Sample Chapter



1. In the hospital where Nurse L. provides care, tradition dictates that oral temperatures be included in every set of patient vital signs, regardless of patient diagnosis or acuity. This is most likely an example of which of the following phenomena?
A) The prioritization of internal evidence over external evidence
B) Practice that lacks evidence to support its application
C) The integration of personal expertise into nursing care
D) Evidence-based practice



2. The clinical nurse educator (CNE) on a postsurgical unit has recently completed a patient chart review after the implementation of a pilot program aimed at promoting early ambulation following surgery. Which of the following components of EBP is the nurse putting into practice?
A) Patient preferences
B) Research utilization
C) Experience
D) Internal evidence



3. Nurse R. has observed that reorienting demented patients as frequently as possible tends to minimize the patients’ level of agitation in the evening. The nurse has shared this observation with a colleague, who is skeptical, stating that, “It’s best to stick to evidence-based practice.” How can Nurse R. best respond?
A) “EBP can include clinicians’ personal expertise.”
B) “Personal experience is often more sound than formal evidence-based practice.”
C) “Traditional practice and EBP are usually shown to be the same.”
D) “My years of experience can be just as valuable as any literature review or randomized trial.”



4. Which of the following factors provides the most important rationale for the consistent implementation of EBP?
A) EBP provides for the most cost-effective patient care.
B) EBP is accessible to all healthcare clinicians.
C) EBP provides consistency in care across healthcare settings.
D) EBP improves patient outcomes.



5. The Institute of Medicine’s Roundtable on Evidence-Based Medicine has been established to address EBP. Which of the following issues is the Roundtable emphasizing?
A) Ensuring that external evidence, rather than internal evidence, is integrated into care
B) Fostering the level of learning that exists in the American healthcare system
C) Issuing clinical guidelines to ensure best nursing practice
D) Comparing the implementation of EBP in the United States with that of other Western countries



6. You have become frustrated with some aspects of patient care that you believe are outdated and ineffective at the long-term care facility where you have recently begun practicing. Consequently, you have resolved to examine some of these practices in light of evidence. Which of the following should occur first in the steps of EBP?
A) Conducting an electronic search of the literature and ranking individual sources
B) Creating “buy-in” from the other clinicians who provide care at the facility
C) Developing an inquisitive and curious mindset
D) Assessing whether the practices in question may, in fact, be evidence-based



7. Which of the following clinical questions best exemplifies the PICOT format?
A) What effect does parents’ smoking have on the smoking habits of their children, ages 13 to 16?
B) Among cancer patients, what role does meditation, rather than benzodiazepines, have on anxiety levels during the 7 days following hospital admission?
C) Among undergraduate college students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new gonorrheal and chlamydial infections reported to the campus medical center?
D) In patients aged 8 to 12, is the effectiveness of a pain scale using faces superior to a numeric rating scale in the emergency room context?



8. After formulating a clinical question, a nurse has proceeded to search for evidence for ways to foster restful sleep in patients who are receiving care in the intensive care unit (ICU). The nurse has identified a relevant meta-analysis in an electronic database. What will this source of evidence consist of?
A) A statistical summary of the results from several different studies
B) An examination of the theoretical and conceptual underpinnings of the issue
C) An interdisciplinary analysis of the clinical question
D) A qualitative study of different interventions related to the clinical question



9. The nurses on a postpartum unit have noted that many primiparous (first-time) mothers are giving up on breastfeeding within the 24 hours following delivery, and the nurses want to create uniform guidelines for promoting breastfeeding on the unit. Which of the following sources is most likely to provide the best evidence in their quest for an intervention?
A) Evidence from a randomized control trial that had more than 2500 participants
B) Evidence from a study that is widely regarded as a classic within the obstetrical nursing community
C) Evidence from a systematic review of breastfeeding-promotion studies that one of the nurses identified in an electronic database
D) The consensus opinion of the most senior nurses on the unit



10. The nurse educator on an acute medicine unit is advocating for the use of evidence-based clinical practice guidelines on wound care in order to standardize and optimize the practice of the nurses on the unit. Which of the following statements best describes clinical practice guidelines?
A) The result of replication studies of existing research by an impartial third party
B) A collection of authorized interventions that are required by law
C) A number of interventions that are the result of a large, publically-funded RCT
D) A group of practice recommendations that result from a rigorous review of the literature



11. A nurse is conducting a literature review on the evidence regarding the use of vacuum dressings on stage IV pressure ulcers. After locating a recent study that appears to be relevant, which of the following questions would the nurse consider first when critically appraising the study?
A) “Are the findings of this study cost-effective in our clinical context?”
B) “How would the implementation of this intervention affect our staffing needs?”
C) “Were the patients in the study similar to the patients on my unit?”
D) “Are the findings of the study significantly different from what we are currently doing on the unit?



12. The primary care provider of a 49-year-old male patient has examined and briefly explained the evidence that supports beginning regular digital-rectal exams. Which of the following factors would justify not performing digital-rectal examinations in this patient’s care?
A) The patient is vehemently opposed to undergoing a digital-rectal exam.
B) Clinical practice guidelines for prostate care have not been published.
C) The clinician has been unable to find any large RCTs in a literature review.
D) The clinician has previously waited until patients are 55 to begin regular digital-rectal exams.



13. The implementation of a new, evidence-based infection-control regimen in a community hospital has resulted in a significant reduction in the incidence of nosocomial (hospital-acquired) infections. What should constitute the final step in the nurses’ evidence-based practice?
A) Calculating the cost-savings that will be realized by using the new regimen
B) Sharing their experience with other healthcare professionals
C) Implementing enforcement measures to ensure compliance with the new regimen
D) Conducting a meta-analysis of other infection-control measures



14. Frustrated by the lack of follow-up provided to patients who are newly diagnosed with type 2 diabetes, a community health nurse has begun the process of identifying evidence for the best interventions for this patient population. Which of the following factors is most likely to promote the use of EBP in this nurse’s workplace?
A) Bringing in nurses who have been educated at a baccalaureate (bachelor’s degree) level
B) Increasing nurses’ accountability for patient outcomes
C) Increased funding
D) Support from the practice leaders and administration



15. In the process of advocating for EBP in the unit guidelines around the management of increased intracranial pressure, a nurse has met with skepticism from other members of the nursing staff, with several stating, “Evidence-based practice is good in theory, but it’s almost impossible to actually search hundreds of journals and find the evidence.” What could the nurse recommend?
A) Self-reflection on the nurses’ current practices
B) Accessing the Cochrane Library
C) Contacting the clinical nurse educator on the unit
D) Beginning with lay publications before progressing to peer-reviewed journals


1. Which of the following components of a clinical question represents the “P” in the PICOT format for asking clinical questions?
A) The nurse’s preparation for patient teaching prior to surgery
B) Early ambulation versus aggressive anticoagulant therapy
C) Individuals who require peritoneal dialysis
D) Deep vein thrombosis



2. An unacceptably high number of patients on a geriatric, subacute medicine unit have developed pressure ulcers during their period of care. The nurses on the unit have agreed on a goal of reducing the incidence of these wounds by 50% over the next 10 weeks. This goal represents which component of the PICOT format for asking clinical questions?
A) O
B) P
C) I
D) C



3. Which of the following scenarios represents the most common obstacle that nurses encounter when attempting to gain the knowledge necessary for EBP?
A) A nurse identifies several articles relevant to a clinical question, but the methodology of each is significantly flawed.
B) A nurse is overwhelmed by the number of hits during a CINAHL search.
C) Current research that relates to the nurse’s clinical question does not exist.
D) The research that the nurse locates is rooted in a medical, not nursing, perspective.



4. A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem?
A) Narrow the scope of the clinical question
B) Restrict the information search to publications from the past 24 months
C) Seek recommendations for information sources from trusted colleagues
D) Limit the search to articles that relate the findings of randomized control trials (RCTs)



5. A pediatric nurse provides care for many children who present to the emergency department (ED) with signs and symptoms of asthma. Which of the following questions is a background question that the nurse can utilize in the process of providing EBP?
A) What evidence exists to recommend the use of nebulizers over metered-dose inhalers (MDIs)?
B) What patient populations respond best to nebulized bronchodilators?
C) How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm?
D) Are nebulizers provided to patients in the ED more often than metered-dose inhalers?



6. Which of the following statements is true of foreground questions?
A) They focus on issues that can be addressed by applying scientific evidence.
B) They have a broad, rather than narrow, scope.
C) They can be answered by examining electronic information sources instead of print sources.
D) They are rooted in the current practices of a nurse’s clinical setting.



7. An oncology nurse is engaged in increasing the quality of EBP that is provided on the cancer unit of the local hospital. Which of the following questions would the nurse consider to be an adequate and useful foreground question?
A) “Are benzodiazepines and analgesics provided before patients have a bone marrow biopsy?”
B) “What is the clinical rationale for using bone marrow biopsy to gauge and predict the course of a patient’s cancer?”
C) “Does guided imagery reduce the anxiety of patients who undergo bone marrow biopsy?”
D) “How often is bone marrow biopsy performed on the unit?”



8. Which of the following clinical questions would be most justified in lacking a comparison?
A) An examination of the antipyretic qualities of cool bed-bathing
B) A study on the perceived meaning of hope among palliative patients
C) A study on the influence of prenatal care on preventing perineal tearing during delivery
D) An examination of the effect of rehydration using lactated Ringer’s on patients’ energy levels



9. Which of the following clinical questions would be considered to be a “meaning” question?
A) “What factors underlie parents’ decisions to refuse immunizations for their children aged 3 months to 24 months?”
B) “What factors, apart from asbestos exposure, may contribute to ex-miners’ diagnoses of mesothelioma?”
C) “How do pregnant women with high-risk pregnancies who have been prescribed bed-rest perceive their situations?”
D) “Are cigarette warning labels an effective deterrent to cigarette smoking among females aged 11 to 15 years?”



10. Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question?
A) The patient population should be as narrow a range as possible.
B) The population in the clinical question should closely match the demographics of the nurse’s geographic region.
C) A specific and defensible rationale should exist for the choice of patient population.
D) The patient population in the clinical question should mirror the populations in prominent studies related to the issue.



11. In the context of the PICOT format for formulating clinical questions, which of the following may be considered to be an intervention?
A) Levels of patient hygiene in an assisted-living facility
B) The incidence and prevalence of stomach cancer among low-income males aged 65 to 85
C) The prevalence of wound dehiscence among postmastectomy patients
D) Occupational exposure to airborne silicon dust



12. Which of the following symptoms could be best clustered into a single outcome for the purposes of crafting a concise clinical question?
A) Increased anxiety, increased serum cholesterol, and low rating of overall well-being
B) Hypotension, tachycardia, and decreased level of consciousness
C) Increased temperature, decreased mobility, and confusion
D) Increased neonatal bilirubin levels and the mother’s choice to feed with formula rather than breastfeed



13. Which of the following clinical questions can be best addressed by a meta-synthesis of qualitative studies?
A) “What is the meaning of spiritual support in hospice patients who are younger than 50?”
B) “What is the effectiveness of physical activity compared with beta-blockers in reducing the blood pressure of adult, African-American men?”
C) “Is the use of a stroke team in the emergency department, rather than standard assessment and treatment, associated with improved outcomes among patients diagnosed with stroke?”
D) “Are single-occupancy hospital rooms, rather than shared rooms, associated with increased patient satisfaction reports?”



14. Which of the following principles can help a nurse rank levels of evidence when answering clinical questions of all types and scopes?
A) Quantitative research supersedes qualitative research.
B) Randomized control trials must be included when answering clinical questions.
C) Sources of evidence must be peer-reviewed.
D) Syntheses are the highest level of evidence.



15. Which of the following groups would most likely be considered a self-selected cohort?
A) Obese, Hispanic females
B) Cigarette smokers
C) Patients with hypertension who take diuretics
D) Teenage females



1. A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement EBP. Which of the following questions could those nurses best answer by consulting a textbook?
A) “What effect does a diagnosis of renal failure have on type 2 diabetics’ glucose monitoring behavior?”
B) “What factors influence clinicians’ decisions to recommend peritoneal dialysis over hemodialysis?”
C) “What are the anatomical characteristics and physiological functions of the kidneys?”
D) “What is the relationship between dosing of erythropoietin therapy and hemoglobin levels in patients with chronic renal failure?”



2. A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first?
A) A newspaper article
B) A systematic review
C) A conference presentation
D) A journal article



3. After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has “googled” the subject. How should the nurse best interpret the results of this search?
A) The nurse must carefully evaluate the results of this search.
B) The results of searching sites such as Google and Yahoo are not clinically useful.
C) The search is likely to yield inaccurate or biased results.
D) The search is a time-efficient substitute for searching online health databases.



4. A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most likely to provide the nurse with specific interventions and practices to achieve this goal?
A) Cumulative Index to Nursing and Allied Health Literature (CINAHL)
B) National Guideline Clearinghouse



5. A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital’s policy on the use of physical restraints. During the search, what parameters should the nurse establish for the dates of articles and other information sources?
A) Articles should be ranked according to publication date, with the most recent articles being prioritized.
B) The nurse should attempt to identify collaborative evidence for any source that is more than 3 years old.
C) The nurse should establish a cutoff for sources more than 5 years old.
D) The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication.



6. While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching “beta blockers.” How should the nurse proceed?
A) Identify the appropriate MeSH term
B) Search for clinical guidelines in the Cochrane Library
C) Consult the reference lists in articles that appeared during the search
D) Search the trade names of specific beta-blocking drugs



7. In light of the large number of gall bladder patients recently admitted to the unit, a nurse is searching PubMed for literature relating to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field?
A) “chole*”
B) “cholecystitis or cholecystectomy or cholelithiasis or cholecystography”
C) “gall bladder”
D) “chole-”



8. A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results?
A) “nutrition OR (delirium OR dementia)”
B) “(delirium OR dementia) AND nutrition”
C) “delirium dementia nutrition”
D) “delirium AND dementia AND nutrition”



9. In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search?
A) Only noncopyrighted resources will be available to the nurse.
B) The nurse will be guaranteed that each result will be from a peer-reviewed source.
C) The nurse will be unable to conduct a valid or useful search.
D) Articles that are relevant may be excluded from consideration.



