Primary Care: Art and Science of Advanced Practice Nursing - An

Interprofessional Approach 5th edition Dunphy Test Bank

Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring

1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the

incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented

findings at a level of significance of <0.01. This indicates that

A) the control group and the experimental group were more than 99% similar.

B) the findings of the study have less than 1% chance of being attributable to chance.

C) the effects of the intervention were nearly zero.

D) the clinical significance of the findings was less than 1:100.

Ans: B

Feedback: The level of significance is the level at which the researcher believes that the study results

most likely represent a nonchance event. A level of significance of <0.01 indicates that there is less

than 1% probability that the result is due to chance.

2. A nurse has read a qualitative research study in order to understand the lived experience of parents

who have a neonatal loss. Which of the following questions should the nurse prioritize when

appraising the results of this study?

A) How well did the authors capture the personal experiences of these parents?

B) How well did the authors control for confounding variables that may have affected the findings?

C) Did the authors use statistical measures that were appropriate to the phenomenon in question?

D) Were the instruments that the researchers used statistically valid and reliable?

Ans: A

Feedback: Qualitative studies are judged on the basis of how well they capture and convey the

subjective experiences of individuals. Statistical measures and variables are not dimensions of a

qualitative methodology.

3. A nurse has expressed skepticism to a colleague about the value of nursing research, claiming that

nursing research has little relevance to practice. How can the nurses colleague best defend the

importance of nursing research?

A) The existence of nursing research means that nurses are now able to access federal grant money,

something that didnt use to be the case.

B) Nursing research has allowed the development of masters and doctoral programs and has greatly

increased the credibility of the profession.

C) The growth of nursing research has caused nursing to be viewed as a true profession, rather than

simply as a trade or a skill.

D) The application of nursing research has the potential to improve nursing practice and patient

outcomes.

Ans: D

Feedback: The greatest value of nursing research lies in the potential to improve practice and,

ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to

education programs, grant funding, or the public view of the profession.

4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy

urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when

they experience early challenges and wonders what could be done to encourage more women to

continue breast-feeding. What role is Tracy most likely to play in a research project that tests an

intervention aimed at promoting breast-feeding?

A) Applying for grant funding for the research project

B) Posing the clinical problem to one or more nursing researchers

C) Planning the methodology of the research project

D) Carrying out the intervention and submitting the results for publication

Ans: B

Feedback: A major role for staff nurses is to identify questions or problems for research. Grant

applications, methodological planning, and publication submission are normally carried out by

nurses who have advanced degrees in nursing.

5. A patient signed the informed consent form for a drug trial that was explained to patient by a

research assistant. Later, the patient admitted to his nurse that he did not understand the research

assistants explanation or his own role in the study. How should this patients nurse respond to this

revelation?

A) Explain the research process to the patient in greater detail.

B) Describe the details of a randomized controlled trial for the patient.

C) Inform the research assistant that the patients consent is likely invalid.

D) Explain to the patient that his written consent is now legally binding.

Ans: C

Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not

responsible for research consent. If patients who have agreed to participate exhibit ambivalence or

uncertainty about participating, do not try to convince them to participate. Ask the person from the

research team who is managing consents to speak with concerned patients about the study, even after

a patient has signed the consent forms.

Multiple Selection

6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among

the nurses on a unit. A nurse who is implementing EBP integrates which of the following? (Select all

that apply.)

A) Interdisciplinary consensus

B) Nursing tradition

C) Research studies

D) Patient preferences and values

E) Clinical expertise

Ans: C, D, E

Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving

approach to the delivery of healthcare that integrates the best evidence from studies and patient care

data with clinician expertise and patient preferences and values.

Multiple Choice

7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to

heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working

with Mrs. Mayes applies evidence-based practice (EBP) whenever possible and has proposed the use

of maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant

and adamantly opposes this treatment despite the sizable body of evidence supporting it. How should

the nurse reconcile Mrs. Mayes views with the principles of EBP?

A) The nurse should explain that reliable and valid research evidence overrides the patients opinion.

B) The nurse should explain the evidence to the patient in greater detail.

C) The nurse should integrate the patients preferences into the plan of care.

D) The nurse should involve the patients family members in the decision-making process.

Ans: C

Feedback: Patient preferences should be integrated into EBP and considered alongside research

evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The

family should be involved, but this is not an explicit dimension of EBP. Similarly, explaining the

evidence in more detail is not a demonstration of EBP.

