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Chapter 7: Evidence-Based Practice in Medical-Surgical Nursing
Test Bank

MULTIPLE CHOICE

1. The cardiac nurse wants to know about the best practices to prevent pneumonia after
open-heart surgery. What does the nurse do first?
a. Critically appraise relevant evidence.
b. Implement acceptable recommendations.
c. Ask clinical experts for their opinions.
d. Search for evidence to answer the question.
ANS: D
The process of evidence-based practice (EBP) is systematic and consists of several steps.
After asking “burning” clinical questions, the next step is to find the very best evidence to try
to answer the question.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Evaluation)

2. The nurse is identifying clinical practice problems on a cardiac unit. What question is a
foreground question?
a. “What is the pathophysiology of congestive heart failure?”
b. “How does smoking affect the internal lumens of arteries?
c. “What is the best treatment for a myocardial infarction?
d. “How are a client’s vital signs affected by anxiety?”
ANS: C
A foreground question asks a question of relationship and may be controversial (best
treatment). All other questions are background questions, which ask for a fact.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Planning)

3. The nursing student asks, “What is the difference between qualitative and quantitative clinical
questions?” What is the nurse’s best response?
a. “Qualitative questions utilize a strict statistical analysis of information.”
b. “Quantitative questions identify relationships between measurable concepts.”
c. “Qualitative questions ask about associations among defined phenomena.”
d. “Quantitative questions analyze the content of what a person says or does.”
ANS: B
Quantitative questions ask about the relationship between or among defined, measurable
phenomena and include statistical analysis of information that is collected to answer a
question. Qualitative questions focus on the meanings and interpretations of human
phenomena or experiences of people and usually analyze the content of what a person says
during an interview or what a researcher observes.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 80

 TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Teaching/Learning

4. The nurse is assessing the following PICO(T) question: In a 60-year-old woman with
osteoarthritis, can a COX-2 inhibitor decrease the risk of gastrointestinal bleeding compared
with other NSAIDs? What is the comparison component in this question?
a. Osteoarthritis
b. COX-2 inhibitor
c. NSAIDs
d. Gastrointestinal bleeding
ANS: C
The comparison component of the clinical question may be the standard or the current
treatment, or may be another intervention against which the innovative practice is compared.
In this question, the standard or current practice is other NSAIDs. The innovative practice
(COX-2 inhibitor) is compared against this standard.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Planning)

5. The nurse is looking for the best interventions for postoperative pain control. When are the
facility’s policies and procedures an appropriate source of evidence?
a. When policies are based on high-quality clinical practice guidelines
b. When evidence is derived from a valid and reliable quantitative research study
c. When procedures originated from opinions of the facility’s chief surgeon
d. When evidence is founded on recommendations from experienced nurses
ANS: A
Facility policies and procedures can be used as evidence of specific nursing practice in the
clinical setting if the policies are based on high-quality evidence. Clinical practice guidelines
are based on systematic reviews, which provide the highest level of evidence. Policies based
on quantitative research, opinions, and experience should not be used because they are not
founded on evidence of highest quality.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 81

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Assessment)

6. The nurse researcher is evaluating clinical questions. Which is a qualitative question?

a. What factors affect clients’ responses to postoperative pain?
b. Do wound vacuum systems improve surgical wound healing time?
c. What are the effects of hourly rounding on client fall rates?
d. Do chlorhexidine swabs decrease central line site infections?
ANS: A
A qualitative question focuses on the participant’s interpretations of or responses to an
experience. Understanding factors that influence a client’s response to a situation would be a
qualitative evaluation. The other questions focus on quantitative or numeric indicators, instead
of on the meaning or interpretation of an event. These questions would be quantitative
questions.
 DIF: Cognitive Level: Knowledge/Remembering REF: p. 80
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Teaching/Learning

7. The nurse is searching for evidence related to a PICOT question. What source provides the
best evidence?
a. Medline database
b. Cochrane library
c. CINAHL database
d. Library of Congress
ANS: B
The top level of evidence consists of systematic reviews. The major purpose of systematic
reviews is to provide high-quality evidence to busy clinicians who do not have the time to
spend finding original studies and then reviewing, critiquing, and synthesizing evidence from
each study. These reviews can be found in the Cochrane library; the Medline and CINAHL
databases provide single studies that are not reviewed, critiqued, or synthesized for the
clinician. The Library of Congress houses the world’s largest collection of historical and
cultural references; it does not provide best evidence related to health care PICOT questions.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 82