10. A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions?
A) Cochrane Database of Systematic Reviews (CDSR)
B) Cochrane Central Register of Controlled Trials (CENTRAL)
C) Cochrane Methodology Register
D) Health Technology Assessment (HTA) Database



11. A nurse has conducted a search of PubMed to answer the question, What factors influence older adults’ decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue? The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed?
A) Date of publication
B) Number of times the article has been cited
C) Ranking by peer review
D) Date the article was added to the database



12. A nurse is working on a literature review using a laptop computer while in a café that provides wireless Internet access but will not allow for connection to the hospital library’s server that provides the nurse’s normal access to database subscriptions. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection?
A) PubMed
B) Cochrane Library



13. Management of a county hospital has been resistant to providing time, facilities, and subscriptions to allow nurses to conduct online searches near the point of care. Which of the following arguments can the nurses present to strengthen their case for these tools?
A) “Online access at or near the point of care has been mandated by law.”
B) “Providing for literature searches has been shown to save money and shorten patient stays.”
C) “It is unethical for nurses to provide care that is not rooted in a recent literature search.”
D) “The increased confidence that nurses gain from accessing knowledge is linked to improved patient outcomes.”



14. Which of the following sources would best provide critical appraisal during a nurse’s search for evidence on which to base practice?
A) A journal that provides assessments of notable articles recently published in other journals
B) The expert opinion of qualified and experienced nurse clinicians
C) A careful examination of the methodology of a study
D) The insight of a trusted hospital librarian



15. Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy?
A) Organize a small-scale clinical trial to test current practices on the unit.
B) Elicit the views of the most senior nurses and those nurses who exemplify EBP.
C) Formulate a question and conduct a thorough search of the existing evidence.
D) Seek input from physicians with expertise in the area of VAP.


1. A nurse is providing care for a 73-year-old female patient whose balance is compromised by a vestibular disorder. The nurse has advocated for the installation of balance bars and handholds throughout the patient’s home, but the patient is reluctant, saying, “Those are for old people.” Which of the following is the best guide for making the decision?
A) The patient’s preference and history of using such devices
B) Research that addresses the effectiveness of this intervention
C) Existing evidence: the nurse’s experience with the intervention and the patient’s opinion
D) The cost of installation, the opinion of the patient and her peers, and evidence-based articles regarding the intervention



2. What is the relationship between research utilization (RU) and evidence-based practice (EBP)?
A) RU is based on an individual clinician’s personal research, while EBP is based on published research.
B) RU considers the personal expertise of nurses, while EBP is based solely on published evidence.
C) RU provides a general guide to practice, while EBP provides patient-specific insights.
D) RU is often based on a single study, while EBP considers the larger body of knowledge.



3. A nurse has approached the unit educator with a recently-published article that calls into question the unit’s practices around routine changing of peripheral intravenous sites. How should the findings of this article be best translated into practice?
A) Unit practices should be amended to reflect the findings of the study.
B) The nurses on the unit should combine the study results with their own expertise to create a new guide for practice.
C) The nurses should search for further evidence before changing unit practices.
D) The nurses should conduct a trial similar to that in the published study.



4. In light of the continually-changing clinical context in which she provides care, a nurse is aware of the need to ensure that her practice is current. Which of the following actions is most likely to help the nurse achieve this goal?
A) Continually eliciting input from more senior nurses
B) Staying current with published evidence that has been critically appraised
C) Regularly attending continuing education opportunities
D) Reviewing the practice guidelines and evidence that are presented in textbooks available on the unit and at the hospital library



5. A nurse has called into question the unit protocol around the regular flushing of percutaneous endoscopic gastrostomy (PEG) tubes to prevent occlusion. Which of the following should guide the nurse’s reconsideration of the evidence around PEG tube flushing?
A) Certainty that a new protocol will reliably prevent occlusion
B) Expressions of patient preference during a designated period of study
C) The rigor and reliability of a chosen research study
D) The combination of expertise and internal evidence



6. A nurse has reviewed a study on the use of signs, symptoms, and blood tests to diagnose acute sinus infections and has concluded that the study was of high quality. Which of the following criteria best describe the quality of a research study?
A) The degree to which the findings are corroborated by other similar studies
B) The degree to which the study has the ability to improve patient outcomes
C) The degree to which the study was designed to minimize biases
D) The degree to which the study cohort reflects the demographics of the nurse’s patient population



7. A nurse is reluctant to recommend a change in practice around teaching deep breathing and coughing to postsurgical patients, citing a lack of randomized controlled trials (RCTs) that directly address the subject. Which of the following statements best captures the role of RCTs in evidence-based practice?
A) Only systematic reviews are considered more valuable than RCTs in establishing EBP.
B) RCTs provide very high levels of quantitative analysis but are prone to lapses in consistency.
C) A qualitative study with a sound and rigorous methodology is considered equal to a well-designed RCT.
D) RCTs are the highest level of evidence that can be used to guide practice.



8. On an acute medicine unit, the results of a pilot program that implemented a new screening tool for drug and alcohol abuse has been shown to be effective at identifying patients who may require intervention. In light of these results, the unit has included the screening tool in the nursing assessment of every patient who is admitted to the unit. The nurses on this unit have made this change in practice based on
A) evidence-based practice.
B) internal evidence.
C) clinician experience.
D) randomized controlled trial (RCT).



9. The manager of a subacute geriatric unit has referenced the Agency for Healthcare Research and Quality National Healthcare Quality Report during the annual review of the unit’s operations. The report will provide the manager with
A) incidence and prevalence statistics for major infectious diseases.
B) measurements of national trends in the effectiveness of patient care.
C) evidence-based practice guidelines.
D) systematic reviews of the 15 most common areas of nursing intervention.



10. A quality improvement initiative at a large university hospital has referred to the National Quality Forum’s list of 15 nursing standards for inpatient care (NQF-15). The NQF-15 are
A) important processes and outcomes that are within the scope of nursing personnel.
B) nursing interventions related to the top 15 causes of morbidity and mortality in the United States.
C) the nursing practices identified each year as being most in need of improvement.
D) evidence-based patient guidelines that are updated annually by the NQF.



11. During a quality improvement initiative aimed at improving patient outcomes in falls prevention, the nursing staff of a long-term care facility utilized the PDSA cycle. This cycle would conclude with which of the following actions?
A) Publishing or presenting the results of the quality improvement initiative
B) Revising, refining, and repeating the change that was implemented
C) Analyzing the results of the change in falls-prevention practice
D) Enacting the change in practice on a small scale



12. Which of the following changes in practice would be most amenable to the PDSA cycle?
A) A change to care guidelines for patients presenting to emergency departments with chest pain
B) A change to the parameters of prescriptive authority held by a state’s nurse practitioners
C) A change to the national guidelines for childhood immunizations
D) A change in a medical unit’s schedule of turning immobilized patients



13. The nursing leadership of a large, urban hospital are dissatisfied with the results of the hospital’s most recent nursing quality audit when the results were examined through the lens of the National Database of Nursing Quality Indicators® (NDNQI®). Which of the following results of the hospital’s review would fall with the scope of the NDNQI’s structure indicators?
A) The incidence of pressure ulcers among inpatients was unacceptably high during the past year.
B) Eleven percent fewer nurses expressed satisfaction with the way their work schedules are organized than the previous year.
C) The number of nurses who possessed baccalaureate degrees increased by 0.9% over the previous year.
D) The average length of stay on the hospital’s post-surgical units decreased from 2.1 days to 1.95 days.



14. The effectiveness of change that is implemented according to the PDSA cycle can be best improved by which of the following measures?
A) The inclusion of external evidence
B) Recognition of the importance of clinician experience
C) An increase in the size of the sample
D) Consultation with outside stakeholders



15. A nurse educator has reviewed a study on the coping strategies of freshman nursing students that presents conclusions that differ markedly from other studies that have examined the issue. The study in question may possibly have a flaw in which of the following domains?
A) Consistency
B) Believability
C) Veracity
D) Utility



1. A nurse is preparing a research proposal in an effort to answer a clinical question. Which of the following measures is most likely to reduce the potential for bias in the study?
A) Replicating the research methodology of an existing study that addresses the clinical question
B) Ensuring the number of participants is sufficiently high
C) Randomly assigning the participants to groups
D) Ensuring the clinical question reflects phenomena identified in relevant qualitative research



2. A nurse researcher is investigating the effectiveness of a new, school-based smoking prevention program. Which of the following should the nurse consider as a potential confounding historical factor?
A) Students’ existing attitudes toward tobacco use
B) The relationship between tobacco use and alcohol use
C) Students’ respiratory health status at the commencement of the program
D) Antismoking messages already present in the media



3. While reviewing a study that appears to favorably recommend the use of an innovative mattress for the prevention of pressure ulcers, the nurse notes that the sum of the experimental group and the control group is significantly less than the total sample. How should the nurse best interpret this fact?
A) This represents a potential threat to the reliability of the study.
B) A significant number of participants did not develop pressure ulcers.
C) The results of the study have most likely been manipulated.
D) A confounding variable was present that the authors did not account for.



4. The historical incidence of deep vein thrombosis in medical patients at a university hospital was 2.5%. This figure dropped to 2% among an experimental group during the implementation of a new prophylaxis regimen. What is the nurse’s most accurate interpretation of this finding?
A) The relative risk of DVT among medical patients is 2/100.
B) The regimen results in a 20% relative risk reduction.
C) The absolute risk of DVT among the control group is 2.5%.
D) The results of the intervention are valid and reliable.



5. The number needed to treat (NNT) for an experimental vaccine is 775. This means
A) 775 individuals will be prevented from developing the disease in question.
B) the relative risk reduction of the disease is -775 among those who were vaccinated.
C) 775 individuals must be vaccinated to prevent one case of the disease.
D) vaccinated individuals have a 1-in-775 chance of developing the disease.



6. The findings of a study indicate that the chance of the effect being attributable to chance is 1 in 25. How would this fact be expressed in the study?
A) RR = 4%
B) AR = 24
C) p = 0.04
D) NNT = 25



7. While reviewing the findings of a study addressing the nursing management of gestational diabetes, the nurse notes that the study fails to address the findings of the existing literature on the subject in a detailed or specific manner. How should this influence the nurse’s view of the study?
A) The findings of the study likely represent a notable advance in gestational diabetes management.
B) This omission should be addressed in the statistical analysis of the study.
C) This is acceptable in a qualitative, but not quantitative, study.
D) The authors should have addressed the existing body of knowledge around the subject.



8. A nurse has presented a published case study to other nurses on the unit that relates the case of a patient who experienced respiratory arrest and sudden death following the infusion of total parenteral nutrition (TPN). How should the nurses respond to the findings of this case study?
A) Modify unit practice around TPN administration
B) Avoid administering TPN until more is known about the subject
C) Take note of the phenomenon and do further research before implementing practice changes
D) Disregard the findings of the case study due to the low level of evidence provided by a case study



9. A cohort study has investigated the effect of an asthma care support program for asthma patients under 18 years old on participants’ frequency of emergency department visits. Which of the following aspects of the study raises questions about the validity or reliability of the study?
A) The study included 310 pediatric asthma patients.
B) The program was initiated over 7 years ago and was evaluated by reviewing medical records.
C) The participants received various types of pharmacological treatment and psychosocial support for their asthma.
D) The study was conducted without the presence of a control group.



10. Which of the following measures is most likely to ensure baseline equivalency in a randomized controlled trial that will test the efficacy of a new bandaging system for chronic venous leg ulcers?
A) Ensuring that clinicians are unaware of whether the bandage they are applying is the experimental or control product
B) Randomly assigning participants to the “new bandage” group and the “old bandage” group
C) Rigorously screening potential participants to ensure they have as many characteristics in common as possible
D) Setting strict criteria around the character and severity of ulcers that will be treated



11. A gerontological nurse is reviewing the findings of a study that tested the efficacy of donepezil in the treatment of Alzheimer’s disease. Assignment to groups in the study included the fact that the researchers distributed participants with early Alzheimer’s and advanced Alzheimer’s evenly among the control group and the experimental group. The nurse would recognize that the researchers implemented which of the following?
A) A quasi-experiment
B) Cluster randomization
C) A cohort study
D) Stratified randomization



12. A nurse who provides care in a psychiatric care facility is reviewing the literature on the use of quetiapine for the treatment of schizophrenia. When reviewing a randomized control trial (RCT) testing the efficacy of the drug, which of the following measures should the nurse look for to best minimize the potential for bias?
A) The participants and clinicians did not know if they were receiving or administering a placebo or the drug.
B) The clinicians were able to select which participants were assigned to the control group or the experimental group.
C) The participants did not know if they were receiving quetiapine or a placebo pill.
D) Participants were selected to the control group or experimental group based on the severity of their symptoms.



13. A nurse is reviewing a study comparing a new alcohol screening instrument to an existing instrument in predicting patients’ withdrawal symptoms during hospital admissions. The nurse notes that the confidence interval of the study includes a relative risk (RR) of 1. What are the implications of this fact?
A) The screening instruments are unable to predict patients’ risks for alcohol withdrawal.
B) Using the new instrument will result in more unanticipated cases of withdrawal.
C) The new instrument is a modest improvement on the existing instrument.
D) The new instrument may be no better than the existing one in predicting withdrawal.



14. In an effort to update the unit protocol for the nursing management of hypoglycemic episodes, a nurse educator has consulted a systematic review that is available on the subject. Which of the following criteria should the nurse prioritize when assessing a systematic review?
A) Ensuring the inclusion criteria limited the review to studies published within the past 5 years
B) Checking to see that both studies that were included and those that were excluded are specified
C) Ensuring that unpublished studies were excluded from the systematic review
D) Confirming that all of the studies that were included in the review were statistically analyzed as one data set



15. When reviewing the studies that were included in a systematic review, a nurse is aware of the potential for publication bias. What is an implication of this phenomenon?
A) Studies with no demonstrated effect may not appear in the literature.
B) Studies that challenge accepted practice are often rejected for publication.
C) The fact that a study has been published constitutes a form of bias.
D) Biased publications often form the basis of accepted practice.



1. A qualitative research study would be considered to be level one evidence in a nurse’s attempt to answer which of the following clinical questions?
A) “What is the meaning of hope among patients undergoing treatment with burn injuries?”
B) “What factors contribute to diabetic patients’ decisions to infrequently monitor their blood glucose levels?”
C) “How does an exercise program compared with dietary control affect weight loss in obese patients?”
D) “How does partial assistance with feeding compared with total assistance affect the nutritional outcomes of stroke patients younger than 70?”



2. A nurse has recognized a need to understand the ways in which women with fibromyalgia adjust their lifestyles to accommodate the effects of their diagnosis. Which of the following domains of research is most likely to provide evidence for the nurse?
A) Randomized controlled trials
B) Qualitative studies
C) Case control studies
D) Cohort studies



3. A nurse is searching for evidence in an effort to answer a series of clinical questions related to childhood asthma. In which of the following areas is qualitative research likely to be most valuable?
A) Identifying if nebulized delivery of bronchodilators is superior to the use of metered-dose inhalers
B) Identifying which environmental exposures are most closely linked to the incidence of bronchospasm
C) Identifying how a family’s accessibility to primary care affects the course of a child’s asthma
D) Identifying values that determine children’s choices of where and when to use their metered-dose inhalers



4. A nurse is seeking to understand the processes of adjustment and coping that parents go through in the year after giving birth to a child with a neural tube defect. Which of the following qualitative traditions is most likely to inform the nurse?
A) Ethnography
B) Phenomenology
C) Grounded theory
D) Hermeneutics



5. A nurse researcher is conducting a phenomenological study among men who have been diagnosed with prostate cancer. Which of the following focuses is most indicative of the nurse’s chosen methodology?
A) Identifying what support programs best meet men’s emotional needs following diagnosis
B) Identifying the role that culture plays in men’s sense-making of their diagnoses
C) Identifying the process that men go through as they suspect, receive, and then live with their diagnoses
D) Identifying and examining the meanings of the lived experiences that the men associate with their diagnoses



6. In the course of gathering and analyzing data for a qualitative study that examines the effect that a child’s chronic illness has on his or her siblings, a nurse has produced fieldnotes. What is the purpose of the nurse’s fieldnotes?
A) Making a record of the nurse’s observations and interactions that occur during data gathering
B) Producing a written record through which other researchers may follow the research process
C) Recording the analytic conclusions of the data
D) Relating the changes in the phenomenon that occur over time



7. While conducting a qualitative research study on patients’ responses to having a colostomy, the nurse is at the stage of doing content analysis. What activities characterize this component of the qualitative research process?
A) Identifying practical applications of the research findings
B) Reflecting on the nurse’s own response to the informants’ experiences
C) Breaking down data and reconstituting them in some other form
D) Gathering data from participants in the form of interviews and focus groups



8. A nurse is writing a research proposal for a grounded theory study that will address the experiences and transitions of women in the months following spontaneous abortion. Which of the following guidelines should the nurse follow when choosing a sampling strategy?
A) Random sampling should be the nurse’s goal with participant self-selection if this is not practicable.
B) The nurse should identify a minimum of 10 informants or 15 informants if purposeful sampling is utilized.
C) The nurse should have a sample small enough to allow depth of inquiry but large enough to include a variety of voices.
D) The nurse should seek as large a sample as possible in order to facilitate thick description and the validity of findings.



9. Which of the following facts about a qualitative study addresses the meanings of a support group for adults with type 1 diabetes that may present a potential flaw?
A) The researcher provides original insights into the etiology of diabetes.
B) The researcher has type 1 diabetes.
C) The researcher was an open attendee of the support group meetings.
D) The researcher did not do random sampling.



10. A researcher has developed and administered a survey that addresses patients’ reactions and responses to being diagnosed with nosocomial (hospital-acquired) infections while inpatients. The researcher has subsequently completed and submitted a manuscript that proposes a theory around the patients’ perceptions of infection control in the hospital setting. The researcher’s actions most clearly represent a potential deficit in which of the following criteria?
A) Veracity
B) Individuality
C) Transferability
D) Credibility



11. A careful reading of a qualitative research study has revealed a potential lack of confirmability. Which of the following observations may have led the reader to this conclusion?
A) The findings appear to be true only among the specific participants in the study.
B) The links between the findings and the data are not evident.
C) The sample consisted of only 8 participants.
D) The researcher makes no mention of producing fieldnotes.



12. The findings of a widely-disseminated qualitative study that addresses the meaning of smoking to teenage cigarette smokers has resulted in significant changes to many of the antismoking strategies undertaken by school nurses. The study has most clearly demonstrated which of the following qualities?
A) Ontological authenticity
B) Credibility
C) Catalytic authenticity
D) Confirmability



13. An oncology nurse has been exposed to numerous qualitative studies addressing the experience and meaning of cancer diagnosis and is now preparing to conduct a metasynthesis of the subject. Which of the following principles should the nurse include in the methodology of this new study?
A) Reanalyzing the raw data from the studies selected for inclusion
B) Performing a thematic analysis of the themes and category titles of the chosen studies
C) Forming a liaison with the authors of the original studies
D) Performing statistical analysis of the combined findings of the chosen studies



14. Though rooted in the voices of the 16 men who were interviewed for the study, the findings of a qualitative study into the health practices of male prison inmates is thought to be true for many members of the larger prison population. This fact about the study most clearly demonstrates
A) Transferability
B) Confirmability
C) Dependability
D) Credibility



15. Use of which of the following data-gathering techniques is most likely to represent a potential flaw in the design of a qualitative study?
A) Participant observation
B) Unstructured interviews
C) Focus groups
D) Online surveys


1. Which of the following activities most clearly indicates that a nurse is engaging in self-improving practice?
A) The nurse reflects on practice in an effort to identify potential mistakes.
B) The nurse seeks input from more experienced colleagues.
C) The nurse attempts to get to know patients on a personal level.
D) The nurse has participated in a research study being conducted on the hospital unit.



2. A nurse has recently marked 10 years of practice on a medical unit. Which of the following aspects of “experience” is most likely to result in improved practice on the part of a nurse?
A) Increased years of practice in a consistent clinical environment
B) Exposure to more patient interactions and conduction of more interventions
C) Examination of interactions and events in the clinical context
D) Engagement with a greater variety of patients and patient populations



3. Which of the following aspects of care on a postsurgical unit is the clearest example of phronesis?
A) “The patient will dangle at the bedside q4h on postoperative day 1.”
B) “The patient will demonstrate independent ambulation prior to discharge.”
C) “The patient will perform leg exercises and deep breathing and coughing exercises twice on the day of surgery.”
D) “The patient will transition from dangling to assisted standing for the first time following surgery with the assistance of the physical therapist.”



4. Which of the following activities by the nurse most directly fosters phronesis in the care of geriatric patients in a long-term care setting?
A) The nurse consistently seeks out and attends continuing education offerings.
B) The nurse stays abreast of current research in geriatric nursing.
C) The nurse has organized a pilot study on falls prevention in the care facility.
D) The nurse makes an effort to get know residents’ individual needs, concerns, and goals.



5. How should a nurse best understand the concept of clinical expertise?
A) Clinical expertise is even more valuable than research evidence.
B) Clinical expertise is enhanced by holistically knowing patients as individuals.
C) Clinical expertise is demonstrated by the formalized knowledge of nursing practice.
D) Clinical expertise is central to good nursing practice, superseded only by the importance of published articles.



6. A nurse is providing care for a 3-year-old girl who has been admitted to the pediatric intensive care unit with a suspected brain injury following a choking episode. Which of the following aspects of the nurse’s care best demonstrates clinical expertise?
A) The nurse has previously cared for a patient in similar circumstances.
B) The nurse has a sound and current knowledge base around respiratory and neurological pathophysiology.
C) The nurse recognizes that there are numerous patient and family variables at play.
D) The nurse demonstrates empathy when caring for the patient.



7. A qualitative study addresses the cues that nurses perceive when they sense a patient’s condition is worsening. The study data are based on narratives from several nurses who provide care in high acuity settings. Narratives are most likely to make which of the following contributions to the study?
A) Insights into the nuances of nurses’ understandings of complex situations
B) Indications of the depth of participants’ knowledge bases
C) Insights into the nurses’ abilities to implement evidence-based practice
D) Indications of the depth of clinical expertise that exists among the sample



8. Which of the following clinical questions is most likely to be informed by the use of nurses’ narratives?
A) How do 8-hour nursing shifts compare with 12-hour shifts to affect patient safety in an emergency department setting?
B) What meaning do nurses assign to conflicts they have with patients and the families of patients?
C) What factors contribute to nurses’ decisions to administer as-needed analgesia?
D) How does a mentorship program compare with traditional orientation of new staff in affecting retention among new nursing graduates?



9. Which of the following statements provides the clearest rationale for the use of narratives in understanding nursing knowledge and clinical expertise?
A) The acuity of patients on admission to a hospital is higher than in previous decades and continues to increase.
B) The ability of  nurses to provide adequate care with ever-increasing patient loads is poorly understood.
C) As life expectancy increases, more patients are living with chronic conditions whose symptoms often overlap.
D) The trajectory of illness and the human experience of it can be complex and highly individualized.



10. Nurse L provides care on a busy medical unit of an inner-city hospital. Which of the nurse’s actions best exemplifies clinical grasp?
A) Nurse L is committed to reading and integrating the most recent, published evidence.
B) Nurse L is able to identify subtle changes in patient condition that are often not obvious to other clinicians.
C) Nurse L has responded appropriately to patients in cardiac or respiratory arrest.
D) Nurse L makes a concerted effort to get to know patients’ families.



11. A nurse paged the attending physician because a postmastectomy patient became somewhat agitated and tachypneic in recent hours. Despite other nurses’ assertions that the patient was simply experiencing some anxiety, the nurse suspected a more serious etiology. The physician prescribed a single dose of a benzodiazepine, which was largely ineffective. Due to the nurse’s persistence, diagnostics were performed, leading to a diagnosis of pulmonary embolism. Which of the following did the nurse exhibit?
A) Evidence-based practice
B) Clinical grasp
C) Patient-centered care
D) Best practice



12. Nurse M makes a conscious effort to think beyond the rigidly-defined signs and symptoms of illnesses and recognizes that context has a highly significant impact on illness situations. This thinking facilitates which of the following?
A) Engaging in detective work
B) Phronesis
C) Making qualitative distinctions
D) Techne



13. A nurse who provides care on a geriatric subacute medicine unit is aware that elderly patients often exhibit signs and symptoms of infection that are very different from those of younger patients. This knowledge is an example of
A) recognizing changing clinical relevance.
B) engaging in detective work.
C) making qualitative distinctions.
D) developing clinical knowledge about specific patient populations.



14. While helping a colleague reposition a patient who is in moderate respiratory distress, the nurse has a sense that it would be appropriate to ensure the bag-valve mask (Ambu bag) is readily accessible and to confirm the patient’s code status. Which of the following qualities does this exemplify?
A) Engaging in detective work
B) Evidence-based practice
C) Future think
D) Phronesis



15. Knowing that the patient was admitted with a diagnosis of sepsis, the nurse has limited the most recent bedside assessment to an oral temperature followed by a review of the patient’s white cell count. This limited-scope assessment will most directly affect the nurse’s ability to
A) engage in experiential learning.
B) see the unexpected.
C) individualize care.
D) provide empathy.


1. A nurse has referred to a clinical practice guideline that addresses prenatal screening. The nurse would recognize that which of the following phenomena provides the best rationale for consulting clinical practice guidelines when planning and providing care?
A) Clinical practice guidelines are a form of evidence that is superior to systematic reviews.
B) Significant variations in care exist between different regions and institutions.
C) Clinicians frequently lack access to databases and publications.
D) The complexity and volume of research means that clinicians do not have the specialized skills needed to implement research findings.



2. Which of the following statements most accurately conveys the relationship between systematic reviews and clinical practice guidelines?
A) Clinical practice guidelines are a more reliable and valid source of guidance than systematic reviews.
B) In the absence of a relevant and current systematic review, clinicians should base their practice on available clinical practice guidelines.
C) Clinical practice guidelines normally integrate the results of systematic reviews into their recommendations.
D) Clinical practice guidelines and systematic reviews are largely synonymous.



3. A nurse is conducting a search for clinical practice guidelines that address the management of constipation in the elderly. Which of the following principles should the nurse integrate into the search?
A) A high-quality clinical practice guideline should have universal applicability.
B) The geographical origin of the authors and sponsoring body should determine clinical applicability.
C) The nurse should reject guidelines that have included levels III and IV evidence.
D) The nurse should appraise the applicability and relevance of guidelines before implementing them.



4. A nurse has consulted a clinical practice guideline addressing the prevention of foot complications among patients with diabetes. Which of the following considerations should the nurse prioritize when appraising the guideline?
A) The authors’ affiliations and qualifications
B) Validity and reliability of the recommendations
C) Clinical applicability of the recommendations
D) The nature and reputation of the sponsoring body



5. A public health nurse has noted that the U.S. Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection for all sexually active nonpregnant young women aged 24 and younger and for older nonpregnant women who are at increased risk. This recommendation is classified as a grade A recommendation. This primarily means that
A) there is good evidence that doing so improves patients’ health outcomes.
B) the evidence underlying the recommendation has been classified as “authoritative.”
C) the recommendation is based on the fact that implementing the recommendation will not harm patients.
D) the recommendation is based solely on randomized controlled trials.



6. A nurse who provides care on a postsurgical unit where many patients have undergone bowel surgery intends to implement a clinical practice guideline on ostomy care and management. Which of the following factors would cause the nurse to reconsider the implementation of the clinical practice guideline?
A) The guideline was prepared 3 years ago.
B) The guideline includes studies that are from a medical perspective.
C) The guideline was prepared and released by a body from outside the country.
D) The guideline focuses on community-based patients with ostomies.



7. When appraising a clinical guideline around interventions for postpartum depression, which of the following is most likely to be of use to an obstetrical nurse?
B) PubMed
C) American Nurses Association online resources
D) The AGREE instrument



8. Which of the following clinical problems should be prioritized for the development of a new clinical guideline?
A) A common health problem for which a sound guideline exists but is 4 years old
B) A health situation that is rare but which has occasionally been associated with sudden death
C) A topic that is common but rarely associated with significant negative outcomes
D) A topic that is uncommon but has implications for public health beyond those individuals directly affected



9. Which of the following factors constitutes the strongest rationale for creating a new clinical practice guideline for the nursing management of patients who have suicidal ideation?
A) There is emerging evidence that there is a large gap between common practices around suicide risk management and optimal practices.
B) The costs to patients, families, healthcare institutions, and third parties associated with depression, psychosis, and suicide are unacceptably high.
C) The problems of depression and suicide are frequently stigmatized among both healthcare providers and members of the public.
D) There is a huge, and growing, amount of research that addresses the problems of suicide and the nursing management of it.



10. Which of the following principles should nurse researchers follow when determining who to include on the panel that will be amending a clinical practice guideline for the assessment and management of venous leg ulcers?
A) Patients should be excluded from the panel in order to maintain objectivity,
B) The panel should include people from a number of disciplines beyond nursing,
C) Individuals who contributed to the previous version of the guideline should be excluded from the current panel.
D) A large majority of the panel members should be nurses who actually provide ulcer care, supported by one or two research experts.



