Review Practice Exercise 3

Research And Evidence Based Practice In Nursing > Fundamentals

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Practice Exercise 3

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Total Questions : 6

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Question 1:

A client in the ICU experiences a sentinel event related to central line catheter care that resulted in serious injury. What performance improvement (PI) model should the unit use to identify errors that led to the sentinel event?

A. Six Sigma B. Root cause analysis C. PDSA D. Balanced scorecard

Answer and Explanation

Choice A:

Six Sigma is a data-driven quality improvement method used to reduce process variation and defects. While it is useful for process improvement over time, it is not the first-line tool used immediately after a sentinel event.

Choice B:

Root Cause Analysis (RCA) is the primary tool used after a sentinel event to investigate and understand the underlying system failures that led to the incident. It involves asking "why" repeatedly to drill down into the fundamental causes.Rationale for incorrect answers:

Choice C:

PDSA (Plan-Do-Study-Act) cycle is a quality improvement model used to test and implement changes in processes. While PDSA can follow RCA to address problems identified, it is not the ideal tool to investigate a serious sentinel event.

Choice D:

Balanced Scorecard is a strategic planning and management system used to align activities with organizational goals by monitoring performance metrics. It is not designed for root-cause investigation or immediate error analysis following a sentinel event.

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Question 2:

The nurse identifies which of the following as outcomes measurements? Select all that apply

A. A nurse teaches a client how to administer an injection and then watches the client do a return demonstration. B. A nurse implements a new pain-management protocol and checks clients’ charts to confirm whether interventions are being provided. C. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries. D. A nursing unit implements a new fall prevention protocol and checks the monthly performance data for incidence of falls on the unit. E. A nursing unit implements a client rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being done on clients.

Answer and Explanation

Choice A:

A nurse teaches a client how to administer an injection and then watches the client do a return demonstration. This is a process evaluation, not an outcome measurement. The nurse is assessing whether the client can perform the procedure correctly, but it does not measure the end result.

Choice B:

A nurse implements a new pain-management protocol and checks clients’ charts to confirm whether interventions are being provided. This is process-focused-it checks compliance with the intervention, not whether the intervention improved the clients' pain levels (which would be an outcome).

Choice C:

A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries. Measuring the incidence of pressure injuries is a true outcome measurement. It evaluates whether the implemented strategies had the desired clinical effect on patient outcomes.

Choice D:

A nursing unit implements a new fall prevention protocol and checks the monthly performance data for incidence of falls on the unit. The incidence of falls reflects the clinical outcome of the fall prevention strategy. This is a classic example of an outcome measurement because it focuses on the end result that matters to patient safety.Rationale for incorrect answers:

Choice E:

A nursing unit implements a client rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being done on clients. This is another process measure-the nurse is checking whether the intervention was carried out, not whether it had the desired impact, such as fewer call lights or improved patient satisfaction.

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Question 3:

The nurse is using the QSEN competency of evidence-based practice (EBP) when working with the unit council to initiate a change related to pain management. Which behaviors demonstrate that the nurse is practicing behaviors associated with EBP? Select all that apply

A. Initiating plan for self-development as a team member. B. Reading original research related to pain management. C. Demonstrating effective use of strategies to reduce risk of harm to self or others. D. Valuing EBP as critical to the development of pain management guidelines for the unit. E. Describing to the unit council reliable sources for locating clinical guidelines. F. Applying technology and information management tools to support safe processes of care.

Answer and Explanation

Choice A:

Initiating plan for self-development as a team member: This behavior is related to teamwork and collaboration or professional development, not specifically to the QSEN competency of EBP. While personal growth is valuable, it does not directly demonstrate evidence-based practice behavior.

Choice B:

Reading original research related to pain management: This is a core behavior of EBP-seeking and critically appraising current research to inform clinical decisions. Reading primary research articles is an essential part of integrating evidence into practice.

Choice C:

Demonstrating effective use of strategies to reduce risk of harm to self or others: This reflects the QSEN competency of safety, not EBP. Although safety overlaps with evidence-based practice in some contexts, this behavior is more aligned with risk reduction and injury prevention.