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Assessment)

8. A hospice nurse routinely uses Therapeutic Touch to promote comfort. A current client
demonstrates anxiety when this intervention is offered. What is the nurse’s best response?
a. Provide pain medication to manage the client’s comfort and pain.
b. Continue with the intervention because it has worked with other clients.
c. Search for alternative interventions to better meet the client’s needs.
d. Share research that supports Therapeutic Touch with the client.
ANS: C
Evidence-based practice integrates best evidence with the clinician’s experience and client
preferences. If a client is not receptive to an intervention, the best nursing response is to
search for an alternative evidence-based intervention that is congruent with the client’s
preferences.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Planning)

9. The health care facility is implementing a new evidence-based nursing protocol. What is
necessary to ensure successful implementation?
a. Tools to evaluate the protocol are valid and reliable.
b. Support from the nurses implementing the protocol is present.
c. Recommendations for the protocol are obtained from senior administrators.
d. The evidence-based protocol is cost-effective for the facility.
ANS: B
Complete buy-in from the people who will be involved in implementing the new protocol is
essential for the success of implementation.
 DIF: Cognitive Level: Comprehension/Understanding REF: p. 83
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Planning)

MULTIPLE RESPONSE

1. The nurse is developing a clinical question in a PICOT format. What components are included
in the question? (Select all that apply.)
a. Population
b. Comparison
c. Observation
d. Intervention
e. Technique
ANS: A, B, D
The major components of a PICOT question are population, intervention, comparison, and
outcome, with an added time component when appropriate.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Teaching/Learning

2. The intervention component of an evidence-based question pertains to the therapeutic

effectiveness of a treatment. Which are possible types of interventions? (Select all that apply.)
a. Exposure to disease
b. A high-risk behavior
c. Age, gender, or ethnicity
d. A prognostic factor
e. A client response
ANS: A, B, D
The intervention component pertains to the therapeutic effectiveness of a new treatment and
may include the following: 1) exposure to disease or harm, 2) a prognostic factor, or 3) a risk
behavior or factor.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 80

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Intervention)

3. A nurse who wants to incorporate evidence-based practices into client care on a medical unit
is meeting resistance. What barriers prevent nurses from engaging in evidence-based
practices? (Select all that apply.)
a. Difficulty accessing research materials
b. Difficulty understanding client needs
c. Lack of value for research in practice
d. Lack of value for client preferences
e. Inadequate available time
f. Inadequate nurse-client ratios
ANS: A, C, E
Major barriers that prevent nurses from engaging in evidence-based practice include lack of
time, lack of value for research in practice, lack of understanding of organization or structure
of electronic databases, difficulty accessing research materials, lack of computer skills, and
difficulty understanding research articles.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 81

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Ethical
Practice) MSC: Integrated Process: Nursing Process (Planning)
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 *7. Who shall remember thee when thou art dead? Do, do now,
my beloved, whatsoever thou art able to do: for thou knowest not
when thou shalt die, nor yet what shall be after thy death.

Now, while thou hast time, lay up for thyself everlasting riches.

Think on nothing but the salvation of thy soul, care for nothing but
the things of God.

8. Keep thyself as a stranger and pilgrim upon earth, who hath

nothing to do with the affairs of this world.

*Keep thy heart free, and lifted up to God, because thou hast
here no abiding city.

*Send thither thy daily prayers and sighs and tears, that after
death thy Spirit may happily pass to the Lord. Amen.

C H A P T E R XVIII.
Of judgment and the punishment of sins.

I N all things remember the end, and how thou wilt be able to stand
before that severe Judge, from whom nothing is hid: who is not
pacified with gifts, nor admitteth any excuses; but will judge
according to right.

O wretched and foolish sinner, who sometimes fearest the

countenance of an angry man! What answer wilt thou make to God,
who knoweth all thy wickedness?
 Why dost thou not provide for thyself against that great day of
judgment, when no man can excuse or answer for another, but every
one shall have enough to answer for himself?

