65188765c3719 Test Bank For Evidence Based Nursing The Research Practice Connection 4

Test Bank for
Evidence-Based Nursing: The Research Practice Connection

4th Edition
By:Sarah Jo Brown
Test Bank for Evidence-Based Nursing: The Research Practice Connection 4th Edition by
Sarah Jo Brown
Table of Contents
Chapter 1 The Research-Practice Connection
Chapter 2 Research Evidence
Chapter 3 Reading Research Articles
Chapter 4 Qualitative Research
Chapter 5 Quantitative Descriptive Research
Chapter 6 Correlational Research
Chapter 7 Experimental Research
Chapter 8 Cohort Research Wrap-Up
Chapter 9 Systematic Reviews
Chapter 10 Evidence-Based Clinical Practice Guidelines
Chapter 11 Asking Clinical Questions
Chapter 12 Searching for Research Evidence
Chapter 13 Appraising Research Evidence
Chapter 14 Appraising Recommendations of Clinical Practice Guidelines
Chapter 15 Appraising Conclusions of Systematic Reviews with Narrative Synthesis
Chapter 16 Appraising Findings of Original Studies
Chapter 17 Evidence-Based Practice Strategies
Chapter 18 Evidence-Based Practice Participation
Chapter 19 Point-of-Care Adaptations

Evidence-Based Nursing: The Research Practice Connection: The Research Practice
Connection 4th Edition Test Bank
Chapter 1 The Research-Practice Connection

MULTIPLE CHOICE
• Which best describes evidence-based-practice (EBP)?

a.A combination of best research evidence, clinical expertise, and the needs
and values of patients.
b.A determination of the factors necessary to control patient
responses to care
. c.The development of population care guidelinesapplicable to all
patients.
d.The utilization of quantitative and qualitative studies to enhance patient outcomes.
CORRECT ANSWER: A
Feedback
AEvidence-based practice evolves from the integration of the best research
evidence with clinical expertise and patient needs and values.
BStudies that attempt to find determinants of patient outcomes are generally
experimental or quasi-experimental. They may be used to guide EBP but do not
completely define it.
CEBP is a combination of guidelines and specific patient needs and values.
DQuantitative and qualitative studies applied to the evaluation of patient
outcomes are part of EBP but do not completely define EBP.
PTS: 1 DIF: Cognitive level: Remembering

(Knowledge) REF: dm. 3
• The nurse is collecting data about the sleep patterns of breastfed babies as
part of a larger research study. Which research method will the nurse use
when collecting data for this study?
a.Co
ntrol
b.De
scrip
tion
c.Ex
plan
atio
n
d.Pr
edict
ion
CORRECT ANSWER: B
Feedback
AControl can be described as the ability to write a prescription to produce the desired outcome.
B Description involves identifying and understanding the nature of nursing

phenomena and the relationships among these phenomena.
C Explanation clarifies the relationships among phenomena and identifies why
certain events occur.
D Through prediction, the probability of a specific outcome can be estimated in a given situation.
PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 6
• The nurse is participating in a study and is collecting data identifying the

number of obese adults whose parents were also obese or overweight. Which
research method is being used in this study?
a.Co
ntrol
b.De
scrip
tion
c.Ex
plan
atio
n
d.Pr
edict
ion
CORRECT ANSWER: D
Feedback
AControl indicates the ability to use a prescribed intervention to produce a desired outcome.
BDescription involves identifying and understanding the nature of nursing
CExplanation clarifies the relationships among phenomena and identifies why
DThrough prediction the probability of a specific outcome can be estimated in a
given situation. By knowing the percentage of parents of obese adults who were
obese, the probability of predicting this may be calculated.
PTS:1DIF:Cognitive level: Applying

(Application) REF: pp. 7-8
• The nurse reviews a study in which adherence to an asthma action plan is
compared among groups of adolescents who received different asthma
education. Which research method does this represent?
a.Co
ntrol
b.De
scrip
tion
c.Ex
plan
atio
n
d. Prediction
CORRECT ANSWER: C
Feedback
A Control indicates the ability to use a prescribed intervention to produce a desired outcome.
B Description involves identifying and understanding the nature of nursing
C Explanation clarifies the relationships among phenomena and identifies why
D Through prediction, the probability of a specific outcome can be estimated in a given situation.
PTS:1DIF:Cognitive level: Applying (Application)
REF: dm. 7
• A nurse manager is interested in learning which attitudes among staff nurses

may indicate relative risk of needle-stick injuries. To study this, the nurse
manager will employ which method of study?
a.Co
ntrol
b.De
scrip
tion
c.Ex
plan
atio
n
d.Pr
edict
ion
CORRECT ANSWER: D
Feedback
BExplanation clarifies the relationships among phenomena and identifies why
CDescription involves identifying and understanding the nature of nursing
DThrough prediction, the probability of a specific outcome can be estimated in a given
situation. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 7-8
• Which is the most important result of Florence Nightingales data collection

and statistical analysis during the Crimean War?
a.Bringing awareness of the rigors of war to the general public.

b.Developing a process for statistical analysis and nursing
documentation. c.Identifying and defining the role of nurses in
modern health care.
d.Using clinical research to evaluate the importance of sanitation, clean
drinking water, and adequate nutrition.
CORRECT ANSWER: D
Feedback
AThis was not the most
important result BThis was not
the most important result
CThis was not the most
important result
DNightingales research enabled her to instigate attitudinal, organizational, and
social changes, including the militarys approach to the care of the sick and societys
sense of responsibility for testing public water, improving sanitation, and preventing
starvation to decrease morbidity and mortality rates.
PTS: 1 DIF: Cognitive level: Understanding

(Comprehension) REF: dm. 11
• The nurse participates in data collection in a study in which two different
pain management protocols are used with randomly assigned patients to
measure differences in postoperative recovery time. Which method of study
is this?
a.Co
ntrol
b.Co
rrela
tion
c.De
scrip
tion
d.Ex
plan
ation
ANS: A
Feedback
BCorrelation examines the relationships between different phenomena.
CDescription involves identifying and understanding the nature of nursing
DExplanation clarifies the relationships among phenomena and identifies why

(Application) REF: dm. 8
• The development of nursing theories and conceptual models in the late

1960s and 1970s served to:
a.determine the effectiveness of nursing
interventions. b.establish the concept of
evidence-based practice. c.provide funding
for nursing research.
d.provide direction for nursing research.
CORRECT ANSWER: D
Feedback
AOutcome studies are used to determine the effectiveness of nursing interventions.
BThe concept of EBP was developed in the 1970s and promoted by the
ANCC Magnet Designation program.
CThe NINR seeks to provide funding for nursing research.
DThe theories developed in the 1960s and 1970s helped to direct future nursing
research. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: pp. 11-12
• Under Ada Sue Hinshaw, the National Institute of Nursing Research (NINR)
began to change its focus to:
a.funding nursing rather than medical
research. b.evaluating outcomes rather than
process studies. c.increasing the status and
funding for nursing research. d.supporting the
dissemination of nursing research.
CORRECT ANSWER: C
Feedback
AThe change in focus from medical to nursing research came about with the first
nursing programs. Specialty nursing organizations today and some nursing
researchers still conduct medical research for specific studies.
BOutcomes research emerged in the 1980s and 1990s to document the
effectiveness of health care services.
CUnder Ada Sue Hinshaw, the national Center for Nursing Research (NCNR)
changed its name to the NINR to increase the status and funding of nursing
research.
DThe NCNRs purpose was to support the dissemination of nursing
research. PTS: 1 DIF: Cognitive level: Remembering (Knowledge)
REF: pp. 12-13
• An emphasis of the American Nurses Credentialing Center (ANCC)

Magnet Hospital Designation Program for Excellence in Nursing is:
a.research and development of clinical practice
guidelines. b.putting qualitative research into practice
in clinical settings. c.using standard nursing care plans
based on outcomes research. d.utilizing evidence-
based practice in nursing.
CORRECT ANSWER: D
Feedback
AClinical practice guidelines are a more recent phenomenon, using evidence-
based research, expert opinion, and patient needs and values to standardize care.
BQualitative research was introduced in the late 1970s to gain insight into the
phenomena related to nursing.
COutcomes research was important in the 1980s to 1990s to document the
effectiveness of health care services.
DANCC implemented the Magnet Hospital Designation Program for
Excellence in Nursing Service in 1990 that emphasized EBP for nursing.

(Knowledge) REF: pp. 12-13
• In a position statement in 2006, the American Association of Colleges of
Nursing (AACN) identified a need to:
a.acquire clinical knowledge and
expertise. b.focus on evidence-
based practice.
c.fund academic nursing
research. d.prepare a workforce
of nurse scientists.
CORRECT ANSWER: D
Feedback
ABasic nursing education focuses on clinical knowledge and expertise.
BEvidence-based practice is a focus of ANCC and the Magnet Designation
Program for Excellence in Nursing Service.
CThe NINR focuses on funding for nursing research.
DThe AACN identified the importance of creating a research culture, providing

high-quality educational programs to prepare a workforce of nurse scientists,
develop a sound research structure, and obtain funding for nursing research.

• The lead agency designated to improve health care quality is:
a.Agency for Healthcare Research and Quality

(AHRQ). b.American Nurses Credentialing
Center (ANCC). c.Quality and Safety
Education for Nurses (QSEN). d.National
Institute for Nursing Research (NINR).
CORRECT ANSWER: A
Feedback
AAHRQ is a scientific partner with the public and private sectors to improve
the quality and safety of patient care.
BANCC provides credentialing for advanced practice nurses and for Magnet
Designation for Excellence in Nursing Service
CQSEN is focused on developing the requisite skills, knowledge, and attitude
statements for the competencies for prelicensure and graduate education.
DThe National Institute of Nursing Research, originally the National Center for
Nursing Research, is a federally funded arm of the National Institutes of Health,
providing nursing with federal support for nursing research priorities.

• To help fulfill the mission of the National Institute for Nursing Researchto
promote and improve the health of individuals, families, communities, and
populationsa study may be conducted which:
a.assesses the effectiveness of strategies for weight management in patients with type 2
diabetes. b.compares the attitudes of nurses toward clients with type 1 and type 2
diabetes.
c.generates up-to-date nursing diagnoses reflecting the needs of clients with type 2
diabetes. d.reviews hospital nurses adherence to glucose-monitoring guidelines for
patients with type 2
diabetes.
CORRECT ANSWER: A
Feedback
AA study that assesses the effectiveness of interventions helps to improve the
health of patient populations by identifying appropriate strategies.
BA comparison of attitudes is a descriptive study that does not improve outcomes.
CA study to generate nursing diagnoses does not directly affect patient outcomes.
DA study reviewing adherence to guidelines seeks to provide data for quality
assurance. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 14-15
• Which best describes the Quality and Safety Education for Nurses (QSEN)
competency for evidence-based practice (EBP)?
a.Adhering to published guidelines to provide care for a specific population.
b.Empowering clients to choose among effective disease management
strategies. c.Relying on expert knowledge to guide care plan development for
an individual patient. d.Using evidence gained solely from experimental
studies to guide care.
CORRECT ANSWER: B
Feedback
AStrict adherence to guidelines does not take the patient/family preferences into account.
BThe QSEN competency for EBP is defined as integrating the best evidence
with clinical expertise and patient/family preferences.
CEBP does not rely solely on expert knowledge or experimental studies.
DAlthough experimental studies provide the highest level of study data, EBP does
not rely soley on experiemental studies..

• Through knowledge gained from her phenomenological qualitative study
identifying levels of experience of professional nurses, Patricia Benner would
identify which nurse as an expert?
a.A hospice nurse who values the unique wishes of each patient when providing palliative care.
b.A medical-surgical nurse who organizes care for a group of patients to
ensure timely administration of medications.
c.A neonatal intensive care nurse who is skilled in inserting peripherally

inserted central catheters.
d.A pediatric nurse who notes subtle changes and intervenes to prevent respiratory failure.
CORRECT ANSWER: D
Feedback
AThe proficient nurse views the patient as a whole and recognizes that each
patient responds differently to illness and health.
BThe competent nurse is able to achieve goals and plans and to take
conscious actions to organize and provide efficient care.
CThe NIC nurse is also an example of a competent nurse who is skilled in a procedure.
DThe expert nurse has an extensive background of experience and is able to
identify and accurately intervene skillfully in a situation. The pediatric nurse in this
case recognizes subtle changes and is able to act to prevent serious circumstances.
PTS:1DIF:Cognitive level: Analyzing

(Analysis) REF: dm. 17
• Which study exemplifies qualitative research?
a.A study that evaluates appetite among residents of a long-term care facility and
correlates this data with whether or not residents are rooming together with their
spouses.
b.A study that defines levels of appetite based on residents descriptions of hunger in
a long-term care facility.
c.A study that observes the interactions of spouses during mealtimes in a long-term care facility.
d.A study that observes the effectiveness of spousal encouragement to eat on
the residents quality of appetite in a long-term care facility.
CORRECT ANSWER: C
Feedback
A Correlational studies are quantitative studies.
B A descriptive study that measures appetite is a quantitative study.
C Qualitative research involves the study of people as they interact in their
sociohistorical settings.
D A measure of the effectiveness of an intervention is a quasi-experimental
quantitative study. PTS:1DIF:Cognitive level: Analyzing (Analysis)
REF: dm. 19
• A nurse researcher wants to know how well adolescent mothers can learn to
manage their childrens asthma and develops an initial study to explore and
define perceptions of asthma among this population. Which best describes
this initial study?
a.Correlational
research
b.Descriptive
research
c.Phenomenological
research
d.Outcomes
research
CORRECT ANSWER: B
Feedback
A Correlational research would attempt to make a connection between perceptions of
asthma and a specific outcome.
B Descriptive research explores new areas of research and describes situations as they exist in
the world. This initial study aims to describe current perceptions of asthma in a given
population.
C Phenomenological research involves gaining deeper insights into perceptions
and values, not simply describing them.
D Qualitative research does not attempt to define variables.
PTS:1DIF:Cognitive level: Analyzing (Analysis)
REF: dm. 20
• Which research technique would be used by a nurse researcher who

wishes to compare bonding patterns of neonatal intensive care (NIC)
infants to non-NIC infants to test various theories about infant-parent
bonding?
a.Experime
ntal
b.Explorato
ry
c.Grounded
-theory
d.Quasi-
experimenta
l
CORRECT ANSWER: C
Feedback
AExperimental and quasi-experimental techniques determine the effectiveness
of particular outcomes.
BExploratory research is performed to describe a problem or issue.
CGrounded-theory research is performed to formulate, test, and refine a theory about
a particular phenomenon.
DPhenomenological research involves gaining deeper insights into perceptions and values.

• What type of study design would be used to evaluate patient satisfaction in
an outpatient clinic?
a.Exploratory-
descriptive research
b.Outcomes research
c.Qualitative research
d.Phenomenological
research
CORRECT ANSWER: B
Feedback
A Exploratory-descriptive research is performed to address an issue or problems by
describing the problem in detail.
B Outcomes research is designed to evaluate patient responses to interventions as
well as satisfaction with care.
C Qualitative research is observational and involves describing patients in a particular setting.
D Phenomenological research involves gaining deeper insights into perceptions and
values. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 21
• The nurse researcher wishes to review a body of qualitative studies about

womens attitudes toward health care in order to develop an overall
interpretation of these findings. Which type of review will the nurse researcher
use?
a.Meta-
analysi
s
b.Meta-
synthes
is
c.Mixed-methods
systematic review
d.Systematic review
CORRECT ANSWER: B
Feedback
AMeta-analyses are used to evaluate quantitative studies.
BA meta-synthesis is used to evaluate qualitative studies.
CA mixed methods systematic review is used to evaluate a variety of study designs.
DA systematic review is a structured, comprehensive synthesis of the research

literature to determine the best research evidence available to address a health
care question.

• Which type of evaluation of research yields the most precise estimates of
treatment effects when describing results?
a.Meta-
analysi
s
b.Meta-
synthes
is
c.Mixed-methods
systematic review
d.Systematic review
CORRECT ANSWER: A
Feedback
AA meta-analysis is conducted to statistically combine or pool the results from
previous quantitative studies into a single statistical analysis that provides one of
the highest levels of evidence about an interventions effectiveness.
BMeta-synthesis is defined as the systematic compiling and integration of
qualitative study results to expand understanding and develop a unique
interpretation of study findings in a selected area.
CMixed-methods systematic reviews might include a variety of study
designs, such as qualitative research and quasi-experimental,
correlational, and/or descriptive studies.
literature to determine the best research evidence available to address a health
care question.

• The nurse serves on a committee to develop a clinical protocol to guide
dressing changes for methicillin-resistant Staphylococcus aureus (MRSA)
abscesses. Which is the most important type of evidence to consider when
formulating this protocol?
a.Assertions from a panel of infectious disease physicians about existing
protocols to treat this organism.
b.A statistical review of experimental studies comparing various dressing change
protocols and patient outcomes.
c.A systematic review of all nursing and medical literature about the
incidence of MRSA infection and various dressing change protocols.
d.Studies identifying the correlations between variables such as dressing types and
subsequent infection rates.
CORRECT ANSWER: B
Feedback
A Expert panel opinions are useful, but do not provide statistically significant
evidence about interventions and results.
B A statistical review of experimental studies is a meta-analysis and is the strongest
level of evidence.
C A literature review is an initial step in developing a protocol or designing a study.
D Correlational studies are not as powerful as experimental studies.
REF: dm. 22 |dm. 24
• What role will a new nurse graduate who has a BSN expect to play in research?
a.Appraising studies and implementing evidence-based guidelines and

protocols. b.Developing, evaluating, and revising evidence-based guidelines
and protocols. c.None, since the BSN affords limited education on the
research process. d.Synthesizing findings and leading health care teams to
make evidence-based changes.
CORRECT ANSWER: A
Feedback
AThe BSN prepares nurses to read and critically appraise research studies and
to assist with implementation of evidence-based guidelines and protocols.
BNurses with a Master of Science in Nursing (MSN) may revise or develop
protocols and identify and critically appraise the quality of evidence-based
studies.
CNurses with a MSN are provided the educational preparation to critically
appraise and synthesize findings from studies to revise or develop protocols,
algorithms, or policies for use in practice (see Figure 1-4). They also have the
ability to identify and critically appraise the quality of evidence-based guidelines
developed by national organizations.
DAdvanced practice nurses and nurse administrators have the ability to lead health
care teams in making essential changes in nursing practice and in the health care
system based on current research evidence. DPNs may lead health care teams to
make evidence-based changes in practice.
REF: pp. 25-26
• A job description for a nurse position in a teaching hospital includes

coordinating research teams to facilitate studies to generate knowledge about
nursing actions. Which type of advanced nursing degree would be required for
this position?
a.Doctorate of Nursing
Practice (DNP) b.Doctorate
in Nursing (PhD) c.Master
of Science in Nursing (MSN)
d.Post-Doctorate in Nursing
CORRECT ANSWER: B
Feedback
ADNP-prepared nurses translate nursing research into practice.
BPhD-prepared nurses can critique, implement, plan, and develop new or revised
guidelines, as well as generate and replicate knowledge via conduction of research.
CMSN-prepared nurses identify problems requiring research and may
conduct studies, but usually in collaboration with other nurse scientists.
DThe difference between PhD and post-PhD is unclearin this situation you are one and
the same PTS:1DIF:Cognitive level: Applying (Application)
Chapter 2 Research Evidence

MULTIPLE CHOICE
• The most important initial step when developing a
research study is to: a.develop the problem statement.
b.explore the background for the research
problem. c.identify the research problem.
d.state the research purpose.
CORRECT ANSWER: C
Feedback
AThe problem statement is written after the research problem has been identified.
BThe background for the research problem is written to identify what is
known about the research problem.
CThe problem provides the basis for developing the research purpose and
identifies gaps in knowledge needed for nursing practice.
DThe research purpose derives from the research problem and identifies specific
goals for the study.

• A nursing researcher determines that there is little information
about the use of complementary practices in treating obesity.
This represents the research:
a.des
ign.
b.pro
blem.
c.pur
pose.
d.sig
nifica
nce.
CORR
ECT
ANSW
ER: B
Feedback
AThe research design is the type of study that will be conducted to study the research problem.
BThe problem provides the basis for developing the research purpose and
CThe research purpose derives from the research problem and identifies specific
DThe problem statement is written after the research problem has been
identified. The significance for the research identifies how important the
knowledge is to the discipline.

• When writing a proposal for a research study, the researcher includes a problem
statement that serves to:
a.define the specific focus of a study.
b.describe what is known about the research
problem. c.identify a gap in knowledge
needed for practice.
d.indicate the importance of the problem to nursing.
CORRECT ANSWER: C
Feedback
AThe research purpose derives from the research problem and identifies specific
BThe problem background identifies what is already known about the topic.
The problem statement is written after the research problem has been
identified.
DThe significance for the research identifies how important the knowledge is to the
discipline. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 131-132
• In a research proposal, the researcher states that the proposed study will
explore childrens feelings about chemotherapy side effects. This statement
describes the:
a.problem background.
b.problem
significance.
c.research
problem.
d.research
purpose.
CORRECT ANSWER: D
Feedback
AThe problem background identifies what is already known about the topic.
identified.
BThe significance of the research identifies how important the knowledge is to the discipline.

• Which is included in a statement of a research study purpose?
a.A description of gaps in knowledge about the research problem.

b.A discussion of the significance of the research problem.
c.A review of what is known about the research problem.
d.A statement about how the research problem will be studied.
CORRECT ANSWER: D
Feedback
AThe problem provides the basis for developing the research purpose and
BThe significance for the research identifies how important the knowledge is to the discipline.
CThe problem background identifies what is already known about the topic.
identified.

• The statement in the introduction of a research study reportwhile children who

have higher asthma control scores tend to have fewer emergency department
visits for asthma exacerbations, it is unclear how nursing interventions can
impact these scoresrepresents the:
a.problem
background.
b.problem
significance.
c.research
problem.
d.research
purpose.
CORRECT ANSWER: B
Feedback
identified.
BThe significance for the research identifies how important the knowledge is to
the discipline and to health care and the health of individuals and families.

(Analysis) REF: pp. 131-132
• The statements in the introductory paragraphs of a research report that cite
results of previous studies about a research problem represent the:
a.problem
background.
b.problem
significance.
c.problem
statement.
d.research
purpose.
CORRECT ANSWER: A
Feedback
identified.
BThe significance for the research identifies how important the knowledge is to
the discipline and to health care and the health of individuals and families.

• Which statement is a research purpose for a correlational study?
a.This study will compare the effects of an oral antidiabetic medication to effects of
a placebo on glucose control in groups of randomly assigned subjects.
b.This study will examine whether pre-appointment telephone reminders
increase show rate among patients in an ambulatory well-patient clinic.
c.This study will use direct observation to identify methods parents use to
discipline children in public places.
d.This study will use questionnaires and school transcripts to examine the relationship of
dietary habits to grades among school-age children.
CORRECT ANSWER: D
Feedback
AA study looking at the effects of an experimental intervention on randomly
assigned subjects to affect a specific outcome is an experimental study.
BA study to look at the effects of an intervention on an outcome is a quasi-experimental study.
CA study to observe and describe behaviors without examining relationships
among variables and without manipulation of the variables by researchers is a
descriptive study.
DCorrelational research is conducted to examine whether there is a
positive or negative relationship among variables without attributing cause
and effect.

• The nurse researcher states that a research purpose is to measure the
effects of bar code medication administration on medication errors. This
is a study purpose for which type of research?
a.Correlat
ional
b.Ground
ed theory
c.Outcom
es
d.Quasi-experimental
CORRECT
ANSWER: C
Feedback
ACorrelational research is conducted to determine whether there are
relationships among variables.
BGrounded theory research is designed to determine how theory explains
phenomena being studied.
COutcomes studies are conducted to examine the end results of care.
DQuasi-experimental research requires some manipulation of variables and
comparison of groups.

• Which statement in a study about preoperative education and postoperative
recovery times represents a research question?
a.What are the types of preoperative education materials that may
be used? b.What are the constructs that facilitate adult learning
among patients? c.What preoperative teaching will shorten
postoperative recovery time?
d.What is already known about preoperative teaching and postoperative recovery?
CORRECT ANSWER: C
Feedback
AThe characteristic of a variable is given in the operational definition.
BThe theoretical framework identifies constructs and theories about the research study.
CA research question focuses on description of variables or concepts, examination
of relationships among variables, and determination of differences between two or
more groups regarding selected variables.
DThe background about what is already known about the topic for conducting is
described in the literature review.

• What type of hypothesis is the following?
Children with cystic fibrosis who use a cough assist device will experience less
anxiety about their disease and have fewer inpatient hospital admissions per year.
a.Complex,
directional
b.Complex,
null
c.Simple,
associative
d.Simple, nondirectional
CORRECT ANSWER:
Feedback
AA complex hypothesis predicts the relationship among three or more variables. In
this example, the variables are cough assist devices (independent), hospital
admissions (dependent), and anxiety (dependent). A directional hypothesis states the
nature of the interaction between two or more variables. In this example, the
direction is indicated by the prediction experience less anxiety.
BA complex hypothesis is correct, but the null hypothesis predicts no difference.
CThis study has more than two variables (not simple) and indicates a direction
and not just an association.
DA simple hypothesis has only two variables (this study has more than two), and
there is a direction predicted (experiencing less anxiety and having fewer inpatient
hospital admissions).

• A statement about the significance of a study describes the:
a.influence of results on nursing

practice. b.relationship among
study variables. c.study design
and methods.
d.validity of the study measurement tools.
CORRECT ANSWER: A
Feedback
AThe statement about the significance of the study identifies its importance to
the body of knowledge and to nursing practice.
BThe research purpose and research question identify proposed relationships
among study variables.
CThe study design and methods describe the type of study, sampling techniques,
and tools used to evaluate data.
DThe validity of measurement tools is determined by whether the tools measure
what they claim to measure.
REF: pp. 140-141
• A reviewer assesses a potential researchers credentials and experience, the

availability of funding and resources, and ethical considerations of a potential
study. This represents evaluation of a studys:
a.exp
ertise
.
b.fea
sibili
ty.
c.pur
pose.
d.sig
nifica
nce.
CORRECT ANSWER: B
Feedback
AExpertise refers to the researchers qualifications, credentials, and experience.
BThe feasibility of a study is determined by examining the researchers
qualifications, the funding and resources available to conduct the study, the
availability of subjects, facilities, and equipment, and ethical considerations.
CThe study purpose identifies the focus and goals of the study.
DThe significance identifies the importance of the study to the body of
knowledge and to practice.

(Comprehension) REF: pp. 143-144
• Identify the independent variable in the following hypothesis:
Mothers of infants born with spina bifida who participate in support groups report
higher levels of confidence when caring for their infants than do mothers who do not
participate in support groups.
a.Confidence in caring for
their infants b.Infants with
spina bifida
c.Mothers of infants with
spina bifida d.Support group
participation
CORRECT ANSWER: D
Feedback
AInfants with spina bifida is part of the criteria for inclusion in the study.
BThe level of confidence in caring for their infants is the dependent variable. It is
measured as a response to whether or not the mothers received the treatment of
using a support group.
CThe mothers of infants with spina bifida are criteria for inclusion as subjects in
the study and are not variables.
DAn independent variable is a stimulus or activity that is manipulated or varied by
the researcher to create an effect on the dependent variable. In this example, use of
support groups is the treatment that is being used to manipulate levels of confidence
in caring for their infants.
• In a research proposal, the author describes what is already known about the
research topic. This would be included in the discussion of the studys:
a.bac
kgro
und.
b.fea
sibili
ty.
c.pur
pose.
d.sig
nifica
nce.
CORRECT ANSWER: A
Feedback
AThe background section describes research about the problem performed to date.
BIn the section about a studys feasibility, the researchers expertise,
funding resources, availability of subjects and settings, and ethical
considerations are examined.
CThe research purpose identifies specific goals and the focus of the study.
DThe studys significance discusses the importance of the study to the
discipline. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 143-144
• Which component of a research study is exemplified in the statement, This

study identifies various themes associated with parenting children who have
chronic disease?
a.Aim or
objective
b.Hypoth
esis
c.Research
methodology
d.Research
problem
CORRECT ANSWER: A
Feedback
AA research objective or aim is a clear, concise, declarative statement that is
expressed in the present tense and which focuses on one or two variables,
indicating whether they are to be identified or described.
BThe hypothesis is a formal statement about an expected relationship between
two or more variables.
CThe research methodology identifies sampling and measurement techniques.
DThe research problem identifies gaps in
knowledge. PTS:1DIF:Cognitive level:
Applying (Application) REF: pp. 145-146
• The statement, Do patients who receive care in a Patient-Centered Medical
Home have fewer emergency department visits than those who do not? is an
example of a research:
a.ai
m.
b.h
ypo
thes
is.
c.m
eth
od.
d.q
uest
ion.
CORRECT ANSWER: D
Feedback
AThe research objective or aim is a clear, concise, declarative statement that is
expressed in the present tense and which focuses on one or two variables,
indicating whether they are to be identified or described.
BThe hypothesis is a formal statement about an expected relationship between
two or more variables.
CThe research methodology identifies sampling and measurement techniques.
DA research question is a concise interrogative statement that is worded in the present tense,
includes one or more variables, and guides the implementation of studies by asking whether
or not there is a relationship between the variables.

• All of the following aspects of a research proposal are part of the research hypothesis
except:
a.met
hodol
ogy.
b.outc
omes.
c.pop
ulatio
n.
d.variables.
CORRECT
ANSWER:
Feedback
AThe methodology is not described in the research hypothesis statement.
BThe hypothesis is a formal statement about an expected relationship between two
or more variables. It will mention the expected outcomes, the population being
studied, and the specific variables.
CThe hypothesis is a formal statement about an expected relationship between two
DThe hypothesis is a formal statement about an expected relationship between two

• In a study comparing the effects of complementary therapies on pain scores
and narcotic analgesic use in homeless women and women who own
homes, which of the following is a demographic variable?
a.Complementary
therapies
b.Homeless
women c.Narcotic
analgesic use
d.Pain scores
CORRECT ANSWER: B
Feedback
A Complementary therapy is the independent variable.
B Demographic variables are characteristics or attributes of subjects that are collected to
describe the sample.
C Narcotic analgesic use and pain scores are dependent variables.
D Pain scores are a dependent variable.
• The statement, In this study, elevated blood glucose is a value greater than 110
mg/dL, is an example of a(n):
a.associative
hypothesis.
b.conceptual
definition.
c.operational
definition.
d.problem
statement.
CORRECT ANSWER: C
Feedback
AA hypothesis indicates the researchers educated guess at what the outcome of the
research will be. An associative hypothesis describes a predicted relationship that the
researcher develops between the established variables being studied. This statement
is an operational definition, not a hypothesis.
BA conceptual definition is the theoretical meaning of a variable.
CAn operational definition is derived from a set of procedures or progressive acts
that a researcher performs to receive sensory impressions that indicate the
existence or degree of existence of a variable. An operational definition is
developed so that a variable can be measured or manipulated in a concrete
situation. In this example, pain is the sensory impression being measured on a
numerical scale.
DThe problem statement indicates the gap in knowledge needed for practice and
provides a basis for the study.

• Which is true about a causal hypothesis?
• It describes the effects of independent variables on dependent variables.

• It predicts a negative or positive interaction between variables.
• It proposes positive or negative relationships among variables.
• It states that a relationship exists between variables without indicating direction.
CORRECT ANSWER: A
Feedback
AA causal hypothesis proposes a cause-and-effect interaction between two or more variables.
BAn associative hypothesis states that a relationship exists among variables.
CA correlational hypothesis proposes negative or positive interactions between variables.
DA causal hypothesis indicates direction.

• Which is an example of a directional, correlational hypothesis?
• Increasing hours spent in study groups is associated with an increase in GPA
among nursing students.
• Increased use of study groups will result in an increase in GPA among nursing
students. c.Nursing students who use study groups are among groups of
students who have higher GPAs. d.Studying in study groups is related to GPA
levels in nursing students.
CORRECT ANSWER: A
Feedback
AA directional hypothesis states whether a positive or negative interaction will
occur between variables. A correlational hypothesis indicates an association
without attributing cause.
BStating that increased use of study groups will result in increased GPA makes this
statement a cause-and-effect hypothesis.
CThe third and fourth statements are nondirectional because they do not state
whether or not there is a positive or negative interaction.
DThe third and fourth statements are nondirectional because they do not state
whether or not there is a positive or negative interaction.

• The statistical (null) hypothesis in a research study states that there is:
a.a causal relationship between variables.

b.a statistically significant relationship between
variables. c.an implied relationship between
variables.
d.no relationship between variables.
CORRECT ANSWER: D
Feedback
AAny hypothesis stating a statistically significant relationship, an implied
relationship, or a causal relationship among variables is a research hypothesis.
BAny hypothesis stating a statistically significant relationship, an implied
CAny hypothesis stating a statistically significant relationship, an implied

DThe null hypothesis is the converse of the research hypothesis and states that
there is no relationship among variables.

