Evidence-based practice in nursing studocu Nursing Concepts (NU 309)
MULTIPLE CHOICE QUESTIONS
1. To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is:
a. A guide for nurses in making clinical decisions. ✅
b. Based on the latest textbook information.
c. Easily attained at the bedside.
d. Always right for all situations.
Correct Answer: A – A guide for nurses in making clinical decisions.
Explanation: Evidence-Based Practice (EBP) serves as a structured guide that helps nurses make well-informed clinical decisions. It integrates:
- Best available research evidence – drawn from systematic reviews, clinical guidelines, and research studies.
- Clinical expertise – using knowledge and experience to interpret evidence effectively.
- Patient preferences and values – ensuring patient-centered care.
Textbooks, while useful, may become outdated quickly, and bedside implementation of EBP is not always straightforward due to various challenges such as time constraints and accessibility to research. Additionally, EBP is not a “one-size-fits-all” approach; it requires critical thinking and adaptation to each patient’s unique circumstances.
Concept Map Of Evidence-Based Practice (EBP)
2. In caring for patients, it is important for the nurse to realize that evidence-based practice is:
a. The only valid source of knowledge that should be used.
b. Secondary to traditional or standard care knowledge.
c. Dependent on patient values and expectations. ✅
d. Not shown to provide better patient outcomes.
Correct Answer: C – Dependent on patient values and expectations.
Explanation: EBP considers patient preferences, values, and expectations. A treatment backed by the best research may not be suitable if it contradicts a patient’s values or is not aligned with their specific needs.
- For example, a patient with religious dietary restrictions might refuse a nutrition plan recommended in a study.
- EBP should be combined with clinical judgment and individualized patient care rather than following rigid rules.
Studies show that using EBP improves patient outcomes by up to 28% compared to traditional methods, reinforcing its importance in modern nursing practice.
3. The first step in evidence-based practice is to ask a clinical question. In doing so, the nurse needs to realize that in researching interventions, the question:
a. Is more important than its format.
b. Will lead you to hundreds of articles that must be read.
c. May be easier if in PICO format. ✅
d. May be more useful the more general it is.
Correct Answer: C – May be easier if in PICO format.
Explanation: The PICO format helps nurses structure research questions effectively, ensuring they are specific and focused:
- P – Population or patient (e.g., elderly patients with hypertension)
- I – Intervention (e.g., low-sodium diet)
- C – Comparison (e.g., regular diet)
- O – Outcome (e.g., reduced blood pressure)
Using PICO prevents the need to sift through hundreds of irrelevant articles and allows nurses to quickly find high-quality evidence.
4. In collecting the best evidence, the gold standard for research is:
a. The randomized controlled trial (RCT). ✅
b. The peer-reviewed article.
c. Qualitative research.
d. The opinion of expert committees.
Correct Answer: A – The randomized controlled trial (RCT).
Explanation:
RCTs are considered the gold standard because they:
- Minimize bias by randomly assigning participants to treatment or control groups.
- Establish causality by controlling variables.
- Produce high-quality evidence for clinical decision-making.
While peer-reviewed articles and expert opinions can be valuable, RCTs provide the most reliable data for determining the effectiveness of interventions.
5. The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the:
a. Abstract.
b. Introduction. ✅
c. Literature review or background.
d. Results.
Correct Answer: B – Introduction.
Explanation: The introduction explains the purpose and importance of the research, attracting the reader’s interest.
- The abstract provides a brief summary, but readers may not engage deeply.
- The literature review provides context but is more technical.
- The results section summarizes findings but doesn’t introduce the topic.
A compelling introduction increases the likelihood that readers will continue engaging with the study.
6. The nurse is caring for a patient with chronic low back pain. In providing care for this patient, the nurse wonders whether the guidelines utilized for this type of pain are adequate. The nurse wants to determine the best evidence-based practice regarding these guidelines. What is the best database for the nurse to access?
a. MEDLINE
b. EMBASE
c. PsycINFO
d. AHRQ ✅
Correct Answer: D – AHRQ (Agency for Healthcare Research and Quality).
