Chapter 14: Outcomes Research My Nursing Test Banks

Chapter 14: Outcomes Research

Grove: Understanding Nursing Research, 6th Edition

MULTIPLE CHOICE

1. The goal of outcomes research is to:

a.

determine the most cost-effective nursing interventions in patient care.

b.

examine the end results of patient care from various health interventions.

c.

help providers make end-of-life decisions about patient care.

d.

improve patient satisfaction with nursing care.

ANS: B

Feedback

A

Cost-effectiveness is one possible outcome, but other patient outcomes may be more important.

B

Outcomes research focuses on the end results of health care practices and interventions.

C

Outcomes research is not solely about end-of-life care and is not focused on end-of-life decision making.

D

Patient satisfaction is one result but is not the goal of all outcomes research.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: p. 467

2. What is the key construct in Donabedians theory of outcomes research?

a.

Efficiency of health care delivery

b.

Healthy outcomes

c.

Professional accountability

d.

Quality of care

ANS: D

Feedback

A

Efficiency, healthy outcomes, and professional accountability all may be examined during outcomes research, but none of these is the key construct.

B

Efficiency, healthy outcomes, and professional accountability all may be examined during outcomes research, but none of these is the key construct.

C

Efficiency, healthy outcomes, and professional accountability all may be examined during outcomes research, but none of these is the key construct.

D

Quality of care is the overriding construct of Donabedians theory of outcomes research.

PTS: 1 DIF: Cognitive level: Remembering (Knowledge)

REF: pp. 468-469

3. Which is an example of a type of nursing service that might be evaluated in outcomes research?

a.

Application of wound care products

b.

Clinical care protocol implementation

c.

Glucose monitoring for newly diagnosed diabetics

d.

Using a Braden Scale for skin assessment

ANS: B

Feedback

A

Application of products, monitoring patient status, and using measurement scales are all examples of nursing interventions.

B

Nursing services can include staffing and education of nurses as well as implementation of protocols and standards of care.

C

Application of products, monitoring patient status, and using measurement scales are all examples of nursing interventions.

D

Application of products, monitoring patient status, and using measurement scales are all examples of nursing interventions.

PTS: 1 DIF: Cognitive level: Remembering (Knowledge)

REF: pp. 468-469

4. Which would be an example of an interdependent role for nurses in the Nursing Role and Effectiveness Model?

a.

Administering a medication to a patient

b.

Arranging for home health care services

c.

Initiating a fall risk protocol

d.

Performing an admission assessment

ANS: B

Feedback

A

Dependent role functions include execution of medical orders and physician-initiated treatments.

B

Interdependent role functions in the Nursing Role Effectiveness Model include communication, case management, and coordination of care.

C

Dependent role functions include execution of medical orders and physician-initiated treatments.

D

Independent role functions include assessment, diagnosis, and nursing-initiated treatments.

PTS:1DIF:Cognitive level: Applying (Application)

REF: pp. 469-470

5. In an outcome study, a researcher demonstrates a link between the number of mothers who successfully breastfeed their infants and the number of maternal-child nurses who are baccalaureate prepared. This illustrates:

a.

interdependent nursing role functions.

b.

nursing-sensitive patient outcomes.

c.

patient-sensitive outcomes.

d.

the Nursing Role Effectiveness Model.

ANS: B

Feedback

A

Interdependent nursing functions are those that include both nurse-initiated and physician-initiated treatments.

B

Outcomes that are nursing sensitive are those that are influenced by nursing care decisions and actions as well as those associated with nursing staffing, education, and assignments.

C

Patient-sensitive outcomes are those that are influenced by different aspects of patients, such as age, gender, or disease process.

D

The Nursing Role Effectiveness Model examines outcomes that are nursing sensitive.

PTS:1DIF:Cognitive level: Applying (Application)

REF: pp. 471-472

6. The development of the Uniform Hospital Discharge Data Set and the Universal Minimum Health Data Set was helped by:

a.

establishing guidelines for outcomes research.

b.

identifying the contribution of nursing care to patient outcomes.

c.

prescribing data elements to be monitored in outcomes research.

d.

reporting financial and statistical data from hospitals.