2. What is it which that infernal fire feeds upon but thy sins?

The more thou sparest thyself now, and followest the flesh, so
much the more hereafter shall be thy punishment, and thou stowest
up greater fuel for the flame.

*In what thing a man hath sinned, in the same shall he be

punished.

There is no quiet, no comfort for the damned there: here we have

some intermission of our labours, and enjoy the comfort of our
friends.

Be now solicitous and sorrowful because of thy sins, that at the

day of judgment thou mayest be secure with the blessed.

For then shall the righteous stand with great boldness before
such as have vexed and oppressed them.

Then shall he stand to judge, who doth now humbly submit

himself to the judgment of others.

Then shall the poor and humble have great confidence, but the
proud shall be compassed with fear on every side.

3. Then will it appear, that he was wise in this world, who had
learned to be a fool and despised for Christ’s sake.

Then shall every affliction, patiently undergone, delight us; and

the mouth of iniquity shall be stopped.

Then shall the devout rejoice, and the profane mourn.

Then shall he more rejoice that hath mortified his flesh, than he
that hath abounded in all pleasure.
 Then shall the poor attire shine gloriously, and the precious robes
appear vile.

4. Suppose thou hadst hitherto lived always in honour and

delights, what would this avail thee, if thou wert to die this instant?

All therefore is vanity, but to love God, and serve him only.

For he that loveth God with all his heart, is neither afraid of death,
nor judgment, nor hell.

C H A P T E R XIX.
Of the zealous amendment of our whole life.

* HEN one that was in great anxiety of mind, often wavering

W between fear and hope, once humbly prostrated himself in
prayer, and said, O if I knew that I should persevere! He
presently heard within him an answer from God, which said, If thou
didst know it, what wouldst thou do? Do what thou wouldst do then,
and thou shalt be safe.

And being herewith comforted and strengthened, he committed

himself wholly to the will of God, and his anxiety ceased:

Neither had he any mind to search curiously farther what should

befall him; but rather laboured to understand what was the perfect
and acceptable will of God, for the beginning and accomplishing
every good work.
 2. Hope in the Lord, and do good, saith the prophet, and inhabit
the land, and thou shalt be fed.

One thing there is that draweth many back from a spiritual

progress, and diligent amendment; the dread of the difficulty, or
labour of the combat.

But they improve most that endeavour most to overcome those

things, which are grievous and contrary to them.

For there a man improveth more, and obtaineth greater grace,

where he more overcometh himself and mortifieth himself in spirit.

3. Gather some profit to thy soul wheresoever thou be; so if thou

seest or hearest of any good examples, stir up thyself to the imitation
thereof.

But if thou seest any thing worthy of reproof, beware thou dost
not the same. And, if at any time thou hast done it, labour quickly to
amend it.

4. Be mindful of the profession thou hast made, and have always

before thine eyes the remembrance of thy Saviour crucified.

Thou hast good cause to be ashamed, looking upon the life of

Jesus Christ, seeing thou hast as yet no more endeavoured to
conform thyself unto him, though thou hast walked a long time in the
way of God.

A religious person that exerciseth himself seriously and devoutly

in the most holy life and passion of our Lord, shall there abundantly
find whatsoever is necessary and profitable for him; neither shall he
need seek any better thing out of Jesus.

*O if Jesus crucified would come into our hearts, how quickly and
fully should we be instructed in all truth!
 An Extract of the

CHRISTIAN PATTERN:
Or, a treatise on the imitation of Christ. Written in Latin by
Thomas a Kempis.

B O O K II.

C H A P T E R I.
Of the inward life.

T HE kingdom of God is within you, saith the Lord. Turn thee with
thy whole heart unto the Lord, and forsake this wretched
world, and thy soul shall find rest.

Learn to despise exterior things, and to give thyself to the interior,

and thou shalt perceive the kingdom of God to come into thee.

For the kingdom of God, is righteousness, and peace, and joy in

the Holy Ghost.
 2. O faithful soul, make ready thy heart for the Bridegroom, that
he may vouchsafe to come unto thee, and dwell within thee!

For he saith, If any man love me, he will keep my words, and we
will come unto him, and will make our abode with him.

Give therefore admittance unto Christ, and deny entrance to all

others.

When thou hast Christ thou art rich, and he will suffice thee. He
will be thy faithful helper in all things, so as thou shalt not need to
trust in men.