Explanation:
- AHRQ contains clinical guidelines and evidence summaries specifically designed to guide medical professionals in best practices.
- MEDLINE and EMBASE focus on broader medical literature.
- PsycINFO is more psychology-based and would not be the most relevant.
AHRQ is the best choice for evidence-based clinical guidelines on managing low back pain.
7. The nurse is developing a PICO question related to whether her patient’s blood pressure is more accurate while measuring with the patient’s legs crossed versus with the patient’s feet flat on the floor. The nurse determines that this is:
a. A true PICO question, because the outcome always comes before the intervention.
b. A true PICO question regardless of placement of elements. ✅
c. Not a true PICO question, because the comparison comes after the intervention.
d. Not a true PICO question, because the outcome comes after the population.
Correct Answer: B – A true PICO question regardless of placement of elements.
Explanation:
- PICO does not require a fixed order.
- The goal is to clearly define the research question, ensuring all four components (Population, Intervention, Comparison, Outcome) are included.
- The sequence does not matter as long as all elements are covered.
This flexibility helps formulate meaningful and researchable clinical questions.
Evidence-Based Practice Fundamentals – Answer Explanations (Continued)
8. In reviewing literature for an evidence-based practice study, the nurse realizes that the most reliable level of evidence is the:
a. Systematic review and meta-analysis. ✅
b. Randomized control trial (RCT).
c. Case control study.
d. Control trial without randomization.
Correct Answer: A – Systematic review and meta-analysis.
Explanation:
- Systematic reviews and meta-analyses are the highest level of evidence because they synthesize data from multiple RCTs, increasing the reliability and generalizability of findings.
- RCTs are strong but may focus on a single study, limiting broader applicability.
- Case control studies and non-randomized control trials have more bias and lower reliability.
When making evidence-based decisions, systematic reviews and meta-analyses provide the most comprehensive and reliable data.
9. Qualitative nursing research is valuable in that it:
a. Excludes all bias.
b. Uses randomization in structure.
c. Determines associations between variables and conditions.
d. Studies phenomena that are difficult to quantify. ✅
Correct Answer: D – Studies phenomena that are difficult to quantify.
Explanation:
- Qualitative research explores experiences, perceptions, and emotions that are not easily measured numerically (e.g., how a patient copes with chronic illness).
- It relies on interviews, focus groups, and observations rather than numbers.
- Quantitative research, by contrast, looks for associations and cause-effect relationships using structured methods like RCTs and statistical analysis.
Qualitative research is crucial in understanding patient-centered care, emotional responses, and cultural perspectives in healthcare.
10. The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurse’s best option?
a. Drop the idea of making the change at this time.
b. Insist that management hire the needed staff to facilitate the change.
c. Seek employment in another institution that may have the staff needed.
d. Conduct a pilot study to develop evidence to support the change. ✅
Correct Answer: D – Conduct a pilot study to develop evidence to support the change.
Explanation:
- If an evidence-based change is not yet feasible, conducting a pilot study allows the nurse to test the intervention on a smaller scale before full implementation.
- Pilot studies provide real-world data on feasibility, effectiveness, and resource needs.
- Dropping the idea or switching jobs is not constructive.
- Demanding more staff may not be practical without supporting data.
Pilot studies are a practical and effective approach to initiating change within healthcare systems.
11. The hospital policy states that when starting an intravenous (IV) catheter, the nurse must first prepare the site with alcohol and dress it using a gauze dressing. However, research suggests that transparent dressings prevent catheter dislodgment. What should the nurse do?
a. Begin using transparent dressings instead of gauze.
b. Bring findings to the policy and procedure committee. ✅
c. Use transparent dressings on half of her IV starts and gauze on the other.
d. Continue following hospital policy without saying anything.
Correct Answer: B – Bring findings to the policy and procedure committee.
Explanation:
- EBP requires systematic change, meaning policy updates should be institutionalized, not applied individually.