ANS: C

Feedback

A

The data sets helped facilitate standards about data elements but did not establish guidelines for outcomes research.

B

The Nursing Role Effectiveness Model helped to identify the contribution of nursing care to patient outcomes.

C

The data sets facilitated consistency in data collection among health care organizations by prescribing the data elements to be gathered.

D

The Canadian Institute for Health Information established a reporting system to report financial and statistical data from hospitals.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: p. 472

7. Which government agency supports research to improve the outcomes and quality of health care?

a.

AHRQ

b.

ARRA

c.

CIHI

d.

FDA

ANS: A

Feedback

A

The Agency of Healthcare Research and Quality (AHRQ) supports research designed to improve the outcomes and quality of health care.

B

The American Recovery and Reinvestment Act (ARRA) is not a government agency; funding from this act allowed AHRQ to expand its work in support of comparative effectiveness research.

C

The Canadian Institute for Health Information (CIHI) helped to establish national Canadian standards for collecting and reporting financial and statistical data from health service organizations.

D

The Federal Drug Administration (FDA) regulates the research and distribution of medications.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: p. 472

8. Which organization includes nursing-sensitive outcomes measures in its performance measurement portfolio?

a.

Agency of Healthcare Research and Quality

b.

Department of Health and Human Services

c.

National Guideline Clearinghouse

d.

National Quality Forum

ANS: D

Feedback

A

The Agency of Healthcare Research and Quality supports research designed to improve the outcomes and quality of health care.

B

The Department of Health and Human Services includes the Agency of Healthcare Research and Design.

C

The National Guideline Clearinghouse is a resource for evidence-based guidelines.

D

The National Quality Forum was created as a national standard-setting organization for health care performance measures and includes nursing-sensitive measures in its portfolio.

PTS: 1 DIF: Cognitive level: Remembering (Knowledge)

REF: p. 474

9. The National Quality Forum was established in 1999 for which purpose?

a.

To identify and develop nursing-sensitive quality measures

b.

To support state and health system efforts to implement and evaluate medical liability reform models

c.

To allow the AHRQ to expand its work supporting comparative effectiveness research

d.

To set standards for health care performance measures

ANS: D

Feedback

A

The NDNQI identifies and develops nursing-sensitive quality measures.

B

The AHRQ supports state and health system efforts to implement and evaluate medical liability reform models.

C

The ARRA allows the AHRQ to expand its work supporting comparative effectiveness research.

D

The National Quality Forum sets standards for health care performance measures.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: p. 474

10. To help meet the requirements for Magnet recognition, which organization will a hospital participate in?

a.

The American Nurses Association (ANA)

b.

The Agency of Healthcare Research and Quality (AHRQ)

c.

The National Database of Nursing Quality Indicators (NDNQI)

d.

The National Quality Forum (NQF)

ANS: C

Feedback

A

Although the ANA is the organization that oversees the Magnet Recognition Program, hospitals do not join this organization.

B

The AHRQ supports research designed to improve the outcomes and quality of health care.

C

Participation in NDNQI meets requirements for the Magnet Recognition Program.

D

The NQF was created as a national standard-setting organization for health care performance measures.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 474-475

11. Which is one of the indicators used by the National Database of Nursing Quality Indicators (NDNQI)?

a.

Assessment, intervention, and reassessment of pediatric pain

b.

Clinical Laboratory Improvement Amendment (CLIA) standards

c.

Protocols for monitoring biometric equipment used in hospitals

d.

The number of hours hospital residents work per week

ANS: A

Feedback

A

NDNQI identifies and develops nursing-sensitive quality measures. Assessment, intervention, and reassessment of pediatric pain is one of the indicators it uses.

B

CLIA standards are those applied to hospital laboratory personnel and equipment.

C

Biometric equipment standards are not nursing-sensitive measures.

D

Standards about hospital residents are not nursing-sensitive measures.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 474-475

12. Which is an important finding in outcomes research about Advanced Practice Nursing (APN) practice?

a.

APNs provide care that is equivalent to that provided by doctors at a fraction of the cost.

b.

Care by APNs shows equivalent or improved outcomes to that provided by physicians.

c.

Hospital readmission rates are slightly higher for patients who use APNs for primary care.

d.

The level of patient satisfaction is greater with APNs regardless of clinical outcomes.

ANS: B

Feedback

A

Studies are not reported showing equivalent care at reduced cost.

B

There is abundant research demonstrating the safety and effectiveness of APNs. In a search of all random controlled trials comparing APNs to usual care, findings consistently showed that care by APNs resulted in equivalent or improved outcomes.

C

Studies do not show increased readmission rates.

D

Patient satisfaction is high, but so are positive clinical outcomes.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 476-477

13. What is an important aspect of outcomes research as defined by Donabedian?

a.

Selection of only proximal outcomes in order to streamline outcomes research

b.

The need for patients or recipients of care to define which outcomes are desirable

c.

The need to link outcomes with specific nursing processes

d.

The use of population groups rather than individuals for outcome studies

ANS: C

Feedback

A

Outcomes research involves studies of all outcomes of nursing care.

B

Donabedian does not identify the need to study patient feelings about outcomes or care.

C

In outcomes research, according to Donabedian, there is a need to clearly link identified outcomes with the processes that caused the outcomes.

D

Donabedian does not identify the need to use population groups rather than individuals for outcome studies.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: p. 477

14. Which is an example of a distal outcome in outcomes research?

a.

Glucose monitoring skills in patients receiving diabetic teaching

b.

Hospital readmission rates in patients admitted for myocardial infarction

c.

Pain scores before and after pain medication

d.

Patient perception of tobacco advertising among COPD patients

ANS: D

Feedback

A

Glucose monitoring skills, hospital readmission rates, and pain scores are proximal outcomes because they are related directly to nursing interventions and not to external forces.

B

Glucose monitoring skills, hospital readmission rates, and pain scores are proximal outcomes because they are related directly to nursing interventions and not to external forces.

C

Glucose monitoring skills, hospital readmission rates, and pain scores are proximal outcomes because they are related directly to nursing interventions and not to external forces.

D

A distal outcome is one which is removed from proximity to the care or service received and is more influenced by external (nontreatment) factors. Quality of life is an example of a distal outcome.

PTS:1DIF:Cognitive level: Applying (Application)

REF: p. 478

15. In outcomes research, a Magnet-designated hospital is an example of which type of variable?

a.

Dependent

b.

Intervention

c.

Outcome

d.

Structural

ANS: D

Feedback

A

A dependent variable is one that is affected by manipulation of another variable.

B

An intervention variable is one that is manipulated to examine the effects of this manipulation on a dependent variable.

C

An outcome variable is one that is linked to patient care.

D

Magnet designation indicates certain standards of structure including shared governance, implementation of nursing practice, and autonomy.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 478-479

16. A nurse uses a care map to guide nursing interventions for patients with COPD. This is an example of using:

a.

evidence-based practice.

b.

practice patterns.

c.

practice styles.

d.

standards of care.

ANS: D

Feedback

A

Evidence-based practice includes clinical guidelines, critical paths, and standards of care.

B

A practice pattern is a concept representing the variation in what type of care is provided.

C

A practice style represents variation in how care is provided.

D

A standard of care is a norm according to which quality of care is judged and includes guidelines, critical paths, and care maps.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 480-481

17. What is the role of evidence-based practice in outcomes research?

a.

Evidence-based practice identifies practice standards that can be evaluated using patient outcomes.

b.

Evidence-based practice defines practice styles and patterns used in professional practice.

c.

The standards used in evidence-based practice clearly identify desired patient outcomes.

d.

There is a clear link between evidence-based practice and improved patient outcomes.

ANS: A

Feedback

A

EBP guidelines contain standards and norms against which patient outcomes can be evaluated.

B

Practice styles and patterns represent variations in what type of care and how care is delivered and are part of clinical guidelines.

C

Very few empirical studies have assessed the impact of EBP on patient outcomes.

