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Chapter 2–Clinical Decision Making and
Evidence-Based Practice
Chapter 2–Clinical Decision Making and Evidence-Based Practice
MULTIPLE CHOICE
1.The nurse is implementing evidence-based practice. Which of the following is not a component of
this process?
1. Patient preference
2. Clinical expertise
3. Research evidence
4. Leader practice
ANS: 4
Evidence-based practice is the combination of applying research findings, creating clinical
guidelines, and the individualization of the plan of care to meet the patient’s needs and desired.
Leader practice is not a component of the evidence-based process.
PTS:1DIF:AnalyzeREF:The Process of EBP
2.The nurse is planning the care for a client using an unstructured approach. Which of the following
approaches did the nurse most likely use?
1. Research
2. Trial and error
3. Nursing theory
4. Validated order
ANS: 2
Examples of unstructured approaches to plan client care include trial and error, tradition, and
authority. The approaches of research, nursing theory, and validated order all represent a structured
approach to planning client care.
PTS: 1 DIF: Analyze REF: Knowledge Bases for Clinical Decisions
3.The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge
Transformation. Which of the following is the nurse doing?
1. Creating evidence summaries
2. Evaluating outcomes
3. Integrating findings into practice
4. Participating in research
ANS: 4
The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to
five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary,
3) translation, 4) integration, and 5) evaluation.
PTS:1DIF:AnalyzeREF:EBP in Nursing
4.A committee has been developed to implement knowledge transformation when providing client
care. The members realize that the purpose of knowledge transformation is to:
1. reduce length of stay.
2. convert research findings to impact health outcomes.
3. reduce the cost of care.
4. increase the number of patients with health insurance.
ANS: 2
The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is
the conversion of research findings to have an impact on health outcomes by way of evidence-based
care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or
increase the number of patients with health insurance.
PTS: 1 DIF: Analyze REF: Definition of Knowledge Transformation
5.An advance practice nurse is being consulted to participate during the translation phase of the ACE
Star Model of Knowledge Transformation. During this phase, which of the following will the nurse
create?
1. Standardized care plans
2. Critical pathways
3. Clinical practice guidelines
4. Checklists to streamline documentation
ANS: 3
In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to
consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to
produce clinical practice guidelines. The nurse is not creating standardized care plans, critical
pathways, or checklists to streamline documentation since these items are not a part of the ACE Star
Model of Knowledge Transformation.
PTS: 1 DIF: Apply REF: Star Point 3: Translation
6.The nurse leaders of a health care organization are creating plans to change clinical and
organizational practices to support evidence-based practice. Which phase of the ACE Star Model of
Knowledge Transformation are the leaders implementing?
1. Integration
2. Evaluation
3. Translation
4. Evidence summaries
ANS: 1
During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation
plans are put into action to change the individual clinician practices, organizational practices, and
environmental policies. Implementation plans are not a part of the evidence summaries, translation,
or evaluation of the ACE Star Model of Knowledge Transformation.
PTS: 1 DIF: Apply REF: Star Point 4: Integration
7.The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines
which of the following will the nurse need?
1. Current client census
2. Evidence summaries
3. Nursing department budget
4. Staffing ratios
ANS: 2
The ideal base for writing clinical guidelines are evidence summaries because they increase the
power and validity of the cause-and-effect relationship between interventions and outcomes. Current
client census, nursing department budgets, and staffing ratios are not used to write clinical practice
guidelines.
PTS:1DIF:ApplyREF:Evidence Summaries
8.The nurse is writing a systematic review. After the nurse formulates questions and locates relevant
studies, the nurse thing the nurse will do is:
1. update the reviews.
2. interpret the findings.
3. summarize and synthesize results.
4. select and appraise the studies.
ANS: 4
The next step in the systematic review writing process is selecting and appraising the studies.
Afterwards, the nurse will complete, in order, summarize and synthesize results, interpret the
findings, and regularly update the reviews.
PTS: 1 DIF: Apply REF: Method for Producing Systematic Reviews
9.The nurse is using the scale for rating the strength of research evidence for one research article for
potential inclusion in a clinical practice guideline. Which of the following is considered the strongest
evidence?
1. Individual cohort study
2. Meta-analysis of randomized clinical trials
3. Expert opinion
4. Case studies
ANS: 2
When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest
evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies.
Expert opinion is Level VII or the weakest evidence. Case studies are Level VI.
PTS:1DIF:Analyze
REF:Table 2-1 Scale for Rating the Strength of Research Evidence
10.The nurse is considering a research study for inclusion in a clinical practice guideline that has
been identified as being sufficient to determine effects on health outcomes. This research study
would be considered as being:
1. fair.
2. passable.
3. poor.
4. good.
ANS: 1
Research studies are rated according to the Scale for Rating the Quality of Research Evidence.
According to this scale, a research study that is sufficient to determine the effects on health outcomes
is considered fair. A good study has consistent results for well-designed, well-conducted studies that
directly assess effects on health outcomes. A poor study has insufficient results to assess the affects
on health outcomes. Passable is not a category of this rating scale.
PTS:1DIF:Analyze
REF:Table 2-2 Scale for Rating the Quality of Research Evidence
11.The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a
client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A.
According to this grade, the nurse should do which of the following?
