ch08.doc

[Osborn] chapter 8

Learning Objectives [Number and Title] Learning Objective 1 Differentiate between basic and applied research.Learning Objective 2 Differentiate between quantitative and qualitative research.Learning Objective 3 Identify three types of quantitative and three types of qualitative research. Learning Objective 4 Describe the first step of the research process.Learning Objective 5 Determine how a research design is selected.Learning Objective 6 Differentiate between research utilization and evidence-based practice.Learning Objective 7 Describe the three ethical principles that guide research studies.Learning Objective 8 Describe the impact of HIPAA on nursing research studies.Learning Objective 9 Explain the four stages of completing a quantitative research critique.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.

1. A nurse asks a patient about things that he has done at home to relieve the arthritis pain in his shoulders. Which of the following is this nurse most likely using?

1. Applied research2. Critical thinking3. Basic research4. Discharge planning

Correct Answer: Applied research

Rationale: Applied research focuses on finding solutions to existing problems. Practicing nurses are most apt to be involved in applied research. Basic research is undertaken to extend the knowledge base in a discipline or to formulate or refine a theory. Critical thinking is a process to determine the best interventions when planning care. Discharge planning is an activity, started upon admission, to determine the patient’s needs once discharged from a health care facility.

Cognitive Level: AnalyzingNursing Process: EvaluationClient Need: Safe, Effective Care EnvironmentLO: 1


2. The nurse is providing care to a patient. Which of the following interventions could be considered applied research?

1. Trying different skin preparations to find the one that will hold the ostomy device the best.2. Measuring the patient’s blood pressure for orthostatic hypotension changes.3. Assisting the patient to ambulate.4. Measuring the patient’s intake and output.

Correct Answer: Trying different skin preparations to find the one that will hold the ostomy device the best.

Rationale: Applied research focuses on finding solutions to existing problems. The intervention where the nurse tries different skin preparations to find the one that will hold the ostomy device the best is an example of an intervention that can be considered applied research. The other interventions would be provided according to the patient’s needs and would not necessarily help to find a solution to an existing problem.

Cognitive Level: AnalyzingNursing Process: ImplementationClient Need: Safe, Effective Care EnvironmentLO: 1


3. The nurse measures the blood pressure and pulse every hour for a patient who has agreed to participate in a research study on the effectiveness of a new blood pressure medication. Which of the following would this activity be considered?

1. Basic research2. Applied research3. Routine nursing care4. Outcome measurement

Correct Answer: Basic research

Rationale: Basic research is done to extend the knowledge base in a discipline or to formulate or refine a theory. The patient is taking an experimental medication for blood pressure. There is no previous data from which to gauge the effectiveness of the medication. The nurse’s intervention of measuring blood pressure and pulse every hour is an example of basic research. Applied research focuses on finding solutions to existing problems. There is not enough information to determine if the patient has been on other blood pressure medications or if the current investigational medication has been previously studied. Measuring a patient’s blood pressure and pulse every hour is not considered routine nursing care. Outcome measurement is done after the implementation of a nursing intervention. The nurse is not conducting an intervention but rather is assessing the effectiveness of an experimental medication.

Cognitive Level: AnalyzingNursing Process: EvaluationClient Need: Safe, Effective Care EnvironmentLO: 1


4.A nurse is assisting a health care provider with a quantitative research study. Which of the following will the nurse most likely do in this study?

1. Conduct a pilot study.2. Clarify the topic area.3. Identify themes and categories.4. Identify a study site.

Correct Answer: Conduct a pilot study.

Rationale: Quantitative research has five distinct phases; phase 2 includes conducting a pilot study, if possible. The other choices are steps within a qualitative research design.

Cognitive Level: AnalyzingNursing Process: ImplementationClient Need: Safe, Effective Care Environment LO: 2


5. The nurse is currently working within the second phase of a qualitative research study. Which of the following activities will the nurse conduct during this phase?

Select all that apply.

1. Develop a sampling plan.2. Collect data.3. Identify themes and categories.4. Conduct a literature review.5. Identify a study site.6. Conduct a pilot study.

Correct Answers: 1. Develop a sampling plan.2. Collect data.3. Identify themes and categories.

