FREE Chapter 2Clinical Decision Making and Evidence-Based Practice My Nursing Test Banks

Chapter 2Clinical Decision Making and Evidence-Based Practice

MULTIPLE CHOICE

1.The nurse is implementing evidence-based practice. Which of the following is not a component of this process?

1.

Patient preference

2.

Clinical expertise

3.

Research evidence

4.

Leader practice

ANS: 4

Evidence-based practice is the combination of applying research findings, creating clinical guidelines, and the individualization of the plan of care to meet the patients needs and desired. Leader practice is not a component of the evidence-based process.

PTS:1DIF:AnalyzeREF:The Process of EBP

2.The nurse is planning the care for a client using an unstructured approach. Which of the following approaches did the nurse most likely use?

1.

Research

2.

Trial and error

3.

Nursing theory

4.

Validated order

ANS: 2

Examples of unstructured approaches to plan client care include trial and error, tradition, and authority. The approaches of research, nursing theory, and validated order all represent a structured approach to planning client care.

PTS: 1 DIF: Analyze REF: Knowledge Bases for Clinical Decisions

3.The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge Transformation. Which of the following is the nurse doing?

1.

Creating evidence summaries

2.

Evaluating outcomes

3.

Integrating findings into practice

4.

Participating in research

ANS: 4

The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation.

PTS:1DIF:AnalyzeREF:EBP in Nursing

4.A committee has been developed to implement knowledge transformation when providing client care. The members realize that the purpose of knowledge transformation is to:

1.

reduce length of stay.

2.

convert research findings to impact health outcomes.

3.

reduce the cost of care.

4.

increase the number of patients with health insurance.

ANS: 2

The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is the conversion of research findings to have an impact on health outcomes by way of evidence-based care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or increase the number of patients with health insurance.

PTS: 1 DIF: Analyze REF: Definition of Knowledge Transformation

5.An advance practice nurse is being consulted to participate during the translation phase of the ACE Star Model of Knowledge Transformation. During this phase, which of the following will the nurse create?

1.

Standardized care plans

2.

Critical pathways

3.

Clinical practice guidelines

4.

Checklists to streamline documentation

ANS: 3

In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines. The nurse is not creating standardized care plans, critical pathways, or checklists to streamline documentation since these items are not a part of the ACE Star Model of Knowledge Transformation.

PTS: 1 DIF: Apply REF: Star Point 3: Translation

6.The nurse leaders of a health care organization are creating plans to change clinical and organizational practices to support evidence-based practice. Which phase of the ACE Star Model of Knowledge Transformation are the leaders implementing?

1.

Integration

2.

Evaluation

3.

Translation

4.

Evidence summaries

ANS: 1

During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies. Implementation plans are not a part of the evidence summaries, translation, or evaluation of the ACE Star Model of Knowledge Transformation.

PTS: 1 DIF: Apply REF: Star Point 4: Integration

7.The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines which of the following will the nurse need?

1.

Current client census

2.

Evidence summaries

3.

Nursing department budget

4.

Staffing ratios

ANS: 2

The ideal base for writing clinical guidelines are evidence summaries because they increase the power and validity of the cause-and-effect relationship between interventions and outcomes. Current client census, nursing department budgets, and staffing ratios are not used to write clinical practice guidelines.

PTS:1DIF:ApplyREF:Evidence Summaries

8.The nurse is writing a systematic review. After the nurse formulates questions and locates relevant studies, the nurse thing the nurse will do is:

1.

update the reviews.

2.

interpret the findings.

3.

summarize and synthesize results.

4.

select and appraise the studies.

ANS: 4

The next step in the systematic review writing process is selecting and appraising the studies. Afterwards, the nurse will complete, in order, summarize and synthesize results, interpret the findings, and regularly update the reviews.

PTS: 1 DIF: Apply REF: Method for Producing Systematic Reviews

9.The nurse is using the scale for rating the strength of research evidence for one research article for potential inclusion in a clinical practice guideline. Which of the following is considered the strongest evidence?

1.

Individual cohort study

2.

Meta-analysis of randomized clinical trials

3.

Expert opinion

4.

Case studies

ANS: 2

When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case studies are Level VI.

PTS:1DIF:Analyze

REF:Table 2-1 Scale for Rating the Strength of Research Evidence

10.The nurse is considering a research study for inclusion in a clinical practice guideline that has been identified as being sufficient to determine effects on health outcomes. This research study would be considered as being:

1.

fair.

2.

passable.

3.

poor.

4.

good.

ANS: 1

Research studies are rated according to the Scale for Rating the Quality of Research Evidence. According to this scale, a research study that is sufficient to determine the effects on health outcomes is considered fair. A good study has consistent results for well-designed, well-conducted studies that directly assess effects on health outcomes. A poor study has insufficient results to assess the affects on health outcomes. Passable is not a category of this rating scale.

PTS:1DIF:Analyze

REF:Table 2-2 Scale for Rating the Quality of Research Evidence

11.The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A. According to this grade, the nurse should do which of the following?