1. Do not use this guideline because the harm outweighs the benefits.
2. Do not use this guideline because the benefits and harms cannot be determined.
3. Use this guideline because the benefit is substantial.
4. Use this guideline but understand that the net benefit to the client is small.
ANS: 3
The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A
grade A guideline is recommended for care since there is high certainty that the benefit to the client
is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has
harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be
determined.
PTS:1DIF:Apply
REF: Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force
12.The nurse identifies errors and hazards in a care environment and implements basic safety to
reduce the likelihood of an adverse event. Which of the following core competencies is this nurse
implementing?
1. Provide patient-centered care
2. Apply quality improvement
3. Employ evidence-based practice
4. Utilize informatics
ANS: 2
Of the five Core Competencies for Health Professions, the competency that focuses on the
identification of errors and hazards with implementation of basic safety is apply quality
improvement. Provide patient-centered care focuses on direct care activities. Employ evidence-based
practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on
communication and the use of information technology to support decision making.
PTS: 1 DIF: Apply REF: Box 2-1 Core Competencies for Health Professions
13.The nurse is participating on a committee to select evidence-based practice guidelines.Which of
the following statements by the nurse indicate a clear understanding of the purpose of these
guidelines?
1. “They provide the best evidence to make decisions about the care of individual clients.”
2. “They promote changes in client care according to a research study.
3. “They ensure cost-effective care to the client.”
4. “They identify safe staffing ratios for client care.”
ANS: 1
Evidence-based practice guidelines provide the best evidence to make decisions about the care of
individual clients. The use of a single research study to make changes in client care is a concept
within research utilization and not evidence-based practice. Evidence-based practice does impact the
costs of client care but their intent is not to ensure cost-effective care but rather to improve the
overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care.
PTS:1DIF:AnalyzeREF:The Process of EBP
MULTIPLE RESPONSE
1.The nurse is determining the best way to ensure adherence to the core competencies for health
professions. Which of the following competencies will the nurse implement when providing client
care? (Select all that apply.)
1. Work in interdisciplinary teams
2. Utilize informatics
3. Implement basic safety principles
4. Employ evidence-based practice
5. Apply quality improvement
6. Provide patient-centered care
ANS: 1, 2, 4, 5, 6
Core competencies for health professions include providing patient-centered care, working in
interdisciplinary teams, employing evidence-based practice, applying quality improvement, and
utilizing informatics. Implementing basic safety principles is only one part of a quality improvement
program.
PTS:1DIF:Apply
REF: Box 2-1 Core Competencies for Health Professions.
2.There are impediments that make the practice of evidence-based practice difficult. Which of the
following are impediments to evidence-based practice? (Select all that apply.)
1. Complexity of science and technology
2. Difficulty of nowledge transformation
3. Variety of knowledge forms
4. Number of patient diagnoses
5. Evidence summary
6. Application of quality improvement
ANS: 1, 3
Hurdles to evidence-based practice are the increasing complexity of science and technology and the
variety of knowledge forms, many of which are not suitable for direct practice. Knowledge
transformation, number of patient diagnoses, evidence summary, application of quality improvement
are not considered impediments to the implementation of evidence-based practice.
PTS: 1 DIF: Apply REF: Applying Evidence-Based Concept
3.The nurse identifyies evidence summaries for evidence-based practice. Which of the following are
references to types of evidence summaries? (Select all that apply.)
1. Review of literature
2. Evidence synthesis
3. Authentication review
4. Systematic reviews
5. Integrative reviews
6. Substantiation evidence
ANS: 1, 2, 4, 5
Evidence summaries are also referred to as being review of literature, evidence synthesis, systematic
reviews, and integrative reviews. These summaries are not referred to as being authentication review
or substantiation evidence.
PTS: 1 DIF: Apply REF: Star Point 2: Evidence Summary
4.A health care organization is determining which clinical practice guidelines to adopt when
providing client care. The organization is using the AGREE Instrument for Assessing Guidelines
because this checklist helps the organization determine which of the following? (Select all that
apply.)
1. Scope and purpose
2. Stakeholder involvement
3. Rigor of development
4. Clarity and presentation
5. Author credentials
6. Application
ANS: 1, 2, 3, 4, 6
The AGREE Instrument for Assessing Guidelines outlines the primary facets of the clinical practice
guideline being appraised for adoption. It includes the following criteria: scope and purpose,
stakeholder involvement, rigor of development, clarity and presentation, application, and editorial
independence. Author credentials is not a criteria of this checklist.
PTS: 1 DIF: Analyze REF: Clinical Practice Guidelines
5.The nurse is participating in a committee to address the Institute of Medicine’s priority areas for
quality improvement. Which of the following are considered priority areas? (Select all that apply.)
1. Diabetes
2. End-of-life organ failures
3. Motor vehicle accidents
4. Scoliosis
5. Tobacco dependence
6. Major depression
ANS: 1, 2, 5, 6
The Institute of Medicine has identified 20 priority areas for quality improvement which include
diabetes, end-of-life organ failures, tobacco dependence, and major depression. Motor vehicle
accidents and scoliosis are not priority areas identified by the Institute of Medicine.
PTS: 1 DIF: Analyze REF: Box 2-7 IOM-Priority Areas for National Action