• Which is an important feature of a testable hypothesis?
a.It may differ from the variables and population identified in the research purpose.
b.Methods of sampling, measurement, and data analysis are included in the hypothesis
statement. c.Relationships among the study variables must be causative.
d.Variables in a testable hypothesis are measurable or able to be manipulated.
CORRECT ANSWER: D
Feedback
AVariables stated in a research hypothesis are those identified in the research purpose.
BThe testable hypothesis does not identify methodological points to avoid
limiting the hypothesis to those methods.
CRelationships in a testable hypothesis may be associative or correlational.
DA testable hypothesis is one that clearly predicts the relationships among variables
and contains variables that are measurable or able to be manipulated in a study.

• Which statement differentiates research variables from research concepts?
a.Concepts are more abstract than variables.

b.Concepts are usually studied in quantitative
research.
c.Variables are less subject to manipulation and
measurement. d.Variables cannot be concisely
defined or clearly described.
CORRECT ANSWER: A
Feedback
AConcepts are more abstract than variables and are usually studied in qualitative research.
BConcepts are more abstract than variables and are usually studied in qualitative research.
CVariables are qualities, properties, or characteristics of persons, things, or situations that can
be manipulated, and measured.
DVariables are qualities, properties, or characteristics of persons, things, or
situations that change or vary and can be concisely defined, and described.

(Comprehension) REF:pp. 153-154| dm. 156
• A researcher wishes to study the effects of a low-fat diet on self-esteem,
weight, and energy levels among obese women over age 40. Which is the
independent variable in this study?
a.Lo
w-
fat
diet
b.Ob
esity
c.Self-esteem, weight, and
energy levels d.Women over
40
CORRECT ANSWER: A
Feedback
A The independent variable in a study is the variable that can be manipulated to
determine whether a specific outcome or result is achieved.
B Obesity and women over 40 are demographic variables.
C Self-esteem, weight, and energy levels are dependent variables, based on the
presence or absence of the independent variable.
D Obesity and women over 40 are demographic variables.
REF: dm. 153
• Which is true about a dependent variable in a
research study? It is: a.manipulated by the researcher
to test the research hypothesis.
b.the cause of changes in other variables in a
research study. c.the experimental variable in a
research study.
d.the outcome the researcher wishes to predict.
CORRECT ANSWER: D
Feedback
AChanges in the dependent variable are presumed to be caused by the independent variables.
B The independent variable is manipulated by the researcher and is presumed to cause

changes in the dependent variable.
C The independent variable is also referred to as the experimental variable.
D The dependent variable is the outcome that the researcher wishes to predict or
explain. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 153
• Which type of variable is used in a
descriptive study? a.Dependent variable
b.Independen
t variable
c.Research
variable
d.Treatment
variable
CORRECT ANSWER: C
Feedback
A The dependent variable is the outcome that the researcher wishes to predict or explain.
B The independent variable is manipulated by the researcher and is presumed to cause
changes in the dependent variable.
C Research variables are the qualities, properties, or characteristics identified in a descriptive
or correlational study.
D The independent variable is sometimes called the treatment
variable. PTS: 1 DIF: Cognitive level: Understanding
(Comprehension)
REF: dm. 153
• During a study to measure the effects of violent video games on aggressive

behavior, the researchers learned that a portion of the subjects lived in
homes with one or more alcoholic parents. In this study, the presence of an
alcoholic parent is a(n):
a.confounding
variable.
b.dependent
variable.
c.independent
variable.
d.unrecognized
variable.
CORRECT ANSWER: A
Feedback
AA confounding variable is an extraneous variable that is not recognized until

the study is in process or is recognized before beginning the study, but cannot be
controlled.
BThe dependent variable is the outcome that the researcher wishes to predict or explain.
CThe independent variable is manipulated by the researcher and is presumed to
cause changes in the dependent variable.
DAn unrecognized variable is a type of extraneous variable that is not noted during
the study, but may or may not influence the outcome.

• To reduce or eliminate the influence of environmental variables on
study results, the researcher may:
a.completely describe all environmental settings encountered in
the study. b.discuss these variables in the study results.
c.use a research unit in a hospital or
laboratory. d.use a qualitative study design
to conduct the study.
CORRECT ANSWER: C
Feedback
ADescribing the environmental variables or discussing them in the study
results does not eliminate the influence of the environment on the study
outcomes.
BDescribing the environmental variables or discussing them in the study
results does not eliminate the influence of the environment on the study
outcomes.
CEnvironmental variables are a type of extraneous variable present in the setting
in which the study is conducted. In order to control for environment, the
researcher will use a laboratory setting or a research unit in a hospital.
DUsing a qualitative study design noes not eliminate the influence of the
environment on study outcomes.

• Which is an example of a conceptual definition of a dependent variable in a
study evaluating the effects of home nursing on coping among patients with
chronic illness?
a.Coping is a set of actions and strategies used by individuals to reduce the
stressors associated with chronic disease management.
b.Coping skills were measured using a five-point Likert scale with higher
scores indicating higher coping skills.
c.Home nursing can include registered nurse and nursing assistant management
of treatments provided at home.
d.Home nursing was measured in the number of hours per week and the number of
hours per day of in-home care.
CORRECT ANSWER: A
Feedback
A A conceptual definition provides the theoretical meaning of a variable. The
dependent variable in this study is coping.
B Operational definitions describe the actions the researcher will take to identify
the characteristics of the variable.
C Home nursing is the independent variable in this study.
D Home nursing is the independent variable in this study.
REF: dm. 155
• Which is true about an operational variable in
quantitative research? a.It is developed so that the
degree of its existence can be measured.
• It is often derived from a theoretical definition of a related concept.
• It is specific to the time and setting of the research study.
• It provides the theoretical meaning of a variable.
CORRECT ANSWER: A
Feedback
A An operational definition is derived from a set of procedures or progressive acts
that a researcher performs to receive sensory impressions that indicate the
existence or degree of existence of a variable.
B The conceptual definition is derived from the theoretical definition of a related concept.
C Operational definitions need to be independent of time and setting.
D The conceptual definition provides theoretical meaning for a variable.
REF: dm. 155
• In a qualitative study, which is true about the definition of research concepts?
a.They are measureable variables that help illustrate theoretical

concepts. b.They are often defined or described as a result of
the study.
c.They are written to provide a concise measure of theoretical
concepts. d.They must be clearly described to proceed with
the study.
CORRECT ANSWER: B
Feedback
AUnlike variables in a quantitative study, they usually are not easily measured.
BIn many qualitative studies, the focus of the study is to define or describe the concept.
CThey are developed as the study unfolds and do not have to be clearly
described in order to proceed with the study.
DThey are developed as the study unfolds and do not have to be clearly
described in order to proceed with the study.

• Which type of variable is used in a summary of sample characteristics?
a.Demographic
variables
b.Dependent
variables
c.Independent
variables
d.Research
variables
CORRECT ANSWER: A
Feedback
A Demographic variables are attributes of subjects that are collected to describe the sample.
B Dependent variables are variables that change as a result of manipulation of the
independent variable.
C Independent variables are variables that are manipulated to observe effects on
dependent variables.
D Research variables are variables used in qualitative studies.
REF: dm. 157
• Which is true about a statement of the research purpose?
• It describes the background for the subject of the research study.
• It includes a discussion of the significance of the study.

• It includes the research problem statement.
• It provides a concise description of the studys focus.
CORRECT ANSWER: D
Feedback
A The review of the literature provides background for the subject of a research study.
B The studys significance is a part of the overall purpose of the study.
C The research problem statement is a separate statement and includes a discussion of the
studys significance.
D The research purpose is a concise, clear statement of the specific goal of focus of
the study. PTS: 1 DIF: Cognitive level: Remembering (Knowledge)
REF: dm. 158
• An examination of the researchers plan for using measurement tools to examine

relationships among variables helps determine the:
a.research
hypothesis.
b.research
objectives.
c.study
feasibility.
d.study
purpose.
CORRECT ANSWER: A
Feedback
A The research hypothesis is determined through the research question and is a
statement about the relationship among the research variables.
B The research objectives are identified in the research purpose.
C The study feasibility is determined by the researchers expertise, the available
funding, measurement tools and sample population availability, and ethical
considerations.
D The study purpose is a statement identifying what will be measured in a
particular study. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 158
• Which is true about a research hypothesis?
• It defines the various research variables and describes how they will be measured.
• It explains the relationship of the research purpose to theory development.
• It includes the research problem, purpose, and research questions.

• It links the research problem statement to the study design and data analysis.
CORRECT ANSWER: D
Feedback
AThe problem statement can link the research purpose to theory development.
BThe introduction contains the research problem, purpose, and research questions.
CThe research purpose links the problem statement to the study design and data analysis.
DThe research hypothesis is the formal statement of the expected relationship
between two or more variables in a specified population.

• In a research proposal, a statement about expected relationships among variables is the:
o
n
c
e
p
t
u
a
l
d
e
f
i
n
i
t
i
o
n
.
b
.
o
p
e
r
a
t
i
o
n
a
l
d
e
f
i
n
i
t
i
o
n
.
c
.
r
e
s
e
a
r
c
h
h
y
p
o
t
h
e
s
i
s
.
d
.
r
e
s
e
a
r
c
h
p
r
o
b
l
e
m
.
CORRECT ANSWER: C
Feedback
A The conceptual definition is derived from the theoretical definition of a related
concept and provides theoretical meaning for a variable.
B An operational definition is derived from a set of procedures or progressive acts
that a researcher performs to receive sensory impressions that indicate the existence
or degree of existence of a variable.
C The research hypothesis is the formal statement of the expected relationship
between two or more variables in a specified population.
D The research problem identifies gaps in
knowledge. PTS:1DIF:Cognitive level:
Applying (Application) REF: dm. 158
• Which type of variable is manipulated by the researcher?
a.De
mogr
aphic
b.Dep
enden
t
c.Ind
epen
dent
d.Re
searc
h
CORRECT ANSWER: C
Feedback
A Demographic variables are attributes of members of a sample population.
B The dependent variable is the outcome variable and is the variable researchers wish to
predict based on manipulation of the independent variable.
C The independent, or experimental variable, is manipulated by the researcher in order to
observe possible effects on the dependent variable.
D A research variable is used in qualitative studies.
Chapter 3 Reading Research Articles

MULTIPLE CHOICE
• One reason for conducting a review of the literature other than for purposes
of developing a research study is to:
• etermine the expertise of
researchers in the field of study.
b.identify current theoretical
frameworks.
c.implement evidence-based practice
guidelines. d.work in a Magnet-
certified hospital setting.
CORRECT ANSWER: C
Feedback
AEvaluation of the expertise of researchers and identification of theoretical
frameworks are part of literature reviews but are not the reason for conducting
them.
BEvaluation of the expertise of researchers and identification of theoretical
frameworks are part of literature reviews but are not the reason for conducting
them.
CAlthough a literature reviews are commonly associated with development of
research studies, they are also conducted when developing projects to establish
evidence-based-practice (EBP).
DNurses in Magnet hospitals often participate in EBP projects and will
conduct literature reviews for these, but not solely to be able to work in these
institutions.

• What is the purpose of a limited research review?
a.To allow the reader to become familiar with the research

problem b.To develop an initial pilot study prior to a more
in-depth study c.To direct the planning and execution of a
study
d.To identify studies published after a study is performed
CORRECT ANSWER: D
Feedback
AA full literature review allows the reader to become familiar with the research
problem and is performed prior to a pilot or a full study.
BThe full literature review directs the planning and execution of the study.
CThe full literature review directs the planning and execution of the study.
DA limited research review is often conducted after an initial literature review in
order to describe any studies performed after the study has been performed. The
results of both the original literature review and the limited literature review are
included in the report.
REF: dm. 163
• A reviewer reading a proposal for a qualitative research study notes that the
author has not included a literature review. The reviewer understands that a
literature review may have been omitted in this case because:
a.it is not necessary to conduct a literature review for qualitative research.
b.qualitative research is conducted to study areas where there is no previous
knowledge. c.some researchers feel that previous studies may bias data collection
in qualitative studies. d.the researcher was not adequately prepared to conduct this
research study.
CORRECT ANSWER: C
Feedback
AA literature review can be helpful in qualitative research and should be performed if possible.
BThis is true of some but not all qualitative methods (for example grounded
theory); however, it is not true of all qualitative designs.
CMany times literature reviews are omitted from qualitative research to
avoid causing expectations that might bias findings, data collection, and
data analysis.
DAt times, there is little or no previous research on the topic, but not always.
Omission of a literature review in qualitative research does not indicate that the
researcher is ill-prepared.

• Which type of study is least likely to include a review of the literature prior
to initiating the study?
a.Grounde
d theory
b.Phenome
nological
c.Qualitati
ve
d.Quantitat
ive
CORRECT ANSWER: B
Feedback
AGrounded theory researchers may have a limited review of relevant studies in
order to make the researcher aware of what studies have been conducted and that a
research problem exists.
BPhenomenological researchers are most likely to delay literature review until

after a study is completed in order to avoid bias.
CQualitative and quantitative research will involve literature reviews, although these
may be less substantial in qualitative studies.
DQualitative and quantitative research will involve literature reviews, although these
may be less substantial in qualitative studies.

• What is the main purpose of a literature review in grounded theory research?
a.To explain, extend, and support the framework used for

the study b.To identify gaps in current knowledge about
the research topic c.To place research findings in context
of what is already known. d.To support the need to study
the selected research topic
CORRECT ANSWER: A
Feedback
AIn grounded theory research, the researcher uses the literature review primarily to
explain, support, and extend the framework used in the study, and not to direct data
collection or study methods. It is usually completed at the end of the analysis rather
than before the proposal development
BThe literature review in quantitative studies is designed to identify gaps in knowledge.
CPhenomenological literature reviews are conducted to place research findings in
the context of what is already known.
DBecause the literature review for grounded theory research is generally conducted
at the end of the analysis, it is not used to support the need for studying the topic,
but to summarize what is known.

• Why might Wikipedia be a questionable reference for a study citation?
• It does not contain factual information.

• It does not provide ideas for other resources.
• It is an online resource..
• It is an open, editable format.
CORRECT ANSWER: D
Feedback
AWikipedia may contain factual information, but this is not reliable.
BWikipedia may provide ideas for other resources.
CWikipedia is an online resource, but that fact does not exclude it from being used.
DWikipedia is an open, editable format; the information may not always be accurate
because it is not peer reviewed and scientifically based.

• Which source of information is rarely cited in academic publications?
a.Conference
proceedings
b.Dissertation or
thesis
c.Encyclopedia
d.Textbooks
CORRECT ANSWER: C
Feedback
A Conference proceedings, dissertations or theses, and textbooks may all be cited.
B Conference proceedings, dissertations or theses, and textbooks may all be cited.
C Encyclopedias tend to provide background information and some information leading to
other resources, but generally not scholarly or primary source information.
D Conference proceedings, dissertations or theses, and textbooks may all be
cited. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 166
• When determining the reliability of a website resource in a literature review, it

is important to determine:
a.accessibility of the website
information. b.costs of
retrieving website information.
c . sponsorship of website
information.
d.whether website information is also published
conventionally. CORRECT ANSWER: C
Feedback
AAccessibility, cost, and conventional publication of website information are not
determinants of reliability of website information.
BAccessibility, cost, and conventional publication of website information are not
CNot all websites are valid and appropriate for citation in a literature review.
Those that are sponsored by companies that sell certain products under study
may not be appropriate resources because their information may be biased.
DAccessibility, cost, and conventional publication of website information are not

• A review of empirical literature will yield information obtained from:
a.concept analyses.
b.descriptions of models and
frameworks. c.research studies.
d.theories.
CORRECT ANSWER: C
Feedback
A Theoretical literature includes concept analyses, models, theories, and conceptual frameworks.
B Theoretical literature includes concept analyses, models, theories, and conceptual frameworks.
C Empirical literature refers to knowledge derived from research and is based on
data from research.
D Theoretical literature includes concept analyses, models, theories, and conceptual frameworks.
PTS: 1 DIF: Cognitive level: Remembering (Knowledge)
REF: dm. 166
• What is an important limitation of secondary sources in
literature reviews? a.The authors do not have high levels of
expertise.
b.They are usually not peer-reviewed
sources. c.They do not contain unique or
original information. d.They may contain
misinterpreted information.
CORRECT ANSWER: D
Feedback
AAuthors of secondary sources have similar levels of expertise as those of primary sources.
BSecondary sources may contain original information as authors synthesize and
analyze findings from primary sources.
CSecondary sources are usually peer reviewed.
DA secondary source summarizes or quotes content from primary sources. Because
authors of secondary sources paraphrase the works of researchers and theorists and
interpret what the primary author wrote, this information may be misinterpreted.

• When reviewing articles in a peer-reviewed publication, the reader is assured
that the articles are:
a.landmark
studies.
b.primary
sources.
c.seminal
studies.
d.trustworth
y sources.
CORRECT ANSWER: D
Feedback
ALandmark studies, primary sources, and seminal studies are included in
peer-reviewed literature, but may also appear in literature that is not peer
reviewed.
BLandmark studies, primary sources, and seminal studies are included in
reviewed.
CLandmark studies, primary sources, and seminal studies are included in
reviewed.
DResearch reports detailing study events, including results and analysis of findings
included in refereed professional journals, are considered one of the most credible
types of evidence and are typically considered one of the most useful sources for
researchers as they conduct a literature review for a current study. Articles found in
refereed journals have been evaluated in an anonymous process by unbiased
reviewers and received favorable review, not only for the integrity of the research
itself, but because the topic of interest has been deemed significant to the
profession.

• For a study to be considered current, it should be published within the last:
a.year.
b.2 years.
c.5 years.
d.10 years.
CORRECT ANSWER: C
Feedback
A This is not a correct statement.
B This is not a correct statement.
C Current sources are those published within 5 years before publication of the manuscript.
D This is not a correct statement.

• Some studies cited in a literature review may be decades old. The researcher
may decide to use studies from this far back because these studies:
a.are groundbreaking or
landmark studies. b.are
particularly well-written studies.
c.are peer-reviewed, relevant
studies. d.are still considered
current studies.
CORRECT ANSWER: A
Feedback
AStudies that are groundbreaking or landmark studies are those that were
significant to the development of knowledge on the topic being reviewed. In this
case, it is appropriate to cite these studies, even if they are very old.
BWell-written, peer reviewed studies that are not current are generally not used
in a literature review.
CWell-written, peer reviewed studies that are not current are generally not used
in a literature review.
DStudies that are decades old, however well-written and relevant, are not current
studies, but are used for historical or seminal context.

• A researcher conducts a study using dependent and independent variables used

in a previous study but uses a different population of subjects. What type of
study is this?
a.L
and
mar
k
b.Pi
lot
c.R
epli
cati
on
d.S
emi
nal
CORRECT ANSWER: C
Feedback
AA landmark study is one that generates knowledge that influences a discipline and
sometimes society as a whole. Landmark studies are often replicated.
BA pilot study is a study using a small sample size to develop the study methods and
tools and is later replicated on a larger scale.
CA replication study is a reproduction or repetition of a study that a researcher
conducts to determine whether the findings of the original study can be consistently
found in different settings with different subjects.
DA seminal study is the first study on a particular topic that signals a new way of
thinking about the topic. These studies are often replicated.

• A nurse appraising a research article should perform which action in
order to critically evaluate the literature review?
a.Locate and review sources and abstracts listed in the research article
b.Note the number of data-based and theoretical sources cited in the
reference list c.Perform a meta-analysis or meta-synthesis on the cited
references
d.Search the literature to determine whether other relevant sources exist
CORRECT ANSWER: B
Fee
dba
ck
ALocating and reviewing all abstracts would be too time consuming and may not be
possible. BBecause it would be very time consuming to search the literature and
determine whether the listed sources are relevant, the reviewer should review the
reference list and determine the focus of the sources, the number of data-based and
theoretical sources cited, and where and
when the sources were
published.
CMeta-analysis and meta-synthesis are not done when critically appraising a

literature review. These techniques are used to perform an in-depth analysis of
studies already cited in the literature.
DIt is not necessary at this point to search the literature to determine other
relevant sources. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 168-169
• When appraising a literature review, one aspect of determining the breadth of
the review is: a.whether the review provides direction for the proposed study.
b.the number and percentages of sources from the past 5 to
10 years. c.whether landmark or seminal studies have been
used.
d.the disciplines of the study authors and journals cited in the review.
CORRECT ANSWER: D
Feedback
AAn assessment of whether the literature review provides direction for the
study does not specifically evaluate the breadth of the literature review.
BThe currency of the literature review is evaluated by noting the number of sources
more than 5 to 10 years old as well as whether landmark or seminal studies are
cited.
CThe currency of the literature review is evaluated by noting the number of sources
more than 5 to 10 years old as well as whether landmark or seminal studies are
cited.
DWhen assessing the breadth of a literature review, the reviewer should identify
the disciplines of the authors cited and the journals in which they published their
studies.

• An initial step when preparing to conduct a literature review is to:
a.choose the types of sources to
use. b.clarify the purpose of the
review. c.determine how many
articles to review. d.select
electronic data bases and
keywords.
CORRECT ANSWER: B
Feedback
AThe types of sources and the number of articles to review depend on the purpose of the review.
BBecause the approach will vary according to the purpose of the review, the
first step in conducting a literature review is to identify the purpose of the
review.
COnce the purpose of the review is established and the author has an idea about
the type and number of sources, the electronic databases and keywords are
selected.
DOnce the purpose of the review is established and the author has an idea about
the type and number of sources, the electronic databases and keywords are
selected.

• When conducting a literature review for a thesis or dissertation and deciding
how far back in the available literature to search, what will the student do?
a.Ask the instructor to specify necessary publication years for
articles cited. b.Base the decision on the number of articles
necessary for the assigned task. c.Locate any seminal or landmark
studies on the topic of research.
d.Look for sources no older than 10 years prior.
CORRECT ANSWER: C
Feedback
AThe breadth and currency of the literature review should be based on the topic and
the purpose of the research and not on an assigned number or a particular number of
years.
BThe breadth and currency of the literature review should be based on the topic and
years.
CWhen beginning a thesis or dissertation, the graduate student should look
for seminal or landmark studies as a place to begin a literature review.
DThe breadth and currency of the literature review should be based on the topic and
years.
• When developing evidence-based-practice guidelines, if a researcher wishes to
identify studies that evaluate a specific intervention in quantitative research,
the literature review should include:
a.grounded theory research.
b.only current research from the
last 5 years. c.replication studies
and meta-analyses.
d. seminal and landmark studies about the topic.
CORRECT ANSWER: C
Feedback
A Grounded theory research is performed to test theory.
B While current research is desired, researchers may review older studies, particularly if they
are seminal or landmark studies, although these are not necessary for this type of literature
review.
C To synthesize evidence related to a practice problem and to evaluate a specific intervention
in quantitative research, replication studies, meta-analyses, and meta-syntheses are used.
D While current research is desired, researchers may review older studies, particularly if they
are seminal or landmark studies, although these are not necessary for this type of literature
review.

• In the following APA-formatted reference, what is indicated by the italicized words?
Maxwell, S. E., & Delaney, H. D. (2004). Designing experiments and analyzing

data: A model comparison perspective (2nd ed.). Mahway, NJ: Lawrence Erlbaum
Associates.
a.Abstract
information
b.Article title
c.Book title
d.Publishing
company
CORRECT ANSWER: C
Feedback
A The abstract information is not included in a reference citation.
B An article title is italicized if the citation is from a journal.
C When citing a book, the title is italicized.
D The publishing company information is
listed last. PTS:1DIF:Cognitive level:
Applying (Application) REF: dm. 184
• A step just prior to beginning a literature search using an electronic database is to:
a. decide how many articles are needed.
b.determine the type of

study. c.identify
keywords for the search.
d.perform a Google
search.
CORRECT ANSWER: C
Feedback
AThe number of articles needed for a literature review depends on the content of the
articles and will not be known ahead of time.
BThe study type is not typically determined just prior to an electronic search.
CTo narrow the number of articles in a search and refine the search to more
relevant articles, identifying keywords is necessary.
DA Google search may or may not be helpful for leading a researcher to other
articles, but it is not a scientific database.

• When conducting a literature search, which electronic product would a nurse
researcher use to track and store reference information?
a.Cumulative Index of Nursing and Health Literature
(CINAHL) b.EndNotes or Ref Works
c.Googl
e
Scholar
d.Scien
ce
Direct
CORRECT ANSWER: B
Feedback
A CINAHL is an electronic database used to search literature.
B EndNotes is reference management software that helps to track and store
information on all search fields and allows the researcher to file this information
with comments about each reference.
C Google Scholar is an electronic search engine.
D Science Direct is an electronic search engine.
Chapter 4 Qualitative Research

MULTIPLE CHOICE
• What role does qualitative research play in evidence-based practice (EBP)?
a.Because it does not involve random-controlled trials (RCTs), it does not

contribute directly to EBP.
• It offers a systematic approach for yielding insights into human experience and behavior.
• It provides a way to measure and evaluate quality outcomes that affect patient care.
• It provides the basis for most EBP guidelines and patient care protocols.
CORRECT ANSWER: B
Feedback
A Many insights gained through qualitative studies are used to develop theories on which
RCTs may be based.
B Qualitative research offers a systematic approach for collecting data about and
evaluating human perception and experience that cannot be achieved through
experimental research.
C Qualitative research is not concerned solely with outcomes research, which looks
at the effects of nursing interventions on patient care outcomes.
D RCTs are the basis for most EBP guidelines and
protocols PTS: 1 DIF: Cognitive level:
Understanding (Comprehension) REF: dm. 67
• A researcher identifies a socioeconomic group of people to study. After
developing a rapport with key members of the group, getting information about
group members from the key members, and spending time working among
group members, the researcher develops theories about the group based on this
experience. Which type of qualitative research does this represent?
a.Ethnogra
phic
b.Grounde
d theory
c.Historica
l
d.Phenome
nological
CORRECT ANSWER: A
Feedback
AEthnographic research was developed by anthropologists as a mechanism for
studying cultures and involves immersion in the group in order to make
observations and get information.
BGrounded theory research is an inductive technique that emerged from the
discipline of sociology. Ethnographic research was developed by
anthropologists as a mechanism for studying cultures.
CHistorical research examines events of the past. Ethnographic research was
developed by anthropologists as a mechanism for studying cultures.
DPhenomenological research describes experiences as they are lived. Ethnographic
research was developed by anthropologists as a mechanism for studying cultures.

• What is true about phenomena in qualitative research?
a.Human behavior is generally the result of the direct influence of independent

variables. b.Knowledge gained by qualitative research is concrete and derived
from statistical data. c.Multiple realities are possible based on meanings created
by individuals and groups. d.Time and context have very little influence on
individual or group perspectives.
CORRECT ANSWER: C
Feedback
AHuman behavior is complex and not just the result of the influence of independent variables.
BKnowledge gained in qualitative research is less concrete than that gained through
quantitative research.
CThe understanding of phenomena in qualitative research is not the same as in
quantitative research. In qualitative research, multiple realities, based on
individual and group meanings, may be derived from research data.
DPhenomena in qualitative research are considered unique to the individual and in
the time and the context that they occur.

• A researcher conducts a qualitative study and learns that individuals
have a variety of reactions to an event. What can the researcher
conclude from this finding?
a.The findings are interesting, but are not useful for theory development.
b.The reactions described in this study may be generalized to a larger
population. c.The study has little significance since there is no well-
defined single outcome. d.The variety of reactions is expected since
perception varies with individuals.
CORRECT ANSWER: D
Feedback
AFindings in qualitative studies are often used to guide initial theory development
whose constructs are later tested through experimental studies.
BReactions in qualitative studies do not have statistical significance and cannot be
generalized to a larger population.
CEven without a well-defined outcome, the results do have significance and
contribute to the larger body of scientific knowledge.
DBecause meaning is subjective, there can be multiple realities in qualitative
research, which seeks to learn how individuals and groups respond to
experiences.

• A researcher develops a study to examine various phenomena that
contribute to theory development. This is an example of which type of
research?
a.Ethnographic
research
b.Grounded theory
research
c.Historical
research
d.Phenomenologica
l research
CORRECT ANSWER: B
Feedback
A Ethnographers observe and document interactions
within a culture. B Grounded theory develops theory
directly from the research data. C Historical research
examines events of the past.
D Phenomenological research attempts to capture the lived experience of study
participants. PTS:1DIF:Cognitive level: Applying (Application)
REF: dm. 67| dm. 70
• A researcher conducts a study to examine the feelings of cancer patients at

various points during their disease, including at diagnosis, when beginning
chemotherapy, and during remission. Which type of study will the
researcher use for this study?
a.Ethnogra
phic
b.Grounde
d Theory
c.Historica
l
d.Phenome
nological
CORRE
CT
ANSWE
R: D
Feedback
A Ethnographers observe and document interactions
within a culture. B Grounded theory develops theory
directly from the research data. C Historical research
examines events of the past.
D Phenomenological research attempts to capture the lived experience of study
REF:dm. 67| pp. 69-70
• What is true about scientific rigor in qualitative
nursing research? a.Studies are rigorous only when
results are quantifiable.
b.Study findings are considered trustworthy when rigor
is applied. c.Scientific rigor is not applicable with
qualitative studies. d.Scientific rigor is only used with
random-controlled trials.
CORRECT ANSWER: B
Feedback
A Rigor can be applied to qualitative research.
B Rigor is valued because the findings of rigorous studies are seen as being more credible and
of greater worth.
C Rigor can be applied to both qualitative and quantitative research.
D Rigor is used with qualitative research.

• When designing a study, which has the greatest influence as a researcher

decides which type of qualitative study design to use?
a.Funding and
resources
b.Literature
review
c.Population
d.Research question
CORRECT
ANSWER: D
Feedback
AFunding and resources influence the size of the population and the types of
measures that may be employed.
BThe literature review and the population do not influence the study design directly.
CThe literature review and the population do not influence the study design directly.
DDeciding which qualitative approach to use depends on the research question and
the purpose of the study.

• A researcher wishes to learn about the experiences that women have when
breastfeeding their infants in the workplace. Which type of study design will
the researcher employ?
a.Ethnographic
b.Exploratory-
descriptive
c.Grounded
theory
d.Historical
CORRECT ANSWER: B
Feedback
AEthnographers observe and document interactions within a culture.
BExploratory-descriptive studies are used when researchers are exploring a
new topic or describing a situation.
CGrounded theory develops theory directly from the research data.
DHistorical research examines events of
the past. PTS:1DIF:Cognitive level:
Applying (Application) REF: pp. 76-77
• A researcher who bases phenomenological research on Husserls philosophy will:
a.incorporate personal biases into conclusions and discussion of the

research. b.interpret subjects experiences according to the researchers
own biases. c.place personal biases aside when considering and
reporting research findings. d.use personal biases to look for hidden
meanings in research data.
CORRECT ANSWER: C
Feedback
AThis is not an accurate statement.
BThis is not an accurate statement.
CAccording to Husserl, to capture the lived experience of study participants, the
researcher must set aside personal biases to describe the phenomena in a nave way.
Heidegger describes ways that personal biases are incorporated into qualitative research.
DThis is not an accurate statement.

• What is a key element of hermeneutics in research?
a.Analysis of documents and interviews to identify themes and

subthemes in data b.Bracketing of the researchers own perceptions for
the duration of the study c.Description of phenomena without
interpretation by the researcher
d.Focusing solely on phenomena themselves without consideration of biases
CORRECT ANSWER: A
Feedback
AHermeneutics is a type of interpretive phenomenological research method that
involves textual analysis and identification of themes and subthemes present in
interviews and published documents in light of the studys research questions.
BHusserl suggested that the researcher must bracket personal biases in order to
examine the research data. Husserl differs from Heidigger in this
regard.Heidigger argued that it is impossible to set aside beliefs and biases.
CHeidiggers approach is interpretive and is part of hermeneutics.
DHeidigger believed that researchers cannot set aside
their biases. PTS:1DIF:Cognitive level: Analyzing
(Analysis)
REF: pp. 69-70
• When performing an external criticism of the documents used in historical

research, the reviewer must determine whether the documents are:
a.genuine or
fraudulent.
b.interesting or
dull. c.well
known or
obscure.
d.written by authors who are still living.
CORRECT ANSWER: A
Feedback
AExternal criticism determines the validity of source material.
BWhether or not the document is interesting has little to do with the
importance of the document.
CAs long as the document is genuine and of interest to the study, whether it is well
known or not is irrelevant.
DAlthough it might be useful to know whether or not the writers of the document
are living, this does not relate to external criticism.

• What is true about grounded theory research?
• It is a method used to quantify theoretical constructs in theory development.