11. A panel has been established and commissioned with creating a new clinical practice guideline for the assessment and device selection for vascular access. Which of the following activities should the panel prioritize before beginning their literature review?
A) Drafting preliminary practice guidelines
B) Identifying evidence sources that will address clinicians’ potential reluctance to implement the new guideline
C) Identifying the inclusion and exclusion criteria for evidence
D) Gaining input from the peer reviewers who will evaluate the finished guideline



12. A new clinical practice guideline for the nursing management of oral hydration has been created by a panel and the recommendations have just been finalized. What should the panel do next?
A) Disseminate the guideline through publications and presentations
B) Submit the new guideline to peer review
C) Compare the new guideline to the literature that addresses oral hydration
D) Test the new guideline clinically



13. A hospital has adopted new clinical practice guidelines around the use of physical restraints. Which of the following measures is most likely to facilitate the knowledge transfer that is necessary for the guideline to be put into practice?
A) Appointing one or more best practice champions to lead the initiative
B) Providing a financial incentive for staff to attend the relevant education initiatives
C) Creating a culture where resistance to evidence-based practice is stigmatized
D) Ensuring that education about the new guideline is provided by experts from outside the hospital



14. The leadership of a pediatric unit are in the process of implementing a new practice guideline for the prevention of medication errors. Which of the following factors is most likely to have the largest influence on the success or failure of implementing the guideline into practice on the unit?
A) The strength of the evidence on which the guideline is based
B) The environment and culture of the unit
C) Nursing workload and the acuity of patients on the unit
D) The size of the gap between actual practice an optimal practice



15. A nurse has encountered skepticism from colleagues when attempting to introduce clinical practice guidelines (CPGs) at a long-term care facility. The nurse will attempt to explain the most significant benefit of clinical practice guidelines, which is their potential to
A) translate research into clinical practice.
B) personalize care while acknowledging context.
C) make the change process occur more quickly.
D) increase nurses’ accountability for the care they provide.



1. As a starting point for an initiative to integrate more evidence into the nursing practice at a community hospital, the nursing leadership has begun by holding meetings and focus groups aimed at developing a shared mental framework. What will this framework encompass?
A) A statement of the goals for practice at a designated point in the near future
B) An action plan for implementing EBP
C) The values and ideals of nurses that can inspire change
D) A brief document that outlines the mission of the organization and the nurses



2. Caregivers and leaders of a university medical center are pleased that their facility has recently been granted Magnet recognition by the American Nurses Credentialing Center (ANCC). What does this designation indicate about the hospital?
A) The hospital has met specific outcomes for which EBP forms the foundation.
B) The hospital has demonstrated positive patient outcomes and attracted practitioners from outside the geographic region.
C) The hospital has proven to be a site where new research is conducted and new evidence is generated.
D) The hospital has demonstrated the presence of a cohort of staff committed to providing EBP.



3. Two recent nursing graduates have resolved to champion EBP on the hospital unit where they provide care. They should begin this initiative by
A) identifying research that relates to their practice setting and patient population.
B) creating a shared understanding of the type of practice environment they envision.
C) identifying a list of achievable goals for practice.
D) enlisting the help of expert nurses who have experience in producing and implementing research.



4. In an effort to create an environment that exemplifies EBP, the nursing leadership has made a concerted effort to include as many caregivers as possible, from numerous levels, in the process. What is the most likely rationale for this aspect of the change process?
A) Promoting engagement
B) Identifying and removing barriers
C) Identifying goals
D) Prioritizing clinical issues



5. A group of nurses has encountered difficulties at many points in their efforts to integrate EBP on the medical unit where they provide care. Which of the following barriers is likely to present the greatest challenge?
A) The difficulty of identifying research that relates directly to their patient population
B) Apathy and resistance on the part of a cohort of nurses on the unit
C) Unfamiliarity of some nurses with the concept of EBP
D) The lack of a common vision for change among the nurses who are advocating EBP



6. In the course of narrowing their focus in a campaign to implement EBP in their workplace, a group of nurses is currently choosing which nursing areas to address. The nurses should prioritize which of the following?
A) Nursing activities that are most familiar to the educators on the unit
B) Areas that relate to the outcomes necessary for Magnet recognition
C) Nursing actions that are addressed in the most detail in the literature
D) Interventions that nurses perform most often during their care



7. Which of the following principles should guide the choice of leadership when implementing EBP?
A) Staff nurses should be mentored into familiarity with EBP by experts.
B) Nurses should independently guide the EBP process in order to facilitate their experiential knowledge.
C) Experts from academic settings should be brought in to carry out the process.
D) Hospital leaders and administrators, assisted by nurses, should guide the EBP process.



8. How can an EBP implementation team best build engagement and buy-in among nurses?
A) By emphasizing the pride and sense of accomplishment that can come from implementing EBP
B) By emphasizing the positive outcomes that can be brought about by the change
C) By identifying the relationship between EBP and the American Nurses Association’s Nursing Standards
D) By explaining the role of EBP in Magnet recognition



9. The nurses on a pediatric unit have identified a need for changes to their assessment practices to minimize sleep disruption to patients. Which of the following strategies should the EBP implementation team use in an effort to disseminate the evidence that forms the foundation of EBP?
A) Distributing new clinical practice guidelines that are reflective of EBP
B) Combining information on relevant changes with stories of the effects of change
C) Increasing nurses’ access to online databases and journals
D) Offering teaching sessions from an expert nurse during scheduled break times



10. The nurses who provide care in the cardiac catheterization clinic of a large hospital are currently engaged in an EBP initiative. Which of the following factors will have the greatest effect on the success or failure of the initiative?
A) Ensuring that practice guidelines are widely-distributed, clear, and well-understood
B) Providing opportunities for staff to see EBP in action at other hospitals and care facilities
C) Restructuring the flow and organization of work to allow EBP to be implemented
D) Ensuring that examples of traditional practice that are not evidence-based are identified and addressed



11. The staff of a medical unit has agreed to pilot test a new, evidence-based educational initiative that addresses the learning needs of adults who have been recently diagnosed with type 2 diabetes. A pilot test is likely to accomplish which of the following?
A) Determine whether the existing research on diabetes education is valid and reliable.
B) Reduce the incidence of type 2 diabetes among local adults.
C) Gauge whether nurses are qualified to perform patient and family teaching related to diabetes.
D) Indicate whether the initiative is feasible to implement and applicable to the population.



12. Nurses on a labor-and-delivery unit are in the early stages of planning an evidence-based initiative aimed at establishing evidence-based practice around fetal monitoring during labor. Which of the following guidelines should the nurses follow when planning the timeline of this EBP initiative?
A) The nurses should be aware that if the initiative spans more than 3 months, it is very difficult to sustain momentum.
B) Constraining the initiative to a written timeline compromises the success of the initiative.
C) The nurses should identify the multiple variables that could affect the project and create a timeline accordingly.
D) Most complex EBP initiatives can be implemented in 8 to 10 weeks.



13. During the planning stages of an evidence-based falls-prevention initiative, the nurses at a convalescent facility are organizing the way that the initiative will be evaluated. When should the nurses plan to audit the incidence of falls at the facility?
A) Immediately following the completion of the initiative
B) One to 2 months after the project has been completed
C) Before and immediately after the project
D) Before and right after the project as well as several weeks or months after the change



14. Use of a new, evidence-based method of securing intravenous catheters and tubing has resulted in 31% fewer incidents of accidental or intentional IV removal on a pediatric unit. This statistic is an example of what type of evaluation indicator?
A) Risk reductions
B) Environmental changes
C) Efficiency of processes
D) Outcome measures



15. Which of the following phenomena would signal that an EBP initiative has resulted in environmental change?
A) Hypo- and hyperglycemia are being addressed more quickly than before an EBP initiative.
B) Nurses are consulting and implementing the unit policy and procedures manual more often than before an initiative.
C) Staff compliance with hand washing and hand sanitizing increased 26% over the course of an initiative.
D) Sick calls and other forms of absenteeism have been reduced following the completion of an EBP initiative.



1. Which of the following actions related to outcomes measurement falls within the scope of the outcomes management (OM) framework?
A) Surveying the views of nurses to elicit effective interventions and outcomes
B) Correlating specific interventions with their outcomes
C) Assessing patients’ understanding of their own health status
D) Quantifying patient satisfaction ratings as a key outcome



2. Staff on a burns-and-plastics unit have implemented a new, evidence-based algorithm around pain control prior to debridement and dressing changes that was based on the Health Outcomes Institute’s Outcomes Management Model. Analysis of the outcomes following the implementation of the new practice reveals that patient reports of pain during the procedures actually increased slightly compared with preexisting practices. The caregivers should prioritize which of the following?
A) Revisiting phase one of the process
B) Disseminating the results of the process
C) Continuing with data collection over a longer period
D) Reexamining the evidence and chosen practices



3. Which of the following actions is most likely to promote acceptance of a new, evidence-based initiative aimed at reducing the incidence of pressure ulcers among stroke patients on a rehabilitative medicine unit?
A) Having an expert talk to staff about the deleterious effects that pressure ulcers have on the quality of life of patients
B) Quantifying and distributing the baseline incidence of pressure ulcers on the unit
C) Encouraging staff to search the health literature for possible new interventions for pressure ulcer prevention
D) Directing staff to be vigilant when charting interventions related to the prevention or treatment of pressure ulcers



4. The nursing leadership at a county hospital are alarmed by an apparent increase in the incidence of nosocomial methacillin-resistant staphylococcus aureus (MRSA) colonization and infection among inpatients. The leaders are eager to determine if this is a real or perceived phenomenon and should proceed by
A) beginning a campaign of data collection related to MRSA.
B) conducting a literature review related to MRSA infection and colonization.
C) examining existing hospital data to see if their suspicions are valid.
D) beginning a program of observation to assess the infection-control practices of care providers.



5. Which of the following data that are required for an EBP initiative are most likely to be obtained from the hospital’s quality management department?
A) Incident reports documenting patient assaults on nurses
B) Patient demographic data
C) Information on staffing levels at various times and locations
D) Medication regimens of patients who have specific illnesses



6. Nurses are attempting to identify the relationship between patient satisfaction and the staffing complement of the hospital as part of the baseline data for an EBP initiative. Which of the following sources should the nurses approach in order to access existing patient satisfaction surveys?
A) Finance
B) Quality management
C) Administration
D) Clinical systems



7. Knowing that the healthcare organization utilizes the International Statistical Classification of Diseases and Related Health Problems Version 9 (ICD-9) for patient and third-party billing, a nurse has requested such records for patients admitted in the last 3 months to the emergency department. The nurse has requested that the records be provided in an electronic, rather than paper-based, format because
A) confidentiality is easier to maintain when working with electronic data.
B) electronic data are more likely to be current than paper-based records.
C) patients often do not grant permission for release of their health records in hard copy.
D) electronic data are easier to manipulate in order to perform statistical analysis.



8. Nurses are attempting to identify any relationship between staffing levels and the incidence of catheter-associated urinary tract infections (UTI). The nurse should begin by doing which of the following?
A) Auditing the staffing records obtained from the human resources department
B) Identifying which other variables may potentially affect UTI development
C) Observing nurses’ current practices related to catheter care
D) Revising the current policy and procedures manual for guidelines to catheter care



9. As a component of data collection for an evidence-based practice initiative, a nurse is constructing a document that is designed to measure the quality of working relationships between disciplines on the hospital unit. Which of the following principles should guide the nurse’s efforts?
A) The instrument should be written by a staff member who is not directly participating in the initiative.
B) The nurse should use a qualitative, rather than quantitative, approach.
C) Complex phenomena, such as human relationships, are not amenable to analysis by documents and surveys.
D) The instrument must be proven valid and reliable before it can be utilized.



10. The educator on an intensive care unit has drafted a new instrument aimed at gauging patient pain, but nurses have called into question the validity of the instrument. What is the nurses’ most likely criticism of the instrument?
A) The instrument is more complex than instruments that already exist.
B) Results of using the instrument will vary greatly from patient to patient.
C) The instrument does not actually measure pain.
D) The nurse did not integrate existing evidence into the development of the instrument.



11. Which of the following numeric measures would be most likely to produce invalid statistical analysis?
A) Analysis of patients’ blood pressures in mmHg
B) Pain rating as: none = 0; slight = 1; much = 2
C) Assessment of oxygen saturation in percentage
D) Analysis of neonatal birthweight in kilograms



12. An oncology nurse is in the habit of asking patients to describe the character and quality of their nausea during chemotherapy treatment. These descriptions would constitute what level of data?
A) Ordinal
B) Interval
C) Nominal
D) Ratio



13. As part of the data-gathering that is being conducted to identify baselines prior to an evidence-based practice initiative, a nurse will be using software to analyze the data statistically. Which of the following levels of data is most likely to produce clinically useful results?
A) Ordinal
B) Ratio
C) Nominal
D) Cardinal



14. In an effort to examine the possible relationship between a particular exercise regimen and serum lipid levels, researchers have opted to use a quasi-experimental design rather than the true experiment that they originally envisioned. Which of the following changes have the researchers likely made to the study?
A) Participants will choose by themselves whether they will join the “exercise” group or the control group.
B) Participants will not be required to stop participating in other forms of exercise.
C) The researchers will perform qualitative, rather than statistical, analysis.
D) The results may be used to strengthen existing evidence but will not constitute new evidence.



15. The leadership of a hospital unit has recently established a dashboard at the nurses station that addresses patient readmission rates. This initiative is likely to have what effect?
A) Increasing adherence to evidence-based practice
B) Gauging the quality of authorized policies and procedures on the unit
C) Allowing nurses to see the cause-and-effect relationship between care and outcomes
D) Allowing nurses to perform statistical analysis at the point of care



1. A nurse has praised the recent efforts on a medical unit to utilize research in an effort to improve the quality of nursing care of patients with dyspnea. The nurse educator on the unit, however, has characterized the initiative as an example of evidence-based practice rather than research utilization. This distinction suggests that
A) the change was based on expert opinion rather than journal articles and textbooks.
B) the effects of the practice change will be evaluated formally and the change will be revisited if outcomes are unsatisfactory.
C) internal evidence was considered during the practice change.
D) there was multidisciplinary input during the planning and implementation of the change.



