Evidence Based Practice Questions

An oncology nurse is concerned about the number of patient falls occurring on the unit. The nurse observes that oncology patients who receive blood transfusions often receive Benadryl before a transfusion to reduce an allergic response. The drug Benadryl is an antihistamine that can cause drowsiness and dizziness. Which of the following is the best-worded PICO question for this practice issue?

1. Do antihistamines lead to patient falls?

2. Does the use of Benadryl before a transfusion compared to no antihistamine prevent falls?

3. In oncology patients does the use of Benadryl reduce allergic responses from blood transfusions?

4. Does the use of Benadryl before transfusions in oncology patients compared to no antihistamine affect the incidence of patient falls?

Answer: 4. This question includes four PICO elements. Option A is a broad background question. Option B does not specify a patient population. Option C does not address the outcome of the clinical situation, falls.
Number the following steps of EBP in the appropriate order.

1. Critically appraise the evidence you gather.

2. Sustain knowledge use.

3. Evaluate the practice decision or change.

4. Collect the most relevant and best evidence.

5. Integrate the evidence.

6. Communicate the results.

7. Ask the clinical question.

Answer: 7, 4, 1, 5, 3, 6, 2.
While conducting a literature review, a nurse is seeking evidence in clinical guidelines developed for the clinical practice issue of pain management in the elderly. Which of the following is an example of a clinical guideline?

1. A summary of randomized clinical trials conducted to determine the effects of giving analgesics around the clock to older adults

2. A case study describing how an adult patient with dementia responded to pain-management approaches

3. A set of practice recommendations for pain management of patients in long-term care settings

4. A study of a cohort of elderly patients and their self-report of satisfaction with pain management in a hospital

Answer: 3. Option 1 is a systematic review. Option 2 is a clinical case study involving only one patient. Option 4 is an individual descriptive study.
A nurse working in a home health setting sees many patients who have asthma. The patients use inhalers that deliver prescribed medications to relieve airway obstruction. The nurse implements an EBP change that teaches patients the importance of taking their inhaler medications correctly and regularly on time using a new DVD program. The nurse measures the patients’ behavior outcome of the practice change using which type of measurement?

1. Measuring the patient’s ability to breathe without distress

2. Chart auditing teaching sessions

3. Observing patient viewing the DVD

4. Checking patients’ inhaler for number of doses taken during a week’s time

Answer: 4. The desired behavioral outcome is adherence to using inhalers as prescribed. Option 1 is a desirable physical outcome but not a measure of the effects of the teaching program. Option 2 is a process measure to track teaching sessions. Option 3 is also a process measure.
A nurse on an orthopedic unit is assigned to a patient in skeletal traction. The nurse has cared for similar patients in the past. In the staff room the nurse talks with other colleagues about what they know about pin-site care. The nurse asks a colleague, “What is the best practice for cleaning pin sites in skeletal traction?” This question is an example of a:

1. Knowledge-focused trigger.

2. Problem-focused trigger.

3. PICO question.

4. Hypothesis.

Answer: 1. This is an example of a knowledge-focused trigger. If the staff had been seeing cases of pin-site infection, it would more likely be a problem-focused trigger. The nurse is raising a broad background question, not a PICO(T) question. In addition, the nurse is not suggesting an association between site care and any other factor, which is needed in a hypothesis.
Which of the following is a process measurement?

1. A nurse teaches a patient how to administer an injection and then observes the patient do a return demonstration.

2. A nurse implements a new pain-management protocol and checks patients’ charts to confirm if interventions are being provided.

3. A nursing unit adopts a set of strategies for reducing pressure ulcers, and the UPC members use direct observation of the skin to measure incidence of pressure ulcers.

4. A nursing unit implements a new fall-prevention protocol and checks the monthly performance data for incidence of falls on the unit.

Answer: 2. A process measure tells you if an intervention is completed as planned. All other choices are outcome measures.
The nurses on a medicine unit have seen an increase in the number of urinary tract infections (UTIs) developing in their patients. The nurses decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of “Do” from that model?

1. Implementing a new protocol for early removal of indwelling Foley catheters

2. Reviewing the incidence of UTIs on patients cared for using the protocol

3. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol on all units

4. Meeting with all disciplines to develop an approach for reducing UTIs

Answer: 1. The implementation of the new protocol is the “DO” or carrying out the test. Option 2 is observing and learning the outcomes (study). Option 3 is determining which modifications are needed to the test (in this case none) and implementing change. Option 4 is developing a plan to test the change (Plan).
After a review of the literature regarding health literacy, the nurses in a diabetes outpatient clinic decide to revise the instructional manual on diabetes management to lower the reading level. Their hope is that by using the instructional materials over time they will see more patients being able to follow their medication regimens and better control their disease. Which of the following are outcome measures for this project? (Select all that apply.)

1. Patients’ reading level

2. Patients’ adherence to oral hypoglycemic medicines

3. Patients’ ability to plan a diabetes diet

4. The number of patients who are given the new instructional manual

Answer: 2, 3. Option 1 is a measure that reflects a patient’s need for low-literacy materials but is not an outcome of the nurse’s instructional method. Option 4 is a process measure.
Consider the following clinical situation. A UPC committee is discussing the need to develop a new fever-management protocol for patients in their ICU. They want the protocol to be evidence based. In the past only the use of antipyretics has been the treatment approach. If the committee were to develop a PICOT question for this problem area, what would be the P?

1. Fever

2. Antipyretics

3. Fever protocol

4. Patients who are critically ill

Answer: 4. The population of interest is the critically ill. The “I” would be a fever protocol, the “C” would be antipyretics, and the “O” would be fever.
During an EBP committee meeting, a nurse discusses the review of an article about the removal of nail polish before measuring pulse oximetry. The nurse reports that there is no conclusive evidence from the study that it is necessary to remove nail polish. A colleague on the committee asks the nurse, “Which level of evidence do you have?” The colleague’s question is referring to:

1. The scientific validity of the study findings.

2. The number of articles that the nurse reviewed on the topic.

3. Whether or not the pulse oximeter in the study is similar to the one used on the nurse’s unit.

4. The level in the hierarchy of evidence for the article that was reviewed by the nurse.

Answer: 4. The level of evidence refers to the strength of evidence as represented in an evidence hierarchy.
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