• It is used to further research in areas where much concrete data is
already known. c.Study designs use a theoretical basis to develop
the research questions.
d.Theory is developed from the data collected during the research.
CORRECT ANSWER: D
Feedback
AExperimental studies are used to quantify theoretical constructs to test theories.
BGrounded theory research is preliminary and is often used when little is known about a subject.
CTheory is developed from the research findings of grounded theory research.
DGrounded theory develops theory directly from the
research data. PTS: 1 DIF: Cognitive level:
Understanding (Comprehension)
REF: dm. 70
• A researcher wishes to understand how inner-city Somali immigrants adapt

health care practices into their experiences with the U.S. health care system.
Which type of study approach will the researcher use?
a.Descriptive-
qualitative
b.Ethnographic
c.Grounded
theory
d.Phenomenolo
gical
CORRECT ANSWER: B
Feedback
AExploratory-descriptive studies are used when researchers are exploring a
BEthnographic research involves observation and documentation of interactions within a culture.
DPhenomenological research attempts to capture the lived experience of study
REF: pp. 70-71
• Which is an example of an etic approach in an ethnographic study?
a.A longitudinal study examining individual immigrants attitudes about health care
b.A study about African tribal women and their feelings about HIV prevention
c.A study comparing various ethnic groups folk health practices
d.A study of differences between BSN- and AND-prepared nurses attitudes about health care
CORRECT ANSWER: C
Feedback
AA study of immigrants attitudes about health care is a phenomenological study.
BA study examining a particular cultural group is an ethnographic study.
CThe etic approach involves studying behavior from outside the culture
and examining similarities and differences across cultures.
DA study of attitudes about health care is a
phenomenological study. PTS:1DIF:Cognitive level:
Applying (Application)
REF: dm. 74
• Which qualitative study will call for an exploratory-descriptive
study approach? a.An evaluation of clinical outcomes of standard
nursing interventions
b.An examination of the effects of a treatment on various ethnic groups
c.A review of data in order to evaluate theoretical constructs
d.A study on a topic about which little is known or understood
CORRECT ANSWER: D
Feedback
AOutcomes research is concerned with clinical outcomes of standard interventions.
BComparing the effects of a treatment on two groups of subjects is a quasi-
experimental design. CTheory testing uses data to evaluate theoretical constructs.
DExploratory-descriptive studies are used when researchers are exploring a

• A researcher utilizes an emic approach in a research study in order to:
a.gather data about lived experiences of

individuals. b.trying to understand behaviors
from within a culture.
c.examine individual human behavior according to
personal biases. d.use techniques such as bracketing and
intuiting.
CORRECT ANSWER: B
Feedback
APhenomenological research attempts to capture the lived experience of study
participants. The emic approach involves studying behaviors from within a culture.
BThe emic approach involves studying behaviors from within a culture.
CThe etic perspective studies behaviors from outside the culture and examines
similarities and differences across cultures. (The emic approach involves studying
behaviors from within a culture.) The ethnographic approach looks at groups, not
individual behaviors.
DBracketing and intuiting are techniques used rather than the focus of a
study. The emic approach involves studying behaviors from within a
culture.
REF: dm. 74
• The goal of grounded theory research is to:
a.develop theories and hypotheses based on research

findings. b.establish an ethnographic perspective on
subjects.
c.provide validity checks for
constructs. d.test theoretical
constructs and hypotheses.
CORRECT ANSWER: A
Feedback
A Theory developed from grounded theory research is grounded in the data from
which it was derived.
B An ethnographic perception of research is part of an ethnographic
perspective. C Validity checks for constructs are not the concern of
grounded theory research. D Theory testing uses data to evaluate
theoretical constructs.

• A researcher wishes to examine the experiences and feelings of siblings of
children who have cancer in order to gain information about this population.
Which type of qualitative study method will the researcher use?
a.Ethnographic
b.Exploratory-
descriptive
c.Grounded
theory
d.Historical
CORRECT ANSWER: B
Feedback
AEthnographic research involves observation and documentation of interactions within a culture.
BExploratory-descriptive studies are used when researchers are exploring a
DHistorical research uses historical documents to
describe events. PTS:1DIF:Cognitive level: Applying
(Application)
REF: pp. 77-78
• When conducting historical research about the experiences of women

refugees from the Sudan, the researcher interviews women who served as
nurses among this population. These nurses represent:
a.control group
subjects.
b.experimental group
subjects. c.primary
data sources.
d.secondary data
sources.
CORRECT ANSWER: D
Feedback
AControl and experimental group subjects are used in experimental,
quantitative, and not in qualitative studies.
BControl and experimental group subjects are used in experimental,
quantitative, and not in qualitative studies.
CPrimary data sources are those gathered directly from the study subjects and can
either be from direct interviews or from diaries or other documents written by the
subjects.
DA secondary data source can be a person who lived at the same time or who had
contact with the subjects of the study. Nurses who cared for Sudanese woman
immigrants would be secondary sources for this population.

• When conducting research about the experiences of early advanced
practice nurses, the researcher may consult which possible secondary
source?
a.A textbook history of early advanced
practice nurses b.Currently practicing
advanced practice nurses c.Former patients
of early advanced practice nurses
d.The scope of practice guidelines for advanced practice nursing
CORRECT ANSWER: C
Feedback
AA textbook history may itself use primary and secondary data sources.
BCurrently practicing APRNs rely on primary and secondary sources for their
information, but are not themselves sources of historical information.
CA secondary data source can be a person who lived at the same time or who had
contact with the subjects of the study.
DThe scope of practice guidelines may use historical information, but it is
not a historical document.

• What are subjects in qualitative research studies usually called?
a.Experimenta
l subjects
b.Participants
c.Primary
sources
d.Secondary
sources
CORRECT ANSWER: B
Feedback
AExperimental subjects are subjects who are part of experimental studies.
BSubjects in qualitative studies are referred to as participants because the
researcher and the participants cooperatively carry out the study.
CPrimary sources are subjects in historical studies who actually lived the
experiences being described.
DSecondary sources are people who knew or worked closely with primary sources
in historical research.

• How are subjects selected for qualitative research studies?
a.As volunteers through advertising
for subjects b.Based on knowledge or
experience
c.By random sampling
methods d.Through
convenience sampling
CORRECT ANSWER: B
Feedback
ASubjects tend to be recruited and do not necessarily volunteer.
BSubjects in qualitative research studies are selected based on their knowledge or

experience or for their views related to the study.
CRandom sampling techniques are not generally used in qualitative research.
DConvenience samples are used when random sampling techniques are not
possible and generally in qualitative research. Subjects in qualitative
research are selected based on knowledge or experience.

• What is the researcher-participant relationship in qualitative research?
a.Attaching personal meanings of the researcher to subjects

responses b.Controlling subjects responses by stating the
aims of the study c.Creating empathetic and honest
relationships with study subjects d.Keeping a distance to
avoid skewing research findings
CORRECT ANSWER: C
Feedback
AIt is necessary for the researcher to be open to the perceptions of the participants.
BThe researcher tries to avoid controlling the subjects responses.
CIn qualitative research, the researcher creates a respectful relationship with each
participant that includes being honest and open about the studys purpose and
methods.
DThe researcher does not maintain a detached distance as with quantitative
studies, but must become closely involved in the subjects experience in order to
interpret it.

• What type of data collection method is most common in qualitative research?
• Distribution and review of

questionnaires from subjects
b.Interviews with and observation of
subjects c.Participation and immersion
in the lives of subjects
d.Review of historical documents and literature about subjects
CORRECT ANSWER: B
Feedback
AQuestionnaires are used occasionally, but are often used in quantitative research as well.
BBecause the data in most qualitative studies are the participants thoughts,
ideas, and perceptions, data collection is most often done by interviewing and
observing participants.
CEthnographic research is a less common type of qualitative research and involves
participation and immersion in the lives of subjects.
DHistorical research is a type of qualitative research that involves review of historical
documents and literature.

• During a qualitative research study, a researcher asks subjects a fixed set of
questions to which the participants respond freely. This is an example of
a(n):
a.open-ended
interview. b.semi-
structured
interview.
c.structured
interview.
d.unstructured
interview.
CORRECT ANSWER: B
Feedback
AAn open-ended interview is unstructured and, while the researcher defines the
focus of the interview, there may be no fixed sequence of questions.
BA semi-structured interview involves a fixed set of questions with no fixed responses.
CA structured interview involves a fixed set of questions with a fixed set of answers.
DAn unstructured interview may not have fixed questions or
answers. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 83-84
• What may characterize questions asked by the researcher during an

exploratory-descriptive study?
a.A focus on participants biographical
information b.Using structured
individual questions
c.One main question with follow-up
questions d.Open-ended questions with
probes to follow up
CORRECT ANSWER: B
Feedback
AEthnographic researchers will focus on biographical data.
BIn an exploratory-descriptive study, the researcher may ask more structured
questions to achieve the purpose of the study.
CInterviews in a phenomenology study may have one main question with follow-
up questions used as needed to elicit the participants perspective on the
phenomenon.
DPhenomenological research interviews begin with open-ended questions followed
up with more probing questions to elicit participants perspectives.

• A researcher investigates how nurses in a rural hospital regard the
importance of asthma education using an ethnographic approach. Why was
this approach appropriate?
a.To find out what it was like for nurses to provide this
education b.To explore the theoretical basis of asthma
education
c.To improve understanding of how these nurses define asthma
education d.To look at the history of asthma education to shed light
on current practice
CORRECT ANSWER: C
Feedback
A A study to learn what it is like to do something would be best learned through an
exploratory study.
B Grounded theory research explores the theoretical basis for interventions.
C The ethnographic approach looks at phenomena within a certain culture, in this
case the hospital, and seeks to describe how that culture deals with the subject of
interest.
D Historical research studies the history of an intervention.
REF: dm. 74
• When appraising a study in which data was collected by interview, the

reviewer will assess for:
a.adequate length of time for each interview.
b.evidence that prompts were not used to encourage
responses. c.use of clinical setting for conducting
interviews.
d.utilization of payment for participation of subjects.
CORRECT ANSWER: A
Feedback
A An important aspect of reviewing interview methods is to assess the length of
time the researcher allowed for each interview to determine whether subjects had
adequate time to respond.
B Prompts may be used in interviews.
C It is better if interviews are conducted in a natural, and not a clinical setting.
D Subjects will ideally be volunteers, recruited for their knowledge and experience.
REF: dm. 83
• A researcher may choose to use a focus group instead of one-to-one
interviews in order to: a.encourage free expression of views of the
participants.
• increase conformity and consistency of
participants responses. c.reduce the time
needed to collect data.
d.allow more time for lengthy and complete responses.
CORRECT ANSWER: A
Feedback
A One of the assumptions underlying the use of focus groups is that group
dynamics can help people to express and clarify their views in ways that are less
likely to occur in a one-to-one setting.
B The goal of a focus group is not to increase conformity, but this may
sometimes occur if participants go along with the group.
C This type of data collection often takes more time that with one-on-one interviews.
D Focus groups often do not allow for lengthy responses by individuals.
Chapter 5 Quantitative Descriptive Research

MULTIPLE CHOICE
• Which type of research design focuses on implementation of a treatment by
the researcher? a.Correlational
b.Des
cripti
ve
c.Exp
erime
ntal
d.Lon
gitudi
nal
CORRECT ANSWER: C
Feedback
ACorrelational and descriptive designs are nonexperimental studies that focus
on examining variables as they naturally occur and not on the implementation
of a treatment by the researcher.
BCorrelational and descriptive designs are nonexperimental studies that focus
on examining variables as they naturally occur and not on the implementation
of a treatment by the researcher.
CQuasi-experimental and experimental studies are designed to examine
causality between a researcher-implemented treatment and a study outcome.
DLongitudinal design refers to data collection from the same subjects at different
points in time and may or may not be used with experimental or nonexperimental
studies.
PTS: 1 DIF: Cognitive level: Comprehension REF: dm. 212
• A researcher administers a written test to evaluate knowledge of insulin

administration and glucose monitoring to a group of subjects at annual
intervals over the next decade. This is an example of which type of study
design?
a.Correl
ational
b.Cross
-section
al
c.Descr
iptive
d.Longi
tudinal
CORRECT ANSWER: D
Feedback
ACorrelational studies seek to examine relationships among variables without
manipulation of a treatment by the researcher.
BCross-sectional designs examine a group of subjects simultaneously in various
stages of development, illness severity, or recovery to identify changes in a
phenomenon across stages.
C A descriptive study is used to examine variables as they occur naturally without
manipulation of variables.
D Longitudinal design refers to data collection from the same subjects at different
points in time.
PTS: 1 DIF: Cognitive level: Application REF: dm. 212
• A nurse researcher wishes to identify rates of pertussis infection in children less

than one year of age and then again at 6 years of age to examine the
relationship of immunization status on
infection rates in this population. This is an example of which type of
study design? a.Correlational, longitudinal
b.Correlational,
cross-sectional
c.Descriptive,
longitudinal
d.Descriptive, cross-
sectional
CORRECT ANSWER: A
Feedback
AA correlational study design looks at predictive relationships between variables. A
longitudinal study design refers to data collection from the same subjects at different
points in time.
BCross-sectional designs examine a group of subjects simultaneously in various
C A descriptive study is used to examine variables as they occur naturally without manipulation.
D Cross-sectional designs examine a group of subjects simultaneously in various
phenomenon across stages. A descriptive study is used to examine variables as they
occur naturally without manipulation.
PTS: 1 DIF: Cognitive level: Applying REF: dm. 212
• Which statement is true about a descriptive study design?
a.It is not possible to operationally define variables in this type

of study. b.Sample selection and size cannot be controlled in
descriptive studies. c.This type of design is used to identify
problems occurring in practice. d.Variables may be
manipulated to avoid bias in this type of study.
CORRECT ANSWER: C
Feedback
ADescriptive designs may involve operational definitions of variables, but
variables are not manipulated in descriptive studies.
BProtection against bias in a descriptive design is achieved through conceptual

and operational definition of variables, sample selection and size, valid and
reliable instruments, and data collection procedures that partially control the
environment.
CDescriptive designs may be used to develop theories and identify problems
with current practice.
DProtection against bias in a descriptive design is achieved through conceptual and
operational definition of variables, sample selection and size, valid and reliable
instruments, and data collection procedures that partially control the environment.
PTS: 1 DIF: Cognitive level: Understanding REF: pp. 212-213
• A nurse conducts a study to see whether there are differences in the number
of books Latino parents and the number of books African-American parents
read to their toddlers each week. Which type of study will this researcher
utilize?
a.Comparative
descriptive
b.Correlational
c.Cross
-section
al
d.Longi
tudinal
CORRECT ANSWER: A
Feedback
A A comparative descriptive design is used to describe variables and to examine
differences in variables in two or more groups that occur naturally in a setting that
may have been formed using gender, age, or socioeconomic status.
B A correlational study design looks at predictive relationships between variables.
C Cross-sectional designs examine a group of subjects simultaneously in various
D Longitudinal design refers to data collection from the same subjects at different
points in time.
• A researcher wishes to conduct a correlational study to determine whether there

is a relationship between stress levels and relapse rates among patients who
have chronic conditions. In order to determine the existence of a relationship
between these two variables, the researcher will attempt to:
a.manipulate the level of stress in study
subjects. b.obtain a large range of
possible scores.
c.provide lengthy descriptions of subjects
behaviors. d.randomly assign subjects to
study groups.
CORRECT ANSWER: B
Feedback
A Correlational studies do not involve manipulation of a variable.
B In correlational designs, a large range in the variable scores is necessary to
determine the existence of a relationship.
C Providing lengthy descriptions of subjects behaviors is a necessary part of the discussion of
the results, but it does not determine the existence of a relationship.
D Subjects in correlational studies are not randomly assigned to
study groups. PTS: 1 DIF: Cognitive level: Applying REF: dm. 217
• If a researcher wishes to describe variables and to examine many
relationships in a study, which type of study design will the researcher
employ?
a.Correlational
b.Descriptive
c.Descriptive
correlational
d.Descriptive cross-sectional
CORRECT ANSWER: C
Feedback
BA descriptive study is used to examine variables as they occur naturally without
CA descriptive correlational design is used to describe variables and examine
relationships among these variables. Using this design facilitates the identification of
many interrelationships in a situation.
DCross-sectional designs examine a group of subjects simultaneously in various
PTS: 1 DIF: Cognitive level: Applying REF: pp. 218-220
• A nurse researcher conducts a study to determine whether women who

breastfeed their infants experience better sleep in the first two postpartum
months. This study will employ which type of research design?
•
or
re
lat
io
na
l
b.
D
es
cr
ip
ti
ve
c.
D
es
cr
ip
ti
ve
co
rr
el
ati
on
al
d.
Pr
ed
ict
iv
e
co
rr
el
ati
on
al
CORRECT ANSWER: D
Feedback
BA descriptive study is used to examine variables as they occur naturally without
CA descriptive correlational design is used to describe variables and examine
relationships among these variables.
DA predictive correlational design is used to predict the value of one variable
based on the values obtained for another variable or variables.
• A researcher theorizes a set of relationships among concepts used to describe

why patients with chronic illness are often depressed. To test the accuracy of
these hypothesized relationships, which type of study will be used?
•
es
cr
ip
ti
ve
co
rr
el
ati
on
al
b.
G
ro
un
de
d
th
eo
ry
c.
M
od
el
te
sti
ng
d.
Pr
ed
ict
iv
e
co
rr
el
ati
on
al
CORRECT ANSWER: C
Feedback
AA descriptive correlational design is used to describe variables and examine
relationships among these variables.
BGrounded theory research is designed to generate theory and to develop new concepts.
CThe model testing design requires all concepts relevant to the model be
measured and the relationships among these concepts examined.
DA predictive correlational design is used to predict the value of one variable
based on the values obtained for another variable or variables.
• A researcher conducts a study to examine possible contributors to glycemic

control in a group of subjects who have type 2 diabetes mellitus in a local
community. A convenience sample of patients includes patients from 28 to 65
years old who range in weight from normal to obese, with time since diagnosis
ranging from several months to several years. To determine causality in this
study, the researcher will:
a.discuss outcomes in terms of the probability that education will improve

glycemic control. b.increase the manipulation of the independent variable to allow
greater control by the
researcher.
c.identify multicausal variables that may influence the outcome of glycemic control
measures. d.limit the study to younger persons only to minimize the effects of
extraneous variables.
CORRECT ANSWER: C
Feedback
A Probability addresses relative and not absolute causality and may be used when
given effects are not produced consistently.
B In this case, increasing the manipulation of the independent variable does not
alter the influence of multiple causes.
C Multicausality is the presence of multiple causes for an effect. In this study,
patient age, weight, and length of time of diagnosis may all influence the outcome
and should be addressed as factors that may alter the results.
D Limiting the study to patients of a certain age only controls for one extraneous
variable. PTS: 1 DIF: Cognitive level: Analyzing REF: dm. 223
• A study in which subjects are assigned by the researcher into
experimental and control groups increases:
a.bias
.
b.con
trol.
c.ma
nipul
ation
d.vali
dity.
CORRECT ANSWER: A
Feedback
A Bias occurs when the attitudes or motivations of the researcher cause a
deviation from a true measurement of the study variables. This may occur when
researchers control assignment to study groups.
B Control is used to manage manipulation of variables and to reduce extraneous
factors in the environment that might alter outcomes.
C Manipulation of independent variables is used to evaluate changes in dependent variables.
D Researcher control over assignment into groups does not increase a studys
validity. PTS: 1 DIF: Cognitive level: Understanding REF: dm. 223
• In a quasi-experimental study examining the effects of nonpharmacologic

treatments on postoperative pain management, the researcher trains nursing
staff so that all experimental group subjects receive the same types of
treatments. This is an example of:
i
a
s
.
b
.
m
a
n
i
p
u
l
a
t
i
o
n
.
c
.
r
e
l
i
a
b
i
l
i
t
y
.
d
.
v
a
l
i
d
i
t
y
.
CORR
ECT
ANSW
ER: B
Feedback
A Bias refers to interference by the researcher that influences the outcome of a study.
B Manipulation is a form of control used in quasi-experimental and experimental studies and
may involve control of the intervention so that it is applied consistently.
C Reliability and validity are related to consistency and trustworthiness of measurement tools.
D Reliability and validity are related to consistency and trustworthiness of
measurement tools. PTS: 1 DIF: Cognitive level: Applying REF: dm. 224
• A researcher conducts a quasi-experimental study to determine whether there is
appropriate weight gain among premature infants who are fed according to
cue-based protocols. The researcher trained neonatal intensive care nurses to
apply cue-based feeding to orally fed infants and notes a statistical difference
in weight gain between infants fed according to cue-based protocols and those
fed according to standard protocols. The reviewer critiquing the study notes
that not all nurses completed the cue-based feeding module. This would affect
which type of validity?
a.Construc
t validity
b.External
validity
c.Internal validity
d.Statistical conclusion validity
CORRECT ANSWER: D
Feedback
AConstruct validity is concerned with the fit between conceptual and operational
variables and requires adequate conceptual and operational definitions.
BExternal validity is concerned with the extent to which findings can be
generalized beyond the study sample.
CInternal validity looks at the influence of extraneous variables on study outcomes.
DStatistical conclusion validity is concerned with whether the conclusions based

on statistical analyses are an accurate reflection of the real world. This can be
threatened by anything interfering with consistent implementation of a variable,
including inadequate training of individuals who implement the intervention.
PTS: 1 DIF: Cognitive level: Analyzing REF: pp. 224-225

improved weight gain among premature infants who are fed according to cue-
based protocols. The researcher trained neonatal intensive care nurses to apply
cue-based feeding to orally fed infants and notes a statistical difference in
weight gain between infants fed according to cue-based protocols and those fed
according to standard protocols. The reviewer notes that components of cue-
based feedings are not clearly identified. This is a threat to:
•
o
n
s
t
r
u
c
t
v
a
l
i
d
i
t
y
.
b
.
e
x
t
e
r
n
a
l
v
a
l
i
d
i
t
y
.
c
.
i
n
t
e
r
n
a
l
v
a
l
i
d
i
t
y
.
d.statistical conclusion validity.
CORRECT ANSWER: A
Feedback
on statistical analyses are an accurate reflection of the real world.
PTS: 1 DIF: Cognitive level: Analyzing REF: dm. 225

weight gain between infants fed according to cue-based protocols and those
fed according to standard protocols. Which might be a threat to internal
validity in this study?
a. The concept of cue-based feeding is not well defined.
b.The study sample is

homogeneous. c.Some infants
developed gastroenteritis.
d.Not all nurses received cue-based protocol education.
CORRECT ANSWER: C
Feedback
AInadequate definitions of constructs are threats to construct validity.
generalized beyond the study sample. A study with a more homogenous sample is
less likely to have findings that can be generalized to other populations.
on statistical analyses are an accurate reflection of the real world. If not all nurses
received cue-based education, the intervention implementation will be unreliable.

weight gain between infants fed according to cue-based protocols and those
fed according to standard protocols. The reviewer notes that parents who gave
consent to participate in the study were from a higher socioeconomic class than
the population as a whole. This is a threat to:
a.construct
validity.
b.external
validity.
c.internal
validity.
CORRECT ANSWER: B
Feedback
• A researcher develops a 7-point Likert scale to evaluate feelings of well-

being in patients who are undergoing chemotherapy. The researcher
administers this measure to other, similar patients in other medical centers.
This is done in order to:
a.decrease mono-
operation bias. b.improve
the test-retest reliability.
c.increase interrater reliability.
d.strengthen the operational definition of constructs.
CORRECT ANSWER: B
Feedback
AMono-operation bias occurs when only one measure is used to evaluate an outcome.
BTo improve the reliability of the measurement tool, it should be tested in
various settings to determine whether it gives consistent measures each time it is
used.
CInterrater reliability refers to consistent results that occur when various people
administer study measures.
DEvaluating the consistency of a measurement tool does not affect the operational
definition of constructs.
PTS: 1 DIF: Cognitive level: Analysis REF: pp. 225-226
• In a research study, ambulatory clinic nurses teach children with asthma how to
monitor peak expiratory flow volumes and how to use metered-dose inhalers to
determine whether asthma control scores improve. The researcher discovers
inconsistencies in how these measures were taught and how well the children
understood the concepts. This represents a lack of:
a.control of extraneous
variables. b.internal
validity.
c.intervention
fidelity. d.precision
of measurement.
CORRECT ANSWER: C
Feedback
ATo control for extraneous variables, the researcher would identify characteristics
of subjects or settings that might influence outcomes.
BInternal validity looks at the influence of extraneous variables on study outcomes.
CConsistent implementation of the treatment is referred to as intervention fidelity. If

the method of administering a research intervention varies from one person to
another, the chance of identifying a true difference based on the independent
variables decreases.
DPrecision of measurement refers to whether or not the tools yield the same
readings or findings from one test to another.
• A researcher wishes to conduct a study of a small number of subjects on a

large hospital intensive care unit. To minimize problems associated with
extraneous variables in the study setting, the researcher will:
a.ensure double-blind data collection methods.
b.randomly assign subjects to treatment and
control groups. c.test the reliability of study
measures.
d.train a small number of nurses to administer the intervention.
CORRECT ANSWER: D
Feedback
ADouble-blind data collection, random assignment of subjects, and reliability of
test measures are important to improve control and reduce bias.
BExtraneous variables in complex settings can influence scores on the dependent variable.
CDouble-blind data collection, random assignment of subjects, and reliability of
test measures are important to improve control and reduce bias.
DOne way to reduce the effect of extraneous variables is to train a small
number of staff to administer the intervention to improve consistency.
• A researcher reviews demographic characteristics of potential study subjects,

such as age and gender, to determine whether these characteristics may
influence the outcome of the study. This is done to help ensure:
a.construc
t validity.
b.external
validity.
c.internal
validity.
CORRECT ANSWER: C
Feedback

• An important measure to decrease threats to internal validity in an
experimental study is to: a.apply the intervention consistently.
• improve the precision of measurement methods.
• increase the sample size.
d.randomly assign subjects to study groups.
CORRECT ANSWER: D
Feedback
AConsistent application of the intervention and improved precision of
measurements help minimize threats to statistical conclusion validity.
BConsistent application of the intervention and improved precision of
measurements help minimize threats to statistical conclusion validity.
CIncreasing sample size minimizes threats to external validity.
DAn important threat to internal validity is any concern about subject selection and
assignment to groups. Randomly assigning subjects to treatment and control groups
helps to minimize this threat.
• Which action will the researcher take to improve construct validity?
a.Allow data collectors to know which subjects are assigned to

which groups b.Ensure that operational definitions reflect
theoretical constructs
c.Make sure that the researcher is involved in data
collection d.Utilize only one measurement method to
measure study variables
CORRECT ANSWER: B
Feedback
AAllowing data collectors to know which subjects are assigned to which groups
and involving the researcher in data collection both increase the risk of bias.
B Construct validity depends on adequate definition and measurement of

constructs. The conceptual definition should emerge from the concept analysis and
the operational definition should clearly reflect both.
C Allowing data collectors to know which subjects are assigned to which groups
and involving the researcher in data collection both increase the risk of bias.
D Using only one measurement tool increases the risk of mono-
operation bias. PTS: 1 DIF: Cognitive level: Analyzing REF: dm. 225
• A researcher wishes to study the effects of effective sleep hygiene on sleep
quality and behavior among children diagnosed with attention deficit disorder.
To minimize mono-operation bias, the researcher will:
a.accurately describe conceptual and operational
definitions. b.adequately discuss construct validity
in the introduction. c.evaluate multiple sleep
hygiene techniques.
d.utilize a double-blind data collection methodology.
CORRECT ANSWER: C
Feedback
A Construct validity is improved with adequate description of conceptual
and operational definitions.
B Construct validity is improved with adequate description of conceptual
and operational definitions.
C Mono-operation bias occurs when only one method of measurement is used to
assess a construct and can be minimized with the use of multiple measures.
D Use of double-blind data collection methods helps to minimize bias.
PTS: 1 DIF: Cognitive level: Analyzing REF: dm. 225|dm. 228
• Multiple replications of an initial study conducted in different populations

produce findings that do not match those in the initial study. The initial study
may lack which type of validity?
a.Construc
t validity
b.External
validity
c.Internal validity
d.Statistical conclusion validity
CORRECT ANSWER: B
Feedback
• In order to increase participation among potential subjects of a larger

population, the researcher will:
a.limit the time and effort required to participate in the study.
b.provide demographic information about those who refuse to
participate. c.provide instruments that are detailed to increase the
amount of data collected. d.offer potential subjects a financial
incentive to participate in the study.
CORRECT ANSWER: A
Feedback
ALimiting the investment demands on subjects helps to improve participation.
BProviding demographic information about those who do not participate is an
important part of the discussion of limitations of a study but does not ensure
generalization to a larger population.
CDetailed instruments may be time consuming and may limit participation to a
small sample size.
DOffering financial incentives does not ensure a sample that is representative
of the larger population.
• In order to attribute causality of a posttest measure in an experimental study, the

independent variable will be:
a.administered to control group subjects
only. b.administered to subjects selected by
the researcher. c.administered to treatment
group subjects. d.defined loosely to avoid
bias.
CORRECT ANSWER: C
Feedback
AThe independent variable is administered to the treatment group and not the control group.
BSelection of subjects by the researcher increases the likelihood of bias.
CTo improve determinations of causality, the independent variable should be
administered consistently to all subjects in the treatment group.
DThe independent variable should be precisely
defined. PTS: 1 DIF: Cognitive level: Applying
REF: pp. 229-230
• In a study to examine the effects of a newly modified anxiety-reducing
nursing action on a group of subjects who have cancer, the control group will
receive:
a.an alternative
intervention. b.no
intervention.
c.the newly modified
intervention. d.the
standard intervention.
CORRECT ANSWER: D
Feedback
AAn alternative intervention would invite comparison, but if it is new, it
would also be experimental.
BOffering no intervention is often unethical.
CGiving the newly modified intervention would not create a difference between the
treatment and the control groups.
DIn many nursing studies, offering no intervention (when one exists) to subjects in
the control group is considered unethical. Subjects in this group generally receive the
standard intervention as a comparison to those in the treatment group.
• In a quasi-experimental study design, the group that receives standard care is

usually referred to as the:
a.compariso
n group.
b.control
group.
c.experimen
tal group.
d.treatment
group.
CORRECT ANSWER: A
Feedback
AIn a quasi-experimental study, the group that does not receive treatment is usually
referred to as the comparison group.
BSubjects not receiving treatment in an experimental group are generally referred to as the
control group.
CGroups that receive the intervention in either type of study are referred to as experimental or
treatment groups.
DGroups that receive the intervention in either type of study are referred to as experimental or
treatment groups.
• In a quasi-experimental study using a convenience sample of subjects from a

local high school, the researcher asks potential subjects to volunteer for
placement in either a low sugar diet program or a regular sugar diet program.
This technique for assigning participation may compromise:
a.construc
t validity.
b.external
validity.
c.internal
validity.
CORRECT ANSWER: C
Feedback
Chapter 6 Correlational Research

MULTIPLE CHOICE
• In addition to the aim or goal of the study, the purpose statement for a
qualitative study should include The phenomenon of interest, the population,
and the
• Setting
• Rationale for conducting the study
• Theoretical framework used
• Hypothesis
CORRECT ANSWER: A
The purpose statement for a qualitative study should include the phenomenon and
population being studied and the setting. The rationale for conducting the study is not
included in the purpose statement for qualitative research. The theoretical framework
used is not a part of the purpose statement. Qualitative studies do not use hypothesis
statements since stating expected outcomes and relationships are not consistent with
the philosophical orientation of this approach. Instead, research questions or
objectives are used.
DIF: Cognitive Level: Comprehension REF: dm. 266
• In contrast to quantitative research study participants who are selected to be as

representative of a population as possible, qualitative research participants are
selected because they
• Are philosophically attuned to the use of narratives and

narrative analysis as the best means to convey their
experience to the researcher and to others
• Meet the requirements for involvement in the study that the
researcher specified at the outset of the studys
implementation
• Also are representative of the population
• Have experienced the phenomenon of interest
CORRECT ANSWER: D
The criterion for selecting participants for a qualitative study is that they have
experienced the phenomenon of interest. The participants view of the value of
narrative research and analysis is not the reason that study participants in a qualitative
study are selected. In qualitative methodology, the method of sampling may differ as
the study progresses, since the researcher may be led to interview a broader range of
subjects than originally intended by what early participants relate. Although
representativeness of the sample, especially through random
sampling, is important to external validity (that is, the extent to which the samples
findings can be applied to the population) for quantitative methods, it is not a
characteristic of qualitative research.
• All of the following statements related to sample size are true

characteristics of qualitative methodology except for which of the
following?
• The criterion of theoretical sufficiency is used to determine

when the sample size is adequate.
• Samples used in qualitative research are typically
much smaller than in quantitative research.
• The criterion of data saturation is used to determine
when the sample size is adequate.
• When asked to indicate in an institutional review board (IRB)
proposal how large the sample will be, the qualitative
researcher should indicate between 25 and 50 subjects to
capture an adequate sample.
CORRECT ANSWER: D
The text authors recommended including a projected sample size of 12 to 25

participants when submitting a study for IRB approval. The criterion of theoretical
sufficiency has been proposed as a means for determining when the sample size is
adequate. This refers to the process where data are collected until the research
question can be adequately addressed. It contrasts with the more established term data
saturation as a criterion to determine when the sample size is adequate, and is
preferred by some researchers who believe that it is more appropriate because one can
never completely know (or be saturated with) all there is to know about a topic.
Samples for qualitative research studies are notably smaller than samples used in
quantitative studies.
Data saturation, or gathering data to the point where one is no longer learning new
information about the phenomenon, is a term used to determine when the sample
size is adequate.
DIF: Cognitive Level: Analysis REF: dm. 268
• The qualitative researchers awareness of personal biases and past

experiences that might influence his or her responses to participants or their
data so that the data can be honestly and intellectually analyzed is termed
• An etic view
• Reflexivity
• A co-constructive process
• An emic view
CORRECT ANSWER: B
Reflexivity is the term used to describe the researchers awareness of personal biases and
past experiences that might influence how he or she responds to the participants and
analyzes data in an intellectually honest way. An etic view is one that reflects the
outsiders perspective and tends to occur when the qualitative interviewer is not careful
about establishing a relationship characterized by openness and trust. As a result, the
view of the phenomenon obtained by the interviewer is an outsiders perspective. The
co-constructive process is a term used to describe the mutual influence the qualitative
researcher and the study participant have on one another in generating findings. An
emic view is the perspective of the participant. Qualitative interviewers should interact
with the participants in a way that is open, fosters trust, and encourages the emic (or
participants) view to emerge.
• Probing is a strategy used in interviews to
• Make it clear that the interviewer is in charge.

• Limit the range of responses.
• Elicit more information in a specific area.
• Ensure a variety of interpretations of the question by different subjects.
CORRECT ANSWER: C
In probing, the interviewer asks participants to elaborate further on a topic through the
use of non-threatening but thought-provoking questions. Although the questions are
controlled by the researcher, the interviewer needs to establish a permissive atmosphere
where the participant is encouraged to respond fully and honestly to the questions
asked. Verbally or non-verbally asserting that the interviewer is in charge hinders this
process. Structured questions may limit the range of responses given by participants,
but this is not the purpose of probing. Ensuring a variety of interpretations of the
question by different subjects is not the purpose of probing.
Interview questions should be designed so that each subjects interpretation of the
question is as consistent as possible while still encouraging the respondent to answer
fully and honestly.
• A clinical nurse at a large urban hospital has decided to conduct a descriptive

qualitative study related to staff nurses perceptions of the causes of various
types of violence against nurses in their facility. As part of his research design,
he hosts a series of focus groups with staff nurses during each of three shifts.
What is considered the main advantage of using a focus group strategy as
opposed to one-on-one interviews for data collection?
• Individuals who are alike on some characteristic are more

likely to feel safer or less anxious expressing their views,
especially with difficult experiences, when participating in
a focus group rather than in a one-on-one interview.
• Focus groups allow the researcher to gather a lot of information in a short time.
• Focus groups require less planning than one-on-one
interviews do, because interviewers should talk little
and listen more.
• It is more efficient and less expensive to transcribe one
interview with several participants rather than to
transcribe several individual interviews.
CORRECT ANSWER: A
The assumption underlying focus groups is that in settings that are permissive and
non- threatening, participants are more likely to express and to clarify their views than
they would be in individual interviews, especially for sensitive topics. This allows for
richer data collection.
Focus groups often generate a great deal of information from the participants perspectives and do
so in a short period of time, but this is not the primary advantage of using this data collection
strategy. Conducting a focus group involves a great deal of advance planning to ensure that the
interviewer asks relevant questions in a way that is non-intrusive, non-threatening, and

safe. Both one-on-one and focus group interviews require careful planning.
Transcribing tapes from both individual and group interviews can be time-consuming
and challenging. This, however, is not the primary reason to conduct a focus group
about the phenomena of interest instead of a one-on- one interview.
DIF: Cognitive Level: Application REF: dm. 269
• What is the typical size and duration of a focus group interview?
• 4 to 12 participants; 3 1/2 hours

• 3 participants; 30 minutes
• At least 12 participants; 3 hours
• 4 to 12 participants; 45 to 90 minutes
CORRECT ANSWER: D
Involving 4 to 12 participants in a discussion that lasts 45 to 90 minutes is typical for

focus groups. Four to 12 participants is considered an appropriate size for a focus group,
although 3 1/2 hours is longer than the typical focus group runs. Three participants is
smaller than the typical number of participants, and a half-hour is less time than is
needed to generate a rich discussion of the phenomenon of interest. Involving more than
12 participants in a focus group may limit hearing the perspective of less vocal
members of the group and can be unwieldy. In addition, 3 hours is longer than typical
focus groups last.
DIF: Cognitive Level: Knowledge REF: dm. 278
• If a researcher decides to transcribe a recorded one-hour interview or focus

group in order to better understand her data, she might need to spend up to
how much time creating a verbatim transcript?
• 1 hour
• 2 hours
• 4 hours
• 6 hours
CORRECT ANSWER: D
Verbatim transcription of a 1-hour interview or focus group may require up to

6 hours. DIF: Cognitive Level: Application REF: dm. 278
• The role of the facilitator involves all of the following except to
• Encourage group members to go beyond the current
discussion or debate to encourage sharing of
perspectives.
• Instruct participants that all points of view are valid and
helpful and to not ask speakers to defend their positions.
• Prepare for the facilitation experience by developing a few
preconceived ideas about the topic in order to direct the
discussion most effectively.
• Reflect on inconsistencies among the views of
participants and with their own thinking.
CORRECT ANSWER: C
Facilitators should prepare themselves to be effective moderators of the discussion, but

to not develop preconceived ideas about the topic as this may hinder their ability to
hear the perspectives of the group members. Encouraging group members to stretch
their thinking and to share their perspectives is the role of an effective facilitator. It is
important to instruct group members at the outset of the meeting that all views are
valid and helpful to the researcher in understanding the topic. Once rapport is
established with the group, one of the facilitators roles is to reflect on inconsistencies
among the participants and in their own thinking to challenge ideas and increase group
interaction.
DIF: Cognitive Level: Synthesis REF: dm. 275
• A researcher is interested in studying the experiences of gay (G), lesbian (L), and
transgender
• youth in the middle school setting. With parental consent and the students
assent to participate, she provided a group of 12 students with disposable
digital cameras and had them each take 15 photos that illustrate their
experiences, both positive and negative, as a GLT
adolescent. The researcher then developed the photos and asked participants to discuss
what they documented. This is an example of what type of qualitative data collection
technique?
• Thick description
• Photovoice or photo novella
• Participatory research
• Data immersion
CORRECT ANSWER: B
Photovoice (or photo novella) is a technique for gathering data from participants that
reflect their individual perspectives of a phenomenon. This strategy involves asking
individuals to record their experiences and perceptions with photos that are then
analyzed for meaning with input from participants. Thick description is a term used to
describe a richness and depth of information gathered from effective qualitative
interviews. Involving study participants in collecting data via taking digital
photographs would be a participatory strategy but is not specific term for this
technique. Data immersion is a term commonly used to describe the researchers
experience of being immersed and fully invested in reading and thinking about the
data.
• The primary disadvantage to the use of Internet-based data collection is that
• It can be difficult to obtain consent.

• It limits the sample to those who can read and write, use
computers, and have Internet access.
• It can only be used with quantitative research methods.
• The subject pool tends to be limited.
CORRECT ANSWER: B
The main disadvantage of Internet-based data collection has to do with sampling those
who are able to read and write, are computer-literate, and who have Internet access.
Thus, the poorly educated, elderly, disabled, or disadvantaged may be underrepresented.
Researchers who conduct
Internet-based research are often able to obtain consent by noting a statement like
Completion and submission of the survey implies consent. Data can be effectively
collected for a qualitative study using the Internet. Although there are some sampling
limitations in terms of certain populations, the subject pool in general tends to be
very large given the extensiveness of the online community not limited by geographic
space.
• In addition to sample bias and ethical issues (e.g., securing consent, assuring
anonymity, and protecting site security), a third concern about factors that may
affect the credibility of Internet- mediated study findings is
• The interviewers ability to establish rapport with study participants
• The fact that use of a pseudonym might cause
participants to make up information about the
phenomenon
• The researchers ability to transcribe the data gathered through online interviews
• Reliability and validity of data, although terms most often
applied to quantitative research, might be an issue since the
researcher cant verify whether or not participants meet
inclusion criteria for the study
CORRECT ANSWER: D
Not being able to ensure that participants meet inclusion criteria and being unable to
control distractions during data collection are the biggest threats to the validity and
reliability of the research findings gathered by Internet-mediated data collection. A
skilled and personable interviewer may be able to establish good rapport and to
effectively conduct online interviews with study participants. Use of a pseudonym,
as well as site controls, helps ensure that participants identities are not made public.
Plans to carefully capture interviews digitally, note- taking, and careful data
transcription minimize problems with transcription of data.
Chapter 7 Experimental Research

MULTIPLE CHOICE
• The goal of appropriate sampling in research is to:
a.accurately reflect the characteristics of the target

population. b.completely define the traits of the
accessible population. c.identify all attributes of the
sample population.
d.study an entire population.
CORRECT ANSWER: A
Feedback
ASampling involves selecting a group of people, events, behaviors, or other
elements with which to conduct a study. Samples are expected to represent a target
population of subjects who meet eligibility criteria for inclusion in the study.
BThe accessible population are those people who are available for participation in
the study. The accessible population may not be representative of the target
population.
CThe aim of sampling is to represent the target population, not to merely identify
characteristics of the sample population.
DThe goal of sampling is to study a representative sample of the larger
population on which conclusions about the larger population may be drawn.
• A researcher wishes to evaluate the management of chemotherapy side effects

in children with acute lymphocytic leukemia (ALL). Children with ALL are an
example of which of the following?
a. Accessible population
b.Element of the
population
c.Sample
population
d.Target
population
CORRECT ANSWER: D
Feedback
A The accessible population is that portion of the entire population that the
researcher can actually use.
B An element is an individual unit in a study.
C A sample is a subset of the population that represents that population.
D The target population is the entire set of individuals who meet the sampling
criteria. PTS: 1 DIF: Cognitive level: Applying REF: dm. 249
• A researcher wishes to conduct a survey of attitudes about illness among
young adults with cystic fibrosis. The researcher contacts a nearby regional
medical cystic fibrosis clinic, where 250 young adults who have cystic
fibrosis are seen. A group of 50 young adults are selected to complete the
survey. These 50 people are the:
a.accessible
population.
b.elements of the
population.
c.sample
population.
d.target population.
CORRECT
ANSWER: C
Feedback
A The accessible population is that portion of the entire population that the
researcher can actually use, which, in this case, would be the 250 patients at this
medical center.
B An element is an individual unit of a study population.
C A sample is that group of people who are representing the entire population and
participating in the study. Samples are expected to represent an entire population.
• A researcher wishes to conduct a study to determine the effects of an
intervention on high school students. In this study, high school students
represent the:
a.accessible
population.
b.elements of the
population
c.sample
population
d.target
population
.
CORRECT ANSWER: D
Feedback
A An accessible population is the portion of the target population to which the
researcher has reasonable access.
B An element is an individual unit of a study population.
C A sample is that group of people who are representing the entire population and
participating in the study. Samples are expected to represent an entire population.
• A researcher wishes to study the effects of a nursing intervention on children
with cancer and obtains a sample of school-age children hospitalized for cancer
treatment in a local hospital. This sample represents the:
a.accessible
population.
b.general
population
c.target
population.
d.theoretical
population.
CORRECT ANSWER: A
Feedback
AAn accessible population is the portion of the target population to which the
researcher has reasonable access. The sample is obtained from the accessible
population.
BA general population is the population as a whole, not just those meeting eligibility criteria.
CThe target population is the entire set of individuals who meet the sampling criteria.
DThe theoretical population is the same as the target population, which is the
entire set of individuals who meet the sampling criteria.
PTS: 1 DIF: Cognitive level: Understanding REF: dm. 250
• In a study of patients who have dementia, a researcher wishes to examine the

effects of moderate exercise on patients abilities to perform self-care. The
researcher decides to use subjects between 70 and 80 years of age who have
been diagnosed with dementia for less than 1 year. A patient who is 65 years
old meets:
a. eligibility criteria.
b.exclusio
n criteria.
c.inclusio
n criteria.
d.samplin
g criteria.
CORRECT ANSWER: B
Feedback
AInclusion criteria, eligibility criteria, and sampling criteria are those
characteristics that the subject or element must possess to be part of the target
population.
BExclusion criteria are characteristics that the researcher does not want in the
elements or subjects of the study.
CInclusion criteria, eligibility criteria, and sampling criteria are those
population.
DInclusion criteria, eligibility criteria, and sampling criteria are those
population.

• The benefit to using a sample that utilizesnarrow sampling criteria is that
there is increased: a.control of extraneous variables.
b.genera
lizability
.
c.hetero
genicity.
d.range of values and scores.
CORRECT ANSWER: A
Feedback
A A sample that is narrowly defined is more homogeneous and has greater control
of extraneous variables.
B The more narrow the sample, the less generalizable it is.
C A narrow sample is homogeneous, not heterogeneous.
D A narrow sample will have a smaller range of values
and scores. PTS: 1 DIF: Cognitive level: Understanding
REF: dm. 251
• A researcher uses a sample whose members have characteristics similar
to those of the population from which it is drawn. This is an example of
a:
a.cluster
sample.
b.purposive
sample.
c.random
sample.
d.representativ
e sample.
CORRECT ANSWER: D
Feedback
AKnowing a sample is a cluster sample tells how it was created but does not
define a representative sample. Representativeness means that the sample,
accessible population, and target population are alike in as many ways as
possible.
BKnowing a sample is a purposive sample tells how it was created but does not
possible.
CKnowing a sample is a random sample tells how it was created but does not
possible.
DRepresentativeness means that the sample, accessible population, and target
populations are alike in as many ways as possible.
• A researcher begins a study with 250 subjects, and 50 subjects drop out
before the study is concluded. The researcher will declare 20% as the
sample:
a.accept
ance
rate.
b.attritio
n rate.
c.refusal
rate.
d.retenti
on rate.
CORRECT ANSWER: B
Feedback
AThe acceptance rate is the percentage of subjects who meet eligibility
requirements who consent to participate.
BThe sample attrition rate is the percentage of subjects who withdraw from a
study after the study has begun.
CThe refusal rate is the percentage of subjects who meet eligibility requirements
who refuse to participate.
DThe retention rate is the percentage of subjects who remain in the study after the
study has begun.
• A pilot study reveals a wide variation in measurement values among subjects

with an overall mean value that is higher than among the general population.
By increasing the sample size in a subsequent study, the researcher expects to:
a.decrease the variation of scores among

subjects. b.increase the variation of scores
among subjects. c.decrease the mean value
of scores among subjects. d.increase the
mean value of scores among subjects.
CORRECT ANSWER: A
Feedback
AThe random variation of scores is the expected difference in values that occurs
when different subjects from the same sample are examined. As sample size is
increased, this variation decreases.
BThe random variation of scores is the expected difference in values that occurs
when different subjects from the same sample are examined. As sample size is
increased, this variation decreases.
CThe systematic variation is related to selecting subjects whose measurement
values differ from those of the population. Increasing the sample size has no effect
on mean scores.
DThe systematic variation is related to selecting subjects whose measurement
values differ from those of the population. Increasing the sample size has no effect
on mean scores.
• To decrease the probability of systematic variation in a study to evaluate

the effects of a teaching program on disease management, the researcher
will use which sampling process?
a.Cluster
sampling
b.Convenience
sampling
c.Random
sampling
d.Systematic
sampling
CORRECT ANSWER: C
Feedback
ACluster, convenience, and systematic sampling increase the risk that the sample
population has attributes that differ from the general population.
BCluster, convenience, and systematic sampling increase the risk that the sample
CRandom sampling decreases the probability of systematic bias.
DCluster, convenience, and systematic sampling increase the risk that the sample
PTS: 1 DIF: Cognitive level: Comprehension REF: pp. 252-254
• A researcher wishes to identify all school-age children who have type 2 diabetes
mellitus in a local community in order to develop a sampling methodology for a
study of this population. Which might serve as a barrier to obtaining this
information?
a.Affordable Care Act (ACA)
b.Consolidated Omnibus Budget Reconciliation Act
(COBRA) c.Health Insurance Portability and
Accountability Act (HIPAA) d.Institutional Review
Board (IRB)
CORRECT ANSWER: C
Feedback
A The ACA does not address the sharing of patient information.
B COBRA is concerned with health care coverage after termination of coverage.
C HIPAA contains guidelines about sharing patient information and may serve as a
barrier to obtaining names of potential subjects.
D IRBs govern the use of human subjects in research.
• A researcher enters a list of subject from a sampling frame into a computer and
the computer randomly assigns subjects to control or treatment groups. This is
an example of:
a.cluster
sampling.
b.simple random
sampling.
c.stratified random
sampling.
d.systematic
sampling.
CORRECT ANSWER: B
Feedback
ACluster sampling occurs when the researcher selects subjects from groups of
subjects within the larger population, as with groups from specific regions or cities.
BSimple random sampling is the most basic of the probability sampling plans and is
achieved by randomly selecting elements from the sampling frame. It can be done
by computer, as in this case.
CStratified random sampling occurs by ensuring that the proportions of
characteristics among the population are represented in both the control and
experimental groups.
DSystematic sampling is used when an ordered list of all members of the population is
available and involves selecting every kth individual on the list.
• A researcher who wishes to study the effects of a prenatal breastfeeding

education program on the length of time African-American inner-city women
breastfeed infants learns that 70% of women in the target population are
unmarried. To achieve stratified random sampling in a sample of 50 subjects,
the researcher will:
a.conduct the study using unmarried subjects only.
b.randomly assign all subjects to control versus
experimental groups. c.select a random sample of 35
unmarried and 15 married subjects. d.select 25 subjects
who are married and 25 who are not married.
CORRECT ANSWER: C
Feedback
AUsing only married subjects makes the results ungeneralizable to unmarried subjects.
BRandomly assigning subjects without stratification does not make the groups representative.
CStratified random sampling is used when the researcher knows some of the
variables in the population that are critical for achieving representativeness, such as
marital status. In this case, subjects are randomly selected, but stratification by
marital status to match the target population proportions helps to improve
generalizability of the findings.
DHaving equal numbers from each group is possible as long as subjects are
randomly assigned and not selected.

• When using stratified random sampling, the
researcher is able to: a.achieve greater control over
subject selection.
b.avoid discussion of the effects of extraneous
variables. c.lower the costs associated with
sampling.
d.use a smaller sample size.
CORRECT ANSWER: D
Feedback
AThe researcher does not achieve greater control of subject selection, since
random selection is still used.
BDiscussion of extraneous variables should always occur, even with stratified
random sampling techniques.
CThere is no guarantee that costs will be less with this type of sampling technique.
DWith stratification, the researcher can use a smaller sample size and achieve the
same degree of representativeness in relation to the stratified variable as a large
sample acquired through simple random sampling.
• When conducting a study in which it is not possible to determine the true

number of subjects who meet eligibility criteria and obtaining a random sample
would be time consuming and expensive, the researcher will use which
sampling method?
a.Cluster
sampling
b.Simple random
sampling
c.Stratified random
sampling
d.Systematic
sampling
CORRECT ANSWER: A
Feedback
ACluster sampling is often used when the researcher is unable to identify the
individual elements making up the population and when obtaining a random sample
is time consuming or expensive.
BSimple random sampling is the most basic random sampling technique and is
usually used when the population is clearly identifiable.
CStratified random sampling is used when the researcher knows some of the
variables in the population that are critical for achieving representativeness.
DSystematic sampling is used when an ordered list of all members of the
population is available and involves selecting every kth individual on the list.
PTS: 1 DIF: Cognitive level: Remembering REF: dm. 261
• A researcher plans to utilize a systematic random sampling method from a

population of 5000 eligible subjects, using a sample of 200 subjects. Beginning
at a randomly selected point on the list of subjects, what is the gap between
elements?
a.25 b.50 c.100 d.200
CORRECT
ANSWER: A
Feedback
AIn systematic sampling, the researcher selects every kth individual on a list,
beginning at a randomly selected starting point. The population size is divided by
the desired sample size to give the gap between elements. 5000/200 = 25
BA gap of 50 between elements would be correct for a sample size of 100 subjects.
C A gap of 100 between elements would be correct for a sample size of 50 subjects.
D A gap of 200 between elements would be correct for a sample size of 25
subjects. PTS: 1 DIF: Cognitive level: Applying REF: dm. 262
• A researcher conducts a pilot study using a convenience sample of children
with seizure disorders. A reviewer of this studys manuscript may conclude
that the findings of this study:
a.are generalizable to most children with
seizures. b.have little credibility; they
are extremely biased. c.provide no useful
information.
d.should be replicated using a wider population.
CORRECT ANSWER: D
Feedback
AIn a convenience sample, representativeness of the sample is a concern, and
generalizability is therefore limited.
BNot all studies with a convenience sample are more biased than studies with
other sampling methods.
CIntervention studies with a convenience sample can certainly provide useful
information, even though further testing might be needed to be able to apply the
findings to a large population.
DRepresentativeness of the sample is a concern in convenience sampling, and
generalizability is therefore limited.
• Which statement is true about systematic sampling?
a.A nonrandom starting point is used when selecting

subjects. b.It can be used when the desired sample size
is unknown.
c.It provides a random chance for inclusion as a
subject. d.Subjects have an equal chance for inclusion
in the study.
CORRECT ANSWER: C
Feedback
A A random starting point is used in this type of sampling.
B Systematic sampling is used when the desired sample size is known.
C Systematic sampling provides a random but not equal chance for inclusion.
D Subjects do not have an equal chance for
inclusion. PTS: 1 DIF: Cognitive level:
Understanding REF: dm. 262
Chapter 8 Cohort Research

MULTIPLE CHOICE
• Planning as a step in the quantitative research process ends when the data
collection has begun. Which is the true statement about planning in the
qualitative research process?
• Since sample size is not usually decided upon ahead of time,

there is no practical reward to planning the qualitative
research study ahead of time.
• There is no planning in the qualitative research process; it
all emanates from the data collected.
• Everything about a qualitative study is planned ahead of
time, except for analysis of the data.
• The researcher may adapt strategies for data collection or
analysis well into the study.
CORRECT ANSWER: D
A data collection plan details how the researcher will implement the study. The plan
for collecting data is specific to the study being conducted and requires that the
researcher consider some of the more common elements of research, mapping out
procedures ahead of time. This extensive planning increases the accuracy of the data
collected and the validity of the study findings. In qualitative methods, however, the
researcher may adapt the data collection or analysis strategies during the study.
• What is the general rule about collecting demographic data during an interview?
• The mood of the qualitative interview, so crucial to quality

data capture, may be intruded upon by demographic data
collection.
• In quantitative interviews, everything excerpted from
medical records must again be verified in face interviews.
• In qualitative interviews, routinely asking twenty or thirty
demographic questions sets the stage for actual data
collection.
• If data can be obtained in other ways, leave the valuable
interview time for actual interviewing.
CORRECT ANSWER: D
The researcher should consider the importance of each piece of datum and the
subjects time required to collect it. If the data can be obtained from patient records or
any other written sources, the researcher does not need to ask the subject to provide
this information. To collect data from a patients records, the researcher must make
sure to include the intent to do so in the consent form and ensure that the institutional
review board has authorized the team to do this. The qualitative researcher has the
power to shape the interview agenda. Participants have the power to choose the level
of responses they will provide. The researcher might begin the interview by asking a
broad question such as Describe for me your experience with or Tell me about.
Ideally, the participant will respond as though she or he is telling a story. The
researcher responds nonverbally with a nod or eye contact to convey interest in what
is being said, and tries to avoid agreeing or disagreeing with what the participant is
saying. The less the researcher says, the better.
• A researcher is collecting data in a hospital during cardiopulmonary

resuscitation. The researcher has devised a data collection form that contains
five columns for data entry. During the first three data collection periods, the
form works reasonably well, although the researcher has to turn the dm. over
and write on the back. During the fourth, however, the CPR incident occurs
in the emergency department and includes many procedures and
interventions, and the
researcher ends up taking a blank piece of paper and recording data on that. Later, it takes him 40
minutes to unscramble and collate the data and record it properly. What must be done now?
• The researcher will go back to the institutional

review board and request permission to use a
different form.
• The researcher will design a new form, with the
assumption that the next CPR incident will be just as
complex as the last was.
• The researcher will continue to use the old form, writing on
the back when necessary, and pulling out blank pieces of
paper, from time to time, for additional data recording.
• The researcher will decrease the amount of data necessary
to record by revising the old study protocol, so that fewer
research questions are asked.
CORRECT ANSWER: B
Before data collection begins, the researcher develops or adapts forms on which to
record data. These forms can be used to record demographic data, information from the
patient record, observations, or values from physiological measures. The researcher also
might need to collect other data that may be extraneous or confounding variables such
as the subjects physician, stage of illness, length of illness or hospitalization,
complications, date of data collection, time of day and day of week of data collection,
and any untoward events that occur during the data collection period. Data collection
forms must be designed so that the data are easily recorded. If a form isnt working,
design a better form. Data collection forms themselves do not need institutional review
board (IRB) approvalthe information to be collected is what the IRB approves.
• The quantitative researcher collects many pieces of quantitative data as

words, not numbers. Prior to statistical analysis, all of the data pieces must be
coded. What does this mean?
• The data are transformed into numerals corresponding to

words, such as 0no college degree, 1bachelors degree,
2masters degree, 3PhD or EdD.
• The essence of each word is noted; later, these essences emerge as themes.
• The data are typed into a computer, and the computer is
instructed to transform the words into binary values, using
only 0 and 1, by adding up the numbers of each letter in
the alphabet.
• The data regarding protected data are transformed to code

names; a list is made and kept in a secure location.
CORRECT ANSWER: A
Coding is the process of transforming language data into numerical symbols that can be
entered easily into the computer. For example, variables such as race, gender, ethnicity,
and diagnoses can be categorized and given numerical labels. For gender, the male
category could be identified by a 1 and the female category by a 2. The coding
categories developed for the research must be both mutually exclusive and mutually
exhaustive so, with respect to the latter, inclusion of 3decline to state and 4none of the
above might be useful.
• A nurse is conducting her masters thesis research in the unit in which she
works as a staff nurse. The focus of her thesis is burned childrens pain, with
versus without a child life specialist assisting the child. She is providing child
life specialist presence every other day at the mid- morning dressing change.
For obvious reasons, she wants to keep everything else consistent for the four
contiguous days of data collection. On the second day of four, with the child
life specialist present, one child demonstrates poor pain control. The nurse
researcher would ordinarily advocate for more pain medication for this child,
but if she does, she will not be able to compare the data with that of the
previous day. This is an example of which of the following?
• Serendipity
• Subject as object
• Role conflict
• Passive resistance
CORRECT ANSWER: C
As a researcher, one is observing and recording events. Nurses who conduct clinical
research often experience a conflict between their researcher role and their clinician
role during data collection. In some cases, the researchers involvement in the event,
such as providing physical or emotional care to a patient during data collection, could
alter the event and thus bias the results. It would be difficult to generalize the findings
to other situations in which the researcher was not
present to intervene. However, the needs of patients must take precedence over the
needs of the study.
MULTIPLE RESPONSE
• A researcher intends to collect data, including patients ratings of pain and

anxiety, during a procedure. No electrical equipment or photography may be
used in the procedure room. In order to record the various pain and anxiety
ratings, the researcher may plan to use which of the following? (Select all that
apply.)
• A plug-in word processor

• A form with large margins, or a column for comments, or both
• A pencil with an eraser
• A form with pre-labeled columns and rows
• A cell phone with camera
CORRECT ANSWER: B, C, D
Before data collection begins, the researcher develops or adapts forms on which to
record data. These forms can be used to record demographic data, information from
the patient record, observations, or values from physiological measures. The
researcher also might need to collect other data that may be extraneous or confounding
variables such as the subjects physician, stage of illness, length of illness or
hospitalization, complications, date of data collection, time of day and day of week of
data collection, and any untoward events that occur during the data collection period.
Data collection forms must be designed so that the data are easily recorded. Pencil and
paper are ideal, since they allow for erasure, in case the subject clarifies data.
• Part of a research study entails that research subjects complete a printed form
with checkboxes. The researcher decides ahead of time that any item that has
more than one response checked will be treated as unanswered. What are
logical ways the researcher can maximize properly answered items, without
skewing the data? (Select all that apply.)
• Make a rule that if there are two checked replies, only

the first one will be counted.
• When the researcher hands the form to the subjects, the
researcher should specify One answer and one answer only
for each these items, please, or I wont be able to include the
double-answered ones in my report.
• Glance at the forms as they are about to be handed in,
and if two boxes for an item are checked, ask the subject
to address this.
• In the printed instructions at the top of the form, be sure to
state that if a question has more than one response checked,
that item will be treated as unanswered.
• Eliminate from the entire study any subject who double-selects an item.
Decision rules for data entry should be finalized during the planning process. The
researcher must realize that any decision rule may skew the data. For example, if a
subject selects two responses for a single item, will the variable be coded as missing,
or does the researcher want to specify that the lowest or highest value should be
entered?
• A researcher is studying the way that ICU nurses prioritize the charting
responsibilities for their 12-hour shift. The researcher happens to discover that
nurses are administering medications as close to the ordered times as possible
but consistently charting the times at which medications are ordered, not the
time they are actually administered, even though that may be two or three hours
later. What could the researcher do with this information? (Select all that apply.)
• The researcher makes the nurse manager aware of the finding,

after the study data have all been collected, because this is
essentially a medication charting error.
• Nothing. This is not a focus of the study, and the information must be suppressed.
• The researcher takes time to educate individual nurses, so
that they understand that what they are doing is not honest.
• The researcher includes the findings in the article,
stating that this is a time- saving strategy, since the
computer allows charting of meds when ordered
(instead of when administered) as a block, saving time.
• The researcher reports this information under
Serendipitous Discoveries in the article that results from
the study.
CORRECT ANSWER: A, B, E
Serendipity is the accidental discovery of something useful or valuable. During the data
collection phase of studies, researchers often become aware of elements or relationships
that they had not previously identified. These aspects may be closely related to the study
being conducted or have little connection with it. They come from increased awareness
and close observation of the study situation. Because the researcher is focused on close
observation, other elements in the situation can come into clearer focus and take on new
meaning. Serendipitous findings are important to the development of new insights in
nursing theory. They can be important for understanding the totality of the phenomenon
being examined.
Educating individual nurses is sure to alienate staff. The manager is the logical choice
for a person in whom to confide this information. Obviously, this should be
communicated as, Some nurses rather than naming names, since the nurses privacy
would be violated by telling their names.
Chapter 9 Systematic Reviews

MULTIPLE CHOICE
• The goal of a critical appraisal should be to:
a.determine where faults exist in the study

design. b.evaluate whether a proposed study is
feasible. c.identify the meaning and credibility
of the study. d.review the credentials and
expertise of the researcher.
CORRECT ANSWER: C
Feedback
AIdentifying faults in the study design is part of a critical appraisal but not the end goal.
BReviewers conduct feasibility analyses prior to approval of a study.
CAn intellectual critical appraisal involves careful examination of all aspects of a
study to judge the strengths, weaknesses, meaning, credibility, and significance of a
study.
DEvaluating the researchers credentials is part of a critical appraisal but not the
end goal. PTS:1DIF:Cognitive level: Analyzing (Analysis)
REF: pp. 362-363
• When critically appraising a research study, the reviewer will
expect to find: a.identification of new research problems.
• implementation of a perfect
research design. c.precise
understanding of the real
world. d.tools to control
outcomes in nursing practice.
CORRECT ANSWER: A
Feedback
AGood scientific inquiry will likely include identification of additional problems.
BThere is no perfect research design. All studies have flaws.
CAlthough an improved understanding of the real world is realistic, no study will
lead to precise understandings of the real world.
DExperimental research strives to predict and control outcomes in practice, but
each study only leads to improvements in this ability.

• How do practicing nurses participate in critical appraisal of research?
a.B y adhering to evidence-based practice guidelines and best

practices b.By presenting findings from their own outcomes
research
c.By questioning the quality, credibility, and meaning of studies
d.By reading research journals to keep current in knowledge and practice
CORRECT ANSWER: C
Feedback
AUsing EBP guidelines and best practices are part of research translation but
are not part of critical appraisal.
BPresenting research findings and reading research journals are part of research
utilization but are not part of critical appraisal.
CIn order for critical appraisal to occur, nurses need to question the quality of
the studies, the credibility of the findings, and the meaning of the findings for
practice.
DPresenting research findings and reading research journals are part of research
utilization but are not part of critical appraisal.

• What will the reviewer do during the evaluation portion of a critical
appraisal of a research study?
a.Assess whether the measurement tools are consistent with the phenomena of
interest b.Determine whether the study findings are meaningful and should be
implemented in practice
• Discuss the statistical analysis of the studys findings including demographic

and experimental data
d.Review the components of the study to gain an overall understanding of the study report
CORRECT ANSWER: B
Feedback
AAnalysis involves identifying incongruence between the phenomenon of
interest and the measurement tool.
BDuring the evaluation of a critical appraisal, the reviewer determines the
credibility and meaning of a study and decides whether the findings are
relevant to practice.
CReviewing statistical data is part of the methodology review.
DThe reviewer reads through a study for comprehension to gain an overall
understanding at the beginning of the critique.