2. Implementation of a new evidence-based practice guideline aimed at reducing urinary incontinence among hospitalized elders has proven difficult because of increased demands on nursing staff. Nurses on the unit state that the guideline requires them to spend more time and effort assessing for precursors to incontinence and toileting patients. Implementation of the practice guideline is being challenged by which of the following factors?
A) Patient preferences and actions
B) Patients’ clinical states
C) Clinical expertise
D) Healthcare resources



3. The nurses who provide care on an obstetrical unit of a busy, urban hospital have resolved to amend their practice around the facilitation of breastfeeding for preterm infants. The nurses will be utilizing the Stetler model and will, consequently, conduct a review of relevant studies they have located in which of the following phases of the model?
A) Translation
B) Preparation
C) Validation
D) Comparative evaluation



4. A nurse who is utilizing the Stetler model for the implementation of evidence-based practice would recognize that the model provides a method for conducting which of the following processes?
A) Critical thinking
B) Evaluation of individual research studies
C) Dissemination of findings
D) Interpreting clinical experiences



5. Which of the following nurses is most likely to have success in following and implementing the Stetler model of research utilization to facilitate evidence-based practice?
A) A practitioner who is an outside consultant and, thus, possesses objectivity
B) A practitioner who has direct leadership experience
C) A practitioner with experience among a large variety of patient populations
D) A practitioner with a graduate-level nursing education



6. The nurse educator on a gerontological unit has recognized the need to implement evidence-based practice around the prevention of wandering. The nurse will be implementing the Iowa model of evidence-based practice. According to the model, which of the following is a “problem-focused trigger” that most likely prompted the nurse’s desire for changes in practice?
A) The emergence of new and innovative research around the prevention and management of wandering
B) The release of new standards by the administration of the hospital
C) The fact that wandering patients have recently fallen or gone missing from the unit
D) Increases in patient acuity of the past several months with no commensurate increase in staffing levels



7. The nursing leadership of a university hospital wishes to implement evidence-based practice around the prevention of Clostridium difficile infection among inpatients. The team will be following the Model for Evidence-Based Practice Change. Which of the team’s activities is beyond the scope of the model?
A) Dissemination of the success or failure of the practice change
B) Engaging stakeholders in the early stages of the practice change
C) Conducting a literature review
D) Implementing a pilot study



8. A chart audit suggests the need for evidence-based practice in an effort to prevent central-line-associated blood infections. In an effort to bring about this change, the leadership team has opted to use the Advancing Research and Clinical practice through close Collaboration (ARCC) model. The team will begin the process by
A) consulting experts to guide the change process.
B) assessing the readiness of the workplace culture.
C) identifying and reviewing the nursing and multidisciplinary literature that addresses line sepsis.
D) exploring the problems that have triggered the need for change.



9. The Advancing Research and Clinical practice through close Collaboration (ARCC) model is being implemented as a hospital system seeks to improve the care of patients’ skeletal pin sites. Which of the following groups will play the primary role in guiding the implementation of the ARCC model?
A) Evidence-based practice mentors
B) Academic experts in nursing and change theory
C) Staff nurses
D) Nursing leadership and administration



10. Nurses at a county hospital are using the Advancing Research and Clinical practice through close Collaboration (ARCC) model to foster evidence-based practice in their screening for delirium, depression, and dementia among older adult patients. Which of the following data sources will be prioritized and combined with research evidence in order to guide practice?
A) Input from an interdisciplinary panel
B) The experiences of other institutions that have undertaken similar initiatives
C) The results of a cost analysis around implementing a change in practice
D) Preferences of patients and families



11. In preparation for an evidence-based practice initiative that will address the spiritual care that is provided to patients and families, a group of nurses is collecting information on the evidence related to the clinical question, the context in which it will be implemented, and the way in which the process will be facilitated. The nurses are most likely utilizing which of the following models for evidence-based practice implementation?
A) Iowa model
B) Advancing Research and Clinical practice through close Collaboration (ARCC) model
C) Promoting Action on Research Implementation in Health Services (PARIHS) framework
D) Johns Hopkins Nursing Evidence-Based Practice model



12. The Promoting Action on Research Implementation in Health Services (PARIHS) framework is being implemented in an effort to identify an evidence base for nurses’ pain management practices. The appointed facilitator will primarily perform which of the following roles?
A) Making the implementation of evidence easier for nurses
B) Identifying research that is relevant to the clinical question
C) Ensuring that the change process follows ethical guidelines
D) Evaluating and disseminating the results of the change in practice



13. Nurses are applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework in order to guide their implementation of evidence-based diabetes education in the hospital. Which of the following considerations will the team examine under the dimension of  “context”?
A) The similarities between sites where research was conducted and the site where it will be implemented
B) The significance that a new diagnosis of diabetes has for patients and families
C) The existing evidence-based practice that is demonstrated in other clinical situations at the hospital
D) The character and quality of leadership that exists in the hospital



14. A group of nurses is attending the Clinical Scholar program as part of their ongoing professional education. The program will equip the nurses for which of the following tasks?
A) Conducting research
B) Being familiar with the language of research
C) Monitoring adherence to evidence-based practice
D) Submitting manuscripts to scholarly publications



15. Pediatric nurses are using the Johns Hopkins Nursing Evidence-Based Practice model to integrate more evidence into their child abuse screening protocol. Which of the following information sources would the nurses consider as an external factor of influence?
A) Legislation that addresses child abuse
B) The staffing levels that are typical on the unit
C) Supplies and equipment that child abuse screening may require
D) Research that addresses the clinical question


1. The nurses on a medical unit recently acknowledged that their efforts to introduce an evidence-based pain management regimen have failed. Which of the following factors is most likely to have contributed to the failure of the EBP initiative?
A) Differences between the educational levels of staff nurses and those promoting the change
B) Contradictions in the body of literature around the assessment and management of pain
C) Failure to integrate principles of the psychology of change
D) The sufficiency of the existing protocols and policies of pain management on the unit



2. A nurse has recognized the need to change the practice on an obstetrical unit so that more women choose to breastfeed their babies after discharge. Which of the following factors is most important in determining the success or failure of the subsequent evidence-based practice change?
A) The positive effects of breastfeeding in neonatal health and development
B) The strength and specificity of the nurse’s vision for change
C) The depth and breadth of the nurse’s experience base
D) The credibility that the nurse holds on the unit



3. How should a group of nurses best address the need for goals at the outset of an evidence-based practice change at their workplace?
A) The team should identify a set of common goals and write them down.
B) The team should allow individual nurses the autonomy to choose their own goals.
C) The team should identify goals from within the literature and disseminate them.
D) The team should allow the project goals to evolve as the initiative progresses.



4. An initiative to improve the quality of care that stroke patients receive is being considered in a county hospital. Which of the following questions should the implementation team ask as part of a SCOT analysis?
A) “Who are the stakeholders that would be affected by a change in our practice?”
B) “How will we define success during this initiative?”
C) “What are the costs that might be incurred if we attempt to change practice?”
D) “What are the challenges in our workplace that we need to address?”



5. A change in practice is being considered on a hospital unit that is producing an unacceptably high number of incident reports. Which of the following characteristics of the unit best exemplifies the first stage of Duck’s Change Curve model?
A) A directive to change has been received but ignored.
B) The nurses on the unit lack knowledge and experience.
C) Relationships between staff and disciplines on the unit are antagonistic.
D) The leadership and culture of the unit are stagnant.



6. Nursing leaders are utilizing Kotter and Cohen’s Model of Change to guide a change in pressure ulcer assessment and prevention. What task should the leaders first perform?
A) Assess nurses’ willingness to change
B) Cultivate a sense of urgency
C) Mobilize evidence-based practice mentors
D) Communicate the proposed vision for change



7. Kotter and Cohen’s Model of Change has been implemented successfully, resulting in an evidence-based change in pressure ulcer assessment and prevention on a unit. What is the final step in this change process?
A) Disseminating the results of the change in practice
B) Sending out mentors to stimulate similar change on other units and in other hospitals
C) Nourishing the change to ensure the new practice is sustained
D) Monitoring nurses’ compliance with the new practice



8. According to Rogers’ theory of diffusion of innovations, which of the following groups of nurses is primarily responsible for initiating evidence-based change?
A) Innovators
B) Mentors
C) Catalysts
D) Leaders



9. The clinical nurse educator on a palliative care unit perceives that many of the staff nurses are in the precontemplative and contemplative stages of readiness to adopt a new, evidence-based approach to pain assessment and management. Which of the following strategies should the educator adopt?
A) Presenting the findings from the literature that support the change in practice
B) Making connections with staff and fostering their readiness to change
C) Implementing the initial changes in practice that are necessary
D) Identifying and addressing those staff members who are resistant to change



10. Nursing leaders in a large, urban emergency department are aware that many nurses are skeptical of a proposed evidence-based change in the management of patients with mental health problems. How should the nursing leaders best address this skepticism?
A) Bring in evidence-based practice mentors from an emergency department that has successfully implemented a similar change
B) Distribute copies of a meta-analysis that encompasses the relevant research and elicit feedback
C) Present the evidence that underlies the proposed change at an open forum
D) Create a venue for the nurses to express and discuss their skepticism directly



11. According to Rohm’s model of personality types, nurses with which of the following personalities are most likely to be effective as evidence-based practice mentors?
A) D
B) I
C) S
D) C



12. In light of the high incidence of nosocomial methacillin-resistant staphylococcus aureus (MRSA), there is an apparent need for improvements in infection-control practice at a county hospital. Which of the following goals should be established for a proposed evidence-based change in practice?
A) “The incidence of nosocomial MRSA will decrease significantly within the next 60 days.”
B) “New cases of MRSA colonization will go down by 15% between now and 90 days from now.”
C) “Within the next 3 months, nosocomial MRSA colonization will be eliminated in our hospital.”
D) “MRSA will decrease by a minimum of 10%.”



13. A group of nurses has introduced evidence-based practice rounds to their community health clinic. What purpose should be primarily accomplished by these rounds?
A) Identifying the nurses’ practices that are evidence-based
B) Generating and answering practice questions
C) Generating evidence to guide practice
D) Assessing the nurses’ readiness to change



14. A group of registered nurses who provide care in the operating room (OR) is vehemently opposed to a role for unlicensed care providers in the OR despite the existence of valid and reliable evidence to support such a change. How should the nursing leadership best address this resistance?
A) Clearly presenting the benefits of the proposed change
B) Allowing unlicensed care providers to present their perceived attributes to the RNs
C) Implementing the change and allowing the benefits to become apparent
D) Listening to the concerns of the RNs and creating a dialogue



15. The time frame that is necessary to fully implement an evidence-based change in the staffing mix on a postpartum care unit is very long. What strategy should the evidence-based practice mentors implement in order to prevent nurses from becoming fatigued and disenchanted with the change process?
A) Issue reminders of the benefits that will result from the change
B) Release regular updates on the progress of the change
C) Celebrate the accomplishment of smaller goals within the larger project
D) Conduct a research study parallel to the change that documents the process



1. A nursing educator is encountering resistance to efforts aimed at teaching evidence-based practice (EBP) in a nursing program. Which of the following statements provides the best rationale for teaching EBP?
A) EBP represents a more efficient use of educational and healthcare resources than alternative models.
B) EBP ensures that nursing practice is standardized despite institutional and geographic differences.
C) EBP is an essential component of providing effective and safe patient care.
D) EBP is the most efficient way of promoting new nursing knowledge.



2. A committee has been established at a school of nursing to integrate evidence-based practice (EBP) into the curriculum in a greater way. Which of the following characteristics of the school’s nursing educators is most necessary for the success of this endeavor?
A) Computer resources and computer literacy
B) A large and recent base of clinical experience
C) Experience in conducting research
D) Adequate clinical placements for students at sites where EBP is practiced



3. A cohort of knowledgeable and experienced faculty members has volunteered to act as evidence-based practice (EBP) mentors in the department of nursing at their college. What function should the mentors prioritize in this role?
A) Assisting faculty and nursing students with the evaluation and appraisal of evidence
B) Helping staff and students understand and implement EBP in teaching and practice
C) Promoting examination of the negative consequences of neglecting EBP
D) Teaching the nursing educators how to conduct research that is valid, reliable, and relevant



4. A nursing educator is preparing a proposal requesting funding for the purchase of new patient simulators. Which of the following benefits of patient simulation should the nurse cite in the proposal?
A) Simulation has been shown to represent a cost savings since fewer instructors are required.
B) Evidence-based practice (EBP) is dependent on the extensive use of patient simulators in nursing education.
C) Simulation is an effective strategy for contexts where EBP is not possible.
D) Simulation provides a safe and supportive environment where students can implement EBP.



5. Which of the following arguments should a nurse educator use in an effort to promote the use of mobile devices by faculty and students?
A) “Mobile devices allow students to make mistakes in a safe and supportive environment.”
B) “A mobile device allows students and instructors to access more evidence than they can by using a computer.”
C) “Mobile devices allow for closer communication between patients and care providers.”
D) “A mobile device allows students to access information at the actual point of care.”



6. A clinical instructor who teaches a group of students has begun using educational prescriptions (EPs) to facilitate students’ learning in the hospital setting. What is the goal of using EPs?
A) Answering clinical questions relevant to the patient’s care and engaging in reflection
B) Identifying the benefits of evidence-based practice and the risks of alternative approaches
C) Assessing the learning needs of patients and families and performing patient education
D) Facilitating a change in practice when research exists to justify such a change



7. A nursing student who is learning how to provide postsurgical care has asked how to prevent postoperative pneumonia. How should the nursing instructor best enhance this student’s learning?
A) Provide the student with evidence from the literature that is reliable and valid
B) Encourage the student to access primary resources that he or she can appraise
C) Encourage the student to systematically test different interventions in the clinical setting
D) Refer the student to relevant clinical practice guidelines



8. Nurses in an intensive care unit are committed to identifying and implementing evidence related to the assessment and management of ventilator-associated pneumonia (VAP). According to the ACE Star model of organizing evidence-based practice processes, which of the following will result from the translation of evidence?
A) Clinical recommendations
B) New research
C) Patient preferences
D) PICOT questions



9. Which of the following learning activities is most likely to promote nursing students’ knowledge and abilities in evidence-based practice?
A) Pairing students according to their clinical interest and having them be responsible to each other for their learning
B) Questioning students about their patients’ histories and diagnoses when they are at a clinical site
C) Testing students on their performance of a frequently used clinical skill
D) Having students perform real-time research and peer-teaching while investigating a clinical problem



10. A nursing educator wants to integrate evidence-based practice into students’ clinical practicum experience on a psychiatry unit. Which of the following strategies is most likely to engage the students and facilitate their implementation of EBP at this early stage?
A) Present a complex and intriguing clinical question that involves controversy in psychiatric treatment
B) Pose a PICOT question around psychiatric nursing that can be answered without requiring a search or evidence appraisal
C) Ask students to create original methods for searching and critical appraisal that address a clinical question
D) Introduce a simple psychiatric nursing question that does not require an extensive search



11. A nurse educator has organized a journal club on campus in which nursing students will engage in a “hunting” approach to identifying and appraising evidence. Which of the following activities will form a component of the club’s activities?
A) Each student will be responsible for scanning a given number of journals for relevant articles.
B) The group will collectively review relevant articles from a secondary publication that surveys the literature.
C) Each member will look for answers to a predetermined PICOT question and then bring the research to the group.
D) The group will decide which publications are most relevant to their areas of clinical interest.



