Chapter 4: Evidence-Based Psychiatric Nursing Practice My Nursing Test Banks

Chapter 4: Evidence-Based Psychiatric Nursing Practice

Test Bank

MULTIPLE CHOICE

1. Which statement could a nurse use in an argument to support evidence-based psychiatric nursing practice?

a.

Licensing helps ensure effective clinicians.

b.

Clinical supervision results in more effective clinicians.

c.

It is unreliable to make generalized assumptions of patients based on only a small sample.

d.

Information gathered by clinical means tends to be in the form of systematic observations.

ANS: C

Little research has been done to examine psychiatric nursing practice patterns, evaluate the nature of the data supporting them, and demonstrate sound clinical decision making in a way that can be empirically supported. Psychiatric nursing currently relies on opinion-based processes and unproved theories.

DIF: Cognitive Level: Application REF: Text Page: 58

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. Which nursing activities are necessary to provide evidence-based psychiatric nursing care?

a.

Obtaining advanced degrees and providing clinical supervision for peers

b.

Seeking sound opinion-based processes and maintaining self-directed practice

c.

Attending educational programs and supporting the advanced practice licensure

d.

Critically synthesizing research findings and applying relevant evidence to practice

ANS: D

Providing evidence-based practice requires searching the research literature, critically synthesizing research findings, and applying relevant evidence to practice. The other activities are myths about what makes effective practitioners.

DIF: Cognitive Level: Application REF: Text Page: 58

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

3. To substantiate clinical practice the psychiatric nurse should place the greatest reliance on the _____ basis.

a.

traditional

b.

regulatory

c.

evidence

d.

philosophical/conceptual

ANS: C

Evidence-based practice includes research findings, performance data, and consensus recommendations of recognized experts. Apart from situations requiring a regulatory basis, the best basis to substantiate clinical practice is the evidence of well-established research findings. Such evidence reflects verifiable, replicable facts and relationships that have been exposed to stringent scientific criteria.

DIF: Cognitive Level: Comprehension REF: Text Page: 58

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

4. Which activity will be most useful to a nurse wishing to provide evidence-based psychiatric nursing care?

a.

Relying on findings of one properly designed, randomized, controlled trial

b.

Using a protocol from several well-designed, cohort, quasiexperimental studies

c.

Seeking sound, opinion-based processes and maintaining self-directed practice

d.

Applying findings from a meta-analysis of relevant randomized, controlled trials

ANS: D

In the hierarchy of research evidence, a meta-analysis of all relevant randomized, controlled trials will give the nurse the highest quality information.

DIF: Cognitive Level: Application REF: Text Page: 60

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. A nurse is developing a set of practice guidelines for a clinical unit and is conducting a literature review to search for examples of criteria that will be relevant to achieving patient-care goals. The search criteria that will be most relevant are those that:

a.

explain their complexity in detail.

b.

include reduced costs as a major criterion for use.

c.

document preferred practices among other mental health professionals.

d.

provide methods and procedures that ensure safe and effective treatment.

ANS: D

Safety and effective care are two important characteristics in the development of practice guidelines. Reduced cost and complexity are not considerations, whereas preferred practice is a criterion but is of lesser relevance.

DIF: Cognitive Level: Application REF: Text Page: 60

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. A nurse working at a facility that has just introduced the use of clinical pathways must understand that clinical pathways:

a.

do not require quality monitoring.

b.

are more specific than clinical algorithms.

c.

do not depend on an interdisciplinary approach.

d.

are maps with timetables for patient care delivery.

ANS: D

Clinical pathways identify the key clinical processes and corresponding timelines to which a patient must adhere to achieve standard outcomes within a specified period of time. They require quality monitoring and interdisciplinary cooperation, and they are less specific than clinical algorithms.

DIF: Cognitive Level: Comprehension REF: Text Page: 61

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. Nurses are easily oriented to the use of algorithms because they are familiar with the format of:

a.

tables.

b.

free text.

c.

flow charts.

d.

nursing notes.

ANS: C

Many algorithms are represented by flowcharts that identify what clinical process might follow from a patients clinical status and response to prior treatments and provide statements of what to do if treatment is not effective. Many nurses are familiar with flowcharts because they are commonly used in nursing documentation.

DIF: Cognitive Level: Application REF: Text Page: 62

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. To what extent is outcome measurement important to the delivery of psychiatric nursing care?

a.