*For men are soon changed, and quickly fail; but Christ
remaineth for ever, and is with us even unto the end.

3. We ought not to put trust in man, frail and mortal as he is,

though he be friendly and serviceable: nor should we be grieved,
although he cross and oppose us.

*They, that to-day take thy part, to-morrow may be against thee,
and so on the contrary; they often turn like the wind.

*Put thy whole trust in God, let him be thy fear and thy love: he
will answer for thee, and do in all things what is best.

Thou hast not here an abiding city; and wheresoever thou be,
thou art a stranger and pilgrim; neither shalt thou ever have rest,
unless thou be intimately united unto Christ.

*4. Why dost thou here gaze about, since this is not the place of
thy rest? In heaven ought to be thy dwelling, and all earthly things
are to be looked upon as they forward thy journey thither.

*All things pass away, and thou together with them.

*Beware thou cleave not unto them, lest thou be entangled and
perish.
 Let thy thoughts be on the highest, and thy prayer directed unto
Christ, without ceasing.

If thou canst not contemplate on high and heavenly things; rest

thyself in the passion of Christ, and dwell willingly in his holy
wounds.

For if thou fly devoutly unto the Lord Jesus, thou shalt feel great
comfort in tribulation, neither wilt thou regard being despised of men,
but wilt easily bear words of detraction.

5. Christ was also despised of men and in his greatest necessity

forsaken by his acquaintance and friends.

*Christ chose to suffer and be despised; and darest thou

complain of any thing?

Christ had adversaries and slanderers; and wilt thou have all men
thy friends and benefactors?

How shall thy patience be crowned, if no adversity happen unto

thee?

*If thou wilt suffer nothing, how wilt thou be the friend of Christ?

Suffer with Christ, and for Christ, if thou desirest to reign with
Christ.

*6. If thou hadst but once entered into Jesus, then wouldest thou
not be careful about thine own advantage or disadvantage; but
wouldst rather rejoice at slanders cast upon thee; for the love of
Jesus maketh a man despise himself.

A lover of Jesus, a true inward Christian, free from inordinate

affections, can freely turn himself to God, and lift himself above
himself.

7. He that relishes all things as they are, and not as they are
esteemed, is truly wise, and taught by God.
 He that can live inwardly, and make small reckoning of outward
things, neither requireth places, nor attendeth times, for the exercise
of his devotion.

*An interior man soon recollecteth himself, because he is never

wholly intent upon outward things.

He is not hindered by outward labour or business; but as things

fall out, so he suiteth himself unto them.

He that hath well ordered and disposed all things within, careth
not for the perverse carriage of men.

*So much is a man hindered and distracted, by how much he

cleaveth to outward things.

8. If all went well with thee, and if thou wert well purified, all
things would tend to thy good.

But therefore many things displease and trouble thee, because

thou art not yet dead unto thyself, nor separated from all earthly
things.

*Nothing so defileth and entangleth the heart of man, as the

impure love of creatures.

C H A P T E R II.
Of humble submission.
M IND not much who is with thee, or who is against thee: but
endeavour and take care that God may be with thee in every
thing thou dost.

Keep a good conscience, and God will defend thee.

For whom God will help, no man can hurt.

If thou canst hold thy peace and suffer, without doubt thou shalt
see the salvation of the Lord.

He knoweth the time and manner how to deliver thee, and

therefore thou oughtest to resign thyself unto him.

It belongs to God to help, and deliver from all shame.

It is often profitable for the keeping us humble, that others know

and reprehend our faults.

2. When a man humbleth himself for his faults, he easily pacifieth

those that are offended with him.

God protecteth and delivereth the humble: unto the humble man
he inclineth himself; unto the humble he giveth great grace; and after
his humiliation he raiseth him unto glory.

Unto the humble he revealeth his secrets, and sweetly draweth

him unto himself.

The humble person though he suffer shame, is yet in peace; for

that he resteth in God, and not in the world.

*Do not think that thou hast profited any thing, unless thou
esteem thyself inferior to all.
 C H A P T E R III.
Of a good and peaceable man.

F IRST keep thyself in peace, and then mayst thou pacify others.

A peaceable man doth more good than a learned one.

