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. An acronym to remember these steps is ASKMME.	
2.	The steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. An acronym to remember these steps is ASKMME.	
3. 	Asking nursing experts and manipulating current practice are not steps in the EBP process.	
4.	Asking nursing experts and manipulating current practice are not steps in the EBP process.	
5.	The steps in the EBP process are Ask, Search, Think, Measure, Make It Happen, and Evaluate. An acronym to remember these steps is ASKMME.	

PTS:	1	CON:	Evidence-Based Practice

	3.	The nurse is implementing the QSEN focus of patient-centered care. Which nursing actions support this focus? (Select all that apply.)
1.	Individualize interventions.	
2.	Schedule interventions to meet the patient’s needs.	
3.	Evaluate interventions for applicability to the patient.	
4.	Scan prescribed medications using the bar-coding system.	
5.	Document responses to treatment in the electronic medical record.	

ANS:	1, 2, 3
Chapter: Chapter 2 Evidence-Based Practice
Objective: 8. Describe how the Quality and Safety Education for Nurses project can promote safe patient care. 
Page: 14
Heading: Quality and Safety Education for Nurses Project 
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Analysis (Analyzing)
Concept: Evidence-Based Practice
Difficulty: Moderate

	Feedback	
1.	When collaborating on the development of nursing care plans, it is important to individualize interventions to provide patient-centered care.	
2.	As nursing interventions are performed, they should meet the patient’s preferred schedules.	
3. 	Nurses should always evaluate each suggested intervention to see if it fits the patient.	
4.	Scanning medication using a bar-coding system and documenting in the electronic medical record are actions that support the focus of informatics.	
5.	Scanning medication using a bar-coding system and documenting in the electronic medical record are actions that support the focus of informatics.	

PTS:	1	CON:	Evidence-Based Practice

ORDERED RESPONSE

	1.	List in order the six steps of EBP using 1 through 6. 
____Search for and collect relevant evidence.
____Think critically.
____Ask the burning question.
____Make it happen.
____Evaluate the practice change.
____Measure outcomes before and after change.

ANS:	
2, 3, 1, 5, 6, 4 
Chapter: Chapter 2: Evidence-Based Practice
Objective: 5. List the six steps of EBP.
Page: 11
Heading: The EBP Process
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: SECE: Coordinated Care
Cognitive Level: Application (Applying)
Concept: Evidence-Based Practice 
Difficulty: Moderate

Feedback: Step 1: Ask the burning question: What do you want to know? Step 2: Search for and collect relevant and best evidence available. Step 3: Think critically: Appraise the evidence you find for validity, relevance to the situation, and applicability. Step 4: Measure outcomes before and after change. Step 5: Make it happen: Implement the desired change. Step 6: Evaluate the practice change to determine if it made a significant difference.

PTS:	1	CON:	Evidence-Based Practice