Choice D:

Valuing EBP as critical to the development of pain management guidelines for the unit: This reflects the attitudinal component of EBP-recognizing the importance of evidence in creating protocols. Valuing evidence is key to fostering a culture of inquiry and improvement.

Choice E:

Describing to the unit council reliable sources for locating clinical guidelines: This demonstrates knowledge of where and how to access reliable, evidence-based resources, which is an important behavior when participating in practice change through EBP.Rationale for incorrect answers:

Choice F:

Applying technology and information management tools to support safe processes of care: This behavior aligns more with the QSEN competency of informatics, not EBP. While technology may assist in EBP efforts, the focus here is on safe care processes, not evaluating or using evidence.

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Question 4:

The nurses in a medical unit have seen an increase in the number of pressure injuries developing in their clients. The nurses decide to initiate a performance improvement (PI) project using the PDSA model. Which of the following is an example of “Plan” from that model?

A. Orienting clients to the unit’s practice of hourly rounding on clients. B. Reviewing the incidence of pressure injuries on clients cared for using the protocol. C. Based on findings from clients who developed injuries, implementing an evidence-based skin care protocol on all units. D. Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries.

Answer and Explanation

Choice A:

Orienting clients to the unit’s practice of hourly rounding on clients: This is an action that occurs after a plan has been made. It falls under the “Do” phase, where interventions are implemented. It reflects putting a plan into practice, not the planning process itself.

Choice B:

Reviewing the incidence of pressure injuries on clients cared for using the protocol: This is an example of the “Study” phase, where data is analyzed to determine whether the intervention had the desired effect. It involves reviewing outcomes, not planning them.

Choice C:

Based on findings from clients who developed injuries, implementing an evidence-based skin care protocol on all units: This reflects part of the “Act” phase, where broader implementation of a successful intervention is carried out. It's a step beyond planning and testing; it represents full-scale application of what has been learned.

Choice D:

Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries: This reflects the “Plan” phase of the PDSA cycle. The team is identifying the problem, engaging key stakeholders, and developing a collaborative strategy to address pressure injuries. Rationale for incorrect answers:

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Question 5:

An 85-year-old client in a nursing home tells a nurse, “Because the doctor was so insistent, I signed the papers for that research study. Also, I was afraid he would not continue taking care of me.” Which client right is being violated?

A. Right not to be harmed B. Right to full disclosure C. Right to privacy and confidentiality D. Right to self-determination

Answer and Explanation

Choice A:

Right not to be harmed: This right protects participants from physical, emotional, or psychological harm during a study. While the situation is ethically concerning, the client did not report harm from the research itself-only pressure to participate.

Choice B:

Right to full disclosure: Full disclosure involves providing complete and understandable information about the research, including its purpose, risks, benefits, and procedures.

Choice C:

Right to privacy and confidentiality: This right pertains to the handling of personal information-ensuring that any data collected is kept confidential and used appropriately. There's no indication in the scenario that the client’s private health information was mishandled.

Choice D:

Right to self-determination: This right means individuals have the freedom to make their own choices-including the right to refuse participation in research-without pressure, coercion, or fear of losing care. Rationale for incorrect answers:

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Question 6:

A nurse implements an EBP change that teaches patients the importance of taking their diabetes medications correctly and regularly on time using videos streamed on the Internet. The nurse measures the patients’ behavioral outcome from the practice change by using which type of measurement?

A. Measuring the patients’ weight B. Chart auditing teaching sessions C. Observing patients viewing the videos D. Checking patients’ blood sugars

Answer and Explanation

Choice A:

Measuring the patients’ weight: Weight may change from many factors and is not a direct indicator of diabetes medication adherence over a short timeframe.

Choice B:

Chart auditing teaching sessions: This is a process measure (documents that teaching occurred), not a measure of patients’ behavior or clinical response.

Choice C:

Observing patients viewing the videos: That shows exposure to the intervention (process), not whether they actually take medications correctly and on time.

Choice D:

Checking patients’ blood sugars: Blood glucose (or A1c) is a clinical outcome closely tied to medication adherence for diabetes and therefore a meaningful measure of whether the educational intervention produced the desired behavioral effect.Rationale for incorrect answers:

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