- Bringing research findings to policy committees ensures hospital-wide improvements rather than individual practices that contradict protocol.
- Randomly using different methods could lead to inconsistencies and compromise patient safety.
This approach demonstrates professional accountability and commitment to improving patient care through EBP.
12. The nurse is conducting interviews and focus groups to identify common themes related to the effectiveness of cardiac rehabilitation. What type of research is the nurse conducting?
a. Evaluation research
b. Experimental research
c. Qualitative research ✅
d. Nonexperimental research
Correct Answer: C – Qualitative research.
Explanation:
- The use of interviews and focus groups indicates a qualitative approach, which aims to explore patient experiences and perceptions rather than numerical outcomes.
- Quantitative research, including experimental and nonexperimental methods, uses structured data collection (e.g., surveys, trials).
This qualitative approach is essential in healthcare to understand how interventions impact patient experiences and behaviors.
13. In conducting a research study, the researcher must guarantee that any information the subject provides will not be reported in a way that identifies them. This concept is known as:
a. Anonymity.
b. Confidentiality. ✅
c. Informed consent.
d. The research process.
Correct Answer: B – Confidentiality.
Explanation:
- Confidentiality ensures participant data remains private and only accessible to the research team.
- Anonymity means even the researcher cannot link participants to their responses.
- Informed consent ensures participants understand the study and voluntarily agree to participate.
Confidentiality is essential in ethical research to protect participants’ privacy.
14. The researcher discloses study limitations in the manuscript, but these are most likely detected during which phase of the research process?
a. Problem identification
b. Study design
c. Formulation of recommendations
d. Analysis of data ✅
Correct Answer: D – Analysis of data.
Explanation:
- Limitations become evident when analyzing data, as researchers encounter issues affecting validity, reliability, or generalizability.
- Problem identification and study design happen earlier, and limitations may not yet be apparent.
- Recommendations are based on findings but do not identify new limitations.
Recognizing limitations strengthens research integrity and guides future studies.
15. When evaluating Quality Improvement (QI) programs in relation to Evidence-Based Practice (EBP), it is easy to note that:
a. Both are designed to improve performance.
b. When implementing EBP projects, it is important to review QI data. ✅
c. EBP is not at all related to QI.
d. Evaluation of processes is the realm of performance improvement (PI), not QI.
Correct Answer: B – When implementing EBP projects, it is important to review QI data.
Explanation:
- Quality Improvement (QI) tracks patient outcomes and system efficiency, providing essential data for EBP projects.
- EBP and QI are interconnected, as EBP ensures clinical interventions are backed by research, while QI evaluates practical effectiveness in a specific setting.
This relationship allows continuous healthcare improvement by ensuring best practices are consistently applied and refined.
16. The hospital’s quality improvement (QI) committee identified a problem on one of the units. In using the PDSA method to determine ways to address the issue, the committee decides to do a literature review. This is an example of quality improvement:
a. Combined with evidence-based practice. ✅
b. With an inability to make the right decision.
c. With a delay in the action needed.
d. With no designated method for dealing with issues.
Correct Answer: A – Combined with evidence-based practice.
Explanation:
- Quality Improvement (QI) and Evidence-Based Practice (EBP) work together.
- The PDSA (Plan-Do-Study-Act) cycle is a structured approach used in QI that benefits from EBP when reviewing existing research to determine best practices.
- Conducting a literature review before making changes ensures decisions are evidence-based rather than arbitrary.
This approach is a hallmark of high-quality, research-informed patient care.
17. The quality improvement (QI) committee has noticed an increase in patient falls at night. A literature review suggests most falls happen when patients try to go to the bathroom. The committee decides to leave bedrails down and conduct hourly rounding. What is the committee’s next step?
a. Evaluate the changes in 1 month.
b. Wait a month before implementing the changes.
c. Implement the changes as a pilot study.
d. Communicate to staff the results of this inquiry. ✅
Correct Answer: D – Communicate to staff the results of this inquiry.