• When reading a research article in a refereed journal, the nurse researcher is
assured that the article:
a.describes a study
undergoing review. b.has
been previously published.
• is printed in abstract form only.
• is of high quality and standards.
CORRECT ANSWER: D
Feedback
AArticles published in refereed journals have already undergone review.
BRefereed journals contain new research not previously published.
CArticles published in refereed journals include abstracts as well as a full report of the study.
DJournals that are refereed are critically appraised by expert peer reviews and tend
to be of high quality.
• A reviewer is asked to critically appraise a report to help determine whether
funding will be allocated for a research study. This reviewer will be
appraising a research:
a.abstract
.
b.article.
c.literatur
e review.
d.proposa
l.
CORRECT ANSWER: D
Feedback
AAbstracts, articles, and literature reviews may all be critically appraised
when evaluating research study reports after the research has been conducted.
BAbstracts, articles, and literature reviews may all be critically appraised
CAbstracts, articles, and literature reviews may all be critically appraised
DCritical appraisals of research proposals are conducted to approve student
research projects, to permit data collection in institutions, and to select studies for
funding.

• What is the goal of an intellectual critical appraisal of a research study?
a.To determine whether a study should be

replicated b.To identify strengths and
weaknesses in a study
c.To determine whether a study should be implemented
into practice d.To weed out and discard studies that are
flawed
CORRECT ANSWER: B
Feedback
ADetermining whether a study should be replicated is not the goal of
intellectual critical appraisal.
BThe purpose of intellectual critical appraisal includes identifying strengths and
weaknesses in studies to help determine their credibility and meaning.
CDetermining whether a study should be implemented into practice is not the goal
of intellectual critical appraisal.
DMany studies are flawed, but this does not mean that they are useless and need to
be discarded. Flaws must be identified and discussed.

• How are study results utilized to develop evidence for practice?
a.Only evidence and data from strong studies

are used. b.Only quantitative studies are used to
build evidence
c.Strong points from multiple studies are used to build
evidence. d.Studies must be replicated successfully to
be used for evidence.
CORRECT ANSWER: C
Feedback
A Many flawed studies contain strong points that may be used to build evidence.
B Qualitative and quantitative studies are both used in evidence building.
C Adding together the strong points from multiple studies slowly builds a solid base of
evidence for practice.
D It is not necessary to replicate every study to use data for evidence.
REF: dm. 365
• What are the steps used to evaluate quantitative research studies?
a.Assess the study design, evaluate the sampling methods, and review the study
conclusions. b.Determine the study purpose, review the study data, and evaluate the
implications for further
research.
• Evaluate the study methods, validate the measurement tools, and
determine the quality of results.
• Identify the steps in the research process, determine the strengths and
weaknesses, and evaluate the credibility and meaning of the findings.
CORRECT ANSWER: D
Feedback
AAll of the other tasks listed are part of the process but do not represent the
three steps in evaluating quantitative research.
BAll of the other tasks listed are part of the process but do not represent the
CAll of the other tasks listed are part of the process but do not represent the
DThere are three steps in the quantitative research critical appraisal process:
identifying the steps of the research process in studies, determining study strengths
and weaknesses, and evaluating the credibility and meaning of the study findings.
REF: dm. 366
• When appraising the introduction section of a research study, what will the
reviewer look for?
a.Completeness and quality of the study
abstract b.Evaluation of a comprehensive
review of the literature c.Significance of the
research problem to practice d.Study purpose
and design
CORRECT ANSWER: A
Feedback
ADuring a critical appraisal, the reviewer will review the introduction and evaluate the
completeness of the study abstract along with the description of the qualifications of the study
authors and the clarity of the article title.
BThe literature review, the significance of the research problem to practice,
and the study purpose and design are not part of the introduction.
CThe literature review, the significance of the research problem to practice,
DThe literature review, the significance of the research problem to practice,

• What is important to assess when critically appraising a literature review?
• If previous studies support the research problem

• If textbooks are included in the
reference list c.What sources are
used to provide study funding
d.Whether relevant studies are
discussed
CORRECT ANSWER: D
Feedback
AIndividual studies do not necessarily support the research problem but are used to
show what is known and not known about a subject.
BTextbooks may be used, but refereed journals with current research are preferred.
CThe sources of funding for studies may be mentioned if relevant to study outcomes.
DThe literature review should evaluate whether relevant studies are discussed, if
the sources are current, whether the studies are critically appraised and synthesized
and if they are from refereed journals, and if a summary of current knowledge is
provided.

• An intellectual critical appraisal differs from other kinds of critiques because it:
a.focuses solely on the strengths of the study.

b.evaluates the quality and meaning of empirical
evidence. c.judges the researchers ability and
credentials.
d.regards both the work itself as well as the study author.
CORRECT ANSWER: B
Feedback
A An intellectual critical appraisal looks at both strengths and weaknesses equally.
B An intellectual critical appraisal is directed at the study and is used to determine credibility
and meaning.
C An intellectual critical appraisal is directed at the study, not the researcher.
D An intellectual critical appraisal is directed at the study, not the
researcher. PTS: 1 DIF: Cognitive level: Understanding
(Comprehension)
REF: dm. 365
• What will the reviewer assess when critically appraising a
study framework? a.How the variables and concepts are
evaluated and measured
b.What the research hypothesis is and how it was
developed c.Whether the literature review is
complete
d.Whether the study variables link to key concepts
CORRECT ANSWER: D
Feedback
AThe methodology is concerned with how variables are evaluated and
measured, but not necessarily how they link to the framework and concepts.
BThe research hypothesis is derived from the study purpose.
CThe framework critique is not concerned directly with the literature review.
DThe reviewer of a study should identify key concepts in the study framework and
then evaluate whether the key variables that will be measured link to those concepts.

• A reviewer is critically appraising a studys variables. What will the researcher evaluate?
a.Conceptual and operational definitions of variables

b.Relationships of demographic variables to key concepts in the study
framework c.Whether variables and key concepts are linked
d.Use of all types of variables, including independent, dependent, and research variables
CORRECT ANSWER: A
Feedback
A When appraising the study variables, the reviewer will note whether variables are
conceptually and operationally defined.
B It is not necessary to relate demographic variables to concepts.
C The evaluation of the link between variables and key concepts occurs during
appraisal of the study framework.
D Not all types of variables are included in all study
types. PTS: 1 DIF: Cognitive level: Understanding
• While critically appraising a study, a reviewer notes that the study includes an
intervention. What will the reviewer assess?
a.If the intervention is consistently implemented using a clearly described
protocol b.How the intervention is administered to each subject in the
study sample
• If the intervention is consistently administered to both experimental and
control subjects d.Whether the intervention has been used in prior studies
CORRECT ANSWER: A
Feedback
AWhen evaluating a study intervention, the reviewer should note whether the
intervention is clearly described with a protocol and consistently implemented.
BThe intervention should be administered in the same way to all members of the
experimental group only.
CThe intervention should be administered in the same way to all members of the
experimental group only.
DIt is not necessary to identify, at this stage of the critique, whether the
intervention has been used in previous studies.

• In which type of study design would a reviewer expect to find a discussion
of extraneous variables?
a.Eth
nogra
phic
b.Qua
litativ
e
c.Quasi-
experimenta
l
d.Phenomen
ological
CORRECT ANSWER: C
Feedback
AAn ethnographic study is not concerned with the effects of one variable on
another; therefore extraneous variables that may affect a variable are not usually
discussed.
BA qualitative study is not concerned with the effects of one variable on
another; therefore extraneous variables that may affect a variable are not
usually discussed.
CExtraneous variables are of most concern in experimental and quasi-
experimental studies in which the researcher seeks to learn the effect of an
independent variable on a dependent variable and must rule out the influence of
other variables.
DA phenomenological study is not concerned with the effects of one variable
on another; therefore extraneous variables that may affect a variable are not
usually discussed.

• A reviewer critically appraising a study about self-care behaviors of
adolescents who have cystic fibrosis evaluates comparisons of this sample to
those from studies of young adults with cystic fibrosis. This appraiser is
evaluating the:
a.credibility and meaning of the
study. b.framework and key
concepts of the study. c.limitations
of the study.
d.reliability and validity of the study.
CORRECT ANSWER: A
Feedback
A When evaluating the credibility and meaning of the study, the reviewer may
examine the relationships among the current study compared with those of
previous studies.
B The framework and key concepts are included in the evaluation of the study framework.
C The review of a studys limitations occurs when evaluating the study discussion
and conclusions.
D The reliability and validity are included in the evaluation of the study methods and
design. PTS:1DIF:Cognitive level: Applying (Application)
REF: dm. 374
• When assessing the conclusions, findings, and implications of a study, the
appraiser will: a.determine whether alternate hypotheses are possible.
b.ensure that results are not based on past research.
c.identify that findings are specific to the sample
population. d.refute the study if limitations are
identified.
CORRECT ANSWER: A
Feedback
A During this phase of study review, the critical appraiser will evaluate, based on
the study results, whether alternate hypotheses are possible.
B Results should be based on the study but may also build on other study findings as well.
C The appraiser should determine whether findings may be generalized to the larger population.
D Limitations should be discussed, but they do not necessarily refute the study.
REF: dm. 374
• A reviewer reads through a study from beginning to end, noting whether the
title and abstract are clear, if relevant terms are defined, and if the introduction,
methods, results, and discussion are plainly identified. This represents which
part of a critical appraisal?
a.Analysis of the study
methods b.Comprehension of
the study outcomes
c.Evaluation of the literature
review
• Identification of the steps of the research process
CORRECT ANSWER: D
Feedback
AThe other actions occur when evaluating the strengths and weaknesses and the
credibility and meaning of the findings.
BThe other actions occur when evaluating the strengths and weaknesses and the
CThe other actions occur when evaluating the strengths and weaknesses and the
DReviewing the abstract and reading the study from beginning to end are the first
steps of a critical appraisal and are part of identifying the steps in the research
process.

• A reviewer conducting a critical appraisal of a research study compares and
contrasts study methods with those that are ideal, representing which step of
the research process?
a.Analy
sis
b.Comp
arison
c.Comp
rehensio
n
d.Evalu
ation
CORRECT ANSWER: B
Feedback
AThe analysis phase involves a critique of the logical links connecting one study
element with another.
BThe comparison phase requires knowledge of what each step of the research
process should be like, and then that is compared with the ideal.
CThe comprehension phase requires the reviewer to thoroughly understand the study.
DThe evaluation phase highlights the meaning and significance of
the study. PTS: 1 DIF: Cognitive level: Understanding
(Comprehension)
REF: pp. 372-373
• During an initial review of a study, the reviewer will expect the methods
section of the research report to include:
a.a description of the study design and sampling methods.
b.the limitations and generalizations of

the study. c.tables and figures
representing study results. d.the
framework and definitions of study
variables.
CORRECT ANSWER: A
Feedback
AThe methods section of a study report will contain a description of the study
design and the sampling methods used to obtain the study population.
BThe limitations and generalizations of the study will be discussed in the conclusion section.
CTables and figures will appear in the results section.
DThe framework and definitions will be included in a discussion of the study
framework. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 372-374
• During a critical appraisal of a research study, the reviewer determines that a

study about blood glucose monitoring of patients with type 1 diabetes mellitus
has implications for patients with type 2 diabetes. The reviewer will determine
this during which phase of the research critique?
a.Analy
sis
b.Comp
arison
c.Comp
rehensio
n
d.Evalu
ation
CORRECT ANSWER: D
Feedback
AThe analysis phase involves a critique of the logical links connecting one study
element with another.
BThe comparison phase requires knowledge of what each step of the research
process should be like, and then that is compared with the ideal.
CThe comprehension phase requires the reviewer to thoroughly understand the study.
DThe evaluation phase highlights the meaning and significance of the study
and includes discussion about application and generalizability of the findings
to other populations.

• A reviewer conducts a critical appraisal of a study and notes that the study
abstract does not include key results. The reviewer will discuss this in which
part of the appraisal?
a.Introduc
tion
b.Literatu
re review
c.Problem
d.Purpose
CORRECT ANSWER: A
Feedback
A The abstract is part of the introduction.
B The abstract is not a part of the literature review.
C The abstract is not included in the discussion of the study problem.
D The abstract is not included in the discussion of the study
purpose. PTS: 1 DIF: Cognitive level: Understanding
(Comprehension)
REF: dm. 374
• A reviewer performs a critical appraisal of a study and notes that the

researcher conducted a previous pilot study. The reviewer will:
a.discount any findings not congruent with the pilot study.
b.ensure that the larger study and pilot study used identical data collection
methods. c.ignore the findings of the pilot study because they are not relevant
to this study. d.note whether the pilot study findings were used to design the
current study.
CORRECT ANSWER: D
Feedback
AFindings in the pilot study may differ from those in the larger study if changes are
made based on the pilot.
BIdentical data collection methods may not be used if results from the pilot
indicated a need for change.
CThe findings of the pilot study provide information that guides the researcher to
change study methods in the subsequent study.
DWhen reviewing a study in which a pilot study was performed, the reviewer may
note whether findings of the pilot study led to changes in study methods in the
subsequent study.
REF: dm. 366
• What is not necessary for a reviewer to include in a critical appraisal when

evaluating study sampling methods?
a.Characteristics of the sample
b.Eligibility criteria
c.Sampl
e
attrition
d.Study
setting
CORRECT ANSWER: D
Feedback
ASample characteristics are an important part of a critical appraisal when
evaluating study methods.
BEligibility criteria are an important part of a critical appraisal when evaluating study methods.
CSample characteristics are an important part of a critical appraisal when
evaluating study methods.
DWhen discussing the sampling methods, the reviewer may address characteristics
of the sample, eligibility criteria to determine the sample, and sample attrition. The
study setting is not part of the discussion about the sample.

• Which is true about the evaluation of study variables in a critical appraisal
of a research study?
a.It is not necessary to identify whether the measures are nominal, ordinal, ratio,
or interval. b.The reviewer will be concerned only with the reliability of measures
in the current study. c.The reviewer will identify the names and authors of the
measurement strategies.
d.The reviewer will make sure research variables are defined conceptually but not operationally.
CORRECT ANSWER: C
Feedback
AThe reviewer will identify the types of measurement scales used.
BThe reviewer will be concerned with the reliability and validity of measures.
CWhen discussing study variables, the reviewer will evaluate the
measurement strategies, including the names and authors of the various
strategies.
DThe reviewer will ensure that variables are defined conceptually and operationally.

• A reviewer critically appraises a study. Which aspect of the review indicates a
weakness in the study?
a.The conceptual definitions of variables are consistent with operational
definitions. b.The literature review identifies what is known and not
known about the problem. c.The researcher identifies and discusses threats
to design validity.
d.The statement of purpose provides a broad, general focus for the study.
CORRECT ANSWER: D
Feedback
A The conceptual and operational definitions should be consistent, so this is a strength.
B The literature review should identify what is known and not known, so this is a strength.
C The researcher should identify and discuss known threats to validity, so this is a strength.
D The purpose should provide a narrow, clear focus for the study, so this is a study
weakness. PTS:1DIF:Cognitive level: Analyzing (Analysis)
REF: dm. 368
• What is the focus of a critical appraisal of qualitative
research studies? a.Completeness of the literature review
b.Conceptual and operational definition of
variables c.Integrity of study design and
methods
d.Validity of study measures
CORRECT ANSWER: C
Feedback
ACompleteness of the literature review is a component of the critical appraisal but not the focus.
BConceptual and operational definition of variables is part of the critical
appraisal of quantitative studies.
CIntegrity of study design and methods is a key component of critical appraisal
of qualitative research studies.
DValidity of the study measures is a component of the critical appraisal but is not the
focus. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 389
• What are the three steps of critical appraisal of qualitative research?
a.Assess the study design, evaluate sampling methods, and review study conclusions.
b.Determine the study purpose, review study data, and evaluate implications for further
research. c.Identify the components of the research process, determine strengths and
weaknesses, and
evaluate the trustworthiness of the study.
d.Identify the steps in the research process, determine strengths and weaknesses, and
evaluate the credibility and meaning of the findings.
CORRECT ANSWER: C
Feedback
AAssessing study design, evaluating sampling methods, and reviewing study
conclusions are parts of the critical appraisal of qualitative research, but are not the
three main steps.
BDetermining the study purpose, reviewing study data, and evaluating
implications for further research are parts of the critical appraisal of qualitative
research, but are not the three main steps.
CIdentifying the components of the research process, determining strengths and
weaknesses, and evaluating the trustworthiness of the study are the components of
critical appraisal of qualitative research studies.
DIdentifying the steps in the research process, determining strengths and
weaknesses, and evaluating the credibility and meaning of the findings are
parts of the critical appraisal of qualitative research, but are not the three main
steps

• What standard may be applied to determine the strengths and weaknesses
in a qualitative research study?
a.Consistency of study methods with guidelines of expert
researchers b.Determination of the generalizability of the
study findings c.Reliability of scales of measurement used
in data collection d.Validity of statistical analyses used in
data analysis
CORRECT ANSWER: A
Feedback
A A critical appraisal may review a qualitative study and note whether study
methods follow guidelines set by expert researchers because there are no hard and
fast rules for study methods in qualitative research.
B Study findings are regarded as transferable and not generalizable in qualitative research.
C Reliability of measurement is part of quantitative research.
D Validity of statistical analyses is part of
quantitative research. PTS: 1 DIF: Cognitive level:
Understanding (Comprehension) REF: dm. 391
• When critically appraising the dependability of qualitative research, the reviewer
evaluates:
a.documentation of decisions made during analysis of the

findings. b.if interrater reliability has been determined.
c.whether measurement tools have
internal validity. d.whether statistical
analysis has been performed.
CORRECT ANSWER: A
Feedback
AIn qualitative research, statistical processes are not used. The reviewer should
evaluate whether the researcher clearly documents how decisions about the data
have been made.
BIn qualitative research, statistical processes are
not used. CIn qualitative research, statistical
processes are not used. DIn qualitative research,
statistical processes are not used.
Chapter 10 Evidence-Based Clinical Practice Guidelines

• A reader of qualitative research notes that a study is identified as Heideggerian
phenomenology. The purpose of the study was to explore the lived experience
of the long-term process of separating from a longtime partner and
subsequently marrying another person, and to
elicit descriptions of the experiences meaning. This topic is unexplored in the

literature. The sample of 21 was randomly selected from 68 volunteers. Participants
interviews were tape- recorded and transcribed, and then coded by two raters, whose
inter-rater reliability was reported as 95%. The findings revealed that there was a
lengthy period of adjustment following separation, and that participants filled this
time by denying permanency, creating possibilities, appreciating silence, developing
personal strengths, trusting, developing skepticism, starting a new dm. and
maintaining mental boundaries. The most immediate evaluative critique point about
this article relates to which the following?
• It is not clear what the findings contribute to the current body of knowledge.
• The development and implementation of the study
methodology is not congruent with its philosophical
foundation.
• Tape-recording, transcription, and coding by two raters is not
likely to capture the essence of this experience, without
video-recording and participant observation.
• The findings do not seem to be a credible reflection of reality.
CORRECT ANSWER: B
Critical appraisal is not complete with making judgments about the validity of the
study. Synthesis of the evaluative criteria for qualitative studies can be reframed as
philosophical congruence, methodological coherence, intuitive comprehension, and
intellectual contribution. Philosophical congruence is the problem here: parts of the
development and implementation of the study (sample selection, data analysis) are not
congruent with phenomenologic enquiry.

• A nurse reader of qualitative research notes that a study is identified as
grounded theory research. The topic of study is how women leave a violent
relationship. The nurse reader herself has never been in a physically abusive
relationship. She has, however, cared for several patients who have told her
their personal stories, and she has a cousin who was in a physically abusive
relationship for several months. Because of this, she has an immediate
understanding and finds the results credible. What aspect of the evaluative
criteria for qualitative research does this reflect?
• Intellectual contribution
• Intuitive comprehension
• Methodological coherence
• Philosophical congruence
CORRECT ANSWER: B
intellectual contribution. This particular phenomenon relates to intuitive
comprehension.
• Philosophical congruence: Were the development and implementation of the

study congruent with the philosophical foundation of the study?
• Methodological coherence: Did the data collection, analysis, and

interpretation processes fit together to form a coherent approach to address
the research problem?
• Intuitive comprehension: Do the findings provide a credible reflection of

reality and expand the readers comprehension of the study topic? If so, how
can the findings be used in nursing practice?
• Intellectual contribution: What do the findings contribute to the current body of

knowledge?
• State the conclusion of the critical appraisal of the study.
• What is the most accurate statement related to a studys strengths?
• A studys strengths always involve a level of

complexitymultiple research questions, many
variables, many references.
• A studys strengths are essentially the elements of the
study that the researcher completed in accordance with
the design of the study.
• A studys strengths are determined by whether the research
results are statistically significant or not.
• A studys strengths are determined by the number of times

the article is cited by other authors.
CORRECT ANSWER: B
The next step in critically appraising a quantitative study requires determining the
strengths and weaknesses of the study. To determine the strengths and weaknesses of
a study, the reader must have knowledge of what each step of the research process
should be like from expert sources.
Then the elements of the research process are compared with the actual study
steps. One determines whether the researcher followed the rules for an ideal
study.
• In deciding whether a framework is suited to a study, what is the principal

question the reader must answer?
• Is a conceptual map provided?

• Is this the best framework for this study?
• Does the framework specify the study variables?
• Is this a theory or merely a framework?
CORRECT ANSWER: B
The questions a reader must ask are presented in this order:
• Is the framework presented with clarity? If a model or conceptual map of

the framework is present, is it adequate to explain the phenomenon of
concern?
• Is the framework linked to the research purpose? If not, would another

framework fit more logically with the study?
• Is the framework related to the body of knowledge in nursing and clinical practice?
• If a proposition or relationship from a theory is to be tested, is the

proposition clearly identified and linked to the study hypotheses
• Why is the first prerequisite for appraising qualitative studies an

appreciation for the philosophical foundation of qualitative research?
• Understanding the research requires a detailed

understanding of each qualitative methodology.
• Qualitative research is not based on truth; it takes work for
the reader to get past this stumbling block.
• There is no common ground among the qualitative
methods. Each requires individual study before
reading a research report can be attempted.
• All qualitative research has slightly different
ground rules. Without an understanding of the
philosophy of the method, appraisal is unfair.
CORRECT ANSWER: D
The first prerequisite for appraising qualitative studies is an appreciation for the
philosophical foundation of qualitative research. Qualitative researchers design their
studies to be congruent with one of a wide range of philosophies, such as
phenomenology, symbolic interactionism, and hermeneutics, each of which espouses
slightly different approaches to gaining new knowledge. Although unique, the
qualitative philosophies are similar in their view of the uniqueness of the individual
and the value of the individuals perspective. Without an appreciation for the
philosophical perspective supporting the study being critically appraised, the appraiser
may not appropriately apply the standards of rigor consistent with that perspective.
MULTIPLE RESPONSE
• What must the person critically appraising a qualitative research

report possess as prerequisites, in order to begin the process?
(Select all that apply.)
• Experience in performing qualitative data collection or analysis

• An empathic point of view toward the participants
perspectives and reported experiences
• A basic knowledge of different philosophical perspectives
• The willingness to learn about the philosophical perspective

supporting the study, in order to apply the standards of rigor
that are consistent with that perspective
• Previous experience in critically appraising qualitative research
Prerequisites of philosophical foundation, type of qualitative study, and openness to

study participants direct the implementation of the following guidelines for critically
appraising qualitative studies. Without an appreciation for the philosophical perspective
supporting the study being critically appraised, the appraiser may not appropriately
apply the standards of rigor consistent with that perspective. A basic knowledge of
different qualitative approaches is as essential for appraisal of qualitative studies as
knowledge of quantitative research designs is for appraising quantitative studies.
Appreciating philosophical perspectives and knowing qualitative approaches are both
superficial, however, without empathy for the participants perspective.
Empathy creates an openness to knowing a participant within a naturalistic holistic
framework. One does not need experience in performing qualitative data collection or
analysis, nor does one need to have previous experience in critically appraising
qualitative research in order to perform this: one must start somewhere.
• Why is identifying the steps of the research process the first step in the
critical appraisal process for quantitative research? (Select all that apply.)
• Identifying the steps in the process indicates that the reader knows what these are.
• Identifying the steps is more important than understanding.
• Identifying the steps implies that the reader
understands everything in the research report.
• Identifying the steps indicates that the reader
comprehends the concepts in the research report.
• Identifying the steps of the research process implies
understanding the terms the researcher uses in the research
report.
CORRECT ANSWER: A, D, E
The critical appraisal process for quantitative research includes three steps: (1)
identifying the steps of the research process, (2) determining study strengths and
weaknesses, and (3) evaluating the credibility and meaning of a study to nursing
knowledge and practice. These steps occur in sequence, vary in depth, and presume
accomplishment of the preceding steps. However, an individual with critical appraisal
experience frequently performs several steps of this process simultaneously. Initial
attempts to comprehend research articles are often frustrating because the terminology
and stylized manner of the report are unfamiliar. Identification of the steps of the
research process in a quantitative study is the first step in critical appraisal. It involves
understanding the terms and concepts in the report, as well as identifying study
elements and grasping the nature, significance, and meaning of these elements.
• What happens during the second step of the quantitative critical appraisal
process, in the case in which the reader determines study strengths and
weaknesses of a particularly weak research report?
• The reader discovers what elements of the study are in

what locations of the report.
• The reader constructs a global appraisal of the researchs lack of rigor.
• The readers task is to analyze the quality of the individual
parts of a research report. This inevitably produces an
impression not only of what the research did not do, but also
of what should have been done.
• The reader is required to examine each part minutely; this
leads to an appreciation of what the researcher did well.
• The reader evaluates the goodness of the study.
CORRECT ANSWER: C, D
knowledge and practice. Identification of the steps of the research process in a
quantitative study is the first step in critical appraisal. The next step in critically
appraising a quantitative study requires determining the strengths and weaknesses of
the study. To do this, the reader must have knowledge of what each step of the
research process should be like from expert sources, such as this textbook and other
research sources. Then the ideal ways to conduct the steps of the research process are
compared with the actual study steps. During this comparison, the reader examines
the extent to which the researcher followed the rules for an ideal study.
• What are the true statements related to evaluation for quantitative research
appraisal? (Select all that apply.)
• Evaluation cannot be performed without having completed

the previous two steps of the appraisal process.
• Evaluation draws no conclusions about the merit of a particular research study.
• Evaluation critically analyzes the parts of a study and points
out their deficits in comparison to an ideal.
• True evaluation implies an examination of related
studies, so as to assess significance, credibility, and
believability.
• Evaluation includes an assessment of the researchs
contribution to nursing knowledge.
• Evaluation plus focused literature review essentially equals concept clustering.
CORRECT ANSWER: A, D, E, F
knowledge and practice. During the second step of this process, not the evaluation, the
reader examines the extent to which the researcher followed the rules for an ideal study.
Evaluation involves determining the validity, credibility, significance, and meaning of
the study by examining the links between the study process, study findings, and
previous studies. The steps of the study are evaluated in light of previous studies, such
as an evaluation of present hypotheses based on previous hypotheses, present design
based on previous designs, and present methods of measuring variables based on
previous methods of measurement. The findings of the present study are also examined
in light of the findings of previous studies. Evaluation builds on conclusions reached
during the first two stages of the
critical appraisal so the credibility, validity, and meaning of the study findings can be determined
for nursing knowledge and practice.
• Which of the following represent the specific attributes that qualitative

research must possess in order to be evaluated as acceptable? (Select all that
apply.)
• Intellectual contribution
• Methodological congruence
• Evaluative strength
• Philosophical congruence
• Suspension of disbelief
• Intuitive comprehension
CORRECT ANSWER: A, B, D, F
intellectual contribution.
• What would be exemplified by poor overall flow of logic in the study, in terms
of the second step of critical appraisal? (Select all that apply.)
• The title of the study mentions the effect of, but the
study design is simple descriptive.
• There was a 60% dropout; nonetheless, the researchers
claimed that the sample was representative.
• Statistical analyses used are all coherent with
the variables levels of measurement.
• The study framework is gratuitous. It does not, in the
slightest, help to explain the relationship between the
principal study variables.
• The problem statement and the purpose of the study arent

closely related. It seems like a big leap to get from the
problem to the gap, and to the purpose.
CORRECT ANSWER: A, B, D, E
The reader must examine the logical links connecting one study element with
another. For example, the problem needs to provide background and direction for the
statement of the purpose. In addition, you need to examine the overall flow of logic
in the study. The variables identified in the study purpose need to be consistent with
the variables identified in the research objectives, questions, or hypotheses. The
variables identified in the research objectives, questions, or hypotheses need to be
conceptually defined in light of the study framework. The conceptual definitions
provide the basis for the development of operational definitions. The study design
and analyses need to be appropriate for the investigation of the study purpose, as
well as for the specific objectives, questions, or hypotheses. Most of the limitations
or weaknesses in a study result from breaks in logical reasoning.
DIF: Cognitive Level: Evaluation REF: dm. 458
• To what do the logic and form of the findings refer in qualitative critique?
• There were numerous cross-checks, to ensure that what

participants reported was objectively true.
• The elements of the research were present in the research
report and located so that the reader could easily find them.
• The readers understanding of the phenomenon was better
after reading the study than it had been beforehand.
• The findings were presented in a way that made sense, taken as a whole.
• The way the report was presented was congruent with its
purpose, methods, and findings.
• There was a clear sense that the themes and
essences emanated from the statements and
perceptions of real people.
CORRECT ANSWER: B, C, D, E, F
The logic and form of the findings are critical to the appraisal of the study. (1) Were
readers able to hear the voice of the participants and gain an understanding of the
phenomenon studied? (2) Were readers able to identify easily the elements of the
research report? (3) Did the overall presentation of the study fit its purpose, method, and
findings? (4) Was there a coherent logic to the presentation of findings?
• In which ways are critical appraisal of quantitative research and critical

appraisal of qualitative research the same? (Select all that apply.)
• Both are concerned with how well the author has

established the objective truth of the data.
• Both must begin with an appreciation for the
philosophical foundation of the research.
• Both define rigor in the same way.
• Both are designed to provide some evaluations about the
intrinsic worth of the research.
• In both, the elements of the research report are identified.
• Both examine how well measurements in the data
collection phase have maintained their precision.
CORRECT ANSWER: B, D, E
The first prerequisite for appraising qualitative studies is an appreciation for the
philosophical foundation of qualitative research. Qualitative researchers design their
studies to be congruent with one of a wide range of philosophies, such as
phenomenology, symbolic interactionism, and hermeneutics, each of which espouses
slightly different approaches to gaining new knowledge; quantitative research espouses
and follows the tenets of the scientific method. Nonetheless, an appreciation for each is
foundational to the critique process. Phenomenologists agree that there is not a single
reality; each individual has his or her own reality. Reality is considered subjective, and
as a result, unique to the individual, and, consequently, objective truth need not be
checked, since the perception of the individual is that persons truth. Quantitative
methods check truthfulness of data. Rigor is defined in quantitative research as in
qualitative research, rigor is
particular to each different method but, overall, implies adherence to that method. Both types of
critical appraisal begin with identification of the elements of the research report.
Chapter 11 Asking Clinical Questions

MULTIPLE CHOICE
• What is the best research approach for investigating the actual representation of
Hispanic managers within health care institutions, and the workplace beliefs and
prejudices that perpetuate their disproportionate representation?
• Triangulated approach
• Quantitative approach
• Qualitative approach
• Outcomes approach
CORRECT ANSWER: A
Triangulation is the combined use of two or more theories, methods, data sources,
investigators, or analysis methods in the study of the same phenomenon. Five types of
triangulation are proposed: (1) data triangulation, (2) investigator triangulation, (3)
theoretical triangulation, (4) methodological triangulation, and (5) analysis
triangulation. Multiple triangulation is the combination of more than one of these types.
In the example, methodological triangulation should be used in the study of the
research problem. Triangulation is used to ensure that the most comprehensive
approach is taken to solve a research problem.
• What is the principal disadvantage of triangulated research?
• Its results are difficult to understand.