Rationale: Develop a sampling plan. This action is within phase 2 of a qualitative research study. Collect data. This action is within phase 2 of a qualitative research study. Identify themes and categories. This action is within phase 2 of a qualitative research study. Conduct a literature review. Conducting a literature review is within phase 1 of a qualitative research study and phase 1 of a quantitative research study. Identify a study site. Identifying a study site is within phase 1 of a qualitative research study. Conduct a pilot study. Conducting a pilot study is within phase 2 of a quantitative research study.

Cognitive Level: ApplyingNursing Process: ImplementationClient Need: Safe, Effective Care EnvironmentLO: 2


6. A group of nurses are studying the effects of protein ingestion on wound healing. After several weeks, the study question was changed to include measuring the degree of wound healing according to different types of protein ingested. This change in the study question would be included in which of the following phases of a research study?

1. Qualitative research phase 12. Qualitative research phase 23. Quantitative research phase 14. Quantitative research phase 3

Correct Answer: Qualitative research phase 1

Rationale: In phase 1 of a qualitative research study, the study begins with a broad research question that may be further refined after the study is under way, which is what the nurses did in the study of protein ingestion and wound healing. Phase 2 of a qualitative research study does not include the revision of the research question. The revision of the research question after the study begins is not a part of any phase within a quantitative research study.

Cognitive Level: AnalyzingNursing Process: Implementation Client Need: Safe, Effective Care EnvironmentLO: 2


7. A nurse is designing a study to determine the different perceptions of illness and hospitalization within a group of Hispanic patients. This nurse is most likely conducting which type of qualitative research?

1. Ethnography2. Phenomenology3. Grounded theory4. Experimental

Correct Answer: Ethnography

Rationale: Ethnography focuses on the culture of a group of people, with an effort to understand the worldview of those under study. Phenomenology describes the meaning of a lived experience through the perspective of the participant. Grounded theory refers to the idea that conclusion of a qualitative study should be grounded in the data, that is, based on direct and careful observations of everyday life within the group. An experimental research design is a type of quantitative research and is used to determine the effects of an intervention. Experimental research most often occurs in a laboratory setting, and is used to determine the effects of an intervention or of the manipulation of an independent variable.

Cognitive Level: AnalyzingNursing Process: PlanningClient Need: Safe, Effective Care EnvironmentLO: 3


8. The nurse is analyzing data collected during a phenomenological research study. Which of the following would be an example of this data?

1. Waiting to have a procedure done is more stressful than the actual procedure2. Blood pressure 150/90 after ambulating 10 feet3. Ten mothers in the same housing community desire a centrally located day care facility4. Urine output 100 cc after ingesting 240 cc of water

Correct Answer: Waiting to have a procedure done is more stressful than the actual procedure

Rationale: Phenomenology describes the meaning of a lived experience through the perspective of the participant. The phrase “waiting to have a procedure done is more stressful than the actual procedure” exemplifies the meaning of a lived experience through the perspective of the participant. Blood pressure 150/90 and urine output of 100 cc are examples of objective data that could be collected during a quantitative research study. Ten mothers desiring a local day care facility is an example of ethnography, which focuses on the culture of a group of people with an effort to understand the worldview of those being studied.

Cognitive Level: AnalyzingNursing Process: AssessmentClient Need: Safe, Effective Care EnvironmentLO: 3


9. A qualitative research study has concluded and the nurse researcher is currently watching the study participants to make sure that the findings from the research can be seen in the routine lives of those who were studied. The nurse is conducting which type of research?

1. Grounded theory2. Experimental3. Ethnography4. Phenomenology

Correct Answer: Grounded theory

Rationale: Grounded theory refers to the idea that conclusions of a qualitative study are grounded in data and based on direct and careful observations of everyday life within the group studied. By observing the study participants, the nurse is following a grounded theory research design. Experimental is a type of quantitative research. Ethnography focuses on the culture of a group. Phenomenology describes the meaning of a lived experience through the perspective of the participant.



10. A nurse is having difficulty understanding why a particular nursing intervention is not successful in helping a patient achieve his health care goals. Which of the following should the nurse do first?

1. Identify the problem.2. Conduct a literature review.3. Design the sampling plan.4. Conduct a pilot study.

Correct Answer: Identify the problem.