A passionate man turneth good into evil, and easily believeth the
worst.

A peaceable man turneth all things into good.

He that is in peace, is not suspicious of any:

But he that is discontented, is neither quiet himself, nor suffereth

others to be quiet.

He often speaketh that which he ought not to speak, and omitteth

that which he ought to do.

He considereth what others are bound to do; and neglects that

which he is bound to do himself.

*First therefore have a careful zeal over thyself, and then shew
thyself zealous for thy neighbour’s good.

2. Thou knowest well how to excuse thine own deeds, and thou
wilt not receive the excuses of others.

It were more just to accuse thyself, and excuse thy brother.

If thou wilt be borne with, bear also with another.

Behold, how far thou art yet from true charity and humility, which
knoweth not how to be angry with any, but one’s self. It is no great
matter to live peaceable with the good and gentle; for every one
willingly enjoyeth peace, and loveth those that are of his own mind:
 But to be able to live peaceably with unquiet and perverse men,
or with the disorderly, or such as cross us, is a great grace.

3. Some there are that keep themselves in peace, and are in

peace also with others.

And there are some, that neither are in peace themselves, nor
suffer others to be in peace; who are troublesome to others, but
always more troublesome to themselves;

And others there are, that keep themselves in peace, and labour
to bring others unto peace.

*Our whole peace in this life consisteth rather in humble

suffering, than in not feeling adversities.

*He that knows best how to suffer, will best keep himself in
peace. He is a conqueror of himself, a lord of the world, a friend of
Christ, and an heir of heaven.

C H A P T E R IV.
Of a pure mind, and simple intention.

* IMPLICITY and purity, are the two wings by which a man is lifted
S up above all earthly things.

*Simplicity is in the intention; purity in the affection: simplicity

tends to God; purity apprehends and tastes him.

*No good action will hinder thee, if thou be inwardly free from
inordinate affection.
 If thou intend and seek nothing but the will of God, and the good
of thy neighbour, thou shalt enjoy internal liberty.

*If thy heart was right, then every creature would be a looking-
glass of life, and a book of holy doctrine.

There is no creature so little and abject, that represents not the

goodness of God.

2. If thou wert inwardly pure, thou wouldst see and understand all
things without any impediment.

A pure heart penetrateth heaven and hell.

Such as every one is inwardly, so he judgeth outwardly.

If there be joy in the world, surely a man of a pure heart

possesseth it. And if there be any where tribulation and affliction, an
evil conscience feels it.

*As iron put into the fire loseth its rust, and becometh all bright
like fire; so he, that wholly turneth himself unto God, is purified from
all slothfulness, and is changed into the likeness of God.

3. When a man beginneth to grow lukewarm, then he is afraid of

a little labour:

But when he once beginneth to overcome himself, then he

esteemeth those things light, which before seemed grievous unto
him.

C H A P T E R V.
 Of the consideration of one’s self.

W E should not trust too much to ourselves, because we have

often neither grace nor understanding.

There is but little light in us, and that we quickly lose by

negligence.

We reprehend small things in others, and pass over greater in

ourselves.

We quickly feel and weigh what we suffer from others, but we

mind not what others suffer from us.

He that rightly considers his own work, will find little cause to
judge hardly of another.

2. The inward Christian prefereth the care of himself before all

other cares.

*He that diligently attendeth unto himself, easily holds his peace
concerning others.

Thou wilt never be inwardly religious, unless thou pass over other
men’s matters, and look especially to thyself.

If thou attend wholly unto God and thyself, thou wilt be little
moved with whatsoever thou seest abroad.

Where art thou, when thou art not with thyself? And when thou
hast run over all, what hast thou profited, if thou hast neglected
thyself?

If thou desirest peace of mind, thou must reject all other cares,
and look only to thyself.

3. Thou shalt profit much, if thou keep thyself free from all
temporal cares.
 Thou shalt greatly fail, if thou esteem any thing of this world.

*Let nothing be great, nothing high, nothing pleasing to thee, but

only God himself, or that which is of God.

*Esteem all comfort vain, which proceedeth from any creature.

*A soul that loveth God, despiseth all things but God.

*God alone, who is everlasting, immense, filling all things, is the

comfort of the soul, and the true joy of the heart.

The End of the Seventh Volume.

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