• Because of its complexity, researchers from different
research traditions may collaborate to produce a
triangulated study.
• The time required to complete a triangulated project is
approximately double that of completing one that utilizes
only one method.
• Publication opportunities are limited.
CORRECT ANSWER: C
investigators, or analysis methods in the study of the same phenomenon. There is
concern that triangulation will be used in studies for which it is not appropriate. An
additional concern is that the popularization of the method will generate a number of
triangulated studies that have been poorly conducted. With methodological
triangulation, both data collection and data analysis are more time-consuming,
because essentially two closely related studies are conducted simultaneously or in
close succession. These strategies require many observations and result in large
volumes of data for analysis. The results are no more difficult to understand than are
the results of any study. Most doctorally prepared researchers have both quantitative
and qualitative preparation; however, because researchers tend to acquire their
research training within a particular research tradition, attempts to incorporate
another research tradition may be poorly achieved. Publication opportunities are
increased with triangulated research, since quantitative and qualitative portions of the
study are often published separately.
• Causality is tested through which of the following?
• Grounded theory
• Experimentation
• All quantitative research
• Triangulated studies
CORRECT ANSWER: B
The first assumptions one must make in examining causality are that things have causes
and that causes lead to effects. The original criteria for causation required that a
variable should cause an identified effect each time the cause occurred. Probability
addresses relative, rather than absolute, causality. From a perspective of probability, a
cause will not produce a specific effect each time that particular cause occurs. The
reasoning behind probability is more in keeping with the complexity of multicausality.
The purpose of an experimental design is to examine cause and effect. The independent
variable in a study is expected to be the cause, and the dependent variable is expected
to reflect the effect of the independent variable.
• Why is selection of an appropriate design for a research study important?
• If the design is an incorrect one, the researcher will

examine variables and their interactions in a way that does
not answer the research question.
• The design provides a blueprint or diagram that appears in the concept map.
• If there is no design, critique is impossible.
• If the design is appropriate, the researcher can eliminate error.
CORRECT ANSWER: A
A research design is the blueprint for conducting a study. It maximizes control over
factors that could interfere with the validity of the study findings. Being able to identify
the study design and to evaluate design flaws that might threaten the validity of findings
is an important part of critically appraising studies. When conducting a study, the
research design guides the researcher in planning and implementing a study in a way to
achieve accurate results. The control achieved through the quantitative study design
increases the probability that the study findings are an accurate reflection of reality.
• Thirty patients with psoriasis are treated with ultraviolet light B phototherapy,
delivered by a therapist. Their symptoms become worse at first, and then
improve. During the summer their symptoms become better without treatment.
Then fall arrives, and symptoms worsen. Patients go back to UVL B, and they
improve. Why, according to Hume, can the relationship between UVL B
phototherapy and symptom severity not be considered a classically causal one?
• Ultraviolet light B phototherapy wasnt invented during Humes lifetime.

• There must be a strong relationship between the proposed cause and the effect.
• The cause (phototherapy) has to be present whenever the effect occurs.
• The cause must precede the effect in time.
CORRECT ANSWER: C
Some of the ideas related to causation emerged from the logical positivist
philosophical tradition. Hume, a positivist, proposed that the following three
conditions must be met to establish causality: (1) there must be a strong relationship
between the proposed cause and the effect, (2) the proposed cause must precede the
effect in time, and (3) the cause has to be present whenever the effect occurs. Cause,
according to Hume, is not directly observable but must be inferred.
• John Stuart Mills insistence that in order for causation to be demonstrated,

there must be no alternative explanation for why a change in one variable
leads to a change in the other variable. This concept of alternative
explanations is the idea that underlies which type of validity?
• Statistical conclusion validity

• Internal validity
• Construct validity
• External validity
CORRECT ANSWER: D
External validity is concerned with the extent to which study findings can be
generalized beyond the sample used in the study. Statistical conclusion validity is
concerned with whether the
conclusions about relationships or differences drawn from statistical analysis are an

accurate reflection of the real world: did the researcher use the right statistical tests in
the proper way? Internal validity is the extent to which the effects detected in the study
are a true reflection of reality rather than the result of extraneous variables: did the
change in one variable really account for the change in the other variable? Construct
validity examines the fit between the conceptual definitions and operational definitions
of variables: are the study ideas measured in a way that makes sense?
• John Stuart Mill and the essentialists insisted that a cause be necessary and
sufficient for an effect to occur. In a modern study alcohol dependency is found
to lead eventually to permanent liver damage, except when the alcoholic
consumes a diet plentiful in the B-vitamins. In addition, liver damage can
emerge in the absence of alcohol dependency. What would John Stuart Mill and
essentialists say about the causative relationship between alcohol dependency
and liver damage?
• The proposed cause is necessary, but not sufficient.

• The proposed cause is neither necessary nor sufficient.
• The proposed cause is sufficient, but not necessary.
• The proposed cause is both necessary and sufficient.
CORRECT ANSWER: B
A philosophical group known as essentialists proposed that two concepts must be considered in
determining causality: necessary and sufficient. The proposed cause must be necessary for the
effect to occur. (The effect cannot occur unless the cause first occurs.) The proposed cause must
also be sufficient (requiring no other factors) for the effect to occur. This leaves no room for a
variable that may sometimes, but not always, serves as the cause of an effect.
• Random selection of 300 subjects yields a sample, but demographic analysis of

that sample reveals that there are 99 teachers in the sample, despite the fact that
there are far fewer than 33% teachers in the total sample. The sample can be
said to be
• Biased
• Controlled
• Multicausal
• Based on probability
CORRECT ANSWER: A
The term bias means to slant away from the true or expected. A biased samples
composition differs from that of the population from which the sample was drawn.
Bias is of great concern in research because of the potential effect on the meaning of
the study findings. Multicausality refers to a scenario in which interrelating variables
cause a particular effect Control means having the power to direct or manipulate
factors to achieve a desired outcome. Error is often discussed in relation to the
researchers ability to make accurate conclusions. Probability addresses relative, rather
than absolute, causality. From the perspective of probability, a cause will not produce
a specific effect each time that particular cause occurs.
• The researcher divides his lab rats into two groups and administers IV
methamphetamine to one of the groups, in order to determine its effect on the
fear-flight response. This is an example of which of the following?
• Bias
• Control
• Correlation
• Multicausality
CORRECT ANSWER: B
Control means having the power to direct or manipulate factors to achieve a desired
outcome. The idea of control is very important to research, particularly to experimental
and quasi- experimental studies. The greater the amount of control the researcher has
of the study situation, the more credible the study findings. The purpose of the research
design is to maximize control factors in the study situation. The term bias means to
slant away from the true or expected. A
biased opinion has failed to include both sides of the question. Correlational research examines
linear relationships between two or more variables and determines the type (positive or negative)
and degree (strength) of the relationship, not cause.
• A researcher is comparing a new and less expensive treatment with an

established treatment, in hopes of showing that there is no difference in
outcome. The researcher does not perform a power analysis and, consequently,
selects a sample size that is smaller than what would be recommended for an
analysis of variance. The results show that there is no significant difference in
outcome between the two treatments. Which type of validity is affected by this?

CORRECT ANSWER: A
Statistical conclusion validity is concerned with whether the conclusions about relationships or
differences drawn from statistical analysis are an accurate reflection of the real world: did the
researcher use the right statistical tests in the proper way? Internal validity is the extent to
which the effects detected in the study are a true reflection of reality rather than the result of
extraneous variables: did the change in one variable really account for the change in the other
variable?
Construct validity examines the fit between the conceptual definitions and operational
definitions of variables: are the study ideas measured in a way that makes sense?
generalized beyond the sample used in the study.

analysis of variance. The results show that there is a significant difference
in outcome between the two treatments, and that the new treatment has poorer outcomes. What is
the negative result of the researchers decision to use a smaller sample?
• The statistical conclusions reached are incorrect.

• There is no negative result.
• The study will have to be replicated, because its sample was small.
• The researcher is guilty of misconduct.
CORRECT ANSWER: B
Statistical conclusion validity is concerned with whether the conclusions about

relationships or differences drawn from statistical analysis are an accurate reflection of
the real world: did the researcher use the right statistical tests in the proper way? The
test was used in the proper way, and the results established a difference in outcomes
between the established treatment and the new one, meaning that the difference in
outcomes must have been quite pronounced for this to be evident with a small sample.
The results dramatically underscore this.
• A researcher tests a new intervention for nausea associated with chemotherapy,

in hospitalized patients. At the same time a new over-the-counter medication
containing natural herbs is marketed aggressively, and some of the hospital
patients are given this herbal remedy by their families. This is a threat to which
type of validity?

CORRECT ANSWER: B
relationships or differences drawn from
statistical analysis are an accurate reflection of the real world: did the researcher use
the right statistical tests in the proper way? Internal validity is the extent to which the
effects detected in the study are a true reflection of reality rather than the result of
extraneous variables: did the change in one variable really account for the change in
the other variable? External validity is concerned with the extent to which study
findings can be generalized beyond the sample used in the study.

in hospitalized patients. He does not want to suggest nausea to the patients, so
as his dependent variable, he uses the answer the patients give to the question,
How are you feeling this morning? This is a threat to which type of validity?

CORRECT ANSWER: C
definitions of variables: are the study ideas measured in a way that makes sense? It
makes little sense to measure nausea by asking a social question. Statistical conclusion
validity is concerned with whether the conclusions about relationships or differences
drawn from statistical analysis are an accurate reflection of the real world: did the
researcher use the right statistical tests in the proper way? Internal validity is the extent
to which the effects detected in the study are a true reflection of reality rather than the
result of extraneous variables: did the change in one variable really account for the
change in the other variable? External validity is concerned with the extent to which
study findings can be generalized beyond the sample used in the study.
• A researcher conducts research and uses a small sample that is not randomly
selected. When he replicates the study, twice, he again uses the same site and
another small sample that is not randomly selected. This is a threat to which
type of validity?

CORRECT ANSWER: D
the real world: did the researcher use the right statistical tests in the proper way?
Internal validity is the extent to which the effects detected in the study are a true
reflection of reality rather than the result of extraneous variables: did the change in one
variable really account for the change in the other variable? External validity is
concerned with the extent to which study findings can be generalized beyond the
sample used in the study.
• If a researcher plans to study graduate-level achievement in all students who

were educated under the Vermont public school system, in a small town that
used both state-mandated texts and enrichment texts of the school boards
choosing, the researcher would be using a fairly small sample, bound by
geography and time. Which type of validity is decreased by a study like this
one?
CORRECT ANSWER: C
generalized beyond the sample used in the study. If the sample IS the historical
population, the findings can be generalized only to predict accomplishment in
subsequent cohorts. Statistical conclusion validity is concerned with whether the
• What is the essential difference between a control group and a comparison group?
• A control groups data is collected at the same time as the

experimental groups data. A comparison groups data is
collected before that of the experimental group.
• A control group is larger in size than a comparison group.
• A control group exists only is a basic lab situation. All
nursing studies use comparison groups.
• A control group is randomly assigned. A comparison group is not.
CORRECT ANSWER: D
If the study involves an experimental treatment, the design usually calls for a
comparison. Outcome measures for individuals who receive the experimental treatment
are compared with outcome measures for those who do not receive the experimental
treatment. This comparison requires a control groupsubjects who do not receive the
experimental treatment. However, in nursing studies, all patients require care, and those
who do not receive the study intervention receive standard care. Nurse researchers often
refer to the group receiving standard care, but no treatment, as the comparison group
rather than the control group. Essentially, the main difference between these terms is
that control groups are nearly identical to their experimental groups, except for
assignment. Comparison groups differ, because of the time at which data are
collected, the way they are constituted, or other circumstances that make them less
likely to be nearly identical, leading to a higher occurrence of threats to internal
validity.
• A school nurse researcher studying bullying discovers that the type of

victimization she is observing is different for different racial groups and genders
within her school district. She wants to study the effect of peer support on
bullying and chooses to make sure that the experimental and control groups,
although randomly assigned, contain equal percentages of children of all races.
What does this strategy exemplify?
• Carryover
• Blocking
• Counterbalancing
• Sequencing
CORRECT ANSWER: B
In blocking, the researcher includes subjects with various levels of an extraneous

variable in the sample but controls the numbers of subjects at each level of the
variable and their random assignment to groups within the study. Designs using
blocking are referred to as randomized block designs. The extraneous variable is then
used as an independent variable in the data analysis. Therefore, the extraneous
variable must be included in the framework and the study hypotheses.
• A researcher uses matching to constitute his control group, while performing

a study on psychotherapy as an adjunct treatment for substance addiction.
What type of validity might be enhanced by matching, in this instance?
CORRECT ANSWER: D
Matching is used when a subject in the experimental group is randomly selected and
then a subject similar in relation to important extraneous variables is randomly
selected for the control group. For example, subjects in the experimental and control
groups might be matched for age, gender, severity of illness, or number of chronic
illnesses. Statistical conclusion validity is concerned with whether the conclusions
about relationships or differences drawn from statistical analysis are an accurate
reflection of the real world: it is not affected by use of matching. Internal validity is the
extent to which the effects detected in the study are a true reflection of reality rather
than the result of extraneous variables: matching can increase internal validity if the
researcher can correctly identify the principal extraneous variables. Construct validity
examines the fit between the conceptual definitions and operational definitions of
variables: matching has no effect on this. External validity is concerned with the extent
to which study findings can be generalized beyond the sample used in the study;
matching does not affect external validity, to any extent.
• Immediately after the intervention in an experimental study of the negative

effects of smoking tobacco, the state tax on cigarettes increases the cost
from $4 to $8 per pack. Which threat to internal validity does this pose?
• Mortality
• History
• Testing
• Selection
CORRECT ANSWER: B
History is an event that is not related to the planned study but that occurs during the
time of the study. History could influence a subjects response to the treatment and
alter the outcome of the study. The attrition threat is due to subjects who drop out of a
study before completion. The
circumstances in which a study is conducted (history) influence the treatment and thus
the generalizability of the findings. Sometimes, the effect being measured (testing)
can be due to the number of times the subjects responses have been tested. The
subject may remember earlier, inaccurate responses and modify them, thus altering
the outcome of teh study.
• Subjects in a multiple group experimental study are tested for how much time it
takes them to navigate a maze and find the chocolate. The maze is reconstructed
after each run, and three different floor plans are used. Each group is tested eight
times in eight hours. at a different time of day. The runs later in the day have
faster times than the earlier ones. Which threat to internal validity might account
for this difference?
• Instrumentation
• Selection
• Maturation
• Statistical regression toward the mean
CORRECT ANSWER: C
Effects can be due to changes in measurement instruments (instrumentation) between the

pretest and the posttest rather than a result of the treatment. Selection addresses the process by
which subjects are chosen to take part in a study and how subjects are grouped within a study.
Maturation is defined as growing older, wiser, stronger, hungrier, more tired, or more
experienced during the study. The subkects in this study may have been through the
three different floor plans enough times to learn them. Such unplanned changes can
influence the findings of the study. Experimenter expectancy occurs when a
researcher expects a particular intervention to relieve pain.
• A researcher believes that therapy is more effective if patients exercise. He

tells his patients that he has arranged for them to use the hospital gym, if they
so desireand that if they are interested, they will then be in the experimental
group. This represents which threat to internal validity?
• Maturation
• Reliability of the implementation
• History
• Selection
CORRECT ANSWER: D
Selection addresses the process by which subjects are chosen to take part in a study and
how subjects are grouped within a study. A selection threat is more likely to occur in
studies in which random assignment is not possible. In some studies, people selected
for the study may differ in some important way from people not selected for the study.
In other studies, the threat is due to differences in subjects selected for study groups. In
this study, subjects choose to be in the experimental group because they were willing to
exercise; in this way, they differ from the rest of the grouppossibly they are less
depressedand this could introduce bias into the study.
• What is the antidote to the carryover effect?
• Random assignment
• Counterbalancing
• Sequencing
• Bias control
CORRECT ANSWER: B
Sometimes the application of one treatment can influence the response to later treatments, a
phenomenon referred to as a carryover effect. If a carryover effect is known to occur, it is not
advisable for a researcher to use this design strategy for the study. However, even when no
carryover effect is known, the researcher may take precautions against the possibility that this
effect will influence outcomes. In one such precaution, known as counterbalancing, the various
treatments are administered in random order rather than being provided consistently in the same
sequence.
• What is the best research approach for investigating the actual representation
of male labor- delivery nurses within healthcare institutions and the workplace
beliefs and prejudices that perpetuate their disproportionate representation?
• Mixed methods approach

CORRECT ANSWER: A
Mixed methods research is characterized as research that contains elements of both

qualitative and quantitative approaches. The philosophical underpinnings of mixed
methods research and what paradigms best fit these research methods are still
evolving. Over the last few years, many researchers have departed from the idea that
one paradigm or one research strategy is right and have taken the perspective that the
search for the truth requires the use of all available strategies. A single approach to
measuring a concept may be inadequate to justify a claim that it is a valid measure of
a theoretical concept. Testing a single theory may leave the results open to the
challenge of rival hypotheses from other theories. To capitalize on the
representativeness and generalizability of quantitative research and the in-depth,
contextual nature of qualitative research, mixed methods are combined in a single
research study.
Chapter 12 Searching for Research Evidence
MULTIPLE CHOICE
• What is the best research approach for investigating the actual representation of
Hispanic managers within health care institutions, and the workplace beliefs and
prejudices that perpetuate their disproportionate representation?
• Triangulated approach
CORRECT ANSWER: A
investigators, or analysis methods in the study of the same phenomenon. Five types of
triangulation are proposed: (1) data triangulation, (2) investigator triangulation, (3)
theoretical triangulation, (4) methodological triangulation, and (5) analysis
triangulation. Multiple triangulation is the combination of more than one of these types.
In the example, methodological triangulation should be used in the study of the
research problem. Triangulation is used to ensure that the most comprehensive
approach is taken to solve a research problem.
• What is the principal disadvantage of triangulated research?
• Its results are difficult to understand.

• Because of its complexity, researchers from different
research traditions may collaborate to produce a
triangulated study.
• The time required to complete a triangulated project is
approximately double that of completing one that utilizes
only one method.
• Publication opportunities are limited.
CORRECT ANSWER: C
investigators, or analysis methods in the study of the same phenomenon. There is
concern that triangulation will be used in studies for which it is not appropriate. An
additional concern is that the popularization of the method will generate a number of
triangulated studies that have been poorly conducted. With methodological
triangulation, both data collection and data analysis are more time-consuming,
because essentially two closely related studies are conducted simultaneously or in
close succession. These strategies require many observations and result in large
volumes of data for analysis. The results are no more difficult to understand than are
the results of any study. Most doctorally prepared researchers have both quantitative
and qualitative preparation; however, because researchers tend to acquire their
research training within a particular research tradition, attempts to incorporate
another research tradition may be poorly achieved. Publication opportunities are
increased with triangulated research, since quantitative and qualitative portions of the
study are often published separately.
• Causality is tested through which of the following?
• Grounded theory
• Experimentation
• All quantitative research
• Triangulated studies
CORRECT ANSWER: B
The first assumptions one must make in examining causality are that things have causes
and that causes lead to effects. The original criteria for causation required that a
variable should cause an identified effect each time the cause occurred. Probability
addresses relative, rather than absolute, causality. From a perspective of probability, a
cause will not produce a specific effect each time that particular cause occurs. The
reasoning behind probability is more in keeping with the complexity of multicausality.
The purpose of an experimental design is to examine cause and effect. The independent
variable in a study is expected to be the cause, and the dependent variable is expected
to reflect the effect of the independent variable.
• Why is selection of an appropriate design for a research study important?

• If the design is an incorrect one, the researcher will
examine variables and their interactions in a way that does
not answer the research question.
• The design provides a blueprint or diagram that appears in the concept map.
• If there is no design, critique is impossible.
• If the design is appropriate, the researcher can eliminate error.
CORRECT ANSWER: A
A research design is the blueprint for conducting a study. It maximizes control over
factors that could interfere with the validity of the study findings. Being able to identify
the study design and to evaluate design flaws that might threaten the validity of findings
is an important part of critically appraising studies. When conducting a study, the
research design guides the researcher in planning and implementing a study in a way to
achieve accurate results. The control achieved through the quantitative study design
increases the probability that the study findings are an accurate reflection of reality.
• Thirty patients with psoriasis are treated with ultraviolet light B phototherapy,
delivered by a therapist. Their symptoms become worse at first, and then
improve. During the summer their symptoms become better without treatment.
Then fall arrives, and symptoms worsen. Patients go back to UVL B, and they
improve. Why, according to Hume, can the relationship between UVL B
phototherapy and symptom severity not be considered a classically causal one?
• Ultraviolet light B phototherapy wasnt invented during Humes lifetime.

• There must be a strong relationship between the proposed cause and the effect.
• The cause (phototherapy) has to be present whenever the effect occurs.
• The cause must precede the effect in time.
CORRECT ANSWER: C
Some of the ideas related to causation emerged from the logical positivist
philosophical tradition. Hume, a positivist, proposed that the following three
conditions must be met to establish causality: (1) there must be a strong relationship
between the proposed cause and the effect, (2) the proposed cause must precede the
effect in time, and (3) the cause has to be present whenever the effect occurs. Cause,
according to Hume, is not directly observable but must be inferred.

• John Stuart Mills insistence that in order for causation to be demonstrated,
there must be no alternative explanation for why a change in one variable
leads to a change in the other variable. This concept of alternative
explanations is the idea that underlies which type of validity?

CORRECT ANSWER: D
generalized beyond the sample used in the study. Statistical conclusion validity is
concerned with whether the

• John Stuart Mill and the essentialists insisted that a cause be necessary and
sufficient for an effect to occur. In a modern study alcohol dependency is found
to lead eventually to permanent liver damage, except when the alcoholic
consumes a diet plentiful in the B-vitamins. In addition, liver damage can
emerge in the absence of alcohol dependency. What would John Stuart Mill and
essentialists say about the causative relationship between alcohol dependency
and liver damage?
• The proposed cause is necessary, but not sufficient.

• The proposed cause is neither necessary nor sufficient.
• The proposed cause is sufficient, but not necessary.
• The proposed cause is both necessary and sufficient.
CORRECT ANSWER: B
A philosophical group known as essentialists proposed that two concepts must be considered in
determining causality: necessary and sufficient. The proposed cause must be necessary for the
effect to occur. (The effect cannot occur unless the cause first occurs.) The proposed cause must
also be sufficient (requiring no other factors) for the effect to occur. This leaves no room for a
variable that may sometimes, but not always, serves as the cause of an effect.
• Random selection of 300 subjects yields a sample, but demographic analysis of

that sample reveals that there are 99 teachers in the sample, despite the fact that
there are far fewer than 33% teachers in the total sample. The sample can be
said to be
• Biased
• Controlled
• Multicausal
• Based on probability
CORRECT ANSWER: A
The term bias means to slant away from the true or expected. A biased samples
composition differs from that of the population from which the sample was drawn.
Bias is of great concern in research because of the potential effect on the meaning of
the study findings. Multicausality refers to a scenario in which interrelating variables
cause a particular effect Control means having the power to direct or manipulate
factors to achieve a desired outcome. Error is often discussed in relation to the
researchers ability to make accurate conclusions. Probability addresses relative, rather
than absolute, causality. From the perspective of probability, a cause will not produce
a specific effect each time that particular cause occurs.
• The researcher divides his lab rats into two groups and administers IV
methamphetamine to one of the groups, in order to determine its effect on the
fear-flight response. This is an example of which of the following?
• Bias
• Control
• Correlation
• Multicausality
CORRECT ANSWER: B
Control means having the power to direct or manipulate factors to achieve a desired
outcome. The idea of control is very important to research, particularly to experimental
and quasi- experimental studies. The greater the amount of control the researcher has
of the study situation, the more credible the study findings. The purpose of the research
design is to maximize control factors in the study situation. The term bias means to
slant away from the true or expected. A
biased opinion has failed to include both sides of the question. Correlational research examines
linear relationships between two or more variables and determines the type (positive or negative)
and degree (strength) of the relationship, not cause.

analysis of variance. The results show that there is no significant difference in
outcome between the two treatments. Which type of validity is affected by this?

CORRECT ANSWER: A
Statistical conclusion validity is concerned with whether the conclusions about relationships or
differences drawn from statistical analysis are an accurate reflection of the real world: did the
researcher use the right statistical tests in the proper way? Internal validity is the extent to
which the effects detected in the study are a true reflection of reality rather than the result of
extraneous variables: did the change in one variable really account for the change in the other
variable?
generalized beyond the sample used in the study.

analysis of variance. The results show that there is a significant difference
in outcome between the two treatments, and that the new treatment has poorer outcomes. What is
the negative result of the researchers decision to use a smaller sample?
• The statistical conclusions reached are incorrect.

• There is no negative result.
• The study will have to be replicated, because its sample was small.
• The researcher is guilty of misconduct.
CORRECT ANSWER: B

the real world: did the researcher use the right statistical tests in the proper way? The
test was used in the proper way, and the results established a difference in outcomes
between the established treatment and the new one, meaning that the difference in
outcomes must have been quite pronounced for this to be evident with a small sample.
The results dramatically underscore this.

in hospitalized patients. At the same time a new over-the-counter medication
containing natural herbs is marketed aggressively, and some of the hospital
patients are given this herbal remedy by their families. This is a threat to which
type of validity?

CORRECT ANSWER: B
relationships or differences drawn from
statistical analysis are an accurate reflection of the real world: did the researcher use
the right statistical tests in the proper way? Internal validity is the extent to which the
effects detected in the study are a true reflection of reality rather than the result of
extraneous variables: did the change in one variable really account for the change in
the other variable? External validity is concerned with the extent to which study
findings can be generalized beyond the sample used in the study.

in hospitalized patients. He does not want to suggest nausea to the patients, so
as his dependent variable, he uses the answer the patients give to the question,
How are you feeling this morning? This is a threat to which type of validity?

CORRECT ANSWER: C
definitions of variables: are the study ideas measured in a way that makes sense? It
makes little sense to measure nausea by asking a social question. Statistical conclusion
validity is concerned with whether the conclusions about relationships or differences
drawn from statistical analysis are an accurate reflection of the real world: did the
researcher use the right statistical tests in the proper way? Internal validity is the extent
to which the effects detected in the study are a true reflection of reality rather than the
result of extraneous variables: did the change in one variable really account for the
change in the other variable? External validity is concerned with the extent to which
study findings can be generalized beyond the sample used in the study.
• A researcher conducts research and uses a small sample that is not randomly
selected. When he replicates the study, twice, he again uses the same site and
another small sample that is not randomly selected. This is a threat to which
type of validity?

CORRECT ANSWER: D
the real world: did the researcher use the right statistical tests in the proper way?
Internal validity is the extent to which the effects detected in the study are a true
reflection of reality rather than the result of extraneous variables: did the change in one
variable really account for the change in the other variable? External validity is
concerned with the extent to which study findings can be generalized beyond the
sample used in the study.
• If a researcher plans to study graduate-level achievement in all students who

were educated under the Vermont public school system, in a small town that
used both state-mandated texts and enrichment texts of the school boards
choosing, the researcher would be using a fairly small sample, bound by
geography and time. Which type of validity is decreased by a study like this
one?
CORRECT ANSWER: C
generalized beyond the sample used in the study. If the sample IS the historical
population, the findings can be generalized only to predict accomplishment in
subsequent cohorts. Statistical conclusion validity is concerned with whether the

• What is the essential difference between a control group and a comparison group?
• A control groups data is collected at the same time as the

experimental groups data. A comparison groups data is
collected before that of the experimental group.
• A control group is larger in size than a comparison group.
• A control group exists only is a basic lab situation. All
nursing studies use comparison groups.
• A control group is randomly assigned. A comparison group is not.
CORRECT ANSWER: D
If the study involves an experimental treatment, the design usually calls for a
comparison. Outcome measures for individuals who receive the experimental treatment
are compared with outcome measures for those who do not receive the experimental
treatment. This comparison requires a control groupsubjects who do not receive the
experimental treatment. However, in nursing studies, all patients require care, and those
who do not receive the study intervention receive standard care. Nurse researchers often
refer to the group receiving standard care, but no treatment, as the comparison group
rather than the control group. Essentially, the main difference between these terms is
that control groups are nearly identical to their experimental groups, except for
assignment. Comparison groups differ, because of the time at which data are
collected, the way they are constituted, or other circumstances that make them less
likely to be nearly identical, leading to a higher occurrence of threats to internal
validity.
Chapter 13 Appraising Research Evidence /Chapter 14 Appraising Recommendations of Clinical
Practice Guidelines /Chapter 15 Appraising Conclusions of Systematic Reviews with Narrative
Synthesis
MULTIPLE CHOICE
• A shepherd in the wilds of eastern Nevada is counting his sheep at

the end of a work day. What is another term for what he is doing?
• Estimating random error

• Measuring
• Using an interval level of measurement
• Calculating risk ratios
CORRECT ANSWER: B
Measurement is the process of assigning numbers to objects, events, or situations in

accord with some rule. The numbers assigned can indicate numerical values or
categories for the objects being measured for research or practice.
• What kind of reliability testing is used extensively in qualitative research?
• Equivalence reliability
• Stability reliability
• External consistency
• Internal consistency
CORRECT ANSWER: A
Equivalence reliability compares two versions of the same paper-and-pencil instrument

or two observers measuring the same event. Determining interrater reliability is a
concern when studies include observational measurement, which is common in
qualitative research. Interrater reliability values need to be reported in any study in
which observational data are collected or judgments are made by two or more data
gatherers. Consequently, it is used in various types of qualitative research in which data
or behaviors are coded.
• Why would interrater reliability be measured in a quantitative research project?
• A verbal quantitative questionnaire is filled out.

• Behavior is observed and classified.
• Phenomenology is the research method.
• Distances are measured.
CORRECT ANSWER: B
Determining interrater reliability is a concern when studies include observational

measurement, which is common in qualitative research. Interrater reliability values
need to be reported in any study in which observational data are collected or
judgments are made by two or more data gatherers. Consequently, it is used in various
types of qualitative research in which data or behaviors are coded or classified.

• What is the purpose of determining an instruments internal consistency?
• It establishes face validity.