It is more nice than it is necessary.

b.

It will support the legitimacy of psychiatric nursing.

c.

It will promote descriptive and correlational nursing research.

d.

It gives information about the appropriate settings for treatment.

ANS: B

Currently no research evidence supports the important contributions psychiatric nurses make to positive patient outcomes. Without such evidence, psychiatric nursing services can be deemed to be cost ineffective and therefore unnecessary.

DIF: Cognitive Level: Comprehension REF: Text Pages: 52-53

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. For psychiatric nurses, an essential part of outcome measurement is the:

a.

development of practice guidelines.

b.

systematic review of research literature.

c.

systematic use of reliable patient-rating scales.

d.

identification of the core knowledge and skills of psychiatric nurses.

ANS: C

Each of the options listed above is important to evidence-based nursing practice, but only the use of rating scales directly relates to outcome measurement.

DIF: Cognitive Level: Application REF: Text Pages: 63-64

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. The psychiatric nurse uses evidence-based practice as a means to better meet patients needs. The most current source of nursing research is:

a.

textbooks.

b.

journal articles.

c.

the DSM-IV-TR.

d.

databases of systematic reviews.

ANS: D

Textbooks become outdated, as do nursing journal articles. The DSM-IV-TR is also like a textbook and is updated only periodically. The only correct answer is to find current relevant information by using electronic databases, which is the most current method for research indicated.

DIF: Cognitive Level: Application REF: Text Page: 64

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

11. The psychiatric nurse is preparing discharge information for a patient diagnosed with schizophrenia. Knowing that the patient will be discharged to a home shared with the patients elderly parents, you want to develop evidence-based care for the patient. You will first:

a.

identify the major support person for the patient.

b.

define the patients current acute clinical problems.

c.

help the patient to find appropriate, attainable employment.

d.

help the patient to be reoriented to living outside a locked psychiatric unit.

ANS: B

Defining the clinical problem for this patient is the first step in evidence-based care. All other options can be useful to the patients future care, but with evidence-based care, it is most important to have a clear question to identify the clinical problems, identify the existing nursing interventions, and specify the expected outcome.

DIF: Cognitive Level: Application REF: Text Page: 59

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

12. A patient is scheduled to be discharged from the locked inpatient psychiatric unit. In order to best evaluate the appropriateness of the patients care the nurse:

a.

brings the care plan and ongoing documentation to an interdisciplinary team meeting, where the patients progression towards discharge will be discussed.

b.

gathers evidence from the chart that shows progression in the patients medical condition to prepare for the evaluation of the outcomes.

c.

asks the patients family to discuss the discharge because they have visited daily since the patients admission.

d.

asks the patient to meet with you to discuss any feelings about discharge and returning home.

ANS: A

In the evaluation phase of evidence-based care, the nurse asks whether the application of evidence leads to an improvement in care. This is done by examining clearly specified outcomes from the evidence-based plan. This also involves the use of outcome measurement and reevaluation. The remaining options look either at medical evidence or subjective information from family and the patient that is anecdotal.

DIF: Cognitive Level: Application REF: Text Page: 59

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

13. Most often, clinical pathways are used in:

a.

inpatient units.

b.

outpatient settings.

c.

home-care settings.

d.

mental health clinics.

ANS: A

The clinical pathway is used most often in inpatient settings and serves as a shortened version of the multidisciplinary plan of care of the patient.

DIF: Cognitive Level: Comprehension REF: Text Page: 61

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. To focus a patients treatment or medication regimen in a very specific format, which tool would be used?

a.

Patient satisfaction survey

b.

Clinical pathway

c.

Algorithm

d.

Graph

ANS: C

Clinical algorithms take practice guidelines to a greater level of specificity by providing step-by-step recommendations on issues such as treatment options, treatment sequencing, preferred dosage, and progress assessment.

DIF: Cognitive Level: Comprehension REF: Text Page: 62

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

15. The categories of outcome indicators include:

a.

process and reliability.

b.

clinical and functional.

c.

process and evaluation.

d.

measurement and evaluation.

ANS: B

The categories of outcome indicators include clinical, functional, satisfaction, and financial. All other answers are incorrect.

DIF: Cognitive Level: Comprehension REF: Text Pages: 62-63

TOP: Nursing Process: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

16. Which best describes the evidence-based model for psychiatric nursing practice?

a.