Rationale: The first step in any research process is to identify a researchable problem. A researchable problem is a situation in need of a solution, alteration, or improvement. It is an area of concern for a particular population that requires investigation and it is derived from a topical area. Conducting a literature review, designing a sampling plan, and conducting a pilot study would all be done after the problem has been identified.



11. The nurse, working with patients in an orthopedic surgical unit, wants to study the impact of assistive devices with progressive ambulation. Which of the following would be an example of a research problem for this study?

1. Do post-hip-replacement patients ambulate faster with the use of one crutch or two?2. Will post-hip-replacement patients recover from surgery faster if discharged within 1

week?3. How does learning postsurgical exercises before the hip replacement impact recovery time?4. Will post-hip-replacement-surgery patients be discharged using a cane for ambulation?

Correct Answer: Do post-hip-replacement patients ambulate faster with the use of one crutch or two?

Rationale: The research problem is a small, specific piece of a phenomenon to be studied. The nurse desires to study the impact of assistive devices with progressive ambulation. The question that best supports the nurse’s quest would be if post-hip-replacement patients ambulate faster with the use of one crutch or two. The other questions do not necessarily address the impact of assistive devices with progressive ambulation.



12. Even though the nurses in a patient care area have been asked to collect data while conducting patient care, several nurses will do the data collection only if time is available. Which of the following research problem criteria does the inconsistent collection of data exemplify?

1. Feasible to address2. Significance to nursing3. Researchable4. Of interest to the researcher

Correct Answer: Feasible to address

Rationale: Feasible to address means there is time to complete the research and cooperation of others. The nurses in the care area will collect the data only if there is time. The inconsistent data collection is not directly related to whether the research has significance to nursing, is researchable, or is of interest to the researcher.

Cognitive Level: ApplyingNursing Process: AssessmentClient Need: Safe, Effective Care EnvironmentLO: 4


13. A nurse is going to determine the best design to use for a research project. Which of the following should the nurse do to assist with this decision?

1. Write an overview of the conceptual framework.2. Collect data.3. Do a review of the literature.4. Identify themes and categories.

Correct Answer: Write an overview of the conceptual framework.

Rationale: The third major step in the research process is selecting the type of research that will answer the question and the concomitant research design. It is helpful to begin the design section by writing an overview in which the theoretical or conceptual framework is stated if one is used. Data collection is done after the research design is identified. A review of the literature will help with research problem identification. Identifying themes and categories is done when analyzing the data.



14. The nurse designing a research study has identified the population to be studied. The next step the nurse should undertake is to:

1. Specify eligibility criteria.2. Specify the sampling plan.3. Recruit the sample.4. Determine statistical significance.

Correct Answer: Specify eligibility criteria.

Rationale: When determining the sample size within a research design, the first step is to identify the population. The second step is to specify the eligibility criteria. The third step is to specify the sampling plan. The last step is to recruit the sample. Determining statistical significance is done during the analysis of study data.



15. The design of a research study included a random sample size of 100 patients. At the end of the study, the sample size decreased to 75 patients. Which of the following should the nurse do with this change in sample size?

1. Document why the patients left the study.2. Determine that the study is invalid and plan a different research design.3. Plan another study using quota sampling.4. Run the study again with purposive sampling.

Correct Answer: Document why the patients left the study.

Rationale: Regardless of the sampling strategy used, it is essential to keep a careful record of the sampling decisions and identify how many people began the study, how many completed the study, and why subjects left the study before completing it. The nurse should not determine that the study was invalid nor plan another study using quota sampling or purposive sampling.



16. While planning care for a patient, the nurse reviews the most current research in addition to studying other sources in effort to apply the best interventions. This nurse is practicing:

1. Evidenced-based practice.2. Critical thinking.3. Research utilization.4. Qualitative research.

Correct Answer: Evidence-based practice.

Rationale: Evidence-based practice (EBP) is a broad concept and relies on more than research to support and improve practice. It extends beyond research utilization and involves making clinical decisions based on the best possible evidence. Critical thinking is a process used for decision making or problem solving. Research utilization is the purposeful application of research findings to the clinical setting to improve patient care by using the findings from a disciplined study or set of studies in a practical, or real-world, application. Qualitative research is a type of research design.



17. A patient has not responded to a long-standing intervention by producing a desired outcome. Which of the following should the nurse do if implementing evidence-based practice?