• It demonstrates that the instrument is measuring
exactly what the researcher thinks it is
measuring.
• It decreases measurement error.
• It is a way of establishing test-retest reliability.
CORRECT ANSWER: D
Tests of instrument internal consistency or homogeneity, used primarily with paper-and-

pencil tests or scales, address the correlation of various items within the instrument. The
original approach to determining internal consistency was split-half reliability. This
strategy was a way of obtaining test-retest reliability without administering the test
twice.
• A new tool and very short tool is developed. It is to be used instead of

a previously validated tool that is very long to administer. What kind
of validity concept will be used for testing this new tool?
• Divergent validity
• Convergent validity
• Discriminant analysis
C
o
n
t
e
n
t
v
a
l
i
d
i
t
y
A
N
S
:
B
In examining the validity of the new instrument, it is important to determine how

closely the existing instruments measure the same construct as the newly developed
instrument (convergent validity). Divergent validity would measure the differences in
measurement, between an existing instrument and a newly-developed one.
Discriminant analysis measures the difference between two related but not identical
concepts. Content validity is the extent to which a measurement represents the concept
being measured.
• Which one of the following instructions to the research subject

will provide the highest possible level of measurement?
• Indicate whether your income is above $20,000 a year or not.

b. What was your income last year: $0$20,000; $20,000$60,000;
$60,000$100,000; or more than $100,000?
• What was your total income last year, before taxes? Enter amount:
• Did you earn money last year?
CORRECT ANSWER: C
An important rule of measurement is that one should use the highest level of
measurement possible. For example, you can collect data on age (measured) in a
variety of ways: (1) you can obtain the actual age of each subject (ratio level of
measurement); (2) you can ask subjects to indicate their age by selecting from a group
of categories, such as 2029, 3039, and so on (ordinal level of measurement); or (3)
you can sort subjects into two categories of under 65 years of age and 65 years of age
and older (nominal level of measurement).
• A band is in on a multi-city tour, and souvenir shirts are ordered

from a factory. They are shipped without the size labels. The vendor
must then sort them into sizesapparently they are small, medium,
large, extra-large, and extra-extra-large. What level of measurement
is this?
• Nominal
• Ordinal
• Interval
• Ratio
CORRECT ANSWER: B
Data that can be measured at the ordinal level can be assigned to categories of an
attribute that can be ranked. Nominal level of measurement is the lowest of the four
measurement levels or categories. It is used when data can be organized into categories
of a defined property but the categories cannot be ordered. It merely names. In interval
level of measurement, distances between intervals of the scale are numerically equal.
Interval scales are assumed to be a continuum of values. They are almost exclusively
manmade scales, measures, inventories, and so forth. Ratio level of measurement is
the highest form of measure and meets all the rules of the lower forms of measures. It
uses the real number scale, on which zero means none of the variable being measured.
• A secretary in a veterinarians office keeps track of how many animals

come in for care in a weeks time and what types of animals they are:
cat, dog, horse, gerbil, duck, snake, and so forth. What level of
measurement is this?
• Nominal
• Ordinal
• Interval
• Ratio
CORRECT ANSWER: A
Nominal level of measurement is the lowest of the four measurement levels or

categories. It is used when data can be organized into categories of a defined property
but the categories cannot be ordered. It merely names. Data that can be measured at the
ordinal level can be assigned to categories of an attribute that can be ranked. In interval
level of measurement, distances between intervals of the scale are numerically equal.
Interval scales are assumed to be a continuum of values. They are almost exclusively
manmade scales, measures, inventories, and so forth. Ratio
level of measurement is the highest form of measure and meets all the rules of the lower
forms of measures. It uses the real number scale, on which zero means none of the
variable being measured.
• Mark is in third grade and has just learned how to use a ruler to
measure. He has become a measuring fool. He measures everything
in the house, writing down all the measurements, and gaily
announcing to his mom, Hey, Mom. Guess what? The salt shaker is
four and a quarter inches tall. What level of measurement is this?
• Nominal
• Ordinal
• Interval
• Ratio
CORRECT ANSWER: D
Ratio level of measurement is the highest form of measure and meets all the rules of the lower
forms of measures. It uses the real number scale, on which zero means none of the variable being
measured. Nominal level of measurement is the lowest of the four measurement levels or
categories. It is used when data can be organized into categories of a defined property but the
categories cannot be ordered. It merely names. Data that can be measured at the ordinal level can
be assigned to categories of an attribute that can be ranked. In interval level of measurement,
distances between intervals of the scale are numerically equal. Interval scales are assumed to be a
continuum of values. They are almost exclusively manmade scales, measures, inventories, and so
forth.
• Depression is measured by the Beck Depression Inventory, which

adds up scores from 21 items to provide a total value ranging from 0
to 63. What level of measurement is this?
• Nominal
• Ordinal
• Interval
• Ratio
CORRECT ANSWER: C
In interval level of measurement, distances between intervals of the scale are
numerically equal. Interval scales are assumed to be a continuum of values. They are
almost exclusively manmade scales, measures, inventories, and so forth. Nominal level
of measurement is the lowest of the four measurement levels or categories. It is used
when data can be organized into categories of a defined property but the categories
cannot be ordered. It merely names. Data that can be measured at the ordinal level can
be assigned to categories of an attribute that can be ranked.
Ratio level of measurement is the highest form of measure and meets all the rules of
the lower forms of measures. It uses the real number scale, on which zero means none
of the variable being measured.
• Inclusion criteria and exclusion criteria in sample selection are mutually

exclusive and mutually exhaustive. A researcher has a list of all of the
studys inclusion and exclusion criteria. These then must be sorted into
an inclusion list and an exclusion list. The method of sorting may be
considered
• Nominal
• Categorical
• Interval
• Ratio
CORRECT ANSWER: A
Nominal level of measurement is the lowest of the four measurement levels or

categories. It is used when data can be organized into categories of a defined property
but the categories cannot be ordered. A study might have inclusion or exclusion
sampling criteria (or both). Inclusion sampling criteria are those characteristics that a
subject or element must possess to be part of the
target population. Exclusion sampling criteria are those characteristics that can cause a
person or element to be excluded from the target population. For age, for instance,
excluded if under the age of 18 and included if over the age of 18 are not acceptable
exclusion/inclusion criteria because they are not mutually exhaustive: what should the
researcher do with someone 18include, or exclude? Similarly, excluded if 65 or
younger and included if 65 or older are not mutually exclusiveagain, what does the
researcher do with the 65-year-old?
• A student finds a tool that measures adaptability that she wants to use
for her masters thesis. It has 25 items, and they are all of the ordinal
level, scaled 0 through 5. The level of measurement of the tool is said
by its authors, pragmatics all, to be which of the following?
• Ratio level
• Interval level
• Ordinal level
• Nominal level
CORRECT ANSWER: D
Pragmatists often treat ordinal data from multiple item scales as interval data, using
statistical methods to analyze them such as the Pearsons Product-Moment
Correlation Coefficient, t-test, and analysis of variance (ANOVA), which are
traditionally reserved for interval or ratio level data. Fundamentalists insist that the
analysis of ordinal data be limited to statistical procedures designed for ordinal data,
such as nonparametric procedures.
• Interval scales of measurement (IQ tests, anxiety inventories,

mental status exams) are products of mans invention how
frequently?
• Never
• Sometimes
• Frequently
• Always
CORRECT ANSWER: D
In interval level of measurement, distances between intervals of the scale are

numerically equal. Such measurements also follow the previously mentioned rules:
mutually exclusive categories, exhaustive categories, and rank ordering. Interval scales
are assumed to be a continuum of values. Thus, the researcher can identify the
magnitude of the attribute much more precisely.
However, it is not possible to provide the absolute amount of the attribute because of
the absence of a zero point that really means zero on the interval scale. Interval scales
are commonly used for surveys, scales, and inventories.

• Tests of stability reliability, such as test-retest, can reveal random
measurement error. Why is systematic measurement error not revealed
when stability reliability determinations are made?
• Actually, reliability testing does not reveal the type of

error: differences on test- retest can indicate problems
with both random and systematic measurement error.
• Tests of stability reliability are not powerful
enough to pick up systematic measurement
error because of its subtlety.
• If an instrument systematically measures all blood
pressures 10 points high, it will do so both at
baseline and on retesting.
• The direction of the systematic measurement error is
reversed on retesting, so it is not visible in the
statistical analysis.
CORRECT ANSWER: C
Stability reliability is concerned with the consistency of repeated measures of the same
attribute with the use of the same scale or instrument over time. It is usually referred to
as test-retest reliability. This measure of reliability is generally used with physical
measures, technological measures, and paper-and-pencil scales. The technique requires
an assumption that the factor to be measured remains the same at the two testing times
and that any change in the value or score is a consequence of random error.
• Specificity of an instrument used for diagnosis refers to what?
• Its ability to detect error

• Its ability to detect the presence of a condition or illness
• Its ability to detect the absence of a condition or illness
• Its true positives minus its false negatives
CORRECT ANSWER: C
Specificity of a screening or diagnostic test is the proportion of patients without the

disease who have a negative test result or true negative. A test with high specificity is
very good at identifying the patient without any disease.

MULTIPLE RESPONSE
• Which of the following must be measured indirectly? (Select all that apply.)
• Number of miles from San Francisco to Disneyland

• Level of consciousness
• Height
• Hope
• Liver function
CORRECT ANSWER: A, D, E
An abstract concept is not measured directly; instead, indicators or attributes of the

concept are used to represent the abstraction. This is referred to as indirect
measurement. In addition, hard- to-access physiologic and behavioral variables and
huge quantities may be measured indirectly.
• Which of the statements is true, relative to error? (Select all that apply.)
• True score plus error score equals observed score.

• Random error of measurement increases the mean.
• The mean of the true measurements is equal to the
mean of the observed measurements when there is
no systematic error.
• No measurement of anything is ever correct.
• Measurement error always exists, if a straightforward
measurement like counting is made often enough and by
enough people.
CORRECT ANSWER: A, C, E
Observed score = true score + random error. Random error does not influence the
mean to be higher or lower but, rather, increases the amount of unexplained
variance around the mean.
Measurement error is the difference between what exists in reality and what is
measured by an instrument.
Chapter 16 Appraising Findings of Original Studies
MULTIPLE CHOICE
• How does a comparative descriptive design differ from a typical descriptive design?
• It compares statistics between the current time and an

earlier time, whereas the typical descriptive design focuses
on only one time period.
• It compares a number of variables and examines the
relationship between them, whereas a typical descriptive
design never does this.
• It differs in name only; both have the same design.
• It describes data from two different groups, whereas a
typical descriptive design focuses on a single group.
CORRECT ANSWER: D
The commonly used descriptive study design examines characteristics of a single

sample. It identifies a phenomenon of interest and the variables within the
phenomenon, develops conceptual and operational definitions of the variables, and
describes the variables. The comparative descriptive design examines and describes
differences in variables in two or more groups that occur naturally in the setting.
Descriptive statistics and inferential statistical analyses may be used to examine
differences between or among groups.
• Why is the threat of subject attrition more problematic in longitudinal

designs than in other types of descriptive research?
• Subjects are elderly.

• Data analysis is complex, and missing data points necessitate
dropping the subject from the analysis.
• Data collection occurs over a much longer period of time.
• There is selection bias because of the study requirements.
CORRECT ANSWER: C
Longitudinal designs examine changes in the same subjects over time. They are
expensive and require a long period of researcher and subject commitment.
Measurement must be carefully planned and implemented, because the measures
will be used repeatedly over time. There is often a bias in selection of subjects
because of the requirement for a long-term commitment. In addition, loss of subjects
(attritionsubject quits participating in the study) can be high and can decrease the
validity of findings.
• What do cross-sectional designs, trend designs, and event-partitioning

designs have in common?
• They all study subjects at one time.

• They all focus on change over time.
• They all involve data collection over months or year.
• They are identical to longitudinal designs.
CORRECT ANSWER: B
Cross-sectional designs examine groups of subjects in various stages of development,

trends, patterns, and changes simultaneously with the intent to describe changes in the
phenomenon across stages. The assumption is that the stages are part of a process that
will progress over time. Selecting subjects at various points in the process provides
important information about the totality of the process, even though the same subjects
are not monitored through the entire process. Trend designs examine changes in the
general population in relation to a particular phenomenon. The researchers select
different samples of subjects from the same population at
preset intervals of time, and at each selected time, they collect data from that particular
sample. A merger of the cross-sectional or longitudinal and trend designs, the event-
partitioning design, is used in some cases to increase sample size and to avoid the
effects of history on the validity of findings. Cook and Campbell referred to these as
cohort designs with treatment partitioning.
True longitudinal designs examine changes in the same subjects over time. They are
expensive and require a long period of researcher and subject commitment.
Measurement must be carefully planned and implemented because the measures will be
used repeatedly over time.
• The difference between a randomized block design and the more modern
variant of including the extraneous variable in a multivariate analysis is which
of the following?
• The potentially extraneous variable is treated as an ordinal

variable in the randomized block design but can be
considered as a ratio or interval variable in a multivariate
analysis.
• In a multivariate analysis, the extraneous variable is excluded from analysis.
• In a randomized block design two to three times as many
subjects were required for statistical analysis.
• In a randomized block design, the sample is chosen so that it
lacks the potentially extraneous variable.
CORRECT ANSWER: A
The randomized block design uses the two-group pretest-posttest or the two-group
posttest pattern with the addition of a blocking variable. The blocking variable, if
uncontrolled, is expected to confound the findings of the study. To prevent
confounding of the findings, the subjects are rank ordered in relation to the blocking
variable. This procedure ensures that the experimental group and the comparison
group are equal in relation to the potentially confounding variable. The effect of
blocking can also be accomplished statistically (through the use of analysis of
covariance) without categorizing the confounding variable into discrete components.
• A factorial design study measures the effect upon hemoglobin levels of four
independent variables, each administered randomly and independently. How
many distinct groups are there in this factorial design?
• 4
• 8
• 12
• 16
CORRE
CT
ANSWE
R: D
In a factorial design, two or more different characteristics, treatments, or events are

independently varied within a single study. This design is a logical approach to
examining multicausality. The simplest arrangement is one in which two treatments or
factors are involved and, within each factor, two levels are manipulated (for example,
the presence or absence of the treatment); this is referred to as a 2 2 factorial design. A
2 2 factorial design produces a study with four cells (A through D). Each cell must
contain an approximately equivalent number of subjects. Cells B and C allow the
researcher to examine of each intervention separately. Cell D subjects receive no
treatment and serve as a control group. Cell A allows the researcher to examine the
interaction between the two independent variables. This design can be used, as in the
randomized block design, to control for confounding variables. With four independent
variables, M, N, O, and P are randomly applied, and so there are sixteen groups. The
formula is that the number of possibilities is equal to the number 2 to the power of
how many binary variables there are. One variable is 2, two variables are 4, three
variables are 8, and four are 16.
M N O P
Va r i a b l e s
Group 1 + +
+ M, N, O
Group 2
+ + M,
O Group
3 + + M,
N Group
4+M
Group 5
+ + N,
O Group
6+O
Group 7
+N
Group 8
None
Group 9 + + + +
M, N, O, P Group
10 + + + M, O, P
Group 11 + + + M,
N, P
Group 12 + +
M, P Group
13 + + + N, O,
P
Group
14 + +
O, P
Group
15 + +
N, P
Group
16 + P
• The following diagram represents what type of design?
Group Subject selection Measurement Treatment

Measurement Experimental R M T M
Comparison NR M M
• Posttest only design

• Factorial design
• Pretest-posttest control group design
• Time series design
CORRECT ANSWER: C
The pretest and posttest design with a comparison group is the most commonly used
design in social science research. Subject selection is random (R) for only the
experimental group, and non-random (NR) for the comparison group. Measurements
for both groups (M) occur both before and after treatment. This quasi-experimental
design is the first design discussed here that is generally interpretable. The
uncontrolled threats to validity are primarily due to the absence of randomization and,
in some studies, to the inability of the researcher to manipulate the treatment.
• Nurses who give discharge teaching to patients after colonoscopy call these
patients the day after the procedure to check on their status. At that time,
patients who have had polyps removed invariably ask how long it will be until
they receive their results. The nurses decide to design a study in which they will
change their discharge teaching, in order to include information about the
timeframe for biopsy results, and measure the results, comparing them with the
results for the next month, before the change. Which of the following types of
research will they use?
• Correlational
• Quasi-experimental
• Experimental
• Descriptive
CORRECT ANSWER: B
The intent of the study is to examine the effect of an intervention; thus, only quasi-
experimental or experimental designs are appropriate. Quasi-experimental and
experimental designs examine causality. The power of the design to accomplish this
purpose depends on the extent to which the actual effects of the experimental treatment
(the independent variable) can be detected by measuring the dependent variable.
Because data collection will not occur simultaneously in both groups, the study cannot
use random assignment to group, which means that it is quasi- experimental, not
experimental. The posttest-only design with comparison group is the specific
study design here. With a posttest-only design with comparison group, selection threat
is a problem. The lack of a pretest would ordinarily be a serious impediment to
defining change, but because very few subjects will know the timeline for receipt of
biopsy results, this objection is of little concern.
• Several television programs, such as American Idol, allows viewers to text in

votes for their favorite performer. From a research point of view, this is what
kind of a design?
• Survey
• Predictive design
• Model testing design
• One-group pretest-posttest design
CORRECT ANSWER: A
The term survey is used in two ways within scientific thought. It is used in a broad
sense to mean any descriptive or correlational study; in this sense, survey tends to
mean nonexperimental. In a narrower sense, survey is used to describe a data
collection technique in which the researcher uses questionnaires or personal interviews
to gather data about an identified population. Surveys, in the narrower definition, are
used to gather data that can be acquired through self-report.
Because of this limitation in data, some researchers view surveys as rather shallow
and as contributing in only a limited way to scientific knowledge.
• If a one-group pretest-posttest study uses subjects as their own controls,

which is the study design?
• Experimental
• Quasi-experimental
• Correlational
• Descriptive
CORRECT ANSWER: B
Quasi-experimental and experimental designs examine causality. Quasi-
experimental study designs were developed to provide alternative means of
examining causality in situations not conducive to experimental controls.
• Identify the type of research design employed in the following study: In order
to determine nursing students stress throughout the four semesters of the
major, nursing students in all four semesters were surveyed as class groups at
the mid-point of two contiguous semesters of coursework. Stress was
assessed by a researcher-composed quantitative questionnaire.
• Cross-sectional design
• Longitudinal design
• Event-partitioning design
• Case-study design
CORRECT ANSWER: C
The event-partitioning design is a merger of the cross-sectional or longitudinal and

trend designs; in event-partitioning, subjects representing the gamut of elapsed time
since an event are sampled more than once each. Longitudinal designs examine changes
in the same subjects over time.
Cross-sectional designs are used to examine groups of subjects in various stages of
development simultaneously with the intent to describe changes in the phenomenon
across stages. Data across subjects is assumed to be comparable, for the variable of
interest, and the relatively large sample size permits analysis of changes over time.
The case study design involves an intensive exploration of a single unit of study, such
as a person, family, group, community, or institution, or a small number of subjects
who are examined intensively. It is seldom quantitative in nature, and is often
regarded as a qualitative method, analogous to one-person or small group historical
research, in terms of the process focused upon. It tells a story.
• Why does testing of a hypothesized causal model require a large sample?
• Many variables are present, so sample size must be large.

• The research is experimental, so a large multi-site sample is preferred.
• Causation cannot be demonstrated in a small sample.
• Differences are often miniscule, and so the effect size is small.
CORRECT ANSWER: A
Some studies are designed specifically to test the accuracy of a hypothesized causal
model. The model-testing design requires that all variables relevant to the model be
measured. A large, heterogeneous sample is required.
• A group of twenty-five Labrador retrievers and their owners, are brought to the
research lab one by one. The Labrador retrievers are shown various stimuli,
including a squirrel that runs along a wire at the top of the lab, to elicit barking.
Then the owners command the dogs to stop barking, and the stimulus is
repeated. The duration of barking is measured. Then the owners are taught a
different technique for quieting their barking dogs. A week later, the dogs and
their owners return to the lab, the stimuli are introduced, and the duration of
barking is measured. This is an example of what type of design?
• One-group posttest-only design

• One-group pretest-posttest design
• Pretest and posttest design with comparison group
• Pretest and posttest design with removed-treatment
CORRECT ANSWER: B
The one-group posttest-only design is referred to as pre-experimental rather than quasi-

experimental because of its weaknesses and the numerous threats to validity. In this
type of study, subjects are only tested after the treatment; the group is not pretested
therefore, there is no direct way to measure change. The one-group pretest-posttest
design, is one of the more commonly used designs; in it there is an experimental group
that undergoes some form of pretesting prior to treatment (the manipulation of the
independent variable) and then is subjected
to posttesting after the treatment. In the pretest and posttest design with a comparison
group, both the experimental group and the comparison group are tested before the
experimental group is treated and after it. The pretest and posttest design with
removed-treatment, even though it uses only one group, creates conditions that
approximate the conceptual requirements of a control group receiving no treatment.
The design is basically a one-group pretest-posttest design. However, after a delay, a
third measure of the dependent variable is taken, followed by an interval in which the
treatment is removed, followed by a fourth measure of the dependent variable.

• What is the study design used in the following research project?
Twenty patients, all of whom have bipolar mania, have been placed on lithium and also
begun on a medication believed to prevent rapid cycling. The patients are followed for
12 months, at which time they are seen by a psychiatrist monthly, to adjust their
dosages. Medication compliance, emergency department visits, and mental health
hospitalizations are measured.
These are compared with another group of patients with the same mental illness, being treated on
lithium alone.
• Posttest-only design with comparison group

• Pretest-posttest design with comparison group
• Pretest-posttest design with removed treatment
• Pretest-posttest design with two comparison treatments
CORRECT ANSWER: A
The posttest-only design with comparison group offers an improvement on the one-
group posttest-only design, because of the addition of a nonequivalent comparison
group. However, subjects are tested only after the treatment; the group is not pretested,
so there is no direct way to measure change. In the example given, there is no mention
of pretesting. In the pretest and posttest design with a comparison group, both the
experimental group and the comparison group are tested both before and after the
experimental group is treated. The pretest and posttest design with removed-treatment
creates conditions that approximate the conceptual requirements of a
control group receiving no treatment. The design is basically a one-group pretest-

posttest design. However, after a delay, a third measure of the dependent variable is
taken, followed by an interval in which the treatment is removed, followed by a fourth
measure of the dependent variable. Pretest-posttest design with two comparison
treatments are used when two experimental treatments are being compared to determine
which is most effective. In most cases, this design is used when one treatment is the
currently identified treatment of choice and the researcher has identified a treatment that
might lead to even better outcomes.
• Researchers studied alcohol recovery, comparing the success rate using 1)

Alcoholics Anonymous, 2) residence in a recovery house, 3) residence in
alcohol rehabilitation, and 4) individual psychotherapy. They measured
sobriety at 18 months post treatment initiation. What study design was used
for this research project?
• Factorial design
• Predictive correlational design
• Crossover strategy
• Classic experimental design
CORRECT ANSWER: B
Predictive designs are used to predict the value of one variable on the basis of values
obtained from another variable or variables. Prediction is one approach used to
examine causal relationships between variables. In a factorial design, two or more
different characteristics, treatments, or events are independently varied within a single
study. This design is a logical approach to examining multicausality. Crossover, or
counterbalancing, is a strategy designed to guard against possible erroneous
conclusions resulting from carryover effects. With counterbalancing, subjects are
randomly assigned to a specific sequencing of treatment conditions. This approach
distributes the carryover effects equally throughout all the conditions of the study,
thus canceling them out. The original, or classic, experimental design, is still the most
commonly used experimental design. In this design, subjects are randomly assigned to
treatment or control groups, and an intervention is enacted upon them by the
researcher.
• A studys hypothesis that a new surgical approach produces safer outcomes in

immunosuppressed patients is tested in a fourteen-site research study across the
United States. Subjects at all sites are randomly selected and randomly
assigned to experimental versus control groups. What study design is used in
this research project?
• Quasi-experimental design
• Randomized controlled trial
• Model testing design
• Counterbalanced design
CORRECT ANSWER: B
A randomized clinical trial (RCT) contains random assignment to experimental and

clinical groups and very often is multi-site. A fully randomized design contains both
random selection and random assignment. Quasi-experimental designs facilitate the
search for knowledge and examination of causality in situations in which complete
control is not possible. Such designs lack a control group, or lack random assignment
to group. Themodel-testing design requires that all variables relevant to the model be
measured, using correlational statistics. A large, heterogeneous sample is required.
Crossover, or counterbalancing, is a strategy designed to guard against possible
erroneous conclusions resulting from carryover effects. With counterbalancing,
subjects are randomly assigned to a specific sequencing of treatment conditions. This
approach distributes the carryover effects equally throughout all the conditions of the
study, thus canceling them out. To prevent an effect related to time, the same amount
of time must be allotted to each treatment, and the crossover point must be related to
time, not to the condition of the subject.
• Methodological designs are used to develop the validity and reliability of

instruments to measure constructs used as variables in research. The process is
lengthy and complex. The average length of researcher time required to
develop a research tool to the point of appropriate use in a study is five years.
Methodological studies include assessment of content validity,
evaluation of the conceptual structure of a scale, construct validity, and assessment of

reliability. A researcher is developing a tool to measure pre-delinquent behaviors in pre-
adolescence. He has already reviewed the literature, gathered qualitative data from
experts, pilot-tested hundreds of pre-delinquent preadolescents, and analyzed the
findings. It is clear that the tool actually measures what it is supposed to measure. This
reflects the tools
• Validity
• Utilizability
• Reliability
• Lack of bias
CORRECT ANSWER: A
Methodological designs are used to develop the validity and reliability of instruments to
measure constructs used as variables in research. The process is lengthy and complex
and should begin with a thorough literature review. Qualitative data is often collected
when there is not much known about a construct and will allow the researcher to
identify key factors/concepts associated with the construct which might be used to
create a checklist.
Chapter 17 Evidence-Based Practice Strategies

MULTIPLE CHOICE
• Which is the most accurate statement about translational research?
• Translational research focuses on providing literal and

readable translations of research in one of the primary 15
languages in which research is read.
• Translational research is essentially evidence-based practice.
• Translational research attempts to discover something

useful in basic scientific discoveries.
• Translational research is applied research based on basic research knowledge.
CORRECT ANSWER: D
Translational research is an evolving concept that is defined by the NIH as the

translation of basic scientific discoveries into practical applications. Basic research
discoveries from the laboratory setting need to be tested in studies with humans. In
addition, the outcomes from human clinical trials need to be adopted and
maintained in clinical practice. Translational research is being encouraged by both
medicine and nursing to increase the implementation of evidence-based
interventions in practice and to determine if these interventions are effective in
producing the outcomes desired in clinical practice.
• Nursing is said to be a science and an art. If best research evidence represents

the science of nursing, what represents the art?
• Clinical expertise
• Patient values and needs
• Synthesis of best research evidence
• Eye-hand coordination
CORRECT ANSWER: A
Evidence-based practice (EBP) is the conscientious integration of best research

evidence with clinical expertise and patient values and needs in the delivery of
quality, cost-effective health care. Best research evidence is largely fact-based and is
intended to produce consistent interventions, usually of a technical nature. Patient
values and needs emanate from the patient. Clinical expertise provides the art of
nursing practice.
• How is best research evidence produced?
• By the conduct and synthesis of numerous high-quality

studies in a health-related area
• By the imaginations of creative health care workers,
who design qualitative research that illuminates our
understanding
• By dissemination of important results at conferences
• By publications that detail the newest advances in health care
CORRECT ANSWER: A
Best research evidence is produced by the conduct and synthesis of numerous

high-quality studies in a health-related area.
• How are evidence-based practice and best research evidence related?
• With best research evidence publications, there is no evidence-based practice.

• Both evidence-based practice and best research
evidence are generated by research.
• Best research evidence is the evidence on which practice is based.
• Best research evidence includes five basic items, one of
which is evidence-based practice.
CORRECT ANSWER: C
Evidence-based practice is the conscientious integration of best research evidence

with clinical expertise and patient values and needs in the delivery of quality, cost-
effective health care. Best research evidence is produced by the conduct and
synthesis of a number of high-quality studies in a selected health-related area.
• If a trigger is defined as a condition of actual or potential harm to the patient,

the nurses, or the institution, the Iowa model becomes a reactive problem-
prioritization and problem-solving process. What is its tie-in with evidence-
based practice?
• The Iowa model addresses utilization of research findings at an individual level.

• Individual nurses enact an Iowa decision tree
when they examine risk- management data.
• Available published evidence drives the process, as scholars
review the literature and bring it forward for committee
focus.
• When evidence is available, it is used for problem-solving.
CORRECT ANSWER: D
The Iowa Model of Evidence-Based Practice provides direction for the development of
EBP in a clinical agency. In a health care agency, triggers initiate the need for change,
and the focus should always be to make changes based on best research evidence.
These triggers can be problem-focused and evolve from risk management data, process
improvement data, benchmarking data, financial data, and clinical problems. The
triggers can also be knowledge- focused: for example, new research findings, changes
in national agencies or organizational standards and guidelines, an expanded
philosophy of care, or questions from the institutional standards committee. The
triggers are evaluated and prioritized based on the needs of the clinical agency. If a
trigger is considered an agency priority, a group is formed to search for the best
evidence to manage the clinical concern. In some situations, the research evidence is
inadequate to make changes in practice, and additional studies are needed to strengthen
the knowledge base. Sometimes the research evidence can be combined with other
sources of knowledge (theories, scientific principles, expert opinion, and case reports)
to provide fairly strong evidence for developing research-based protocols for practice.
The strongest evidence is generated from meta- analyses of several RCTs and
systematic reviews that usually include meta-analyses, and individual studies. Thus,
systematic reviews provide the best research evidence for developing evidence-based
guidelines. The research-based protocols or evidence-based guidelines would be pilot-
tested on a particular unit and then evaluated to determine the impact on patient care. If
the outcomes are favorable from the pilot test, the change would be made in practice
and monitored over time to determine its impact on the agency environment, staff,
costs, and the patient and family. An agency can promote EBP by using the Iowa model
to identify triggers for change, implement patient care based on the best research
evidence, and monitor changes in practice to ensure quality care.
• In the Iowa model, what is the focus of intervention?
• The patient level

• The family level
• The institutional level
• The conceptual level
CORRECT ANSWER: C
The Iowa Model of Evidence-Based Practice provides direction for the development
of EBP in a clinical agency. In a health care agency, triggers initiate the need for
change, and the focus should always be to make changes based on best research
evidence. These triggers can be problem-focused and evolve from risk management
data, process improvement data, benchmarking data, financial data, and clinical
problems. The triggers can also be knowledge- focused, such as new research
findings, changes in national agencies or organizational standards and guidelines, an
expanded philosophy of care, or questions from the institutional standards committee.
The triggers are evaluated and prioritized based on the needs of the clinical agency. If
a trigger is considered an agency priority, a group is formed to search for the best
evidence to manage the clinical concern.
• A researcher locates twelve research studies that all examine the effect of a
different cognitive-behavioral strategy for decreasing painhypnosis,
distraction, focusing, music therapy, and so forth. Why would these twelve
studies make a poor meta-analysis?
• Cognitive-behavioral interventions are not a suitable focus

for all patients, and consequently should not be studied.
• Twelve studies would be too many for synthesis of any kind.
• Secondary analyses of pooled data are not used for
meta-analysis on pain, because of interindividual
differences in perception.
• The result, if statistically significant, will produce a general
recommendation, If in pain, do something cognitive-
behavioral, which is meaningless.
CORRECT ANSWER: D
A meta-analysis is conducted to statistically pool the results from previous studies

into a single quantitative analysis that provides one of the highest levels of evidence
about an interventions effectiveness. This approach has objectivity, since it includes
analysis techniques to determine the effect of an intervention while examining the
influences of variations in the studies selected for the meta-analysis. The studies to
be included in the analysis need to be examined for variations or heterogeneity in
such areas as sample characteristics, sample size, design, types of intervention, and
outcomes variables and measurement methods. Heterogeneity in the studies included
in a meta-analysis produces broad and meaningless results.
MULTIPLE RESPONSE
• The Magnet Program represents a credentialing process, whereby

organizations of quality are recognized. What does the Magnet Recognition
Program require, relative to research and evidence-based practice? (Select all
that apply.)
• Nurses will participate in the institutional review process.

• Nursing research will be a budget line item.
• Only nurse researchers will conduct clinical research.
• The institution will keep track of nursing research
projects in progress and recently completed.
• Care applied to patients will be, in a large part, supported by research.
CORRECT ANSWER: A, B, D
Approval for Magnet status is obtained through the American Nurses Credentialing
Center (ANCC). The Magnet Recognition Program recognizes evidence-based practice
as a way to improve the quality of patient care and revitalize the nursing environment.
Selection criteria for Magnet status that require health care agencies to promote the
conduct of research and the use of research evidence in practice follow. Some of its
point items are availability of current literature, dissemination of current literature,
application of current literature to practice, nurse involvement in the institutional review
process, research consultants actively involved in mentorship, budget
line items for nursing research, tracking of all nursing research activities in progress,
and education that has changed practice.
• Evidence-based practice is based on three things. On what would a nurse

base practice in a new area of nursing if there is yet no research evidence?
• Nursing theory
• The nurses own clinical expertise
• Client values and needs
• Evidence in parallel, related fields
• Past documentation in the medical record
Evidence-based practice is the conscientious integration of best research evidence

with clinical expertise and patient values and needs in the delivery of quality, cost-
effective health care. Best research evidence is produced by the conduct and synthesis
of a number of high-quality studies in a selected health-related area.
• Which of the following statements about the Stetler model of research

utilization are true? (Select all that apply.)
• Its goal is to assure that research it utilized.

• It is a framework.
• It facilitates synthesis of research knowledge.
• It is used to update hospital policies.
• In its validation phase, scientific soundness is assessed.
• It provides a step-by-step way to assess and evaluate research findings.
CORRECT ANSWER: B, C, D, E, F
The Stetler (2001) model provides a comprehensive framework to enhance the use of
research findings by nurses to facilitate an evidence-based practice. The use of
research findings can be at the institutional or individual level. The five stages of the
Stetler model are preparation, validation, comparative evaluation/decision making,
translation/application, and evaluation. It is used to synthesize research knowledge,
but it does this in a step-by-step way, evaluating each study on its own merits.
Ultimately, its use is practice-based.
• What are the basic problems with meta-syntheses of qualitative research?

• Qualitative research itself is a subjective interpretation;

a meta-synthesis of qualitative research is a compiling
of information generated subjectively.
• If individual studies have different methods, it may be
difficult to find common ground and to devise a meaningful
interpretation of the results.
• Qualitative research has no implications for practice, so
performing a meta- synthesis is unjustifiable.
• In qualitative research, multiple valid interpretations
may occur if different researchers examine the text.
• The recommendation for practice that results from meta-
synthesis of qualitative research lacks statistics.
• The raw data are not available to the qualitative meta-synthesizer.
CORRECT ANSWER: A, B, D, F
Meta-synthesis is defined as the systematic compiling and integration of qualitative

study results to expand understanding and develop a unique interpretation of study
findings in a selected area. The focus is on interpretation rather than the combining of
study results as with quantitative research synthesis. Meta-synthesis involves the
breaking down of findings from different studies to discover essential features, and then
the combining of these ideas into a unique, transformed whole. Meta-summary is a step
in conducting meta-synthesis. A process for conducting a meta- synthesis is described
in the following section. The process of interpretation occurs in the mind of the reader.
Corbin and Strauss describe interpretation as translating the words and actions of
participants into meanings that readers and consumers can understand. The virtual text
grows in
size and complexity as the researcher reads and rereads the transcripts. Throughout the
process of analysis, the virtual text develops and evolves. Although multiple valid
interpretations may occur if different researchers examine the text, all findings must
remain trustworthy to the data. This trustworthiness applies to the unspoken meanings
emerging from the totality of the data, not just the written words of the text.
• Nursing practice has been said to have the potential to be increasingly

evidence-based in the next ten years. What are the impediments to enacting
EBP? (Select all that apply.)
• A misunderstanding of what EBP is has resulted in

mandates and policies; bedside nurses sense that their
expertise is being overridden.
• Only about one-seventh of published nursing research is
experimental or quasi- experimental.
• Systematic reviews and meta-analyses in nursing are limited.
• Most hospitals do not have computer access to practice evidence.
• Population-based knowledge may or may not translate to
the care of individual patients.
CORRECT ANSWER: A, B, C, E
Barriers to the EBP movement have been both practical and conceptual. One of the
most serious barriers is the lack of research evidence available regarding the
effectiveness of many nursing interventions. Between 2000 and 2006, published
research in major journals was only 7% experimental and 6% quasi-experimental;
interventional studies are required for EBP. The systematic reviews and meta-analyses
conducted in nursing have been limited. Another concern of the EBP movement is that
the development of evidence-based guidelines has led to a cookbook approach to
health care. Health professionals are expected to follow these guidelines in their
practice as developed. However, the definition of EBP describes it as the conscientious
integration of best research evidence with clinical expertise and patient values and
needs.
• A systematic review should address the components specified in PICOS.