Proof that the psychiatric nurse in a home-care setting really does care for assigned patients

b.

Description of what the psychiatric nurse does including how the nurse adds value to the health care organization

c.

How psychiatric nurses prove to their employers that they do what they are required to do for patient care

d.

The process by which the psychiatric nurse documents nursing care on the psychiatric nursing unit

ANS: B

In the evidence-based model for psychiatric nurses, the practitioners are being asked to describe what they do and how they add value to the health care organization. Their responses should be couched with sensitivity for the issues of effectiveness, cost, and quality.

DIF: Cognitive Level: Comprehension REF: Text Page: 64

TOP: Nursing Process: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

17. Practice guidelines are formulated to:

a.

establish evidence of appropriate psychiatric care based on anecdotal data collected only on the unit where you are using the practice guidelines.

b.

promote consistency of patient care for all patients with a particular need regardless of age or DSM-IV-TR diagnosis.

c.

identify treatments that are safe and effective for a particular psychiatric disorder based on collected data.

d.

minimize the need for nurses to continuously update the guidelines after they have been established.

ANS: C

Practice guidelines can be developed in a variety of ways. The best mental health practice guidelines are based on a scientific review of the available clinical research literature to determine which treatments are safe and effective for particular psychiatric disorders.

DIF: Cognitive Level: Comprehension REF: Text Page: 65

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. Which prevention and treatment option used in informed decision making regarding behavioral health assessment and treatment has the strongest evidence base?

a.

Standards

b.

Algorithms

c.

Best practices

d.

Practice guidelines

ANS: B

Algorithms and protocols are the most specific set of treatment decisions based on the strongest evidence base. Standards identify all possible prevention and treatment options, whereas best practices and practice guidelines are broader than algorithms and protocols.

DIF: Cognitive Level: Comprehension REF: Text Page: 61

TOP: Nursing Process: N/A MSC: NCLEX: Health Promotion and Maintenance

19. Several nursing colleagues have formulated a task force to identify a process to set up clinical pathways for patient care of those who are severely depressed. The initial step is to:

a.

identify the nursing skills used while depressed patients are hospitalized.

b.

review patient records to identify why most depressed patients are admitted.

c.

identify the number of depressed patients who are admitted more than once within a calendar year.

d.

review for efficiency and necessity of the interventions that are implemented during admission and aftercare for the depressed patient.

ANS: D

The development of clinical pathways involves reviewing for efficiency and necessity the many activities that occur from the time the patient enters the health care facility through discharge and aftercare. These activities include preadmission work-ups, tests, consultations, treatments, activities, diet, and health teaching.

DIF: Cognitive Level: Application REF: Text Page: 62

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

20. For a theory to be useful in practice, nurses need to validate the theory by:

a.

learning the theory.

b.

performing research.

c.

formulating a theoretical paradigm.

d.

informing other clinicians of theoretical frameworks.

ANS: B

A theory that arises out of practice is validated by research, which rebounds to direct practice and inform clinical care. The only correct answer is research. The other options are important to practice, but theory is validated by research.

DIF: Cognitive Level: Comprehension REF: Text Page: 64

TOP: Nursing Process: N/A MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Dimensions that are considered regarding outcome measurement tools such as quality report cards include: (Select all that apply.)

a.

patient care goals.

b.

nurses system evaluations.

c.

performance appraisals.

d.

situational content.

e.

intended audience.

ANS: D, E

A type of outcome measure is related not to the patient but to the performance of the behavioral health care organization itself. One must consider the three dimensions when discussing these report cards: content, point of view, and intended audience. The remaining options are incorrect.

DIF: Cognitive Level: Comprehension REF: Text Page: 64

TOP: Nursing Process: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. The reason for routinely using the behavioral rating scale is to assess the: (Select all that apply.)

a.

changes in the patients condition related to treatment.

b.

effectiveness of the units patient behavior scales.

c.

strength of the behavioral scales reliability.

d.

patients state at the time of admission.

e.

patients status to support discharge.

ANS: A, D, E

Psychiatric nurses should routinely use rating scales to assess their patients to determine their state at baseline (before beginning treatment), their progress during treatment, and the clinical progress they have made at the end of treatment. In this way nurses will be able to document the effectiveness of the care they provide.

DIF: Cognitive Level: Comprehension REF: Text Page: 63

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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