1. Find research, quality improvement study outcomes, and information from experts to change the intervention.

2. Apply the intervention again.3. Find a research study about the intervention and apply the study’s finding.4. Evaluate what went wrong with the intervention.

Correct Answer: Find research, quality improvement study outcomes, and information from experts to change the intervention.

Rationale: Evidence-based practice stresses the use of research findings, quality improvement data, and consensus of experts to substantiate practice. The nurse should find research, quality improvement study outcomes, and information from experts to change the intervention. The nurse should not apply the intervention again. The nurse has already evaluated what went wrong with the intervention. Finding a research study about the intervention and applying the study’s finding would be research utilization and not evidence-based practice.

Cognitive Level: ApplyingNursing Process: PlanningClient Need: Safe, Effective Care EnvironmentLO: 6


18. The nurses have been instructed on the use of an evidence-based practice method to monitor patients; however, several nurses continue to conduct patient monitoring using the previous method. Which of the following can be done to increase the use of the evidence-based practice method?

1. Review the evidence-based material again with those nurses who are not using the new method.

2. Assign the nurses not using the new method to participate in gathering data for a research study.

3. Ask the nurse manager to review the performance expectations.4. Determine that either method would be appropriate for the nurses to use.

Correct Answer: Review the evidence-based material again with those nurses who are not using the new method.

Rationale: Strategies to promote the use of evidence-based practice include continuing education and inservice programs to teach the nurses about the practice. The material should be reviewed again with those nurses who are not using the new method. The nurses should not be assigned to participate in data gathering for a research study, nor should the nurse manager be asked to counsel the nurses on performance expectations. Determining that either method would be appropriate to use would not be in support of the evidence-based practice approach and should not be used.

Cognitive Level: ApplyingNursing Process: PlanningClient Need: Safe, Effective Care EnvironmentLO: 6


19. A patient refuses to participate in a research study for an experimental medication. The nurse accepts this patient’s decision as exercising which of the following ethical principles?

1. Respect for persons2. Beneficence3. Justice4. Informed consent

Correct Answer: Respect for persons

Rationale: Inherent in the principle of respect for persons are the concepts of autonomy, dignity, uniqueness, freedom, and choice. This principle forms the foundation of the participants’ rights to informed consent, privacy, and confidentiality, and involves respecting people’s autonomy or right to choose freely for themselves. In regard to ethical research, the principle of beneficence means the duty to promote or do good in addition to doing no harm. The principle of justice means that people are treated fairly. The patient refused to participate, which is a part of the ethical principle of respect for persons.



20. A patient tells the nurse that he will participate in a research study about HIV medications but does not want anyone to know of his participation. Which of the following ethical principles should the nurse use to address this patient’s concern?

1. Respect for persons2. Beneficence3. Nonmalfeasance4. Justice

Correct Answer: Respect for persons

Rationale: Inherent in the ethical principle of respect for persons are the concepts of autonomy, dignity, and freedom. This principle forms the foundation of the participants’ rights to informed consent, privacy, and confidentiality. The nurse should use the principle of respect for persons to address this patient’s concerns. Beneficence is the duty to promote good. Nonmalfeasance is included within the ethical principle of beneficence. Justice requires that people be treated fairly.



21. A patient with severe hypertension, identified to receive an investigative medication that has shown a dramatic decrease in blood pressure, has been told that his participation in the study is no longer needed. The patient is upset because he wanted to try the medication to control the blood pressure. Which of the following should the nurse do to support this patient?

1. Talk with the researchers about the patient’s right to receive the investigational medication.2. Explain to the patient that investigational medications hardly ever produce the desired

results.3. Tell the patient that he can participate some other time.4. Help the patient understand that his participation “wasn’t meant to be.”

Correct Answer: Talk with the researchers about the patient’s right to receive the investigational medication.

Rationale: The principle of justice requires that people be treated fairly. This includes the patient’s right to receive research treatments. The nurse should talk with the researchers about the patient’s right to receive the medication. The nurse should not minimize the patient’s participation by stating that investigational medications hardly ever produce the desired results or make a false promise of participating sometime in the future. Stating that his participation “wasn’t meant to be” is dismissive of the impact of the change for the client.