12. A nursing educator who is teaching a group of students on an acute medicine unit has attempted to assess each student’s skill level in EBP and informatics at the beginning of the semester. What is the purpose of this assessment?
A) To identify students’ areas of clinical interest and expertise
B) To create a learning partnership between the students and the educator
C) To identify resource needs and possible teaching assistance for the coming semester
D) To minimize students’ frustration and maximize their growth



13. A nursing educator is attempting to integrate evidence-based practice into the maternity rotation. Which of the following actions is most likely to ensure that the process has meaning for the students?
A) Choosing scenarios that closely mimic those that the students encounter in their clinical practicum
B) Ensuring that evidence presented is peer-reviewed, reliable, and valid
C) Bringing in guests who are recognized experts in the field of obstetrical nursing
D) Including evidence about birthing choices from popular books, magazines, and newspaper articles



14. Which of the following actions best demonstrates that a student has assimilated the evidence-based practice (EBP) paradigm?
A) The student acknowledges the value of evidence in providing sound patient care.
B) The student is able to teach others about the process of identifying and appraising evidence.
C) The student uses the EBP process when making clinical decisions regarding patient care.
D) The student is able to synthesize the EBP process in a case study and present it in an academic paper.



15. A clinical practicum instructor who is teaching within an evidence-based practice (EBP) integration curriculum has created a learning task that requires the application of the specific principles of EBP. What time constraints should the educator place on the activity?
A) Allow students the autonomy to determine the pace and end date of the assignment
B) Have the students complete the task in a series of real-time stages within clinical time
C) Establish a firm deadline that is sufficient to maintain students’ attention but not too distant
D) Establish a deadline that is no more than 48 hours past the introduction of the task



1. On a busy postsurgical care unit, many patients have undergone bowel surgery and are faced with the prospect of caring for a new permanent or temporary ostomy. Traditionally, preoperative and predischarge teaching has been minimal and sporadic, with high levels of patient anxiety evident. An initiative for implementing evidence-based practice around patient education ideally should originate with which of the following people or groups?
A) The nurses who provide care on the postsurgical unit
B) The medical team who perform colectomies and bowel resections
C) The leadership who oversee the care and organization of the hospital’s surgical program
D) Patient and family groups who have experienced bowel surgery in the past



2. A nurse educator who works in a postpartum obstetrical unit wishes to introduce an evidence-based algorithm for the nursing management of breastfeeding challenges. How can the educator best create a desire among nurses for a change in practice?
A) Create incentives for nurses for complying with a change in practice
B) Evenly distribute the workload required for implementing the change among the nursing staff
C) Demonstrate how a similar change has improved outcomes in other hospitals
D) Link the change to the mandates released by regulatory agencies



3. Assessment of the characteristics and practices of the nurses at a large, university hospital reveals that numerous barriers to the implementation of evidence-based practice exist. On which of the following barriers should the nurse educators focus their efforts in an attempt to integrate evidence with patient care at the hospital?
A) The majority of nurses graduated from nursing school more than 10 years ago.
B) Most nurses cannot demonstrate the ability to search a bibliographic database.
C) The average age of nurses at the hospital is 49 years.
D) Nurses must care for an increasing number of patients per shift.



4. Traditional practice has proven resilient at a county hospital, and efforts to implement the evidence-based practice (EBP) paradigm have been met with significant resistance from nurses. What is the most significant disadvantage of basing nursing practice on tradition?
A) It denies the individuality of patients.
B) It is a less efficient use of time and resources than EBP.
C) It promotes intellectual stagnation on the part of nurses.
D) It does not guarantee predictable outcomes.



5. Which of the following statements most accurately captures a trend that has been identified as a barrier to the implementation of evidence-based practice in the clinical setting?
A) Apathy has become an increasingly common trait among nurses.
B) Nursing demographics involve a decreasing average age and, consequently, less maturity.
C) Even recent nursing graduates are frequently unfamiliar with EBP concepts.
D) Access to valid and reliable research has become more difficult in recent years.



6. There is an apparent lack of familiarity and application of evidence-based practice on a geriatric, subacute medicine unit. Which of the following principles should guide the nurse educator’s efforts to change this situation?
A) The outcomes of traditional practice should be quantified in order to determine if EBP is necessary.
B) Efforts to teach the EBP paradigm should be focused on the younger nurses and recent graduates.
C) Funding sources must be secured prior to beginning a change initiative.
D) It is important to plan a strategy for creating buy-in among the nursing staff.



7. Quality control audits have revealed a need for evidence-based practice (EBP) in an inner-city hospital. Which of the following factors is the most important determinant of the success of an EBP initiative?
A) Transformational leadership
B) Competent, committed, and accessible hospital librarians
C) Manageable patient loads
D) Adequate funding



8. An Evidence-Based Practice council has been established within a group of long-term care facilities. The council’s mandate should prioritize which of the following activities?
A) Critically appraising evidence sources relevant to the practice setting
B) Guiding the application of evidence in practice settings
C) Assessing patient outcomes that result from the application of traditional practice
D) Assisting nurses to upgrade their education to a baccalaureate level



9. Due to low levels of familiarity with evidence-based practice (EBP) among the hospital’s staff nurses, a group of nurse educators has identified a need for an EBP educational initiative. How should the educators begin preparing for this educational initiative?
A) Identifying resources that are available for the program
B) Assessing the strengths and shortcomings of past EBP educational programs
C) Performing a critical appraisal of the literature
D) Forming a cadre of EBP practice mentors for each unit at the hospital



10. High incidence rates of nosocomial infections, pressure ulcers, and other nonreimbursable health problems suggest that an evidence-based practice (EBP) educational initiative is necessary at a county hospital. Which of the following groups should first receive teaching on EBP?
A) The leadership and management of the hospital’s nursing units
B) The mentorship team that has been established
C) The nurses who provide direct patient care
D) The hospital’s nursing educators



11. A hospital has refreshed the knowledge of its leaders and nurse educators and has mobilized them in preparation for an institution-wide evidence-based practice (EBP) educational initiative. How should the leaders and educators now proceed with the initiative?
A) Identify available resources
B) Introduce evidence-based clinical practice guidelines (CPGs) to each unit
C) Begin to educate the bedside caregivers
D) Begin to measure the outcomes of the initiative in preparation for dissemination



12. Scheduling challenges on the part of nurses form a significant challenge to the EBP education initiative that is being planned at a hospital. How should the leadership team best address this challenge?
A) Require each nurse to attend on one of his or her normal days off
B) Provide self-directed learning modules
C) Create a group of nurses that will learn about EBP and a group that will not
D) Remind nurses to implement EBP as much as possible in their practice



13. Which of the following factors is the most significant determinant of the success or failure of an evidence-based practice (EBP) educational initiative in a hospital system?
A) The prior familiarity with EBP of the bedside caregivers
B) The educational level and demographics of the nursing staff
C) The availability and quantity of financial resources
D) The amount and quality of evidence within the specialties of each hospital unit



14. Which of the following learning outcomes should be prioritized in the early stages of a hospital’s evidence-based practice (EBP) educational initiative?
A) “Participants will formulate PICOT questions relevant to their clinical context.”
B) “Participants will generate clinical practice guidelines (CPGs) that are evidence based.”
C) “Participants will perform critical appraisal of evidence sources.”
D) “Participants will correlate evidence with the policies and protocols of the unit.”



15. The nursing leadership of a large, urban emergency department recognizes a need to foster evidence-based practice (EBP) in their care setting, an effort that will require an educational initiative to familiarize staff with the principles of the EBP paradigm. The leaders should attempt to form a partnership with which of the following groups?
A) Local universities
B) Third-party payers
C) Regulatory and accrediting agencies
D) Patient advocacy groups


1. The nursing leadership of a hospital system is mobilizing evidence-based practice (EBP) mentors in the early stages of an evidence-based initiative to amend infection-control practices. The leaders are most likely utilizing which of the following models of evidence-based change?
A) The Model for Evidence-Based Practice Change
B) The Iowa model
C) The Stetler model
D) The Advancing Research and Clinical practice through close Collaboration (ARCC) model



2. An evidence-based practice (EBP) initiative in home care nursing has been announced with the goal of improving home-based wound care. Among the nurses who have expressed an interest in acting as EBP mentors is Nurse L. Which of the following characteristics of Nurse L would most clearly preclude a mentorship role?
A) Nurse L lacks a graduate degree in nursing.
B) Nurse L  is 23 years old.
C) Nurse L has an advanced beginner level of knowledge.
D) Nurse L began working at the home care office 9 months ago.



3. A nurse has begun a mentorship role during an evidence-based practice (EBP) initiative aimed at improving triage in a busy emergency department. Which of the following roles should the mentor delegate to another staff member?
A) Teaching mentees how to search and appraise literature
B) Evaluating mentees’ work performance
C) Identifying practice goals in collaboration with mentees
D) Advising mentees on possible improvements to their nursing practice



4. A pediatric unit will be announcing an evidence-based practice initiative shortly, and nursing educators on the unit are actively recruiting mentors. Which of the following nurses most clearly exemplifies the attributes of an effective mentor?
A) A nurse who has 18 years of practice experience in varied settings and a nurse practitioner designation
B) A nurse who is nearing completion of a PhD degree
C) A nurse who both provides bedside care and teaches in a school of nursing
D) A nurse who is considered an expert and has an inquisitive nature



5. An enthusiastic cadre of mentors has been mobilized during a community health center’s transition to evidence-based postpartum care in the community. What is the primary role that mentors play within the evidence-based practice (EBP) paradigm?
A) Mentors provide a link between the theory of EBP and its actual implementation.
B) Mentors ensure collaboration among leaders, educators, and care providers.
C) Mentors guide the process of critical appraisal that is foundational to EBP.
D) Mentors ensure accountability during periods of transition from traditional practice to EBP.



6. A group of nurses in an intensive care unit is making a case for the implementation of a mentorship program at their worksite. Which of the following arguments in favor of such a program is most accurate?
A) “We’ll likely see the number on incident reports decrease on the unit.”
B) “This could result in lower staff turnover than we’ve seen lately.”
C) “This will probably spur on nurses to conduct and publish research.”
D) “A mentorship program will allow us to track individual nurses’ performance more closely.”



7. A nurse educator is championing an evidence-based practice (EBP) initiative. Which of the following factors is most likely to support the success of the initiative?
A) Effective teaching techniques that implement adult-learning theory
B) A sufficient quantity of evidence within the nursing literature
C) Motivated individuals who can mobilize the transition
D) Incentives for abandoning traditional practice and adopting EBP



8. A comprehensive mentorship program is necessary for which of the following?
A) American Nurses Association membership
B) Hospital approval by the Joint Commission
C) Hospital Magnet status
D) American Nurses Credentialing Center nurse certification



9. A group of mentors is currently engaged in an evidence-based practice (EBP) initiative at their public health agency that began several months ago and has met expectations to this point. The mentors will finish the EBP process by performing which of the following tasks?
A) Evaluating the results of the EBP initiative
B) Celebrating the successes to this point
C) Debriefing with the nurses and other stakeholders
D) Disseminating the results of the initiative



10. A group of nursing educators has participated in a multiday educational workshop that was aimed at increasing their familiarity with the rationale and execution of mentorship programs. What is the ultimate purpose of this workshop?
A) Implementation of EBP in the participants’ clinical settings
B) Identification of potential mentors in participants’ worksites
C) Increased effectiveness in participants’ own mentorship roles
D) Confidence in simultaneously acting as a mentee and mentor



11. There is both a need and a desire to implement evidence-based practice (EBP) at a community hospital that has experienced many patient falls in recent months. Which of the following strategies is most likely to identify potential EBP mentors at the outset of this EBP falls-prevention initiative?
A) Solicit the assistance of the most senior nurses on the unit
B) Attract the participation of nurses who work full time at the hospital
C) Identify nurses who combine expertise with inquisitiveness
D) Ask those who have graduated most recently to share their learning about EBP



12. A group of evidence-based practice (EBP) mentors has been mobilized during a new EBP initiative in a community hospital. Which of the following principles should guide the mentors’ engagement with members of other healthcare disciplines at the hospital?
A) The mentors should elicit leadership from physicians who have experience with EBP.
B) The mentors should collaborate with other disciplines to foster EBP that is not limited to nurses.
C) The mentors should keep other disciplines informed of the EBP initiative.
D) The mentors should limit participation in the initiative to nursing staff.



13. An evidence-based practice (EBP) initiative at a large hospital is in the formative stages. Which of the following outcomes should be prioritized during the EBP mentorship program that will be foundational to the initiative?
A) Dissemination of the findings of an EBP initiative
B) High-quality interactions between mentors and mentees
C) Increased familiarity with EBP by mentees
D) Implementation of EBP by caregivers



14. Mentorship has been shown to transform practice more effectively than teaching alone. Which of the following is the most significant result of mentorship?
A) Bedside application of the principles of evidence-base practice (EBP)
B) More effective and accurate critical appraisal of evidence
C) Better literature-searching skills than other nurses
D) Clearer clinical decision making



15. The administration of a rural hospital has struggled in recent years to attract and retain nurses. What effect is an evidence-based practice (EBP) mentorship program likely to have on staffing levels?
A) Elimination of the need for unlicensed care providers
B) Increased recruitment of new staff
C) Decreased attrition of nurses
D) Increased efficiency and consequent decreased staffing needs



1. A team of nurse researchers has the opportunity to present the findings of their recently-completed research study that tested a community-based smoking prevention program. How should the nurse who will present the findings begin the presentation?
A) By providing a brief overview of the methodology that the team used
B) By eliciting questions about the effects of smoking from members of the audience
C) By outlining the major components of the prevention program, with an emphasis on its innovative aspects
D) By briefly citing some of the facts about smoking that motivated the development of the program



2. A patient advocacy group has convened a panel presentation to address current clinical questions related to mental illness. What is the primary advantage of this presentation format?
A) A consensus opinion on mental illness can be presented that represents the views of a group rather than an individual.
B) Differing viewpoints related to mental illness can be presented.
C) The panel of experts can present information related to mental illness in greater detail than if one expert presented.
D) The presentation is likely to attract greater media attention than alternative formats.