Explanation:
- Staff education is critical before implementing practice changes to ensure understanding, compliance, and safety.
- Communicating findings allows collaboration and ensures staff is aware of evidence supporting the change.
- After communication, the next step would be a pilot study before full implementation.
Successful QI programs prioritize communication to gain staff buy-in and ensure smooth transitions.
18. The quality improvement (QI) committee has noted an increase in needlestick injuries. When using the PDSA model, what is the committee’s first step?
a. Plan. ✅
b. Do.
c. Study.
d. Act.
Correct Answer: A – Plan.
Explanation:
- The PDSA model is used in QI to systematically improve patient safety and care.
- Plan: Identify the problem and review available data to understand it.
- Do: Implement a small-scale intervention.
- Study: Evaluate the intervention’s effectiveness.
- Act: Make necessary changes based on results.
The first step is always “Plan”, as a thorough understanding of the issue ensures appropriate intervention.
19. The quality improvement (QI) committee is investigating an increase in medication errors. Their primary focus should be:
a. Nurses who administer the medications.
b. Pharmacy that prepares the medications.
c. Secretaries who enter the orders.
d. None of the above. ✅
Correct Answer: D – None of the above.
Explanation:
- QI focuses on systems, not individuals.
- Blaming nurses, pharmacy, or secretaries misses the root cause.
- Instead, QI teams evaluate the entire medication administration process to identify and correct system failures.
Effective QI improves workflow, safety protocols, and interdisciplinary communication rather than placing blame on individuals.
MULTIPLE RESPONSE QUESTIONS
20. The nurse is preparing to conduct research requiring precise measurement of a phenomenon. Which methods will provide the right data? (Select all that apply.)
a. Experimental research. ✅
b. Surveys. ✅
c. Evaluation research. ✅
d. Phenomenology.
e. Grounded theory.
Correct Answers: A, B, C
Explanation:
- Experimental research, surveys, and evaluation research are all quantitative methods used for precise measurement.
- Phenomenology and grounded theory are qualitative approaches used to explore subjective experiences rather than numerical data.
Quantitative research provides objective, measurable, and reproducible results.
21. Before conducting a study with human subjects, researchers must obtain approval from the Institutional Review Board (IRB). The IRB ensures that researchers: (Select all that apply.)
a. Obtain informed consent. ✅
b. Minimize risk to subjects. ✅
c. Ensure confidentiality. ✅
d. Identify risks and benefits of participation. ✅
e. Ensure that subjects complete the study.
Correct Answers: A, B, C, D
Explanation:
- The IRB exists to protect research participants and ensure ethical research practices.
- Key responsibilities include:
- Obtaining informed consent to ensure voluntary participation.
- Minimizing risk by reviewing study protocols.
- Ensuring confidentiality to protect participants’ privacy.
- Identifying risks and benefits to ensure transparency.
Subjects must be allowed to withdraw at any time, meaning researchers cannot force participation.
22. The nurse is conducting a literature review to address a potential problem on the unit. Nursing research is important because it is designed to: (Select all that apply.)
a. Enhance the nurse’s chance at promotion.
b. Identify new knowledge. ✅
c. Improve professional practice. ✅
d. Enhance effective use of resources. ✅
e. Lead to decreases in budget expenditures.
Correct Answers: B, C, D
Explanation:
- Nursing research contributes to professional development and improves patient care.
- Key objectives:
- Identifying new knowledge that can advance the field.
- Improving clinical practice through evidence-based interventions.
- Enhancing resource utilization to improve patient care efficiency.
- Research is not done for promotions or budget cuts, though it can indirectly impact cost-effectiveness.
Nursing research drives evidence-based practice and leads to better patient outcomes.
Final Thoughts on EBP and QI
- EBP is essential for delivering high-quality, patient-centered care.
- QI ensures that healthcare systems continuously improve.
- Combining EBP and QI leads to the best patient outcomes.
These concepts are integral to modern nursing practice and require continuous learning and adaptation.