Why is this so? (Select all that apply.)
• Interventional research always uses some means of comparison.

• Interventions that are actually naturally occurring
conditions should be noted, since they decrease
confirmatory power of the collective evidence.
• Study design is essential, since recommendations for
change in practice can be based only on some designs.
• Desired outcomes, not actual outcomes of the study, are the focus of the review.
• The specific population from which a sample was drawn,
and its similarity to those of others studies reviewed,
affects generalizability.
CORRECT ANSWER: A, B, C, E
A systematic review is a structured, comprehensive synthesis of the research literature

to determine the best research evidence available to address a health care question. A
systematic review involves identifying, locating, appraising, and synthesizing quality
research evidence for expert clinicians to use to promote an EBP. Systematic reviews
are often conducted by two or more researchers and/or clinicians in a selected area of
interest to determine the best research knowledge in that area. Systematic reviews need
to be conducted with rigorous research methodology to promote the accuracy of the
findings and minimize the reviewers bias. A systemic review or meta-analysis is best
directed by a relevant clinical question that focuses the review process and promotes the
development of a quality synthesis of research evidence. One of the most common
formats used to organize a systematic review is the PICO or PICOS format described in
the Cochran Handbook. PICOS are (1) population (or sample), (2) intervention, (3)
comparison group or condition, (4) outcomes, and (5) study design. Naturally occurring
interventions indicate a non-interventional design; the researcher enacts the research
intervention.
Chapter 18 Evidence-Based Practice Participation

MULTIPLE CHOICE
• Which is true about evidence-based practice?
a.Evidence-based guidelines are unrelated to accreditation

regulations. b.Evidence-based practice is determined only through
experimental studies. c.Most nursing interventions are based on
evidence-based principles.
d.The use of evidence-based practice results in improved patient outcomes.
CORRECT ANSWER: D
Feedback
AThe Joint Commission revised their accreditation criteria to emphasize patient
care quality achieved through EBP.
BEBP guidelines are based on all types of research, using the best research knowledge available.
CSome nursing interventions are evidence based currently, but many require
additional research to generate the knowledge essential for making changes in
practice.
DThe greatest benefits of EBP are improved outcomes for patients, providers,
and health care agencies.

• Which standards were developed to help nursing students develop the skills,
knowledge, and attitudes needed to continuously improve quality and safety?
a.EBP b.IRB c.QSEN
d.Magnet
CORRE
CT
ANSWE
R: C
Feedback
AEBP is evidence-based practice, which is the basis for developing practice
guidelines that are grounded in the best evidence and research.
BIRBs are institutional review boards, whose purpose is to protect human
subjects in research studies.
CThe Quality and Safety Education for Nursing, or QSEN, project was
implemented to improve prelicensure nurses knowledge, skills, and attitudes
necessary to continuously improve quality and safety in health care systems.
DMagnet criteria are standards for a practice model for hospitals seeking
accreditation through the American Nurses Credentialing Center.
REF: dm. 416
• When addressing a health care question to determine best practice, the nurse
identifies and appraises quality research using a structured, comprehensive
synthesis of the research literature to determine the best research evidence
available. This is an example of a:
a.literature
review
b.meta-
analysis.
c.meta-
synthesis.
d.systemati
c review.
CORRECT ANSWER: D
Feedback
AA literature review seeks to find all literature about a topic and is not as rigorous
or systematic as a systematic review.
BA meta-analysis is a review of quantitative studies by statistically pooling or
combining the results from these studies into a single quantitative analysis.
CA meta-synthesis is used to pool and combine findings from qualitative studies.
literature to determine the best research evidence available to help determine
best practice.

• What is the purpose of the PRISMA statement?
a.To help researchers develop a clinical question before a

review b.To help determine whether studies reviewed
should be replicated c.To improve reporting of meta-
analyses and systematic reviews
d.To outline the abstract when reporting on meta-analyses and other reviews
CORRECT ANSWER: C
Feedback
AIt is not used to develop a clinical question prior to analyses or to determine
whether studies should be replicated.
BIt is not used to develop a clinical question prior to analyses or to determine
whether studies should be replicated.
CThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement was developed in 2009 to improve the quality of reporting
for systematic reviews and meta-analyses and includes 27 items to ensure that
this is done.
DIt is not used to outline the abstract when reporting on analyses and other
reviews. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 426
• To develop a clinical question when reviewing the effectiveness of nursing

interventions, the nurse will use which format?
a.
PI
C
O
S
b.
P
R
IS
M
A
c.Study
design
d.Systemat
ic review
CORRECT ANSWER: A
Feedback
APICOS (Population, Intervention, Comparison of intervention, Outcomes, and
Study design) is the most common format for developing a research question by
nurse researchers.
BThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement was developed in 2009 to improve the quality of reporting
for systematic reviews and meta-analyses and includes 27 items to ensure that
this is done.
CThe study design is part of PICOS but, by itself, does not determine the study question.
DThe systematic review is conducted to evaluate existing research and is generally
performed when the study question is known.
• A nurse studies the effects of teaching the MyPlate.gov materials to
preschoolers by providing this education to preschoolers in a single day care
center and then following their BMI scores over a 5-year period and comparing
their scores to those of children from another day care center. In this study,
which element is represented by the O in the PICOS acronym?
• BMI scores
• Five-
year
follow-
up
c.MyPl
ate.gov
materia
ls
d.Presc
hoolers
CORRECT ANSWER: A
Feedback
A In PICOS, the O stands for outcomes, which, in this study, are the BMI measures thought to
be affected by the intervention.
B The 5-year follow-up is part of the study design, or S.
C The MyPlate.gov materials are used for the intervention, or I.
D The preschoolers are the population, or
dm. PTS:1DIF:Cognitive level: Applying
• Which type of research literature would be included in grey literature sources?
a.Book
chapter
s
b.Disse
rtations
c.Journ
al
articles
d.Textb
ooks
CORRECT ANSWER: B
Feedback
A Book chapters, journal articles, and textbooks are all published sources.
B Grey literature sources tend to be those that are not published and may include dissertations
or theses.
C Book chapters, journal articles, and textbooks are all published sources.
D Book chapters, journal articles, and textbooks are all published
sources. PTS: 1 DIF: Cognitive level: Remembering (Knowledge)
REF: dm. 424
• What must a researcher describe to identify that a comprehensive, systematic

literature search was conducted?
a.All key search terms and databases used in the search
b.A list of grey literature sources used in
the review c.The date restrictions applied to
the literature search d.The use of literature
only from prestigious journals
CORRECT ANSWER: A
Feedback
AThe key search terms, different databases searched, and search results need to be
recorded in the systematic review and meta-analysis publications in order to
indicate that a comprehensive search was performed.
BA list of grey literature sources and the data restrictions applied are important
parts of the discussion about the review but do not indicate how comprehensive
the search has been. CA list of grey literature sources and the data restrictions
applied are important parts of the discussion about the review but do not indicate
how comprehensive the search has been.
DUsing literature only from prestigious journals can lead to bias because it may
exclude other relevant sources.

• What is true about a meta-analysis?
• It helps to determine whether studies should be replicated.

• It identifies and appraises previous research.
• It pools results from previous studies into a single quantitative analysis.
• It replicates previous studies to confirm statistical results.
CORRECT ANSWER: C
Feedback
A The meta-analysis does not determine which studies need to be replicated.
B A systematic review is a structured, comprehensive synthesis of the research
literature to determine the best research evidence available to help determine best
practice.
C A meta-analysis is a review of quantitative studies by statistically pooling or
D A meta-analysis examines previous studies but does not replicate previous
studies. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF:dm. 428|dm. 433
• Which is true about the literature search criteria for a
meta-analysis? a.They include only published works
from refereed journals.
b.They include the full range of related sources based on the
topic. c.They usually are narrowly focused around the
research question. d.They use works from a single database
in order to remain consistent.
CORRECT ANSWER: C
Feedback
AThe search needs to be rigorous and to include published and unpublished
works that are pertinent, using varied databases.
BThe search needs to be rigorous and to include published and unpublished
CThe search criteria for a meta-analysis are usually narrowly focused around
the research question.
DThe search needs to be rigorous and to include published and unpublished

• A study yielding negative results is withheld for publication for several years,
contributing to which type of bias?
• Citation
bias
b.Locati
on bias
c.Outco
me-
reportin
g bias
d.Time-
lag bias
CORRECT ANSWER: D
Feedback
ACitation bias occurs when certain studies are cited more often than others and are
more likely to be identified in database searchers.
BLocation biases occur if studies are published in lower-impact journals and
indexed in less- searched databases.
COutcome-reporting biases occur when study results are not reported accurately and clearly.
DTime-lag bias occurs when results of some studies are released several years
after those from other studies, meaning that the later results cannot be reported.

• In a meta-analysis, the researcher displays a symmetrical funnel plot of the data
from a group of studies. This indicates:
a.heterogenicity of study
samples. b.limited
publication bias.
c.methodological bias.
d.reporting bias.
CORRECT
ANSWER: B
Feedback
AA symmetrical funnel plot indicates limited publication bias and occurs with
homogeneity of study samples.
BA symmetrical funnel plot indicates limited publication bias and occurs with
homogeneity of study samples.
CAsymmetry of the funnel plot indicates publication, methodological, and reporting bias.
DAsymmetry of the funnel plot indicates publication, methodological, and reporting
bias. PTS:1DIF:Cognitive level: Analyzing (Analysis)
REF: pp. 433-434
• What is true about reporting the mean difference between two groups in a
meta-analysis? a.It is a measure of differences between nominal data for the
two groups.
• It is an estimate of the effect of differences between the two groups of subjects.
• It is not used to examine differences in ratio-level data.
• It is appropriate only when the same scale is used to measure outcomes.
CORRECT ANSWER: D
Feedback
AIt is not used to compare nominal data but is useful for ordinal and ratio-level data.
BIt measures differences in outcomes and not subjects.
CIt is not used to compare nominal data but is useful for ordinal and ratio-level data.
DThe mean difference is reported in a meta-analysis to identify the effect of an
intervention but is appropriate only if the outcome is measured by the same scale
in all the studies.
• In a meta-analysis, a researcher wishes to examine differences in temperatures
of subjects in two groups but notes that one study uses a centigrade scale and
the other study uses a Fahrenheit scale. Which statistic will the researcher apply
in this case?
a.Dichotomous data
reporting b.Funnel
plot
c.Mean difference
d.Standardized mean
difference
CORRECT ANSWER: D
Feedback
ADichotomous datareporting is used to describe outcome data that are noncontinuous.
BThe funnel plot is used to provide graphic representations of possible effect sizes.
CThe mean difference is reported in a meta-analysis to identify the effect of an
intervention but is appropriate only if the outcome is measured by the same scale
in all the studies.
DThe standardized mean difference is a summary statistic reported in a meta-
analysis when the same outcome is measured by different scales.

• Which method will a researcher use to evaluate a group of qualitative studies?
a.Meta-
analysi
s
b.Meta-
synthes
is
• Mixed-methods
systematic review
d.Systematic
review
CORRECT ANSWER: B
Feedback
AA meta-analysis is a review of quantitative studies by statistically pooling or
BA meta-synthesis is used to pool and combine findings from qualitative studies.
CA mixed-methods systematic review is used to evaluate a combination of
quantitative and qualitative studies.
literature to determine the best research evidence available to help determine
best practice.

• A researcher evaluates data from a variety of studies, including those
involving qualitative and quantitative research, and uses findings from
qualitative studies to interpret synthesized quantitative studies. This is an
example of:
a.meta-synthesis.
b.mixed-method
synthesis.
c.multilevel
synthesis.
d.parallel
synthesis.
CORRECT ANSWER: D
Feedback
AA meta-synthesis is used to pool and combine findings from qualitative studies.
BA mixed-methods synthesis review is used to evaluate a combination of
quantitative and qualitative studies.
CA multilevel synthesis involves synthesizing the findings from quantitative
studies separately from qualitative studies and integrating the findings in the
report.
DParallel synthesis involves the separate synthesis of quantitative and qualitative
studies, but the findings from the qualitative synthesis are used in interpreting the
synthesized quantitative studies.

• Which is the strongest source of research and evidence for developing
evidence-based guidelines?
a.Meta-analyses of specifically focused research
questions b.Panels of experts sharing their
opinions on best practices c.Quasi-experimental
studies
• Rigorous experimental studies
CORRECT ANSWER: A
Feedback
AThe strongest source of research evidence is synthesized to develop
recommendations for practice and generally comes from meta-analyses. Often
consultants, other researchers, and additional expert clinicians are asked to
review the guidelines as well.
BAlthough panels of experts may be asked to review the guidelines, the use of
meta-analyses provides the strongest research evidence.
CQuasi-experimental studies, along with other studies, are included in meta-
analyses to provide the strongest research evidence.
DRigorous experimental studies are analyzed together in meta-analyses to provide
the strongest research evidence.
REF: pp. 454-456
• When using the Stetler Model of research utilization, the nurse researcher
reviews the risks, resources, and readiness of staff associated with making
changes in practice based on evidence. Which part of the model is this?
a.Phase I:
Preparation
b.Phase II:
Validation
c.Phase III: Comparative
Evaluation d.Phase IV:
Translation/Application
CORRECT ANSWER:
Feedback
AIn the Preparation phase, the researcher determines the purpose, focus, and
potential outcomes of making an evidence-based change in practice.
BIn the Validation phase, the researcher critically appraises the research reports
to determine their soundness.
CIn the Comparative Evaluation phase, the researcher substantiates the evidence,
evaluates the fit of the health care setting, determines the feasibility of using
research findings, and identifies concerns with current practice using the three Rs of
risks, resources, and readiness.
DIn the Translation/Application phase, the researcher plans for actual use of
the research evidence in practice.

• Which research discipline seeks to develop practical applications
based on research knowledge?
a.Meta-
analysi
s
b.Meta-
synthes
is
• Rigorous
experimental
studies
d.Translational
research
CORRECT ANSWER: D
Feedback
AA meta-analysis is a review of quantitative studies by statistically pooling or
BA meta-synthesis is used to pool and combine findings from qualitative studies.
CRigorous experimental studies are analyzed together in meta-analyses to provide

the strongest research evidence.
DTranslational research is a new type of research to improve the
translation of research knowledge into practice.
Chapter 19 Point-of-Care Adaptations

MULTIPLE CHOICE
• The goal of outcomes research is to:
a.determine the most cost-effective nursing interventions in

patient care. b.examine the end results of patient care from
various health interventions. c.help providers make end-of-life
decisions about patient care.
• improve patient satisfaction with nursing care.
CORRECT ANSWER: B
Feedback
A Cost-effectiveness is one possible outcome, but other patient outcomes may be more
important.
B Outcomes research focuses on the end results of health care practices and interventions.
C Outcomes research is not solely about end-of-life care and is not focused on end-
of-life decision making.
D Patient satisfaction is one result but is not the goal of all outcomes
research. PTS: 1 DIF: Cognitive level: Understanding
(Comprehension)
REF: dm. 467
• What is the key construct in Donabedians theory of
outcomes research? a.Efficiency of health care delivery
b.Healthy
outcomes
c.Professional
accountability
d.Quality of care
CORRECT ANSWER: D
Feedback
AEfficiency, healthy outcomes, and professional accountability all may be
examined during outcomes research, but none of these is the key construct.
BEfficiency, healthy outcomes, and professional accountability all may be

CEfficiency, healthy outcomes, and professional accountability all may be
DQuality of care is the overriding construct of Donabedians theory of outcomes
research. PTS: 1 DIF: Cognitive level: Remembering (Knowledge)
REF: pp. 468-469
• Which is an example of a type of nursing service that might be

evaluated in outcomes research?
a.Application of wound care
products b.Clinical care
protocol implementation
c.Glucose monitoring for newly diagnosed
diabetics d.Using a Braden Scale for skin
assessment
CORRECT ANSWER: B
Feedback
AApplication of products, monitoring patient status, and using measurement
scales are all examples of nursing interventions.
BNursing services can include staffing and education of nurses as well as
implementation of protocols and standards of care.
CApplication of products, monitoring patient status, and using measurement
DApplication of products, monitoring patient status, and using measurement

• Which would be an example of an interdependent role for nurses in the
Nursing Role and Effectiveness Model?
a.Administering a medication to
a patient b.Arranging for home
health care services c.Initiating a
fall risk protocol d.Performing
an admission assessment
CORRECT ANSWER: B
Feedback
ADependent role functions include execution of medical orders and
physician-initiated treatments.
BInterdependent role functions in the Nursing Role Effectiveness
Model include communication, case management, and coordination
of care.
CDependent role functions include execution of medical orders and
physician-initiated treatments.
DIndependent role functions include assessment, diagnosis, and nursing-initiated
treatments. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 469-470
• In an outcome study, a researcher demonstrates a link between the number

of mothers who successfully breastfeed their infants and the number of
maternal-child nurses who are baccalaureate prepared. This illustrates:
a.interdependent nursing role
functions. b.nursing-sensitive
patient outcomes. c.patient-
sensitive outcomes.
d.the Nursing Role Effectiveness Model.
CORRECT ANSWER: B
Feedback
AInterdependent nursing functions are those that include both nurse-initiated
and physician- initiated treatments.
BOutcomes that are nursing sensitive are those that are influenced by nursing care
decisions and actions as well as those associated with nursing staffing, education,
and assignments.
CPatient-sensitive outcomes are those that are influenced by different aspects of
patients, such as age, gender, or disease process.
DThe Nursing Role Effectiveness Model examines outcomes that are nursing
sensitive. PTS:1DIF:Cognitive level: Applying (Application)
REF: pp. 471-472
• The development of the Uniform Hospital Discharge Data Set and the
Universal Minimum Health Data Set was helped by:
a.establishing guidelines for outcomes research.

b.identifying the contribution of nursing care to patient
outcomes. c.prescribing data elements to be monitored
in outcomes research. d.reporting financial and statistical
data from hospitals.
CORRECT ANSWER: C
Feedback
AThe data sets helped facilitate standards about data elements but did not establish
guidelines for outcomes research.
BThe Nursing Role Effectiveness Model helped to identify the contribution of
nursing care to patient outcomes.
CThe data sets facilitated consistency in data collection among health care
organizations by prescribing the data elements to be gathered.
DThe Canadian Institute for Health Information established a reporting system to
report financial and statistical data from hospitals.

• Which government agency supports research to improve the outcomes and
quality of health care?
a.AHRQ b.ARRA c.CIHI d.FDA
CORRECT ANSWER: A
Feedback
AThe Agency of Healthcare Research and Quality (AHRQ) supports research
designed to improve the outcomes and quality of health care.
BThe American Recovery and Reinvestment Act (ARRA) is not a government
agency; funding from this act allowed AHRQ to expand its work in support of
comparative effectiveness research.
CThe Canadian Institute for Health Information (CIHI) helped to establish national
Canadian standards for collecting and reporting financial and statistical data from
health service organizations.
DThe Federal Drug Administration (FDA) regulates the research and distribution of
medications. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: dm. 472
• Which organization includes nursing-sensitive outcomes measures in

its performance measurement portfolio?
a.Agency of Healthcare Research
and Quality b.Department of Health
and Human Services c.National
Guideline Clearinghouse d.National
Quality Forum
CORRECT ANSWER: D
Feedback
AThe Agency of Healthcare Research and Quality supports research designed to
improve the outcomes and quality of health care.
BThe Department of Health and Human Services includes the Agency of
Healthcare Research and Design.
CThe National Guideline Clearinghouse is a resource for evidence-based guidelines.
DThe National Quality Forum was created as a national standard-setting
organization for health care performance measures and includes nursing-sensitive
measures in its portfolio.

• The National Quality Forum was established in 1999 for which purpose?
a.To identify and develop nursing-sensitive quality measures

b.To support state and health system efforts to implement and evaluate medical
liability reform models
c.To allow the AHRQ to expand its work supporting comparative effectiveness
research d.To set standards for health care performance measures
CORRECT ANSWER: D
Feedback
AThe NDNQI identifies and develops nursing-sensitive quality measures.
BThe AHRQ supports state and health system efforts to implement and evaluate
medical liability reform models.
CThe ARRA allows the AHRQ to expand its work supporting comparative
effectiveness research.
DThe National Quality Forum sets standards for health care performance measures.

• To help meet the requirements for Magnet recognition, which organization
will a hospital participate in?
a.The American Nurses Association (ANA)
b.The Agency of Healthcare Research and Quality
(AHRQ) c.The National Database of Nursing Quality
Indicators (NDNQI) d.The National Quality Forum
(NQF)
CORRECT ANSWER: C
Feedback
AAlthough the ANA is the organization that oversees the Magnet Recognition
Program, hospitals do not join this organization.
BThe AHRQ supports research designed to improve the outcomes and quality of health care.
CParticipation in NDNQI meets requirements for the Magnet Recognition Program.
DThe NQF was created as a national standard-setting organization for health care
performance measures.

• Which is one of the indicators used by the National Database of Nursing
Quality Indicators (NDNQI)?
a.Assessment, intervention, and reassessment of pediatric
pain b.Clinical Laboratory Improvement Amendment
(CLIA) standards c.Protocols for monitoring biometric
equipment used in hospitals d.The number of hours
hospital residents work per week
CORRECT ANSWER: A
Feedback
ANDNQI identifies and develops nursing-sensitive quality measures. Assessment,
intervention, and reassessment of pediatric pain is one of the indicators it uses.
BCLIA standards are those applied to hospital laboratory personnel and equipment.
CBiometric equipment standards are not nursing-sensitive measures.
DStandards about hospital residents are not nursing-sensitive measures.

• Which is an important finding in outcomes research about Advanced Practice
Nursing (APN) practice?
a.APNs provide care that is equivalent to that provided by doctors at a fraction of
the cost. b.Care by APNs shows equivalent or improved outcomes to that provided
by physicians. c.Hospital readmission rates are slightly higher for patients who use
APNs for primary care. d.The level of patient satisfaction is greater with APNs
regardless of clinical outcomes.
CORRECT ANSWER: B
Feedback
AStudies are not reported showing equivalent care at reduced cost.
BThere is abundant research demonstrating the safety and effectiveness of APNs.
In a search of all random controlled trials comparing APNs to usual care, findings
consistently showed that care by APNs resulted in equivalent or improved
outcomes.
CStudies do not show increased readmission rates.
DPatient satisfaction is high, but so are positive clinical
outcomes. PTS: 1 DIF: Cognitive level: Understanding
• What is an important aspect of outcomes research as defined by Donabedian?
a.Selection of only proximal outcomes in order to streamline outcomes

research b.The need for patients or recipients of care to define which
outcomes are desirable c.The need to link outcomes with specific nursing
processes
d.The use of population groups rather than individuals for outcome studies
CORRECT ANSWER: C
Feedback
AOutcomes research involves studies of all outcomes of nursing care.
BDonabedian does not identify the need to study patient feelings about outcomes or care.
CIn outcomes research, according to Donabedian, there is a need to clearly
link identified outcomes with the processes that caused the outcomes.
DDonabedian does not identify the need to use population groups rather than
individuals for outcome studies.

• Which is an example of a distal outcome in outcomes research?
a.Glucose monitoring skills in patients receiving diabetic

teaching b.Hospital readmission rates in patients admitted for
myocardial infarction c.Pain scores before and after pain
medication
d.Patient perception of tobacco advertising among COPD patients
CORRECT ANSWER: D
Feedback
AGlucose monitoring skills, hospital readmission rates, and pain scores are
proximal outcomes because they are related directly to nursing interventions and
not to external forces.
BGlucose monitoring skills, hospital readmission rates, and pain scores are
CGlucose monitoring skills, hospital readmission rates, and pain scores are
DA distal outcome is one which is removed from proximity to the care or service received and
is more influenced by external (nontreatment) factors. Quality of life is an example of a distal
outcome.

• In outcomes research, a Magnet-designated hospital is an example of which type of
variable?
a.De
pend
ent
b.Int
erve
ntio
n
c.Ou
tcom
e
d.Str
uctu
ral
CORRECT ANSWER: D
Feedback
AA dependent variable is one that is affected by manipulation of another variable.
BAn intervention variable is one that is manipulated to examine the effects of this
manipulation on a dependent variable.
CAn outcome variable is one that is linked to patient care.
DMagnet designation indicates certain standards of structure including shared

governance, implementation of nursing practice, and autonomy.

• A nurse uses a care map to guide nursing interventions for patients with
COPD. This is an example of using:
a.evidence-based
practice.
b.practice
patterns.
c.practice styles.
d.standards of
care.
CORRECT ANSWER: D
Feedback
AEvidence-based practice includes clinical guidelines, critical paths, and
standards of care. BA practice pattern is a concept representing the variation in
what type of care is provided. CA practice style represents variation in how care
is provided.
DA standard of care is a norm according to which quality of care is judged
and includes guidelines, critical paths, and care maps.

• What is the role of evidence-based practice in outcomes research?
• Evidence-based practice identifies practice standards that can be

evaluated using patient outcomes.
• Evidence-based practice defines practice styles and patterns used in
professional practice. c.The standards used in evidence-based practice
clearly identify desired patient outcomes. d.There is a clear link between
evidence-based practice and improved patient outcomes.
CORRECT ANSWER: A
Feedback
AEBP guidelines contain standards and norms against which patient outcomes can be evaluated.
BPractice styles and patterns represent variations in what type of care and how care
is delivered and are part of clinical guidelines.
CVery few empirical studies have assessed the impact of EBP on patient outcomes.
DVery few empirical studies have assessed the impact of EBP on patient
outcomes. PTS: 1 DIF: Cognitive level: Understanding (Comprehension)
REF: pp. 480-481
• What type of sample is generally used in
outcomes studies? a.Small sample
b.Heterogeneo
ussa mple
c.Homogeneou
s sample
d . Vo l u n t e e r
sample
CORRECT ANSWER: B
Feedback
AA small sample would not provide a heterogeneous sample.
BBecause the target population in outcomes studies is often heterogeneous, it is
necessary to obtain large, heterogeneous samples.
CTypical sampling criteria for outcomes research include obtaining a very large,
heterogeneous sample in which all patients have the likelihood of being
represented.
DA volunteer sample is generally not encouraged, as it does not allow for the
researcher to influence the sample characteristics.

• Which type of study design is commonly used in outcomes studies?
a.Phenome
nological
b.Qualitati
ve
c.Quasi-
experimental
d.Random-
control trial
CORRECT ANSWER: C
Feedback
APhenomenological and qualitative studies do not account for effects of
variables on patient outcomes.
BPhenomenological and qualitative studies do not account for effects of
variables on patient outcomes.
CQuasi-experimental studies and observational research designs are most

commonly used for outcomes research to provide effectiveness and efficiency.
DRandom controlled trieals also seek to provide evidence about the effects
interventions, but, with outcomes studies, the intervention is not limited to
medications or clinical procedures..

• A researcher identifies a group of Native American subjects who are at
risk for type 2 diabetes mellitus and follows this group over time to
observe actual rates of acquiring this disease. This is an example of a:
a.clinical
database.
b.prospective
cohort study.
c.qualitative
study.
d.quasi-experimental study.
CORRECT ANSWER: B
Feedback
AA clinical database is a collection of data about a group of patients.
BA prospective cohort study is an epidemiologic study in which the researcher
identifies a group of people who are at risk for a condition and follows them over
time.
CA qualitative study is a nonexperimental study to examine attributes of a group of subjects.
DA quasi-experimental study is one in which the researcher has less control over
independent variables than in a random controlled trial.

• A nurse identifies an unusual incidence of acute lymphocytic leukemia (ALL)
in school-age children in a nearby community and conducts a study to examine
exposure to a variety of water pollutants from a local industry. This is an
example of a:
a.phenomenologica
l study.
b.qualitative study.
c.prospective
cohort study.
d.retrospective
cohort study.
CORRECT ANSWER: D
Feedback
AQualitative and phenomenological studies are nonexperimental studies to examine
attributes of groups of subjects.
BQualitative and phenomenological studies are nonexperimental studies to examine
attributes of groups of subjects.
CA prospective cohort study is an epidemiologic study in which the researcher
identifies a group of people who are at risk for a condition and follows them over
time.
DA retrospective cohort study is an epidemiologic study in which the
researcher identifies a group of people who have experienced a particular event
and examines possible previous causes for this event.

• A researcher wishes to widely disseminate findings of outcomes
research in order to influence practice in a variety of settings. Which
methods might this researcher use?
a.A series of presentations and publications in professional and
public forums b.An oral presentation at an international conference
c.Publication in scholarly, peer-reviewed journals
d.Writing about this research in a chapter of a nursing textbook
CORRECT ANSWER: A
Feedback
AEmploying a series of presentations and publications in many venues is the only
approach that achieves a widespread dissemination of the research findings.
BAn open forum for exchange of ideas is excellent but is not sufficient in the eyes
of outcomes researchers. Outcomes researchers consider wide dissemination of the
results to providers and consumers necessary to promote change in health care
practices.
CPresenting the findings, even at a prestigious conference, is not sufficient in
the eyes of outcomes researchers. Outcomes researchers consider wide
dissemination of the results to providers and consumers necessary to promote
change in health care practices.
DOutcomes researchers consider wide dissemination of the results to providers
and consumers necessary to promote change in health care practices.

65188765c3719 Test Bank For Evidence Based Nursing The Research Practice Connection 4

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65188765c3719 Test Bank For Evidence Based Nursing The Research Practice Connection 4

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Evidence-Based Nursing: The Research Practice Connection

Chapter 1 The Research-Practice Connection

Chapter 2 Research Evidence

Chapter 3 Reading Research Articles

Chapter 4 Qualitative Research

Chapter 5 Quantitative Descriptive Research

Chapter 6 Correlational Research

Chapter 7 Experimental Research

Chapter 8 Cohort Research Wrap-Up

Chapter 9 Systematic Reviews

Chapter 10 Evidence-Based Clinical Practice Guidelines

Chapter 11 Asking Clinical Questions

Chapter 12 Searching for Research Evidence

Chapter 13 Appraising Research Evidence

Chapter 14 Appraising Recommendations of Clinical Practice Guidelines

Chapter 15 Appraising Conclusions of Systematic Reviews with Narrative Synthesis

Chapter 16 Appraising Findings of Original Studies

Chapter 17 Evidence-Based Practice Strategies

Chapter 18 Evidence-Based Practice Participation

Chapter 19 Point-of-Care Adaptations

Chapter 1 The Research-Practice Connection

• Which best describes evidence-based-practice (EBP)?

PTS: 1 DIF: Cognitive level: Remembering

B Description involves identifying and understanding the nature of nursing

• The nurse is participating in a study and is collecting data identifying the

PTS:1DIF:Cognitive level: Applying

• A nurse manager is interested in learning which attitudes among staff nurses

• Which is the most important result of Florence Nightingales data collection

a.Bringing awareness of the rigors of war to the general public.

PTS: 1 DIF: Cognitive level: Understanding

PTS:1DIF:Cognitive level: Applying

• The development of nursing theories and conceptual models in the late

REF: pp. 12-13

• An emphasis of the American Nurses Credentialing Center (ANCC)

PTS: 1 DIF: Cognitive level: Remembering

DThe AACN identified the importance of creating a research culture, providing

PTS: 1 DIF: Cognitive level: Understanding

a.Agency for Healthcare Research and Quality

PTS: 1 DIF: Cognitive level: Remembering

PTS:1DIF:Cognitive level: Applying

c.A neonatal intensive care nurse who is skilled in inserting peripherally

PTS:1DIF:Cognitive level: Analyzing

• Which research technique would be used by a nurse researcher who

PTS:1DIF:Cognitive level: Applying

• The nurse researcher wishes to review a body of qualitative studies about

DA systematic review is a structured, comprehensive synthesis of the research

PTS:1DIF:Cognitive level: Applying

PTS: 1 DIF: Cognitive level: Understanding

a.Appraising studies and implementing evidence-based guidelines and

PTS: 1 DIF: Cognitive level: Understanding (Comprehension)

REF: pp. 25-26

• A job description for a nurse position in a teaching hospital includes

Chapter 2 Research Evidence

PTS:1DIF:Cognitive level: Applying

PTS:1DIF:Cognitive level: Applying

PTS:1DIF:Cognitive level: Applying

a.A description of gaps in knowledge about the research problem.

PTS:1DIF:Cognitive level: Applying

• The statement in the introduction of a research study reportwhile children who

PTS:1DIF:Cognitive level: Analyzing

PTS:1DIF:Cognitive level: Analyzing

PTS:1DIF:Cognitive level: Applying