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A team of nurses wants to integrate evidence-based practice into a facility's clinical pathways. Which step should the team implement first?
- A. Acquire findings from published literature.
- B. Apply the research findings to clinical practice.
- C. Assess the outcomes of using new research findings.
- D. Ask questions to identify clinical problems that should be changed.
Correct Answer: D
Rationale: Integrating evidence-based practice is a multistep process rather than a single change event. The first step is to identify clinical problems that should be changed. Each step must proceed in order when integrated into a clinical environment.
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An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring?
- A. My nurse always asks me which type of juice I want to help me swallow my medication.
- B. My nurse explained my treatment plan to me and asked for my ideas about how to make it better.
- C. My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon.
- D. My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone.
Correct Answer: D
Rationale: Caring evidences empathic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice.
Which research evidence would most influence a group of nurses to change their practice?
- A. Expert committee report of recommendations for practice
- B. Systematic review of randomized controlled trials
- C. Nonexperimental descriptive study
- D. Critical pathway
Correct Answer: B
Rationale: Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed.
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the website's address most alerts the nurse that the site may have biased and prejudiced information?
- A. Address ends in '.org.'
- B. Address ends in '.com.'
- C. Address ends in '.gov.'
- D. Address ends in '.net.'
Correct Answer: B
Rationale: Financial influences on a site are a clue that the information may be biased. '.com' at the end of the address indicates that the site is a commercial one. '.gov' indicates that the site is maintained by a government entity. '.org' indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. '.net' can have multiple meanings.
An experienced nurse says to a new graduate, 'When you've practiced as long as I have, you will instantly know how to take care of psychotic patients.' What is the new graduate's best analysis of this comment?
- A. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice.
- B. New research findings must be continually integrated into a nurse's practice to provide the most effective care.
- C. Experience provides mental health nurses with the tools and skills needed for effective professional practice.
- D. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error.
- E. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs.
Correct Answer: A,B
Rationale: Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.
Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will demonstrate what behavior?
- A. Denying suicidal ideation
- B. Reporting a sense of well-being
- C. Taking medications as prescribed
- D. Attending clinic appointments on time
Correct Answer: B
Rationale: Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery.