(Download PDF) Medical Surgical Nursing 7th Edition Ignatavicius Test Bank Full Chapter
(Download PDF) Medical Surgical Nursing 7th Edition Ignatavicius Test Bank Full Chapter
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
*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.
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.
For then shall the righteous stand with great boldness before
such as have vexed and oppressed them.
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 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.
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.
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.
*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.
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.
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.
*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.
*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.
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.
Christ had adversaries and slanderers; and wilt thou have all men
thy friends and benefactors?
*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.
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.
He that hath well ordered and disposed all things within, careth
not for the perverse carriage of men.
8. If all went well with thee, and if thou wert well purified, all
things would tend to thy good.
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.
If thou canst hold thy peace and suffer, without doubt thou shalt
see the salvation of the Lord.
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.
*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 passionate man turneth good into evil, and easily believeth the
worst.
*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.
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.
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.
*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.
*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.
2. If thou wert inwardly pure, thou wouldst see and understand all
things without any impediment.
*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.
C H A P T E R V.
Of the consideration of one’s self.
He that rightly considers his own work, will find little cause to
judge hardly of another.
*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.
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