3. A public health nurse has completed a research study that introduced and tested an intervention to increase childhood immunization rates. Which of the following dissemination formats is most likely to allow for interaction between the nurse and fellow public health nurses?
A) A podium presentation
B) Participation in a panel presentation
C) A poster presentation
D) Participation in a roundtable discussion



4. A nurse educator has prepared a podcast that presents the evidence-based practice (EBP) guidelines for the care of women who have undergone autologous breast reconstruction. The nurse should most consider which of the following characteristics of podcasts when choosing this medium?
A) Podcasts do not normally allow for interaction between presenter and listener.
B) Security cannot be ensured when podcasts are posted online.
C) Podcasts allow for only a limited amount of detail.
D) Users must listen to a podcast at the time that it is accessed.



5. One component of a community hospital’s current evidence-based practice (EBP) initiative is the establishment of an onsite journal club for nurses. Which of the following individuals would be the best candidate to lead the club?
A) A member of another health discipline who has led such groups before
B) An advanced practice nurse who is familiar with research
C) A nursing professor from a local university who has performed research
D) A staff nurse who is experienced and well-regarded by colleagues



6. An onsite journal club has been established for a hospital’s oncology nurses. Which of the following practices should the club implement in its proceedings?
A) Time should be allocated during each meeting for members to search the literature.
B) Quantitative research should be prioritized over qualitative research.
C) The leader of the club should have the final word on the acceptability of any journal articles.
D) Journal articles for discussion should be distributed and read prior to meetings.



7. Following the completion of her graduate degree, an advanced practice nurse has been encouraged to consider publishing. How can the nurse best build familiarity in preparation for publishing?
A) By serving on a work committee that regularly creates publications
B) By forming a relationship with a nurse educator at their common clinical site
C) By committing to reading more journal articles than in the past
D) By taking an online course that is geared to publishing



8. Eager to begin producing publications, a recently graduated advanced practice nurse is in the process of determining a topic on which to begin researching and writing. Which of the following should guide the nurse’s choice of subject matter?
A) High-profile issues that have garnered much attention in the popular media
B) The nurse’s particular area of clinical expertise and learning
C) The subject focus of the journal in which the nurse would like to publish
D) The specialty area of the nurse’s publication mentor



9. A nurse has sought out a mentor in order to assist with producing ideas and manuscripts and bringing them to publication. Which of the following factors is most likely to influence the success of the nurse’s endeavor?
A) Critical thinking
B) Experience
C) Persistence
D) Professional relationships



10. During the process of writing an article on anxiety-reduction strategies for intravenous catheterization, a nurse is performing a literature review. How will the nurse know when the search for evidence should be concluded?
A) After CINAHL, PubMed, and the Cochrane Library have been thoroughly searched
B) When the nurse no longer finds new references and is knowledgeable with the literature
C) When a peer with research expertise concludes that the search is comprehensive and sufficiently broad
D) When the anonymous peer-reviewers of the journal approve the nurse’s literature review



11. After completing the first draft of a manuscript on the educational experiences of student nurses, a nurse researcher is in need of proofreading. Which of the following is the best choice for performing this role?
A) A professional proofreader with experience in the publishing industry
B) Reviewers from the journal to which the nurse will submit the manuscript
C) Nursing educators who are currently teaching nursing students
D) Colleagues who have expertise in the area as well as those who do not



12. A congressman’s office has requested a policy issue brief from the dean of a local university’s school of nursing. What is the primary purpose of this document?
A) To enlist the congressman’s support in evidence-based practice (EBP) initiatives within his or her jurisdiction
B) To provide the congressman’s office with answers to possible questions from members of the media and the public
C) To provide the legislator with information that can be used to amend health legislation
D) To establish productive working relationships between health academics and legislators



13. A group of nurses is preparing a health policy issue brief that addresses H1N1 influenza. Which of the following should the nurses prioritize in the content of the brief?
A) The practical application of what is currently known about H1N1
B) The reliability and validity of current research into H1N1
C) The role of the popular media in disseminating misinformation about H1N1
D) The role of nurses in prevention, treatment, and education around H1N1



14. A group of nurse researchers is excited that the smoking-cessation intervention they developed and tested with pregnant women is nearly twice as effective as traditional treatment. Buoyed by the significance of their findings and the gravity of smoking, the nurses have proceeded to contact the media. Which of the following factors is likely to have the greatest effect on a reporter’s decision on whether to report these findings?
A) The loss of life and staggering healthcare costs associated with smoking
B) The potential interest that the public may have in the story
C) The lack of success associated with many other smoking-cessation programs
D) The interests of tobacco companies and retailers



15. A reporter from the local TV station has contacted a public health nurse in the context of a news story about teenage sexual behavior. Which of the following principles should guide the nurse’s decision of whether to commit to an interview?
A) Newspapers and magazines are more likely to present a balanced perspective than radio and TV.
B) News media exposure can be positive or negative depending on numerous factors.
C) Nurses should avoid media exposure that is reporter-initiated rather than nurse-initiated.
D) Most media exposure results in frustration and misunderstanding.



1. A published study has drawn the conclusion that an online clinical decision-making module has significantly improved the decision-making abilities of the nurses who completed the program. On critical appraisal, however, a nurse reader suspects that the effect was a result of the experimental group’s clinical context, rather than the efficacy of the educational module. This study primarily demonstrates a deficit in which of the following areas?
A) External validity
B) Generalizability
C) Internal validity
D) Conceptualization



2. A community health nurse is disturbed by the apparently high incidence of postpartum depression among women who have recently given birth. As a result, the nurse has formulated an idea for a research study addressing postpartum depression. What should the nurse do after formulating an idea for research?
A) Investigate funding options
B) Create a research team
C) Recruit participants
D) Search for systematic reviews



3. A researcher wishes to test the effect that a specific childhood nutritional supplement will have on participants’ incidence of dementia later in life. Which of the following aspects of the study question is likely lacking?
A) Relevance
B) Feasibility
C) Ethics
D) Interest



4. Which of the following study questions should be answered within a nonexperimental study design?
A) “How will a peer-counseling program influence the glycemic monitoring behaviors of newly diagnosed diabetics?”
B) “How does oral administration of ginseng affect humoral immune function?”
C) “What effect does regular physical exercise have on the self-esteem of obese children?”
D) “What effect do high-risk sexual behaviors have on college students’ incidence of chlamydial infection?”



5. A group of nurse researchers wishes to identify potential predictor variables that may be present in adults with skin cancer and absent in those who do not have skin cancer. Which of the following designs should the researchers choose?
A) Quasi-experimental
B) Descriptive
C) Case control
D) Randomized controlled trial (RCT)



6. A nurse wishes to identify the possible effect of an innovative mattress on the incidence of pressure ulcers among the hospitalized elderly and is planning to conduct a true experiment. Which of the following is most important to the integrity of this study design?
A) A sufficiently large number of independent variables
B) Random assignment of study participants to groups
C) A correlation between the variable and the outcome
D) A sufficiently large number of participants



7. Funding has been secured to test the efficacy of a new antidepressant. Participants who have been diagnosed with depression have been recruited and randomly assigned to experimental and control groups. Members of both groups have had the severity of their depression gauged by a reliable and valid instrument. Over the next several weeks, the experimental group has been administered the new drug while the control group received standard treatment. At the completion of the study, the same instrument was used to measure depressive symptoms. Which of the following study designs has the research team utilized?
A) Two-group RCT with pretest/posttest
B) Two-group RCT with true control group
C) Two-group RCT with long-term repeated measures
D) Two-group RCT with posttest design only



8. Nurses have written a proposal for a quasi-experimental study that tests the effect of web-based teaching on nursing students’ psychomotor skills. Which of the following is a characteristic of quasi-experimental design?
A) Participants are assigned to groups by a method other than random assignment.
B) The design includes a posttest but does not apply a pretest.
C) The results of the study provide description but do not identify association.
D) The effects of an intervention are identified by examining characteristics of participants’ histories.



9. A longitudinal study is tracking the effects of a program aimed at improving the health-related decision-making skills of teenagers over the course of their high school years. The researchers have had to account for maturation effects in the methodology of the study. Maturation would have which of the following effects on the study participants?
A) A decrease in the effectiveness of the intervention with passing time
B) An accumulation of the effects of the intervention over time that exaggerates its effectiveness
C) Developmental changes in the participants that are not related to the intervention
D) An increase in the sophistication and effectiveness of the intervention with repeated applications



10. A master’s-educated nurse has been recruited to conduct a pilot study prior to the commencement of a large, multisite quantitative research project. A pilot study is used primarily to inform which of the following parameters of a larger study?
A) Feasibility
B) Relevance
C) Ethics
D) Generalizability



11. A research team is writing a proposal for a quantitative study that will test the efficacy of an online prenatal education module. The team recognizes the need to control for extraneous variables. Which of the following strategies will best accomplish this goal?
A) Pairing each member of the experimental group with a member of the control group who shares similar characteristics
B) Utilizing multiple control groups
C) Randomly assigning participants to either the experimental group or the control group
D) Performing the assignment to groups after all participants have completed a pretest



12. During the early conceptualization of a study that will assess the influence of cognitive behavioral therapy on the smoking behavior of teenage girls, the researchers have addressed the need to prevent attrition during the course of the study. How can this best be accomplished?
A) Inform potential participants that they will be reimbursed according the quality of the data they provide
B) Assign more participants to the control group than the experimental group
C) Create disincentives for leaving the study before completion
D) Maintain frequent contact with participants throughout the study



13. A study that is examining healthcare workers’ adherence to standard infection-control precautions began shortly before an outbreak of Clostridium difficile. This outbreak of C. diff constitutes what type of threat to the internal validity of the study?
A) History
B) Testing
C) Externality
D) Construct



14. A nurse’s doctoral dissertation addresses the effect that a support program may have on patients with pulmonary hypertension. Given that pulmonary hypertension has a very low incidence and prevalence, which of the following sampling strategies is applicable to the nurse’s research needs?
A) Heterogeneity sampling
B) Snowball sampling
C) Modal instance sampling
D) Stratified sampling



15. In retrospect, a team of nurse researchers believes that they had too few participants in a true experiment that tested the effectiveness of a new type of ostomy appliance in preventing stomal leakage. Which of the following may be a consequence of a sample that is too small?
A) The researchers may have concluded that the appliance is an improvement on existing types when, in fact, it is not.
B) The team could have underestimated the effectiveness of the new device.
C) The nurses may have committed a type one error.
D) The construct validity of the study may be lacking.



1. Using a qualitative methodology, a nurse researcher is planning an investigation into a health phenomenon that has not been explored previously. Which of the following statements best conveys the philosophical underpinnings of qualitative research?
A) Reality is subjective and cannot be quantified.
B) Participants’ realities can be generalized to larger populations.
C) The human experience is made up of multiple realities.
D) Individual realities may be understood only within relationships.



2. A nurse researcher’s proposal for a qualitative research study is being reviewed by the university’s behavioral research ethics board. Which of the following aspects of the subject matter of the study is the best justification for using a qualitative methodology?
A) The topic of the research study is highly controversial.
B) The phenomenon in question is poorly understood.
C) The subject matter is known to be highly complex.
D) Recruitment for the study is anticipated to be difficult.



3. A nurse is gathering qualitative data on the experiences of individuals who have chosen to admit a family member to palliative care. Which of the following principles will the nurse integrate into the conduction of this study?
A) The nurse will conduct data collection and data analysis simultaneously.
B) The nurse will maximize the number of participants to ensure validity.
C) The nurse will follow up the results of the study with quantitative description.
D) The nurse will ensure equivalence between groups by using random sampling.



4. At the completion of a qualitative phenomenology exploring the meaning of mobility to patients with spinal cord injuries, a nurse researcher has generated a number of conclusions. These conclusions will be the result of which of the following processes?
A) Description
B) Synthesis
C) Exploration
D) Interpretation



5. An advanced practice pediatric nurse is privy to the challenges and emotions that parents face when dealing with a child’s illness and wishes to contribute to the related body of research by conducting a qualitative study. How should the nurse best learn to conduct qualitative research?
A) By completing a graduate-level course in qualitative research methods
B) By becoming well-versed in the writings of qualitative researchers who are highly respected
C) By conducting a pilot study and eliciting feedback from nursing professors
D) By seeking out a mentor who is experienced in qualitative methods



6. An obstetrical nurse is planning a qualitative study aimed at understanding fathers’ perceptions of their partners’ pain experience during labor. How should the nurse begin the process of conducting a qualitative study?
A) By searching the literature for gaps in the evidence
B) By formulating a PICOT question
C) By identifying a study question
D) By conducting a small-scale pilot study



7. A nurse has sought assistance from a qualified nursing researcher in an attempt to select and define an appropriate theoretical perspective during the conceptualization of a qualitative study on the meaning of drug use among intravenous drug users. Specifying the theoretical perspective will contribute to the study in what way?
A) It will define the steps in the research process for the nurse.
B) It will allow the findings from participants’ data to be applied to similar populations.
C) It will result in an interpretive, rather than descriptive, study.
D) It will identify the philosophical assumptions that underlie the study.