D

Very few empirical studies have assessed the impact of EBP on patient outcomes.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 480-481

18. What type of sample is generally used in outcomes studies?

a.

Small sample

b.

Heterogeneous sample

c.

Homogeneous sample

d.

Volunteer sample

ANS: B

Feedback

A

A small sample would not provide a heterogeneous sample.

B

Because the target population in outcomes studies is often heterogeneous, it is necessary to obtain large, heterogeneous samples.

C

Typical sampling criteria for outcomes research include obtaining a very large, heterogeneous sample in which all patients have the likelihood of being represented.

D

A volunteer sample is generally not encouraged, as it does not allow for the researcher to influence the sample characteristics.

PTS:1DIF:Cognitive level: Applying (Application)

REF: pp. 481-482

19. Which type of study design is commonly used in outcomes studies?

a.

Phenomenological

b.

Qualitative

c.

Quasi-experimental

d.

Random-control trial

ANS: C

Feedback

A

Phenomenological and qualitative studies do not account for effects of variables on patient outcomes.

B

Phenomenological and qualitative studies do not account for effects of variables on patient outcomes.

C

Quasi-experimental studies and observational research designs are most commonly used for outcomes research to provide effectiveness and efficiency.

D

Random controlled trieals also seek to provide evidence about the effects interventions, but, with outcomes studies, the intervention is not limited to medications or clinical procedures..

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 483-484

20. A researcher identifies a group of Native American subjects who are at risk for type 2 diabetes mellitus and follows this group over time to observe actual rates of acquiring this disease. This is an example of a:

a.

clinical database.

b.

prospective cohort study.

c.

qualitative study.

d.

quasi-experimental study.

ANS: B

Feedback

A

A clinical database is a collection of data about a group of patients.

B

A prospective cohort study is an epidemiologic study in which the researcher identifies a group of people who are at risk for a condition and follows them over time.

C

A qualitative study is a nonexperimental study to examine attributes of a group of subjects.

D

A quasi-experimental study is one in which the researcher has less control over independent variables than in a random controlled trial.

PTS:1DIF:Cognitive level: Applying (Application)

REF: pp. 484-485

21. A nurse identifies an unusual incidence of acute lymphocytic leukemia (ALL) in school-age children in a nearby community and conducts a study to examine exposure to a variety of water pollutants from a local industry. This is an example of a:

a.

phenomenological study.

b.

qualitative study.

c.

prospective cohort study.

d.

retrospective cohort study.

ANS: D

Feedback

A

Qualitative and phenomenological studies are nonexperimental studies to examine attributes of groups of subjects.

B

Qualitative and phenomenological studies are nonexperimental studies to examine attributes of groups of subjects.

C

A prospective cohort study is an epidemiologic study in which the researcher identifies a group of people who are at risk for a condition and follows them over time.

D

A retrospective cohort study is an epidemiologic study in which the researcher identifies a group of people who have experienced a particular event and examines possible previous causes for this event.

PTS:1DIF:Cognitive level: Applying (Application)

REF: pp. 485-486

22. A researcher wishes to widely disseminate findings of outcomes research in order to influence practice in a variety of settings. Which methods might this researcher use?

a.

A series of presentations and publications in professional and public forums

b.

An oral presentation at an international conference

c.

Publication in scholarly, peer-reviewed journals

d.

Writing about this research in a chapter of a nursing textbook

ANS: A

Feedback

A

Employing a series of presentations and publications in many venues is the only approach that achieves a widespread dissemination of the research findings.

B

An open forum for exchange of ideas is excellent but is not sufficient in the eyes of outcomes researchers. Outcomes researchers consider wide dissemination of the results to providers and consumers necessary to promote change in health care practices.

C

Presenting the findings, even at a prestigious conference, is not sufficient in the eyes of outcomes researchers. Outcomes researchers consider wide dissemination of the results to providers and consumers necessary to promote change in health care practices.

D

Outcomes researchers consider wide dissemination of the results to providers and consumers necessary to promote change in health care practices.

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 494-495

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