1.

Do not use this guideline because the harm outweighs the benefits.

2.

Do not use this guideline because the benefits and harms cannot be determined.

3.

Use this guideline because the benefit is substantial.

4.

Use this guideline but understand that the net benefit to the client is small.

ANS: 3

The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A grade A guideline is recommended for care since there is high certainty that the benefit to the client is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be determined.

PTS:1DIF:Apply

REF: Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force

12.The nurse identifies errors and hazards in a care environment and implements basic safety to reduce the likelihood of an adverse event. Which of the following core competencies is this nurse implementing?

1.

Provide patient-centered care

2.

Apply quality improvement

3.

Employ evidence-based practice

4.

Utilize informatics

ANS: 2

Of the five Core Competencies for Health Professions, the competency that focuses on the identification of errors and hazards with implementation of basic safety is apply quality improvement. Provide patient-centered care focuses on direct care activities. Employ evidence-based practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on communication and the use of information technology to support decision making.

PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions

13.The nurse is participating on a committee to select evidence-based practice guidelines.Which of the following statements by the nurse indicate a clear understanding of the purpose of these guidelines?

1.

They provide the best evidence to make decisions about the care of individual clients.

2.

They promote changes in client care according to a research study.

3.

They ensure cost-effective care to the client.

4.

They identify safe staffing ratios for client care.

ANS: 1

Evidence-based practice guidelines provide the best evidence to make decisions about the care of individual clients. The use of a single research study to make changes in client care is a concept within research utilization and not evidence-based practice. Evidence-based practice does impact the costs of client care but their intent is not to ensure cost-effective care but rather to improve the overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care.

PTS:1DIF:AnalyzeREF:The Process of EBP

MULTIPLE RESPONSE

1.The nurse is determining the best way to ensure adherence to the core competencies for health professions. Which of the following competencies will the nurse implement when providing client care? (Select all that apply.)

1.

Work in interdisciplinary teams

2.

Utilize informatics

3.

Implement basic safety principles

4.

Employ evidence-based practice

5.

Apply quality improvement

6.

Provide patient-centered care

ANS: 1, 2, 4, 5, 6

Core competencies for health professions include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Implementing basic safety principles is only one part of a quality improvement program.

PTS:1DIF:Apply

REF: Box 2-1 Core Competencies for Health Professions.

2.There are impediments that make the practice of evidence-based practice difficult. Which of the following are impediments to evidence-based practice? (Select all that apply.)

1.

Complexity of science and technology

2.

Difficulty of nowledge transformation

3.

Variety of knowledge forms

4.

Number of patient diagnoses

5.

Evidence summary

6.

Application of quality improvement

ANS: 1, 3

Hurdles to evidence-based practice are the increasing complexity of science and technology and the variety of knowledge forms, many of which are not suitable for direct practice. Knowledge transformation, number of patient diagnoses, evidence summary, application of quality improvement are not considered impediments to the implementation of evidence-based practice.

PTS: 1 DIF: Apply REF: Applying Evidence-Based Concept

3.The nurse identifyies evidence summaries for evidence-based practice. Which of the following are references to types of evidence summaries? (Select all that apply.)

1.

Review of literature

2.

Evidence synthesis

3.

Authentication review

4.

Systematic reviews

5.

Integrative reviews

6.

Substantiation evidence

ANS: 1, 2, 4, 5

Evidence summaries are also referred to as being review of literature, evidence synthesis, systematic reviews, and integrative reviews. These summaries are not referred to as being authentication review or substantiation evidence.

PTS: 1 DIF: Apply REF: Star Point 2: Evidence Summary

4.A health care organization is determining which clinical practice guidelines to adopt when providing client care. The organization is using the AGREE Instrument for Assessing Guidelines because this checklist helps the organization determine which of the following? (Select all that apply.)

1.

Scope and purpose

2.

Stakeholder involvement

3.

Rigor of development

4.

Clarity and presentation

5.

Author credentials

6.

Application

ANS: 1, 2, 3, 4, 6

The AGREE Instrument for Assessing Guidelines outlines the primary facets of the clinical practice guideline being appraised for adoption. It includes the following criteria: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application, and editorial independence. Author credentials is not a criteria of this checklist.

PTS: 1 DIF: Analyze REF: Clinical Practice Guidelines

5.The nurse is participating in a committee to address the Institute of Medicines priority areas for quality improvement. Which of the following are considered priority areas? (Select all that apply.)

1.

Diabetes

2.

End-of-life organ failures

3.

Motor vehicle accidents

4.

Scoliosis

5.

Tobacco dependence

6.

Major depression

ANS: 1, 2, 5, 6

The Institute of Medicine has identified 20 priority areas for quality improvement which include diabetes, end-of-life organ failures, tobacco dependence, and major depression. Motor vehicle accidents and scoliosis are not priority areas identified by the Institute of Medicine.

PTS: 1 DIF: Analyze REF: Box 2-7 IOM-Priority Areas for National Action

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