8. A team of nurse researchers is proposing a study that will seek to explain the process that couples go through as they consider and attempt in vitro fertilization and do not experience pregnancy. Which of the following qualitative designs is most likely appropriate?
A) Grounded theory
B) Phenomenology
C) Hermeneutics
D) Ethnography



9. A nurse researcher is proposing a phenomenology that will examine the experiences of emergency department nurses in providing care for patients with acute mental illness. What is the specific focus of the researcher’s chosen design?
A) Explaining the techniques that nurses use to navigate their interactions with mentally ill patients
B) Generating a theory of how nurses move through their interactions with these patients
C) Interpreting what the experience of working with this patient population is like for nurses
D) Identifying the factors that underlie nurses’ behaviors within the phenomenon of mental illness



10. A large, mixed methods study addressing patients’ pain experiences has been launched at a county hospital. The design of this study will include which of the following?
A) Both qualitative and quantitative components
B) A multidisciplinary research team
C) Aspects of both grounded theory and phenomenology
D) A phenomenological approach within the context of an ethnographic setting



11. A nurse educator is conceptualizing a study that will address the role of social support for a family who has a child in the neonatal intensive care unit (NICU). During the planning stages, the educator has created a statement that presents the study purpose. This statement will include which of the following?
A) The focus, participants, and design of the study
B) The changes in practice that the researcher hopes to catalyze
C) The nurse’s rationale for the chosen research design
D) The gaps in knowledge that the study will attempt to address and the current state of evidence



12. A research team is proposing a qualitative study that will examine the concept of loss that men experience following transurethral prostatic resection (TUPR). Which of the following principles will guide the sampling strategy that the nurses propose?
A) The N should be identified at the outset of the study.
B) The final number of participants will be determined during the course of data collection and analysis.
C) Men who have had a TUPR should be interviewed separate from participants who have not.
D) Researchers should justify their choice of sample size with reference to examples of similar studies in the literature.



13. A university’s research ethics board has granted approval to a nurse researcher’s study proposal that addresses African-American patients’ perceptions of their care in the emergency department. Which of the following issues is the primary focus of the ethical considerations surrounding this proposed study?
A) Risks of participation
B) Issues related to confidentiality
C) Potential unwanted effects of the observation and interview process
D) The researcher’s qualifications for engaging participants



14. A nurse who provides care on a postsurgical unit is reviewing a qualitative study that examines the experiences of patients upon awakening in postanesthetic recovery (PAR). Which of the following considerations is the most significant determinant of the study’s quality and rigor?
A) The researcher has explicitly justified the chosen study design.
B) The findings and interpretations of the study are rooted in the data.
C) The conclusions of the study are consistent with existing literature on the subject.
D) The findings have the potential to positively impact nursing practice.



15. During a literature review on the health-related practices of inner-city members of a particular ethnic group, a public health nurse has identified a qualitative study that appears to address the nurse’s clinical question. How should the nurse assess the transferability or generalizability of the study?
A) By comparing the demographics of the study sample with the demographics of the nurse’s community
B) By examining the relevance of the study design that the researcher chose
C) By asking questions about the fit between the study findings and the nurse’s practice experience
D) By assessing the sufficiency and justification of the sample size used in the study



1. A team of nursing researchers is drafting a grant proposal to secure funding for a study into a new algorithm for geriatric assessment. The team has paid particular attention to the abstract of the proposal, knowing that the abstract primarily performs which of the following functions within the larger proposal?
A) Informing funding agencies of the academic and research qualifications of the principle investigator and the research team
B) Creating a concise but compelling argument for funding the research project
C) Presenting preliminary, anticipated research findings and linking them to evidence-based practice and improved outcomes
D) Presenting the potential benefits for the funding agency that the project may bring



2. The first draft of a grant proposal has been completed to fund a study into the nursing care of patients who have experienced an acute cerebrovascular accident (CVA). Which of the following statements is most likely to persuade reviewers to fund the project?
A) “This study will address many of the most common aspects of stroke care that are applicable to numerous healthcare settings.”
B) “This study has the potential to discount much of the substandard, antiquated, and dangerous practice that is prevalent in American hospitals.”
C) “This study may provide new knowledge with the goal of improving the outcomes of stroke patients.”
D) “This study will enhance our team’s research skills while simultaneously improving stroke care.”



3. A grant proposal for the implementation of an innovative prenatal care program for low-income immigrants has been prepared by a team of public health and obstetrical nurses. Which of the following principles should guide the team’s budget development for the proposal?
A) The team should prepare a liberal budget in anticipation that only partial funding may be offered.
B) The team should specify why it is not possible to recoup some costs of the study from participants themselves.
C) Indirect costs should be clustered within the category of direct costs in order to maximize funding.
D) The team should determine what expenses are not eligible for funding by the grant provider.



4. Nurse researchers are drafting a research grant in an effort to fund an intervention aimed at increasing the immunization rates of children in lower income neighborhoods. Which of the following information should be included in the introduction to the grant?
A) The clinical significance of immunization and the rates of immunization in lower income children
B) The gaps in the nursing literature around promoting immunization and intervening to increase participation rates
C) The biographical information that qualifies the researchers to carry out the study rigorously
D) The deficiencies of current immunization programs and the underlying reasons for these problems



5. A funding proposal for a study predicts that watching an ostomy care video for patients (the independent variable) will result in an better ability to perform ostomy care (the dependent variable) than patients who do not watch the video. This relationship constitutes which component of the proposal’s background section?
A) Outcome
B) Hypothesis
C) Projection
D) Result



6. A nurse researcher is leading a team that wants to test the effect that a new, enzymatic debriding agent will have on the healing and progression of necrotic foot ulcers. Which of the following aspects of the study should the team emphasize in the design and methods section of their funding proposal?
A) Measures that they will take to enhance generalizability
B) Potential threats to external validity and how these will be addressed
C) The prior research experience of the team members
D) Measures that will be taken to strengthen internal validity



7. A very large sample has been proposed for a multisite, randomized controlled trial of an antilipid medication. Increasing the size of the sample will most directly enhance which of the following aspects of this proposed study?
A) Power
B) Generalizability
C) External validity
D) Plausibility



8. Several professors who teach in the high-acuity specialty program at a school of nursing have applied to the National Institutes of Health (NIH) to fund a study the will address the nursing management of increased intracranial pressure (ICP). Which of the following components should the research team integrate into their grant proposal?
A) The sample should include women, minorities, and children under 21.
B) The results of the study should be disseminated to all relevant federal agencies.
C) The sample should include participants from at least two states.
D) An overseer from the NIH should be included on the research team as a consultant.



9. A grant proposal for a study into the effects of cognitive behavioral therapy (CBT) on the anxiety of patients recently diagnosed with human immunodeficiency virus (HIV) will use a recently developed instrument to measure patients’ anxiety. A member of the research team, however, has expressed concern about the validity of the instrument. Which of the following facts would raise doubts about the validity of the instrument?
A) It is unclear that the instrument consistently measures anxiety when used repeatedly.
B) The instrument is potentially unusable with members of other cultures.
C) The instrument appears to measure both fear and anxiety, not anxiety alone.
D) There is a high level of preknowledge about anxiety that is required of users.



10. A nurse educator has submitted a proposal to the National Institutes of Health (NIH). Because the proposed study is a clinical trial, the nurse has included a data and safety monitoring plan. This plan will address which of the following issues?
A) Confidentiality of data
B) Management of adverse effects
C) Consent from participants
D) The inclusion of a safety consultant on the research team



11. A team of researchers has received word that their grant proposal has been rejected by a funding agency. Given that the funding agency permits one resubmission, how should the team best respond to this development?
A) Add more experienced members to the research team before resubmitting.
B) Write a letter of thanks to the reviewers in order to build credibility.
C) Integrate reviewers’ criticisms into an amended version of the proposal and resubmit.
D) Provide greater detail on the rationales for the study design and methods before resubmission.



12. Which of the following studies is most likely to be funded by a federal agency?
A) A study that will test the effects of nursing care on outcomes of very low-birth-weight infants.
B) A study that will test the effectiveness of a mentorship program on the attrition rate of registered nurses in a tertiary care hospital.
C) A study that will examine the educational experience of nursing students who are over 35 years old.
D) A study that will examine the use of unlicensed care providers in subacute settings.



13. A novice nurse researcher has conceptualized an innovative research study but is unsure which funding sources to pursue. How should the nurse determine the best funding source for this proposal?
A) Send abstracts of the proposal to several of the larger funding agencies
B) Request preliminary grant approval from a foundation
C) Review the recently funded projects of potential funding agencies
D) Request funding-source information from the National Institutes of Health (NIH)



14. The nurse educators at a large, tertiary care hospital have proposed a research project that will gauge the implementation of evidence-based practice around falls prevention. What is the most distinctive characteristic of an evidence-based practice implementation project?
A) The results may be applied to settings beyond the study site.
B) The study will apply existing knowledge rather than creating new knowledge.
C) The interventions in question are within the scope of independent nursing practice.
D) The interventions will take clinical expertise and patient preferences into account.



15. Which of the following studies is most likely appropriate for funding by a foundation?
A) A study that has potential application within a geographical area or population
B) A study that is innovative but that lacks the rigor necessary for federal funding
C) A study that may create new knowledge but does not lead to direct clinical application
D) A study that has been reluctantly rejected by large, federal funding agencies


1. The leadership of a large, tertiary care hospital is under pressure from various sources to implement both evidence-based practice (EBP) and quality improvement (QI). Which of the following statements most accurately conveys an aspect of these philosophies?
A) EBP integrates patient preferences into clinical care decisions.
B) QI allows for the expertise of clinicians to be taken into account.
C) QI does not account for effects on patients who will be excluded from care.
D) EBP is linked to better patient outcomes than QI.



2. Which of the following factors differentiates evidence-based practice (EBP) implementation from clinical research?
A) Clinical research has more stringent ethical standards than EBP implementation.
B) EBP implementation is often less generalizable than clinical research.
C) The implementation of EBP creates new knowledge while clinical research confirms or disputes existing knowledge.
D) EBP implementation takes place on a larger scale than clinical research.



3. A leadership team is planning an evidence-based practice (EBP) initiative that will address the policies and protocols around wound care. Which of the following developments in the implementation may be construed as unethical?
A) Evidence-based treatments may be a benefit to some patients’ healing but exacerbate others.
B) The implementation of evidence-based wound care may be impractical from a staffing perspective.
C) The clinical practice guidelines that form the basis of the practice change may have been developed at a different site.
D) Clinicians may find that existing routines around wound care are difficult to change.



4. Which of the following activities would most likely be categorized as evidence-based practice (EBP) implementation rather than clinical research?
A) Testing the effectiveness of new composite dressing in promoting wound healing
B) Assessing whether a school-based antismoking initiative reduces smoking rates among teenagers
C) Determining the efficacy of an innovative antihypertensive medication in patients who do not respond to standard therapy
D) Examining whether the introduction of a clinical practice guideline around falls prevention results in a reduction in falls



5. Which of the following beliefs underlies many of the ethical debates surrounding evidence-based practice (EBP) implementation?
A) It is sometimes claimed that ethics approval for the implementation of others’ research should be obtained by the person who originally conducted that research.
B) Some believe that the implementation of existing research does not require ethical approval.
C) Some nurses state that considering patient preferences and integrating these into practice is an adequate form of ethics approval.
D) It is sometimes claimed that EBP is inherently ethical, negating the need for further ethics approval.



6. In preparation for a credentialing process, a county hospital will be conducting an audit. What is the primary focus of this activity?
A) Evaluating whether ethical principles are being integrated into bedside care
B) Determining caregivers’ knowledge base around evidence-based practice (EBP)
C) Determining whether patient outcomes at the hospital align with patient expectations
D) Evaluating whether current practice is based on the best available evidence



7. Which of the following activities most clearly requires ethical approval?
A) Implementation of a new clinical practice guideline
B) Recruitment for a case-control study
C) Modification of hospital policy and procedures
D) Modification of a nurse’s practice habits



8. Which of the following factors should be prioritized in the decision of whether to seek ethical approval for a project involving a change in practice?
A) The project’s classification as either quality improvement (QI) or clinical research
B) The stated values and mission statement of the site where it will be implemented
C) The question of whether the implementation represents a risk to participants
D) The stance of the agency or foundation that is funding the implementation



9. An evidence-based quality improvement (EBQI) initiative will soon be commenced at a university hospital. Which of the following characteristics of the project cause it to be categorized as EBQI?
A) The project is aimed at changing practice to improve outcomes so that they are more evidence based.
B) The project is being spearheaded by individuals who possess knowledge and experience in evidence-based practice (EBP).
C) The implementation of the project is based on valid research and does not represent a risk to participants.
D) The project has dual goals of improving outcomes while producing new knowledge that is generalizable.



10. Which of the following characteristics of a practice change is most closely associated with evidence-based quality improvement (EBQI)?
A) The change is implemented by the individuals who provide patient care.
B) The funding source for the practice change is an organization external to the clinical site.
C) The ultimate goal of the project is to generate new evidence that can be applied universally.
D) The individuals who carry out the change are brought in from outside the organization.



11. The nurses at a long-term care facility have recently completed an evidence-based quality improvement (EBQI) project that aimed to improve the outcomes of residents with dementia. Which of the following principles should guide the decision of whether to publish the results of the initiative?
A) The results of the project should be submitted for publication if they have produced new knowledge.
B) The results should be considered for publication if they are thought to be applicable to other settings.
C) Publication should be considered if it was an explicit goal of the project and if participants have granted consent for publication.
D) The nurses are obligated to disseminate their results as part of the evidence-based practice (EBP) process.



12. The nursing leaders at a county hospital are aware of the need for rigor during the implementation of an EBQI project that will address emergency department triage. How should the leaders apply rigor to this project?
A) By ensuring that instruments for measuring effectiveness have face and content validity
B) By justifying their choice of methodology in terms of the clinical question and the characteristics of the site
C) By seeking ethical approval and patient consent prior to beginning the project
D) By ensuring that resources will not be wasted and patients will not be placed at risk



13. An evidence-based quality improvement (EBQI) project has been proposed that will increase the number of school-aged children who receive an annual influenza vaccination. The project will be implemented in an affluent suburban community despite the fact that vaccination rates are much lower in poorer neighborhoods. The implementation of this project may be in violation of which of the following ethical principles?
A) Respect for potential and enrolled subjects
B) Social or scientific value
C) Scientific validity
D) Fair subject selection



14. Members of the nursing leadership at a hospital disagree about the need for informed consent from patients who are participating in an evidence-based quality improvement (EBQI) project. Which of the following principles should guide the team’s decision of whether to seek informed consent from patients?
A) The decision should be deferred to the ethical review board of the hospital.
B) EBQI is a part of normal clinical care and likely does not require written consent.
C) Proceeding with EBQI without informed consent violates patient autonomy.
D) Participation in clinical research is a tacit understanding of seeking hospital care.



15. A group of nurses is taking measures to ensure that an evidence-based quality improvement (EBQI) initiative is conducted ethically. Which of the following actions most clearly demonstrates appropriate selection of subjects?
A) Distributing risks and benefits fairly
B) Maximizing the number of participants in the sample
C) Randomly assigning patients to receive or not receive the changed practice
D) Sampling selectively to ensure equivalence between groups