8. The administrators of a long-term care facility are considered the use of specialized, pressurereducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have

sought input from the nurses on the unit, all of whom are aware of the need to implement the

principles of evidence-based practice (EBP) in this decision. Which of the following evidence

sources should the nurses prioritize?

A) A qualitative study that explores the experience of living with a pressure ulcer

B) A case study that describes the measures that nurses on a geriatric unit took to reduce pressure

ulcers among patients

C) Testimonials from experienced clinicians about the effectiveness of the mattress in question

D) A randomized controlled trial that compared the pressure-reducing mattress with standard

mattresses

Ans: D

Feedback: The most reliable evidence is considered RCTs. Qualitative studies, case studies, and

expert opinion are low on the hierarchy of evidence.

9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their

attempt to ascertain the most efficient and effective way to communicate between nurses who are on

different units, a project that will consider many types of evidence. Which of the following

information sources should the administrators prioritize?

A) A systematic review about communication in nursing contexts

B) Nurses ideas about communication methods

C) The results of a chart review

D) The hospitals accreditation status

Ans: A

Feedback: Systematic reviews are assigned a high value in EBP. Reviews would be prioritized over

nurses ideas or a chart review, though both are potential considerations. The hospitals accreditation

status is not a relevant consideration.

10. A nurse has resolved to apply the evidence-based practice (EBP) process to the way that

admission assessments are conducted and documented on a unit. How should the nurse begin the

process of establishing EBP?

A) Gather evidence showing the shortcomings of current practices

B) Formulate a clear and concise question to be addressed

C) Elicit support from the nurses who are most often responsible for admissions

D) Search the literature for evidence that is potentially relevant to the practice need

Ans: B

Feedback: The first step in applying EBP is to ask a clear, focused question. This should precede a

search of the literature or the recruitment of participants. An assessment of the shortcomings of the

current system is not an explicit component of the EBP process.

11. Which of the following questions best exemplifies the PICOT format for asking evidence-based

questions?

A) What affect does parents alcohol use have on the alcohol use of their teenage children?

B) Among postsurgical patients, what role does meditation rather than benzodiazepines have on

anxiety levels during the 48 hours following surgery?

C) Among high school 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 sexually transmitted

infections?

D) In children aged 68, is the effectiveness of a descriptive pain scale superior to a numeric rating

scale in the emergency room context?

Feedback: The correct answer includes a population (postsurgical patients), intervention

(meditation), comparison (benzodiazepines), outcome (anxiety levels), and a time frame (48 hours).

No other option contains each of the five elements of a PICOT question.

12. A nurse has made plans to implement the University of North Carolina (UNC) model of 5 As

during the process of applying evidence-based practice (EBP) to a practice problem. What is the

final step that the nurse will take in applying this model?

A) Analyze the results of the EBP process

B) Advocate for others to embrace the identified change

C) Adopt the changes identified in the review process

D) Assess the outcomes of the new practice

Ans: D

Feedback: The final step in the UNC rubric is to Assess the change using the quality improvement

process in place in the institution.

13. A nurse has been asked to make a presentation to a group of high school students on the subject

of sexual health. However, the nurse does not have a background in this practice area and requires

rapid access to evidence-based guidelines. Which of the following strategies is most likely to

provide the nurse with valid and reliable evidence in a time-efficient manner?

A) Search the Cochrane Library of Systematic Reviews

B) Google search terms such as sexual health teens and sexual education

C) Search Medline using PubMed and order relevant articles

D) Scan the most recent issues of nursing journals that address this area of practice

Feedback: For some problems, a systematic review may be available from a source such as the

Cochrane Library. Often this review is done by an expert panel providing excellent information on

which to base decisions. This approach is more likely to produce valid and reliable results than a

Google search and is more efficient than searching journal manually or ordering articles through

PubMed.

14. The nurses at a university hospital have been informed that a computerized record system will be

implemented over the next 12 months. The nurses should be aware that such as system presents

particular challenges in the area of

A) vulnerability to errors in charting and the inability to make changes.

B) patient privacy and confidentiality of records.

C) enforcing compliance with the system on the part of nurses.

D) ensuring compatibility with different computer operating systems.

Ans: B

Feedback: Concerns about privacy become magnified when information is available to many people

in many sites far removed from where the patient is located, a situation that exists when