22. A nurse wants to study outpatient medical records to determine a specific pattern of care. Which part of HIPAA should this nurse consult to guide her actions?

1. Accessing data2. Creating data3. Disclosing data4. Destroying data

Correct Answer: Accessing data

Rationale: It is the covered organization’s obligation not to disclose information improperly when a researcher seeks data that includes private health information. A covered organization is one that “transmits information in an electronic form, and includes health plans, health care clearing houses, and health care agencies.” All covered entities are required to comply with the privacy rule. Researchers will be expected to work closely with clinical agencies used as research sites to ensure that both sides meet HIPAA obligations. Creating data can be done through the course of conducting research. Disclosing data is sharing information about patients’ personal health information. The HIPAA law does not provide information on the destroying of data.



23. A researcher plans to share the results of a research study after removing all study subjects’ names, addresses, and dates of birth. The nurse realizes that the researcher has done which of the following with the patients’ personal health information?

1. Deidentified the information2. Reviewed the information prior to conducting the research3. Received authorization4. Created data

Correct Answer: Deidentified the information

Rationale: Deidentification means that all information that acts as an identifier has been removed. After it has been removed, the information can be freely shared because it is no longer considered personal health information. Identifiers include name, address, and date of birth. Reviewing the information prior to conducting the research means the researchers assessed the feasibility of projects by examining information in patient medical records. Received authorization means the researcher has a signed authorization from a patient to be able to access personal health information. Created data means that the researcher created additional personal health information and will need authorization to disclose the contents.



24. While conducting a research study, the researcher creates a table of new health information data. Which of the following should the researcher do with this new data?

1. Gain permission from the patients to use the data, and discuss who will receive it.2. Ask the patients’ health care providers if the information is valid.3. Validate the data with laboratory results in the patients’ medical records.4. Ask the patients’ nurses if the data appears to be correct and then document it was

validated.

Correct Answer: Gain permission from the patients to use the data, and discuss who will receive it.

Rationale: The HIPAA privacy regulation impacts nursing research in three ways: data access, data creation, and data disclosure. Within data creation, any protected health information obtained is covered by HIPAA and the research is bound by HIPAA regulations. The researcher needs to obtain permission from the patient to use the data, including who is going to receive it. The researcher should not discuss the data with the patients’ health care providers or nurses. The researcher should also not review the patients’ medical records without with patients’ permission to do so.



25. A nurse is implementing stage 2 of a critique of a quantitative research study. In this stage, the nurse will:

1. Focus on the conduct of the research.2. Review the purpose of the research.3. Study the findings. 4. Summarize the quality of the study.

Correct Answer: Focus on the conduct of the research.

Rationale: Stage 2 focuses on the conduct of the research. This refers to studying the manner in which the research was conducted and includes determining if the methodology was applied correctly. Stage 1 focuses on the review of the purpose of the research. In stage 3, the findings are studied. Stage 4 includes a summary of the quality of the study.



26. While critiquing a quantitative research study, the nurse is curious about the sample size. Which of the following would be an appropriate question about the size of the sample for the study?

1. Is the sample size appropriate to meet the assumptions of the statistical test?2. Are the rights of the research participants protected?3. Were ethical issues handled appropriately?4. What are the strengths of the study?

Correct Answer: Is the sample size appropriate to meet the assumptions of the statistical test?

Rationale: When critiquing the sample of a research study, an appropriate question to ask about the size of the sample would be if the sample size was appropriate to meet the assumptions of the statistical tests. Questions about the participants’ rights and ethical issues would be appropriate if critiquing the human rights of conducting the research. The strengths of the study would be an appropriate question if critiquing the overall quality of the study.



27. The nurse, critiquing a quantitative research study, is particularly interested in information obtained in stage 3 of the critique. This information would most likely include:

1. How the findings of the study advance nursing knowledge.2. The major strengths of the study.3. Whether the study can be replicated.4. How ethical issues were handled.

Correct Answer: How the findings of the study advance nursing knowledge.

Rationale: Stage 3 of a quantitative research critique focuses on the findings, discussion, implications, and conclusions. Within implications and conclusions, the issue of how the findings of the study advance nursing knowledge should be addressed. The major strengths of the study and whether the study can be replicated are critiqued in the fourth stage of the process. How ethical issues were handled is critiqued in stage 2 of the process.



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